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Difficulty: MediumAccident, Error, and Injury Prevention

A clinical manager is conducting safety rounds on an acute care unit. Which observed action by a registered nurse best demonstrates the correct application of accident, error, and injury prevention principles?

  1. Utilizing a designated enteral syringe that cannot connect to an intravenous hub to administer liquid medication via a gastrostomy tube.Answer
  2. B
    Applying bilateral soft limb restraints to an agitated client who is repeatedly pulling at a surgical drain before attempting environmental modifications.
  3. C
    Delegating the initial bedside swallow screening of a client presenting with acute neurological deficits to the unlicensed assistive personnel.
  4. D
    Establishing only standard and droplet isolation precautions for a client who is admitted with a confirmed diagnosis of disseminated herpes zoster.

Answer

Utilizing a designated enteral syringe that cannot connect to an intravenous hub to administer liquid medication via a gastrostomy tube.
Tubing misconnections (e.g., inadvertently connecting an enteral feeding syringe to an intravenous line) can lead to catastrophic, life-threatening injuries. Utilizing enteral-specific syringes that are physically incompatible with Luer-lock intravenous hubs is a proven engineering control that directly prevents these fatal medication errors, demonstrating optimal adherence to injury prevention principles.

Step-by-Step Solution

1
Analyze the safety implications of the enteral medication administration.
Using syringes specifically designed for enteral feeding prevents accidental intravenous injection of enteral fluids.
Tubing misconnections are a critical, often fatal safety hazard that must be mitigated by standardized physical incompatibility.
2
Evaluate the use of physical restraints.
Applying restraints before attempting less restrictive measures violates safety protocols.
Restraints are a measure of last resort due to the high risk of injury, skin breakdown, and psychological harm.
3
Assess the delegation of the swallow screening.
Initial clinical assessments cannot be delegated to unlicensed assistive personnel.
Swallow screenings require advanced nursing judgment to recognize subtle signs of dysphagia and prevent aspiration.
4
Determine the appropriate precautions for disseminated herpes zoster.
Disseminated herpes zoster requires airborne and contact precautions.
Unlike localized shingles in a healthy adult, disseminated disease can spread via airborne particles, requiring stricter isolation.

Key Concept

Implementing systemic safeguards, such as physical equipment incompatibility and adherence to standardized protocols, is essential for preventing clinical errors and ensuring a safe care environment.
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Topics

Accident, Error, and Injury Prevention

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