Chapter 3 Patient Safety, Communication, and RecordKeeping

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Chapter 3 Patient Safety, Communication, and
RecordKeeping

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Objectives

• Describe how to apply good body mechanics and
  posture to moving patients.
• Describe how to ambulate a patient and the
  potential benefits of ambulation.
• Write definitions of key terms associated with
  electricity including voltage, current, and
  resistance.
• Identify the potential physiologic effects that
  electrical current can have on the body.

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Objectives (cont.)

• State how to reduce the risk of electrical shock
  to patients and yourself.
• Identify key statistics related to the incidence
  and origin of hospital fires.
• List the conditions needed for fire and how to
  minimize fire hazards.
• State how communication can affect patient care.
• List the factors associated with the
  communication process.

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Objectives (cont.)

• Describe how to improve your communication
  effectiveness.
• Describe how to recognize and help resolve
  interpersonal or organizational sources of
  conflict.
• List the common components of a medical record.
• State the legal and practical obligations
  involved in
• record keeping.
• Describe how to maintain a problem-oriented
  medical record.

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Safety Considerations

• Patient Movement and Ambulation
• Good posture minimizes the risk of injury when
  moving patients or heavy equipment.
• RTs should use their legs with a straight spine
  to lift patients and heavy objects.

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Basic Body Mechanics
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Moving the Patient in Bed
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Ambulation

• Extended bed rest can lead to new medical
  problems such as atelectasis.
• Ambulation (walking) helps restore and maintain
  normal body function.
• It should begin as soon as the patient is stable
  and free from severe pain.
• It can reduce the length of hospital stay.

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Electrical Safety

• Fundamentals of Electricity
• Electricity moves from point A to point B due to
  differences in voltage.
• Voltage is the power behind the electrical
  energy.
• Most homes and hospitals are powered with 120-V
  power sources.

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Electrical Safety (cont.)

• Power sources with high voltage have the
  potential to generate large amounts of electrical
  current.
• The current is directly related to the voltage
  difference between point A and point B, and
  inversely related to the resistance of the
  object.
• Objects with little resistance (e.g., copper
  wire) allow maximum current to flow.

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Electrical Safety (cont.)

• Objects with high resistance (e.g. rubber tubing)
  allow minimal or no current to flow.
• Current represents the greatest danger when
  electrical shorts occur.
• Current is reported in amperes resistance is
  reported in ohms.

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Electrical Safety (cont.)

• The harmful effects of current depend on the
• 1 Amount of current flowing through the body
• 2 Path it takes
• 3 Duration the current is applied
• High currents that pass through the chest can
  cause ventricular fibrillation, diaphragm
  dysfunction, and death.

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Electrical Safety (cont.)

• In electrical devices, a hot wire and a
  neutral wire exist.
• The neutral wire completes the circuit by taking
  the current to a ground.
• A ground is a low-resistance pathway to a point
  of zero voltage.

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Electrical Safety (cont.)
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Electrical Safety (cont.)

• Preventing Shock Hazards
• Most shock hazards are caused by inadequate
  grounding.
• All electrical equipment should be connected to
  grounded outlets with three-wire cords.
• All electrical equipment used for patient care
  must be checked by a qualified expert on a
  regular basis.

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Fire Hazards

• In 1980, about 13,000 fires were reported in
  health care facilities in the United States.
• By the year 2000, the number had dropped to
  2,000.
• This dramatic decrease is due to education and
  enforcement of strict fire codes.

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Fire Hazards (cont.)

• Most hospital fires start in the kitchen.
• About 15 of hospital fires occur in patient care
  areas and are often related to smoking.
• Hospital fires cause approximately 9 million in
  damage.
• Fires in patient care areas where oxygen is being
  used are especially dangerous.

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Fire Hazards (cont.)

• Fires in oxygen-enriched atmospheres (OEAs) are
  larger, more intense, faster burning, and more
  difficult to extinguish.
• Hospital fires are more serious because
  evacuation of critically ill patients is
  difficult.

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Fire Hazards (cont.)

• Three conditions must exist for fire to start
• Flammable material must be present.
• Oxygen must be present.
• The flammable material must be heated above its
  ignition temperature.
• Oxygen is not flammable, but it can greatly
  accelerate the rate of combustion.

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Fire Hazards (cont.)

• Flammable material should be removed from the
  vicinity of oxygen use.
• Ignition sources, such as cigarette lighters,
  should not be allowed in rooms where oxygen is in
  use.
• Children should not play with toys that may
  create a spark when oxygen is in use.

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Fire Hazards (cont.)

• RACE the core fire plan
• R Rescue patients in the immediate area of the
  fire.
• A Alert other personnel to the fire.
• C Contain the fire shut doors to prevent
  spreading of the fire.
• E Evacuate other patients and personnel.

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Communication in Health Care

• Success as an RT depends on your ability to
  communicate well with patients and other members
  of the team.
• Poor communication can limit your ability to
  treat patients, work well with others, and find
  satisfaction in your employment.

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Communication in Health Care

• Factors affecting communication
• The internal qualities (e.g., values,
  experiences, etc.) of the sender and receiver
• The verbal and nonverbal communication skills of
  the sender

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Effective Communication
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Improving Communication

• Share information rather than telling it.
• Seek to relate to people rather than to control
  them.
• Value disagreement as much as agreement.
• Use effective nonverbal communication techniques.

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Improving Communication (cont.)

• The Practitioner as a Listener
• Work at being a good listener.
• Stop talking. Avoid interrupting the speaker.
• Resist distractions. Tune them out.
• Keep your mind open be objective.
• Hear the speaker out before making an evaluation.
• Maintain composure control emotions.

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Improving Communication (cont.)

• Providing feedback
• Attending involves the use of gestures and
  confirming remarks
• Paraphrasing repeating the others response in
  ones own words
• Requesting clarification should be nonjudgmental
  in nature

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Improving Communication (cont.)

• Providing feedback
• Perception checking done by confirming or
  disproving the more subtle components of a
  communication interaction
• Reflecting feelings provide the opportunity for
  patients to express and reflect on their emotions

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Conflict and Conflict Resolution

• Sources of Conflict
• Poor communication is the primary source of
  conflict in organizations.
• Structural problems occur more often with larger
  organizations and when employees have little
  control over their work.

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Sources of Conflict (cont.)

• Personal behavior various personalities and
  beliefs can create conflict in the workplace.
• Role conflict occurs when an employee is pulled
  in different directions by individuals with
  different expectations.

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Conflict Resolution

• Competing represents an assertive and
  uncooperative conflict resolution strategy (e.g.,
  the boss uses his or her authority to settle the
  dispute)
• Accommodating represents the opposite of
  competing conflict settled by giving in
• Avoiding both parties do not pursue their
  concerns may lead to unresolved issues

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Conflict Resolution (cont.)

• Collaborating involved parties try to find
  mutually satisfying solutions to the conflict
• Compromising a middle-ground strategy that
  combines assertiveness and cooperation
• Deciding which type of conflict resolution
  strategy to use requires insight into the context
  of the problem.

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Recording Keeping

• A medical record or chart provides a written
  picture of occurrences pertaining to a patient
  during his or her stay in the hospital or clinic.
• Medical records are strictly confidential.
• The records represent a legal document that could
  be used in court.

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General Rules for Record Keeping

• Entries should be printed or handwritten.
• Do not use ditto marks.
• Do not erase.
• Record each patient interaction and sign the
  entry.
• Document patient complaints.

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General Rules for Record Keeping (cont.)

• Do not leave blank lines in the chart.
• Use standard abbreviations only.
• Use the present tense.
• Use proper spelling.
• Document all important conversations.
• Be accurate.

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The Problem-Oriented Medical Record

• The POMR is a documentation format used by some
  health care institutions.
• The POMR has four basic parts.
• Database
• Problem list
• Plan
• Progress notes

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The Problem-Oriented Medical Record

• The POMR progress notes use the SOAP format
• S Subjective (patients complaints)
• O Objective (results of physical exam, lab
  tests, ABGs,
• chest radiograph, etc.)
• A Assessment (What is the problem?)
• P Plan (How is the problem to be treated?)