Patient Safety
Laura
Units:
Acute Psychiatric Unit (Men/Women)
Gerontopsychiatrie Unit
Intensiv Unit
OR
Suchtmedizinische (Jungend)
ALL Units
Call lights: Each patient's room in acute psychiatric unit and gerontopsychiatrie unit had call bells within reach of the door. The Intensive unit had beds in two rooms and patients were continally watched. Many were comatose in the intensiv unit, but a button was provided for the family.
Patient identifiction: Patients on Acute psychiatric units and suchtmedizinische do not wear identification on there arms. This includes the patient in the OR. I observed two neurosurgeries and both patients did not have a wrist band. They just had a folder with their information. However, gerontopsychiatrie and Intensiv did have bands identifying them.
Medication: Patients would come up to the counter to take their medication. No wrist bands were checked. However, if a patient is known to not take their medication, the nurse inspects their mouth. The nurse told me they do not need to check wrist bands because they know their patients. Medication is kept in a closet in a locked room. Narcotics on the floor were locked however since many of the patients had addictions. Each patient had a pill container with their last name and first inital. Medication is filled each morning for morning, midday and evening doses.
Documentation: Documentation is important like in America. Nurses must document every assessment, vital sign and changes. Nurses put documentation in paper chart and on computer charting. Medication is documented only through paper form and a nurse must document that medication was provided.
Risk Identification:The computer program for the hospital has a box for each patient on the main page. In each box are little icons that identify a specific risk. There is an icon for a patient at risk for falling, a patient who is a run risk, has a allergy, among others. This is where nurses can view risks. It is accessible and is always visible.
Acute Psychiatrie
Close Ward on Women & Men Psychiatric units: Patients were to be with a nurse, doctor or family member at all times if out of the closed ward. They had to have a nurse transport them if they had to go to therapy on a different floor. One day after lunch, my assigned nursing student and I noticed a patient from the ward walking on the first floor alone. We informed the head nurse right away who called down so the patient could have a nurse find her immediately.
Smoking: Smoking is common in Austria. However, in order to protect the patients who wish not to smoke, there are designated smoking rooms on the floor. The closed ward had it's own smoking room.
Tranquilizers: In the event a patient has to be given a tranquilizer, the nurse must fill out a form that a doctor must sign within 24 hours. The form states who the patient was, when it happened and why it happened.
OR
Infection: Before walking into the surgical unit, nurses and doctors go into a dressing room where they are provided green scrubs, white socks, green shoes and a head cover. Then they walk into a smaller room to wash their hands before walking onto the floor. Something was struck me as very odd was the fact no one wore covers on their shoes and the surgeon was wearing croc shoes with no socks. Nursing students told me this was not a common thing. However, sterile field was kept throughout surgery. I asked about their risk of infection and a nurse stated they are very low. However, I intend to do some research back at ODU on HAIs in Austria.
Procedures: The operating room, while it had similiarities, had a few differences compared to America. At the beginning of the second surgery, the surgeon did not have a time out asking for the patient's name, age, procedure and if he had any allergies.
Gerontopsychiatrie Unit
Dementia: In the gerontology unit, many of the patients are diagnosed with dementia. The nurses have to ensure they do not leave the floor and know their whereabouts at all times. Each patient was provided a watch. However, these watches were in fact not a watch. They were trackers that also set off the alarm if they tried to leave the floor. The patients were told they were watches so they would wear them. The most interesting part of the floor was a large black circle at the entrance/exit. The black dot is there so the patients will not leave. Supposedly those with dementia are too afraid to walk over it, fearing they will fall into a black hole.
Restraints: Patients who tend to wander due to their dementia are placed in a big comfortable chair with a tray placed in front of them. This tray is locked so they are unable to get up. Patients however are not left in these for too long, but just during meal time and when nurses do handoff. The nurse said a doctor must write off on the order if restraints are used.
Suchtmedizinische (Jungend)
Infection: Patient safety is vital in this unit due to Hepatitis C. Many patients who come in and are experiencing withdrawal have Hep. C. In the patient's chart, a yellow circle is placed in the patient's chart, both paper and computer. Cleaning crew disinfects entire unit tpo rduce risk of infection.
Substitution Protocol: Patients going through withdrawal sometimes are in the substition program. However, there is only a certain amount they are allowed to take. Patient's cannot take more and can only decrease in amount. Medication was locked since it too could be addictive.
Vital Signs: A sheet in the nurses station provided the exact vital signs that made it necessary to call the doctor. It was in yellow and red to make it pop out. (Insert photo). Blutdrück (blood pressure) is taken in the morning and afternoon to look for Systolic BP over 200. During morning assessment, the nurse checks their vitals, especially blood pressure and respiration as they experienced withdrawal.
Rachel
Teen/Youth Open Inpatient Psychiatric Unit
Call lights: Patient's rooms have a call light system attached to the wall adjacent to the door and also right next to the bed. This system has an emergency button for the patient to press in the event that they needed a nurse or medical attention and could not leave their room. The system right next to the door also has a button that the nurse can press while he/she is in the patient's room to communicate with the rest of the staff on the unit that a nurse or staff person is in this patient's room.
Patient identification: Patients do not wear medical idenfication wrist bands with their name, DOB, or barcode. Patients are simply identified based on familiarity. Patient's on this unit typically stay anywhere from 3 days to 10 weeks, so nurses and doctors often become quite familiar with the patients.
Medication administration: Since the patient's do not wear wrist bands, medication administration is again based on familiarity. Administration is documented in a computer system and therapeutic drug levels are check when the patient is on psychiatric drugs. Medication draws are not locked and are located in a cabinet within a lock room or area of the nursing station. Upon opening the medication cabinet, access to all medications stored on this unit is feasible.
Documentation: Patients on this particular psychiatric unit must be documented on by the nurse or social educator (position we may not have in the U.S.) twice per day. This documentation will include evaluation of their progress, emotions, mood, stability, etc.
Uniforms: Nurses, physicians, and staff persons wear uniforms that are provided by the clinic. When a uniform is dirty, the staffperson returns the uniform to the designated area in the clinical and retrieves a new uniform set. The dirty uniform he/she dropped off is then cleaned by a cleaning company that the hospital hires as an outsource.
Sterilization: Sterilization and disinfection is very important here in Austria. Urinals and bedpans, for instance, are not disposable (single-use) supplies. These are either a durable plastic (for the urinal) or metal (for the bedpan) and multi-use. Between each patient using the designated supply, it is sterilized in an automated machine for reuse. Furthermore, hand-sanitizing stations are common but are not located outside of every door as in hospitals in the U.S.
Restraints: Restraints are used as a last resort, just as in the U.S., but are used on occasion. In fact, there was a patient on the closed unit just next door to me on Day 1 that had to be restrained for aggressive behavior. Restraints can be 4-point restraints to a typical hospital bed. These are locked via a magnetic system that can only be operated by a staff person. Just as in the U.S., if a patient is placed in a restraint, a doctor's orders must be obtained within 1 hour and the patient must be assessed and documented on every 15 minutes. Within 96 hours of the patient being placed in a restraint, a lawyer must visit the patient and the facility and deem in having been a necessary and appropriate use of the restraint. Furthermore, the restraint must be removed as soon as possible.
Smoking: Many people in Austria, and the parts of Europe we have visited, smoke - especially young people. Nurses are allowed time as needed to step just outide the hospital building to take a smoke break. Patients, even on the teen unit, are provided with a smoking room that is inside of the unit. This smoking room is located between the nursing station a patient's rooms and is enclosed with a door and and glass wall. All patients 16+ are allowed in the smoking room.
Neurology Unit
Bed systems: Beds can be lowered all the way to the ground floor for patients with the highest fall risk standing. The height of the bed at this position would only be as tall as the height of the mattress. For this position, railings are also adjustable to enclose the entire perimeter of the bed.
Pressure ulcer prevention: Moisturizing creams are applied during all incontinence care. Patients are turned or repositioned every 3-4 hours at a minimum. For patients who are completely bedridden, have very thin frail skin, or are unable to intake adequate nutrition, a pressurized mattress is used. The system is called Thero-Activ for Dekubitus-Therapie. Pressure points can be set to alternate at set time intervals and in a particular pattern.
Patient identification: All patients wear a patient idenfication wrist band with name and DOB. Bands do not include a bar code for scanning.
Medication administration: Documentation of an administered medication is done in a paper format. Included in each patient's chart is a medication schedule with all of the prescribed drugs and dosages listed out in categories: parenteral, oral, etc. Columns along side the drugs are separated by day of the week and times (morning, midday, evening, and night). There is a symbol in the corresponding box if a patient is to receive a medication at a certain time. Once a medication is given, the nurse initials in a designated box above the symbol. There is no electronic record of medication administration.
Fall prevention: Typically, senso-mats are used next to the patient's beds to alarm if a patient attempts to get out of bed. The unit also carries bed alarms and chair alarms but these are used less frequently.
Call bells: All patients are provided with a call bell at their bedside that allows them to call a nurse if help is needed and control the functions of the TV and bed.
Wheelchairs: A personal wheelchair is given to each patient to keep for the duration of their stay. This personal chair is adjusted to the height and settings needed for this patient. For patients who have limited control over their head and neck, there are taller seat backs which have protective sidings that prevent the patient from falling from one side to the other.
