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3 What would make you suspect that a patient in your care had a urinary tract infection?

a The doctor has requested a midstream urine specimen.

b The patient has a urinary catheter in situ, and the patient’s wife states that he seems more forgetful than usual.

c The patient has spiked a temperature, has a raised white cell count (WCC), has new-onset confusion and the urine in his catheter bag is cloudy.

d The patient has complained of frequency of faecal elimination and hasn’t been drinking enough.

4 You are caring for a patient in isolation with suspected Clostridium difficile. What are the essential key actions to prevent the spread of infection?

a Regular hand hygiene and the promotion of the infection prevention link nurse role.

b Encourage the doctors to wear gloves and aprons, to be bare below the elbow and to wash hands with alcohol handrub. Ask for cleaning to be increased with soap-based products.

c Ask the infection prevention team to review the patient’s medication chart and provide regular teaching sessions on the ‘5 moments of hand hygiene’. Provide the patient and family with adequate information.

d Review antimicrobials daily, wash hands with soap and water before and after each contact with the patient, ask for enhanced cleaning with chlorine-based products and use gloves and aprons when disposing of body fluids.

5 What steps would you take if you had sustained a needlestick injury?

a Ask for advice from the emergency department, report to occupational health and fill in an incident form.

b Gently make the wound bleed, place under running water and wash thoroughly with soap and water. Complete an incident form and inform your manager. Co-operate with any action to test yourself or the patient for infection with a bloodborne virus but do not obtain blood or consent for testing from the patient yourself; this should be done by someone not involved in the incident.

c Take blood from patient and self for Hep B screening and take samples and form to Bacteriology. Call your union representative for support. Make an appointment with your GP for a sickness certificate to take time off until the wound site has healed so you don’t contaminate any other patients.

d Wash the wound with soap and water. Cover any wound with a waterproof dressing to prevent entry of any other foreign material. Wear gloves while working until the wound has healed to prevent contaminating any other patients. Take any steps to have the patient or yourself tested for the presence of a bloodborne virus.

Answers to the multiple choice questions can be found in Appendix 3.

These multiple choice questions are also available for you to complete online. Visit www.royalmarsdenmanual.com and select the Student Edition tab.

Chapter 4

Risk Management

Overview

The fundamental goal for every healthcare professional is to ensure that their patients are treated in a safe environment and protected wherever possible from harm. This manual is devoted to ensuring that the care nurses give to patients is consistently of a high quality and based on sound evidence of good practice. Whilst nurses are obliged to keep updated in their practice and only undertake roles and activities for which they feel they have the knowledge, skills and experience (NMC 2008), keeping patients safe involves a deeper understanding of the hazards which may exist along a patient’s pathway of care.

This chapter will look at the ways in which risks to patients and staff can be identified at an early stage and managed appropriately. The management of risk is everybody’s business and as the main caregivers in the NHS, it is essential that nurses understand the key principles of risk management and ensure that they know how to keep their patients, colleagues and indeed themselves safe.

Risk management

Definitions

Risk management can be defined as the culture, processes and structures that are directed towards the effective management of potential opportunities and adverse effects (Standards Australia and