A nurse is conducting a home visit with an older adult client. Which of the following observations should the nurse address to promote a safe environment?

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.

A. Lower maternal morbidity rates: Rural health often does not reflect lower maternal morbidity rates. In fact, rural areas may experience higher maternal morbidity due to limited access to healthcare services, fewer prenatal resources, and a shortage of specialized medical providers, leading to potential complications during pregnancy.

B. Reduced incidence of death from motor-vehicle crashes: Rural areas tend to have higher rates of motor vehicle crashes due to factors such as longer travel distances, less regulated driving conditions, and often poorly maintained roads. These conditions contribute to an increased risk of accidents and fatalities in these regions.

C. Increased rates of chronic illness: Rural health is often characterized by increased rates of chronic illnesses, such as hypertension, diabetes, and obesity. Contributing factors include limited access to healthcare, fewer health education resources, socioeconomic disparities, and lifestyle factors like diet and exercise habits that may be less favorable in rural settings.

D. More frequent dental preventative care visits: Rural areas typically have fewer dental care resources and access, which can lead to less frequent dental visits for preventative care. This situation can result in higher rates of dental issues and a lack of regular screenings and treatments for oral health problems.