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Difficulty: MediumAccident, Error, and Injury Prevention

A clinical nurse educator is conducting safety rounds on an inpatient medical-surgical unit. Which observed action by a staff nurse demonstrates the correct application of accident, error, and injury prevention principles?

  1. Implementing a proactive, scheduled toileting routine every two hours for a client receiving intravenous diuretics to mitigate fall risk.Answer
  2. B
    Applying bilateral soft wrist restraints to an agitated client who is picking at a surgical dressing, before attempting alternative de-escalation techniques.
  3. C
    Directing an unlicensed assistive personnel (UAP) to evaluate the swallowing ability of a client who recently experienced an acute ischemic stroke.
  4. D
    Entering the room of a client diagnosed with disseminated herpes zoster while wearing a standard surgical mask, isolation gown, and clean gloves.

Answer

The correct action is to implement a proactive, scheduled toileting routine for a client receiving intravenous diuretics to prevent falls associated with urinary urgency.
Clients receiving intravenous diuretics experience rapid and significant diuresis, creating sudden urinary urgency. This urgency frequently leads to unassisted ambulation, which is a primary cause of inpatient falls. Implementing a scheduled toileting routine anticipates this physiological response and proactively mitigates the environmental risk, perfectly demonstrating accident and injury prevention.

Step-by-Step Solution

1
Analyze the clinical scenario and the objective.
The goal is to identify the single nursing action that correctly applies accident, error, and injury prevention principles across different domains of patient safety.
Understanding the broad scope of safety principles is necessary to evaluate multiple distinct nursing interventions.
2
Evaluate the intervention involving scheduled toileting.
Intravenous diuretics increase urine output and urgency, significantly elevating fall risk if the client attempts to ambulate unassisted. Scheduled toileting proactively addresses this hazard.
Anticipating physiological responses to treatments and modifying the environment/routine is a core injury prevention strategy.
3
Evaluate the restraint intervention.
Applying physical restraints without first attempting less restrictive alternatives violates safety protocols and patient rights.
Restraints pose their own significant injury risks and must follow a strict hierarchical protocol.
4
Evaluate the delegation action.
Assessing a stroke client's ability to swallow requires clinical judgment to prevent aspiration and cannot be delegated to an unlicensed assistive personnel (UAP).
Improper delegation can lead directly to catastrophic patient injury, such as aspiration pneumonia or airway obstruction.
5
Evaluate the isolation precautions.
Disseminated herpes zoster requires airborne precautions. A standard surgical mask does not provide adequate respiratory protection against airborne particles.
Incorrect application of transmission-based precautions risks exposing the healthcare worker and other vulnerable patients to severe infectious diseases.

Key Concept

Accident and injury prevention requires proactive hazard mitigation, such as anticipating fall risks from medications, strictly adhering to restraint hierarchies, ensuring appropriate delegation, and applying precise transmission-based precautions.
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Topics

Accident, Error, and Injury Prevention

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