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. "We should start tracking how soon clients are discharged after laparoscopic versus open surgery.": This statement reflects the QSEN concept of quality improvement by focusing on collecting and analyzing data related to patient discharge times. By tracking this information, the team can identify trends, evaluate the effectiveness of care, and implement changes to improve patient outcomes and streamline the discharge process.

B. "We should be sure to log out of the computers immediately following documentation.": While this statement emphasizes an important aspect of safety and confidentiality in documentation, it does not directly address quality improvement initiatives. It focuses more on operational procedures rather than evaluating and enhancing the quality of patient care.

C. "We should involve our clients' partners in care planning as much as possible.": Involving clients' partners in care planning aligns with the QSEN concept of patient-centered care. While this approach is essential for improving patient satisfaction and outcomes, it is not specifically a quality improvement initiative.

D. "We should provide change-of-shift report as a team, including the assistive personnel who assisted with care.": This statement reflects teamwork and communication strategies, which are important for effective patient care. However, it does not directly focus on quality improvement initiatives aimed at evaluating and enhancing the overall quality of care provided to clients.