Transcript Safety

Safety
Foundations of Nursing
Christensen Kockrow
Mosby
Sharon L. Kinley Schwing BSN 2006
Leslie Lehmkuhl RN 2009
Safety
• The need for a safe environment is always
present.
• A safe environment implies freedom from injury
with focus on helping to prevent falls, electrical
injuries, fires, burns, and poisoning.
• Both protection and education are primary
nursing responsibilities, with nurses directly and
actively involved in ensuring a safe health care
environment.
SAFETY continued
• The first priority in providing client care.
• Constant attention to safety factors
enables the nurse to maintain a safe
environment for the client.
• Safety is associated with health
promotion and illness prevention.
FACTORS AFFECTING SAFETY
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Age
Lifestyle/occupation
Sensory/perceptual changes
Mobility
Emotional state
Safe Environment
• The need for a safe environment is always
needed for every body.
• Focus is placed on the:
Immediate environment
Local concerns
National concern
• This includes many issues within the
environment.
Safety Is for
Every Age
ACCIDENTS IN THE HEALTH CARE SETTING
• Client behavior accidents–client’s
behavior or actions.
• Therapeutic procedure accidents–delivery
of medical or nursing interventions.
• Equipment accidents–malfunction,
improper use of medical equipment.
Precautions to Promote Safety
• Orient patient to environment.
• Place bedside table, and needed items within reach.
• Assist patients who have had surgery, receiving
narcotics, or are sedated.
• Assist all patients during ambulation, or the first time
out of bed.
• Use bed alarms for the restless, confused patient.
• Where non-slip shoes.
IDENTIFY CLIENT
• Checking the client’s ID band ensures
that the correct person receives care.
• Client identification is essential before
rendering any care.
Precautions to Promote Safety continued
• Wipe, mop up spills to prevent injury.
• Adequate lighting.
• Emergency light, call bells in reach.
• Answer bells in a timely manner.
• Follow all “fall precaution” policies, adopted by
your institution.
Nurses Responsibilities
• Overall safety of the patient.
• Safe hospital environment.
• Recognition and identification of potential hazards, and
threats within the work setting.
• Freedom from injury for patients, visitors and staff.
• Providing and maintaining a safe environment within
the work place.
• See JACHO recommended patient safety goals.
Left Handed
• Unique challenges.
• Hospital rooms are typically set up for right
handed patients, and nurses !
• 12-30% of the population is a south paw.
• Being left handed increases the risk of injury for a
patient.
Safety for the Left Handed Patient
• Place all bathing articles at the patients left.
• Left hand may be stronger by nature than the
right.
• Arrange meal trays, so that silverware, and drinks
are at the left.
• Ambulate the pt. by walking on the left side.
• Adjust the patient room to accommodate the left
handed patient.
Falls
• Common problem.
• All patients are at risk for a fall.
• Majority of patients fall during a transfer of some type.
• Fall are the major , #1 concern for all patients in all
institutions.
• Very young, older adults, ill, and injured are all at risk for a fall.
• Use of Anesthesia, sedatives, and or narcotics increase the
risk of falls.
Safety Reminder Devices
• SRD/ defined as any number of devices used to
immobilize a patient, or any part of the patients body
part.
• When would a SRD be used ?
• What is the downside of SRDs ?
• Doctors orders must be obtained. Patients must be
closely watched.
• Documentation includes:
response.
Why, How, How long, pts
Elderly
Safety
Applying Safety Reminder Devices
• Safety reminder device (SRD) is any device that
immobilizes the patient or a part of the patient.
– Soft restraint (Posey).
• Used for patient safety and maintain treatment.
• Prevent the disoriented patient from wondering and
prevent or reduce risk of patients falling.
• May be used with aggressive patient to protect other
patients and staff.
Extremity (ankle or wrist) Restraint
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Precautions When Using SRDs
• Document the following:
– Position of device
– Circulation
– Physical and mental status
– Ongoing need for the device
• SRDs should be removed at least every 2 hours and the
skin assessed
• Know the agency policy and procedures regarding SRD
use
Use of Gait Belts
• Apply gait belt securely around patients waist.
• Walk to the side of the patient.
• Nurse should walk on the patients weaker side.
• Use of hand rail, support systems as needed.
• Remove gait belt after ambulation.
• Document procedure.
Infants and Children
• Infants and children require different type of safety
within their environment.
• These small patient require protection within their
environments.
• Accidents involving children are largely preventable.
• Growth and development skills need to be taken into
consideration, during the care of the young patient.
Older Adult Considerations
• Adults taken many different medications, and have an
increase in fall risks.
• Use of safety devices are encouraged.
• Accidental poisoning/over doses are common in adults.
• Changes in:
Vision
Perception
Hearing
Muscle strength
Joint function
Cardiovascular
Peripheral vascular system
Safety within the
Hospital/Health Care Environment
• Hospital environment is a source of potential hazards.
• Use of various biologic, chemical, and physical hazards have been
identified.
• Use of laser, can cause skin and eye irritation. Fire risks are
increased.
• Exposure to blood, body fluids, needle, radiation and resp. diseases
pose threats to all hospital personnel.
• Needle sticks are still the prime source of blood borne pathogens.
• “Do not Recap” and needle-less systems are now common practice
Work Place Safety
• Employee Right to Know Laws:
• Regulation Relation to Hazardous
Materials
• Material Safety Data Sheets
USE PROPER BODY MECHANICS
• Center of gravity–located in center of
body, in pelvic area. All movement should
pivot around this central point.
• Base of support–feet are base of support.
The feet should be kept wide apart when
lifting heavy items.
Patient Teaching for Infection
Control
• The nurse will need to educate patient about the nature
of infection and the techniques to use in planning or
controlling its spread.
– Infection control for home and hospice settings.
– Prevention of infection.
Hand washing
Food preparation
IV lines
Waste containers
Body fluid spills
Hospital Environment
• The hospital environment is a source of potential safety
hazards to health care workers:
Biological
Chemical
Physical hazards
Blood and body fluids
Radiation
Contaminated needles
Equipment
Electrical Hazards
• Much of the equipment used in health care are electrical.
• Use of properly grounded plugs.
• Use of only red plugs for life supportive equipment.
• Do not use any equipment that is in poor condition.
• Avoid use of electrical equipment , in or near water.
REDUCE EXPOSURE TO RADIATION
• Minimize time spent in contact with and distance from the
radiation source.
• Use appropriate radiation shields.
• Monitor exposure with a film badge.
• Label all potentially radioactive material.
• Never touch dislodged implants or body fluids of a client
receiving radiation.
• Radiation:
Radiation and radioactive materials are
used to treat and diagnosis diseases.
Environment related risks are present.
Minimize time / Maximize distance
Wear monitors / Never touch dislodged implant
• Mercury Spill:
Mercury is considered a hazardous chemical
according to OSHA.
Mercury spill cleanup procedures.
Safety Promotion
• Education is the key to safety in and out
of the hospital !
What are some examples of safety
education ?
Cultural and Ethnic Considerations
• Cultural heritage affects all dimensions of
health, in and out of the hospital.
• Ones culture may influence a persons every
day life.
• The medical personnel need to understand
their own cultural beliefs, prior to taking care
of patients.
• Planning is as important as implementation
when it comes to cultural and ethic
differences, and patient care.
Ensuring Fire Safety
• Both homes and health care facilities are at risk for fire.
• Fire in health care facility are most often related to
smoking in bed.
• Statistics report that approximately 8100 hospital and
4300 nursing home fires occur yearly.
• Established fore safety programs are mandatory for
health care facilities.
• All employees should know hospital policies, escape
routes, and location of all fire equipment.
• RACE
Ensuring Fire Safety Continued
• Fires in the health care facility are often related to
smoking in bed or faulty electrical equipment.
• Established fire safety program is mandatory for all
facilities.
• Prevention by:
Elimination of combustible materials
Maintenance of fire protection devices, and equipment
Special precautions for cooking and laundry
equipment
PREVENT FIRE
• Make sure fire exits are clearly marked.
• Identify the locations and demonstrate
the operation of fire extinguishers.
• Practice fire evacuation procedures.
PREVENT FIRE (continued)
• Post emergency phone numbers near all
telephones.
• Keep open spaces and hallways clear of
obstacles.
• Check electrical cords for exposed or damaged
wires.
• Teach clients about fire hazards.
Disaster Planning
• Disaster planning, or emergency preparedness, enables
rescuers to respond.
• A disaster situation is and uncontrollable , unexpected,
psychologically shocking.
• Disaster situations are unique, and directly affects
health care facilities.
• What thing are considered disasters?
• What affects response to disasters?
Accidental Poisoning/Interventions
• When a poisoning occurs.
• Assess for changes in mental status.
• Notify the poison control center.
• Do not induce vomiting unless directed.
• Wash hands
• Document
• Follow-up
• Reduce risk of accidental overdose.
Accidental Poisoning
• Childhood poisoning is one the major causes of death in
children under 5 years of age.
• Specific antidotes and treatments are available for all
types of poisons.
• Potential for accidental poisoning:
Cleaning solutions and disinfectants
Drugs
Substances in unmarked containers
OTHER IMPLEMENTATIONS
• Prevent poisoning.
• Prevent choking.
• Prevent suffocation.
• Prevent drowning.
• Reduce noise pollution.
Hygiene and Care of the
Patients Environment
HYGIENE
• The study of health and ways of preserving
health.
• Provides comfort and relaxation, improves
self-image, and promotes cleanliness and
healthy skin.
• Part of safety in that proper hygiene
protects the client against disease.
• When providing the patient’s hygiene needs, the
nurse has a opportunity to observe the patient.
• All body systems can be assessed during the
days care.
• Patients are often place in a dependant role.
• Nurse will help the patient remain as independent
as possible, teaching health promotion and
hygiene.
• Hygiene, the science of health. Includes care of
the whole body.
• Conscientious personal hygienic practices are
essential for the nurse. Nurses are role models
.
• Promotion of medical asepsis, clean technique.
• Hygiene inhibits the growth and spread of
pathogenic microorganisms.
Factors that Influence a
Patient’s Personal Hygiene
• Social practice.
• Body Image.
• Socioeconomic status.
• Knowledge.
• Personal preference.
• Physical condition
• Cultural variables.
Cultural and Ethnic considerations
Personal Hygiene
• Touching or lack of touch has cultural significance and
symbolism.
• Chinese-Americans, and Vietnamese Americans may
view tasks associated with closeness and touch as
being offensive.
• Nurses must be aware of each patients reaction to
touch.
• Individual preferences usually do not affect health care,
and must be added onto the care plan.
CULTURAL CONSIDERATIONS cont.
• Bathing hygiene is different within many cultures. Some
cultures believe that hot water may be added to cold,
however cold may never be added to hot.
• Some cultures do not permit women to submerge their
bodies in water during menstruation–fear that she may
drown.
• North Americans typically bathe daily and use deodorant
products.
• Many Europeans do not bathe daily or use deodorant
products.
Components of Patient’s Hygiene
• Care of the skin
• Oral hygiene
• Hair care
• Perineal care
• Eye, ear, and nose care
PROVIDE FOR CLIENTS’ BATHING
NEEDS
• Cleansing baths–routine for personal hygiene:
– Shower
– Tub Bath:
Self help/Complete bed /Partial bath
– Therapeutic Bathes
PROVIDE FOR CLIENTS’ BATHING NEEDS (continued)
• Therapeutic baths–require a physician’s
order stating type of bath, body surface to be
treated, type of medicated solutions to be
used:
– Hot, warm, or tepid
– Soak or sitz
– Oatmeal, cornstarch, sodium bicarbonate
OTHER HYGIENE
IMPLEMENTATIONS
• Provide clean bed linen.
• Provide perineal care.
• Offer back rubs.
• Provide foot and toenail care.
• Provide oral care.
• Provide hair care.
• Provide eye, ear, and nose care.
Sitz Bath
Personal Hygiene for Nurses
• Daily bath or shower.
• Strong, odorless and effective deodorant everyday.
• Clean undergarments.
• Clean uniform daily.
• Shampoo hair as necessary to maintain cleanliness.
• Keep hair off collar.
• Wear hose or socks.
• Wear white comfortable shoes.
•
Short , clean fingernails.
• Minimal to moderate make-up.
•
Small earrings.
• Very light cologne, perfume, aftershave.
• Standard departmental uniform.
•
Facial hair, clean and short, neatly trimmed.
• Breath mints.
Patient’s Room Environment
• Patients with sever illnesses may be restricted to
prolonged bed rest.
• Patients with limitations such as traction, casts, or
monitoring equipment.
• Rooms should be comfortable and safe, increases
the sense of well-being.
• The patients illness can not be controlled, however
something can be controlled.
• Emptying and rinsing bedpans, and bedside
commodes keep the room order free, and
encourages a restful environment.
• A patients energy must be directed toward recovery,
keeping environment stimuli to a minimal will
encourage this.
A typical
hospital
room.
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Room Equipment
• Bedside stand.
• Over bed table.
• Chairs, lounge and straight back.
• Lights.
• Call bell.
• Beds.
• Water repellent mattresses.
• Bed controls.
Bathing
• The extent of the patient's bath and methods used for bathing
depend on t e patient's capabilities, and degree of hygiene
required.
• Sitz bath
• Cool water tub bath
• Warm water tub bath
• Hot water tub bath
• Other baths
• Back care/Bath rub
Bed bath.
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Bed bath.
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Nursing Process for Hygiene
• Determine if the patient can tolerate
hygienic procedures
• Nursing diagnoses:
– Oral mucous membrane, impaired
– Mobility, impaired physical
– Skin integrity, impaired
– Self-care deficit – bathing/hygiene,
dressing/grooming
Care of the Skin
• Normal skin has the following characteristics:
Intact without abrasions.
Warm and Moist.
Localized changes in texture across surface.
Good turgor, generally smooth and soft.
Skin color variations from body part to body part.
• Prevention is the ultimate goal, when not possible,
interventions can result in:
Healing
Decrease discomfort
Decrease length on hospitalization.
Stages of Pressure Ulcers
• I – Nonblanchable erythema of the intact skin.
• II – Partial-thickness skin loss involves epidermis and or dermis.
• III – Full-thickness skin loss involves damage or necrosis of
subcutaneous tissue that may extend down to but not through
underlying fascia.
• IV – Full-thickness skin loss occurs with extensive destruction,
tissue necrosis, or damage to muscle, bone, or supporting
structures.
Diagram of shearing force exerted against sacral area.
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Stage I pressure ulcer.
(From Potter, P.A., Perry, A.G. [2005].
Fundamentals of nursing. [6th ed.]. St.
Louis: Mosby.)
Stage II pressure ulcer.
Stage III pressure ulcer .
Stage IV pressure ulcer .
Stage IV Pressure Ulcer
Oral Hygiene
• Oral hygiene
• Dentures
• Oral care must be provided on a regular basis.
• Beneficial outcomes of oral hygiene may not be seen for
several days.
• Repeated cleansing is often needed to remove
tenacious dried, including the tongue.
Conditions that Place Patients at Risk
for Oral Disorders
• Lack of knowledge about oral hygiene.
• Inability of perform oral care.
• Alteration in the integrity of teeth and mucosa resulting
from disease or treatments.
• Lack of aggressive care.
Patients who are particularly at risk:
Paralysis
Diabetes
Being seriously ill
NPO Status
Upper extremity activity limitations
Radiation therapy
Unconsciousness
Chemotherapy drugs
Disorientation
Oral surgery
Hair Care
• Proper hair care is important to the patient’s self image.
• Bed ridden patients hair may soon become tangled.
• Patients are aware of their appearance.
• Good hair care must be completed daily.
• Shampoo, and cleansing might have to be completed
for the bed ridden patients in bed.
• Shaving the patient.
• Hand, foot and Nail Care.
• Perineal Care.
• Perineal care, Indwelling catheter.
• Eye, Ear, and Nose Care.
Contact lens
Hearing aids
Hearing aid.
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St.
Louis: Mosby.)
Assisting the Patient with Elimination
• The nurse should offer the bedpan or urinal frequently.
• This procedure is personal and the patient should be afforded as
much privacy as his or her condition allows.
• It is not unusual for the patient to procrastinate using the bedpan
because it is uncomfortable and embarrassing.
• Poor cleaning after elimination leads to skin break down.
Care of the Incontinent Patient
• Incontinence characterized by urine of fecal slow at unpredictable
times.
• Incontinence is a very common problem, especially among older
adults.
• Incontinence is due to pressure in the bladder, or sphincter is weak.
• Incontinence may be a small leak.
• Products to guard against incontinence must be kept discreet for
the alert patient.
Care of the Comatose Client
• Eye Care:
Wipe gentle every four hours.
Keep moist / Liquid tears.
Shields or tape gently closed.
• Oral Care:
Never used fingers or tongue blade
Assess gag reflex.
Small amount of liquids / have suction on.
Prevent aspiration.
Patient Teaching: Hygiene
•
Initiated at the beginning of hospitalization and though out.
•
Independence should be taught and encouraged.
•
Explain steps.
•
Teach elderly how to evaluated water temperatures.
•
Teach proper cleaning.
•
Hand washing.
•
Use of sunscreen
•
Prevention or healing of chapped, dry lips.
•
Teach care and cleaning of dentures.
Home Health Considerations
Hygienic Care
• Bathing
• Skin Care
• Oral Care
• Hair care
• Shaving
• Nail and Feet
• Bed making
Nursing Process
• Assessment
• Nursing Diagnosis
• Expected Outcome/Planning
• Implementation
• Evaluation
Nursing Process
• Using the nursing process, nurses can reduce the risk of
injury to patients
• Diagnoses:
– Risk for falls
– Impaired physical mobility
• Interventions:
– Health promotions
– Developmental considerations
– Environmental protection
Questions ?