2021_Book_TextbookOfPatientSafetyAndClin

17 Patient Safety in Internal Medicine
also for post-round briefing to summarize all
issues, identify and prioritize tasks, and delegate
responsibilities appropriately [80]. IRs are proactive
nurse rounds to check patients at set intervals.
During IRs, nurses assess patient’s
experience and essential care needs (4 P: positioning,
pain, personal needs, and placement). In
terms of patient safety, positioning check helps to
prevent pressure ulcers, personal needs (i.e., toilet)
and placement of personal items checks
reduce falls. Nevertheless, IRs facilitate team to
organize workload [80].
17.2.5.3 Clinical Records
Keeping clinical records (CRs) is an integral
component in good professional practice and the
delivery of high-quality care. Regardless of the
type of documentation (electronic or paper), a
good and updated CRs allow continuity and coordination
of care, aid informed decision-making,
avoid repetition of tests or other investigations,
improve communication between the various
health professionals and improve time management.
Bad CRS misinform healthcare professionals
and patients, prolong hospitalization,
jeopardize patient care leads to serious incidents
and increase medical-legal risk [84]. Figure 17.3
summarizes what to do and not to do to keep
good medical records.
17.3 Safety Practices
and Implementation
Strategy
231
According to the Agency for Healthcare Research
and Quality and the National Quality Forum “a
Patient Safety Practice is a type of process or
structure whose application reduces the probability
of adverse events resulting from exposure to
the healthcare system across a range of diseases
and procedures” [85].
In 2001 [86] and 2013 [85], an international
panel conducted an evidence-based assessment
of patient safety strategies (PSSs). The PSSs
were categorized according to the following
aspects: frequency and severity of the problem
addressed, strength of evidence of the effectiveness
of the safety strategy, the evidence or potential
harmful consequence of the safety strategy,
an estimation of implementation difficulties and
costs. It categorizes each PSS according to the
following: the scope of the underlying problem
that the PSS addresses (its frequency and severity);
the strength of evidence about the effectiveness
of the safety strategy; the evidence or
potential for harmful consequences of the strategy;
a rough estimate of the cost of implementing
the strategy (low, medium, or high); and an
assessment of the difficulty of implementing the
strategy. As a result of this process, 10 PSSs were
identified as “strongly encouraged” and other 12
as “encouraged” for adoption [85].
Here, we report some safety practices relevant
to IM, most of them included in the list of strongly
encouraged or encouraged for adoption [87].
17.3.1 Prevention of Age and Frailty-
Related Adverse Events
Falls. The rate of falls in acute care hospitals varies
from 1 to 9 per 1000 bed-days. The first effective
strategy relies on the timely recognition of
patients with risk factors for falls (Table 17.10)
[88]. The National Institute for Health and Care
Excellence (NICE) recommends to regard as the
population at risk all inpatients older than 65 and
those between 50 and 64 who are identified as
being at high risk of falling [89]. Actually, some
tools are available to discriminate between highand
low-risk patients, but they may show limitations
in specific populations. Morse Falls Score
(MFS) and STRATIFY Score are the two most
widely validated tools. However, they were not
judged to be diffusely adopted and generate
greater benefits than nursing staff clinical judgment
[90]. NICE guidelines do not recommend
any predictive score [89]. Besides, various
assessments and interventions should take place
(Table 17.11): (1) all aspects of the inpatient
environment —including flooring, lighting, and
furniture— must be identified and addressed; (2)
high-risk patients should be considered for multifactorial
evaluation in order to timely identify
cognitive impairment, incontinence, fall history,