****** - Verified Buyer
4.5
I wanted to read this book for several reasons.1. Author is Pat Iyer. Her writing style is concise and clear. She is direct, well experienced, very well respected and one of the "gurus" of Legal Nursing.2. Am presently working on a case involving perceived nurse negligence contributing to patient fall with fractured hip injury.3. Knew I was scheduled for a rather involved surgery and I wanted to review the latest information on adverse event prevention for myself!Pat Iyer does not disappoint. The book is written for an audience of Legal Nurse Consultants, however, bedside RNs will find the book extremely beneficial for prevention and quality care reasons. Her subject matter is separated in Chapters discussing three potential threats to all hospital stays- a preventable patient fall, a preventable patient pressure sore and a IV Therapy event that should have been recognized early onset.As an experienced bedside nurse, I concede that there are some patients who appear destined to fall. They attempt to climb out of bed over the siderails. They attempt to go to the bathroom and trip and fall over the Foley catheter placed so they can rest and be safe. I remember an ICU patient whom I believed was calm, stable, comfortable. I had completed a couple of hours of care for him, and thought it safe to dim the lights, and hurry next door to admit my new patient. The monitor tech yelled at me only a few minutes later that my patient's leads were off. I found him face down on the floor, unresponsive.(By the way, the siderails were still up). CPR ensued however he did not respond. I did not stay in the ICU area very long, in fact I bolted back to the Outpatient Dialysis center (my comfort zone) where ambulatory patients were (hopefully) escorted by staff to the lobby.Which brings me to the current case I am working. Where the dialysis staff did not escort the patient to the scale, where he fell and sustained a complex hip fracture. The chapters in this book were very helpful in analyzing this case.And my own hospital experience? IV infiltrated times 4, when I requested a PICC line, was told they could just discontinue the IV, was deemed fit to "walk laps" around unit escorted only by my trusty IV pole. I noticed the Surgical Unit I was on, had every patient door labeled with High Risk For Falls. Preoperatively, the nurse applied a preventive Sacral Dressing/ padding to protect my intact sacral area from breakdown from the long surgery on the hard surface of the OR table. I saw this as innovative and proactive in pressure sore prevention. However, not one time did anyone inspect my sacral area to ensure that I was still intact. So, points given for proactive. Points taken for follow-through.I absolutely recommend this book, and plan to use it as reference for many years to come. Thank you Pat Iyer for your assistance in un-raveling some of the mysteries of "what went wrong and what could have been done better".Sharon Barber RN CNN LNCNursing Judgment ConsultingEvans, GA
