Transcript safety
SAFETY PYRAMID POINTS • Safety assessment • Maintaining precautions to prevent errors or accidents • Disaster planning and priority nursing actions in the event of an emergency or a disaster • Standard and transmission-based precautions • Handling hazardous and infectious materials • Guidelines regarding the use of restraints • Nosocomial infections • Poisoning FIRE SAFETY • Keep open spaces free from clutter • Clearly mark fire exits • Know the location of all fire alarms, exits, and extinguishers • Know the telephone number for reporting fires • Know the agency’s fire drill and evacuation plan • Never use the elevator in the event of a fire • Turn off oxygen and appliances in the vicinity of the fire FIRE SAFETY • In the event of a fire, if the client is on life support, maintain the client’s respiratory status manually with a resuscitation (Ambu) bag until the client is moved away from the threat of fire • In the event of a fire, ambulatory clients can be directed to walk by themselves to a safe area, and in some cases may be able to assist in moving clients in wheelchairs FIRE SAFETY • Bedridden clients are generally moved from the scene of a fire by a stretcher, their bed, or a wheelchair • If a client must be carried from the area of a fire, appropriate transfer techniques need to be used • If fire department personnel are at the scene of the fire, they can help evacuate clients PRIORITY ACTIONS IN THE EVENT OF A FIRE • RACE – R - Rescue • Remove all clients from the vicinity of a fire – A - Alarm • Activate the fire alarm; report a fire before attempting to extinguish it – C - Confine • Close doors and windows when a fire is detected – E - Extinguish • Extinguish the fire, using the appropriate fire extinguisher TYPES OF FIRE EXTINGUISHERS • Type A: Water – Wood, draperies, upholstery, paper, and rubbish • Types B and C: Carbon dioxide or dry chemical – Flammable liquids or gases, grease, and electrical • Types A, B, or C: Multipurpose or dry chemical – Any fire USING A FIRE EXTINGUISHER • PASS – P - Pull the pin – A - Aim at the base of the fire – S - Squeeze the handles – S - Sweep the fire from side to side USING A FIRE EXTINGUISHER From Leahy, J. & Kizilay, P. (1998). Foundations of nursing practice. Philadelphia: W.B. Saunders. (Used by permission of Costal Video Communications Corp. All rights reserved.) ELECTRICAL SAFETY • Electrical equipment must be maintained in good working order and should be grounded • Use a three-pronged electrical cord • In a three-pronged electrical cord, the third longer prong of the cord is the ground; the other two prongs carry the power to the piece of electrical equipment • Any electrical equipment that the client brings into the health care facility must be inspected for safety prior to use ELECTRICAL SAFETY • Check electrical cords and outlets for exposed, frayed, and damaged wires • Avoid overloading any circuit • Read warning labels on all equipment; never operate unfamiliar equipment • Use safety extension cords only when absolutely necessary and tape to the floor with electrical tape • Never run electrical wiring under carpets ELECTRICAL SAFETY • Never pull a plug using the cord; always grasp the plug itself • Never use electrical appliances near sinks, bathtubs, or other water sources • Always disconnect a plug from the outlet before cleaning equipment or appliances • If a client receives an electrical shock, turn off the electricity before touching the client RADIATION SAFETY From Harkreader, H. (2000). Fundamentals of nursing. Philadelphia: W.B. Saunders. RADIATION SAFETY • Know the health care agency protocols and guidelines • Label potentially radioactive material • Monitor radiation exposure with a film badge • Place the client with a radiation implant in a private room • Never touch dislodged implants • Wear gloves when handling body discharges RADIATION SAFETY • To reduce exposure to radiation – The time spent near the source should be limited – The distance from the source should be as great as possible – A shielding device such as a lead apron should be used DISPOSAL OF INFECTIOUS WASTES • Handle all infectious materials as a hazard • Dispose of waste in designated areas only, using proper containers for disposal • Ensure that infectious material is properly labeled • Needles should not be recapped, bent, or broken • Dispose of all sharps immediately after use in closed, puncture-resistant disposal containers that are leak-proof and labeled or color-coded MEASURES TO PREVENT FALLS • Assess the client’s risk for falling • Assign the client at risk for falling to a room near the nurses’ station • Alert all personnel to the client’s risk for falling • Orient client to physical surroundings • Instruct client to seek assistance when getting up • Explain use of call bell system MEASURES TO PREVENT FALLS • Keep bed in the low position with side rails up if required • Lock all beds, wheelchairs, and stretchers • Keep personal items within reach • Eliminate clutter and obstacles in the client’s room • Provide adequate lighting • Reduce bathroom hazards • Maintain the client’s toileting schedule throughout the day RESTRAINTS • Protective device used to limit the physical activity of a client or to immobilize a client or an extremity • Physical restraints – Restricts client movement through the application of a device • Chemical restraints – Medications given to inhibit a specific behavior or movement RESTRAINTS • IMPLEMENTATION – When restraints are necessary, the physician’s orders should state the type of restraint, specific client behaviors for which restraints are to be used, and identify a limited time frame for use – Physicians’ orders for restraints should be renewed within a specific time frame according to the agency’s policy RESTRAINTS • IMPLEMENTATION – Restraints are not to be ordered PRN – The reason for the restraints should be given to the client and the family, and their permission should be sought – Restraints should not interfere with any treatments or affect the client’s health problem – Use a half bow or clove hitch knot so that the restraint can be changed and released easily – Ensure that there is enough slack on the straps to assure some movement of the body part RESTRAINTS • IMPLEMENTATION – Secure restraint to the bed frame, not to the side rails – Assess skin integrity, neurovascular, and circulatory status every 30 minutes and release the restraint to permit muscle exercise and promote circulation – Continually assess the need for restraints HALF BOW AND CLOVE HITCH KNOT From Harkreader, H. (2000). Fundamentals of nursing. Philadelphia: W.B. Saunders. RESTRAINTS • DOCUMENTATION – Reason for restraint – Method of restraint – Date and time of application of restraint – Duration of use of the restraint and client’s response – Release from restraint with periodic exercise and circulatory, neurovascular, and skin assessment – Assessment of continued need for restraint – Evaluation of the client’s response ALTERNATIVES TO RESTRAINTS • Orient client and family to surroundings • Explain all procedures and treatments to the client and family • Encourage family and friends to stay with client and utilize sitters for clients who need supervision • Assign confused and disoriented clients to rooms near the nurses’ station • Provide appropriate visual and auditory stimuli to client, such as clocks, calendars, television, and a radio ALTERNATIVES TO RESTRAINTS • Place familiar items near the client’s bedside, such as family pictures • Maintain toileting routines • Eliminate bothersome treatments, such as tube feedings, as soon as possible • Evaluate all medications that the client is receiving • Use relaxation techniques with the client • Institute exercise and ambulation schedules as the client’s condition allows POISONS • Any substance that impairs health and destroys life when ingested, inhaled, or otherwise absorbed by the body • Specific antidotes or treatments are available for only some types of poisons • The capacity of body tissue to recover from the poison determines the reversibility of the effect • Poison can impair the respiratory, circulatory, central nervous, hepatic, gastrointestinal (GI), and renal systems of the body POISONS • The toddler, preschooler, and young school-age child must be protected from accidental poisoning • In older adults, diminished eyesight and impaired memory may result in accidental ingestion of poisonous substances or an overdose of prescribed medications • The Poison Control Center phone number should be visible on the telephone itself in homes with small children; in all cases of expected poisoning, the number should be called immediately POISONS • IMPLEMENTATION – Remove any obvious materials from the mouth, eyes, or body area immediately – Identify the type and amount of substance ingested – Call the Poison Control Center before attempting an intervention – If the victim vomits or vomiting is induced, save the vomitus if requested to do so, and deliver to the Poison Control Center POISONS • IMPLEMENTATION – If instructed by the Poison Control Center to take the victim to the emergency department, call an ambulance – Vomiting is never induced following ingestion of lye, household cleaners, grease, or petroleum products – Vomiting is never induced in an unconscious victim DISASTERS • Know the agency’s disaster plan • Internal disasters are those in which the agency is in danger • External disasters occur in the community, and victims will be brought to the health care facility for care • When the health care facility is notified of a disaster, specific plans as specified in the agency policy must be carried out NOSOCOMIAL INFECTIONS • Also referred to as hospital-acquired infections • Infections acquired in the hospital or other health care facility that were not present or incubating at the time of the client’s admission NOSOCOMIAL INFECTIONS • Illness impairs the body’s normal defense mechanism • The hospital environment provides exposure to a variety of virulent organisms that the client has not been exposed to in the past; therefore, the client has not developed resistance to these organisms • Infections can be transmitted by health care personnel who fail to practice proper handwashing procedures or fail to change gloves between client contacts COMMON DRUG-RESISTANT NOSOCOMIAL INFECTIONS • Vancomycin resistant enterococci (VRE) • Methicillin-resistant, Staphylococcus aureus (MRSA) • Multidrug-resistant (MDR) tuberculosis STANDARD (UNIVERSAL) PRECAUTIONS • Must be practiced with all clients in any setting regardless of their diagnosis or presumed infectiousness • Promotes hand washing and the use of gloves, masks, eye protection, and gowns when appropriate for client contact • These precautions apply to blood; all body fluids, secretions, and excretions except sweat regardless of whether they contain blood; nonintact skin; and mucous membranes STANDARD (UNIVERSAL) PRECAUTIONS • IMPLEMENTATION – Handle all blood and body fluids from all clients as if they are contaminated – Hands are washed between client contacts; after contact with blood, body fluids, secretions, and excretions and after contact with equipment or articles contaminated by them; and immediately after gloves are removed STANDARD (UNIVERSAL) PRECAUTIONS • IMPLEMENTATION – Gloves are worn when touching blood, body fluids, secretions, excretions, nonintact skin, mucous membranes, or contaminated items; gloves should be removed and hands washed between client care – Masks, eye protection, or face shields are worn if client care activities may generate splashes or sprays of blood or body fluid – Gowns are worn if soiling of clothing is likely from blood or body fluid; wash hands after removing a gown STANDARD (UNIVERSAL) PRECAUTIONS • IMPLEMENTATION – Client care equipment is properly cleaned and reprocessed, and single-use items are discarded – Contaminated linen is placed in leak-proof bags and handled to prevent skin and mucous membrane exposure – All sharp instruments and needles are discarded in a puncture-resistant container; needles are disposed of uncapped, or a mechanical device for recapping or covering the needle is used if necessary STANDARD (UNIVERSAL) PRECAUTIONS • IMPLEMENTATION – Spills of blood or body fluids are cleaned with a solution of bleach and water (diluted 1:10) or agency approved disinfectant – The nurse should consult with the infectioncontrol professional if there are any concerns regarding a potential for the transmission of an infection TRANSMISSION-BASED PRECAUTIONS • Airborne precautions • Droplet precautions • Contact precautions AIRBORNE PRECAUTIONS • DISEASES – Measles – Chicken pox (varicella) – Disseminated varicella zoster – Pulmonary or laryngeal tuberculosis (TB) AIRBORNE MODE OF TRANSMISSION From Leahy, J. & Kizilay, P. (1998). Foundations of nursing practice. Philadelphia: W.B. Saunders. AIRBORNE PRECAUTIONS • BARRIER PROTECTION – Single room maintained under negative pressure; door kept closed except when entering or exiting the room – Negative airflow pressure in the room with a minimum of 6 to 12 air exchanges per hour depending on the health care agency – Mask or respiratory protection device AIRBORNE PRECAUTIONS • BARRIER PROTECTION FOR TB – Use of ultraviolet germicide irradiation or HEPA filter, which may reduce the number of droplet nuclei – Use of personal respiratory protective devices (masks) capable of filtration of 95% efficiency when entering the isolation room; ability to fittest masks to obtain a face-seal leakage of less than or equal to 10% – Place a mask on the client when out of the room; the client leaves the room only if necessary DROPLET PRECAUTIONS • DISEASES – Diphtheria (pharyngeal) – Rubella – Streptococcal pharyngitis – Mycoplasma pneumonia or meningococcal pneumonia or sepsis – Scarlet fever in infants and younger children – Pertussis – Mumps – Pneumonic plague DROPLET MODE TRANSMISSION From Leahy, J. & Kizilay, P. (1998). Foundations of nursing practice. Philadelphia: W.B. Saunders. DROPLET PRECAUTIONS • BARRIER PROTECTION – Private room or cohort client – Use of a mask – Place a mask on the client when out of the room; the client leaves the room only if necessary CONTACT PRECAUTIONS • DISEASES – Respiratory syncytial virus (RSV) – Shigella and other enteric pathogens – Major wound infections – Herpes simplex – Scabies – Varicella zoster (disseminated) – Colonization or infection with multidrugresistant organism CONTACT PRECAUTIONS • BARRIER PROTECTION – Private room or cohort client – Use of gloves and a gown when in contact with the client