A community health nurse is instructing a group of newly licensed nurses about diseases that require airborne precautions. Which of the following diseases should the nurse include?

A. Provide educational in-services for staff: While staff education is an important component of a quality improvement project, it is not the first action to take. Understanding the underlying factors contributing to MRSA infections should be the priority to ensure that educational initiatives are targeted and relevant.

B. Develop a MRSA protocol for implementation: Developing a protocol is necessary for guiding practice and reducing infections. However, it is essential to first gather data on existing practices and factors contributing to MRSA infections to ensure the protocol addresses specific issues.

C. Evaluate outcomes resulting from interventions: Evaluation of outcomes is a crucial step in the quality improvement process but occurs after implementing interventions. Initial actions should focus on identifying the root causes of MRSA infections before assessing the effectiveness of any interventions.

D. Conduct a chart review to evaluate precipitating factors of clients who develop MRSA: Conducting a chart review is the first action the nurse manager should take. This step allows for the identification of patterns and factors contributing to MRSA infections, providing valuable data that will inform the development of effective protocols and interventions tailored to the facility's needs.

Near miss:

• Incident Report 1: The nurse identified the client's allergy before administering azithromycin, preventing an adverse reaction. Holding the medication and notifying the provider ensured patient safety, making this a near miss rather than an adverse event.

Adverse Event:

• Incident Report 2: The client did not receive prescribed prophylactic antibiotics during labor, leading to neonatal sepsis. The lack of antibiotic administration increased the risk of serious complications, making this an adverse event with potential long-term consequences.

• Incident Report 3: A tenfold dosing error led to the administration of 60 units instead of 6 units of insulin, resulting in severe hypoglycemia and unresponsiveness. This critical medication error placed the client at significant risk for neurological damage or death, classifying it as an adverse event.

• Incident Report 4: A critically low platelet value was reported but not communicated to the provider, delaying intervention and leading to a coma. The failure to act on critical lab results contributed to a preventable deterioration in the client’s condition, making this an adverse event.

• Incident Report 5: Despite being identified as a fall risk, the client sustained a fall due to a malfunctioning call bell, leading to an injury. The failure to address the defective equipment compromised patient safety, making this an adverse event that could have been prevented.