Transcript Chapter 13

Fundamentals of Nursing Care: Concepts, Connections, & Skills
Chapter 13
Safety
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Safety




High priority when caring for others
Patient
Self
No matter how many years in the field
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Safety
 Don’t add to the list of tragedies
 Number one injury among healthcare workers
 Communicable diseases
 Blood and body fluids
 Radiation
 Chemotherapy drugs
 Chemicals
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Safety
 Facilities develop policies to protect you and
the patient
 The Joint Commission
 Independent, non-profit organization
 Evaluates and accredits healthcare facilities
throughout the country
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Safety
 Accreditation reflects a symbol of quality
 Mission—to continuously improve healthcare
 To excel in providing safe and effective care
of the highest quality and value.
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Safety
 In 2002, established National Patient Safety
Goals
 To address specific areas of concern in regard
to patient safety.
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
National Patient Safety Goals




Identifying patients
Communicating with caregivers
Administering medication
Reducing health-care-associated infections
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
National Patient Safety Goals
(cont.)
 Reconciling medications when patients are
discharged or transferred
 Reducing falls
 Improving recognition and response to
changes in patients’ conditions
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
National Patient Safety Goals
 Requirements to meet each goal are
established by the committee
 Each facility must determine how they will
meet the requirements
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Factors Contributing to an Unsafe
Patient Environment
 Everything changes
 Unfamiliar setting
 Loss of privacy
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Factors Contributing to Unsafe
Patient Environment






Age and ability to understand
Impaired mobility-weakness, blood loss, gait
Communication—language barrier? HOH?
Pain and discomfort
Delayed assistance
Equipment-tubing, alarms
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Morse Fall Scale






History of falling: 25
Secondary diagnosis: 15
Ambulatory aid: 15 or 30
IV/saline lock: 20
Gait/transferring: 10 or 20
Mental status: 15
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Morse Fall Scale (cont.)
 0 to 24: implement level I preventive fall
precautions
 25 to 50: implement level II—modified fall risk
 Greater than 51: implement level III—strict fall
risk
 Strict fall risk—identify pt. as high risk—flag
chart, Kardex, door, and armband
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Level I





Bed in lowest position
Side rails
Non-skid footwear
Call bell in reach
Floor free of clutter
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Level II
 All of level I fall prevention precautions




Plus: fall risk armband
Fall risk identified on chart
Stay with patient in bathroom
Do not allow patient OOB without supervision
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Level III
 All of Level I fall prevention precautions
 All of Level II fall prevention precautions
 Plus: identification above patient’s bed or
doorway
 Use of restraint alternatives
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Restraint Alternatives




Chair, bed, or leg monitor
Soft devices
Strategies
Less restrictive ways to remind patients not to
get up and or try to walk alone
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Fall Prevention Strategies
 Place patient in a room next to the nurse’s
station
 Stay with patient in bathroom
 Keep bed at lowest level
 Place overbed table across wheelchair
 Offer regular opportunities to toilet
 Provide back rubs and distractions-night lights
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
If a Fall Occurs………….
 Check patient for obvious injuries—bleeding,
LOC, assess for signs of hip fracture, observe
for deformities of joints, assess for paralysis or
weakness on one side of the body
 Call for help
 Follow facility policy for moving a patient who
has fallen
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
If a Fall Occurs……
 Take vital signs
 If unconscious, unstable vital signs, not
breathing or without a pulse—call a code
 Assist conscious patient to bed with the help
of others—according to policy
 Notify patient’s physician—explain what
happened—give patient’s current condition
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
If a Fall Occurs……
 Be prepared to take orders for x-rays and
other tests
 Document the incident according to policy
 Complete incident report
 Charting should include—details of finding the
patient, vital signs, assistance to bed, and
notifying the physician and orders obtained
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Types of Restraints




Vests
Waist
Extremity
Mitt
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Restraints
 NEVER threaten patient with a restraint
 Physical
 Chemical
 Only use if absolutely necessary—not for
convenience
 Always try restraint alternatives first
 1:1
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Guidelines for Using Restraints
 Obtain a physician’s order—type and time
 Check on patient every 30 minutes—skin and
circulation
 Remove restraint every 2 hours
 Document all actions on appropriate flow
sheet
 Follow agency policy
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Guidelines
 When restraint off (q2h)






Offer fluids
Toileting
Change position
Assess skin integrity
Neurovascular check
Must stay with patient when restraint off
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Restraints
 Restraint checks
 Restraint releases
 Delegate?
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
RACE Acronym for Fire Alarms




Rescue
Alarm
Confine
Extinguish
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Acronym PASS for Fire
Extinguishers
 Pull the pin found between the handles
 Aim the nozzle of the fire extinguisher at the
base of the flames
 Squeeze the handles together to release the
contents of the extinguisher
 Sweep the nozzle back and forth at the base
of the flames to extinguish the fire
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Types of Fire Extinguishers
 Type A: paper, wood, fabric, and trash fires
 Type B: fires caused by combustible liquids
such as oil, gasoline, and other petroleumbased products, and flammable gases
 Type C: electrical fires such as shorts in wires,
and motor or equipment fires
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Oxygen Use
 No open flames in same room as oxygen
source
 No smoking
 No burning candles
 No open flame heaters
 No wool blankets or sweaters(static electricity)
 No electrical appliances that could spark
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Responding to Individual
Emergencies




Cardiopulmonary resuscitation
Heimlich maneuver
First aid certification
Code Blue
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Mass Casualty Event (MCE)
 Involving thousands of victims
 Guidelines established for acceptable
standards of care in an MCE
 Each facility must have a plan in place
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Guidelines for Responding to
Mass Casualty Event (MCE)




Using a disaster triage model
Treating those most likely to survive first
Planning for an MCE
Adapting the use of existing facilities for
various needs
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
MCE
 Healthcare worker




Familiar with MCE policy (at least where located)
Expect to be called in to work
Ensure safety of your family first
Follow the plan of your facility—when and if to
report to workplace
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Types of Safety Risks
in the Workplace
 Physical hazards: bodily injury from patient
care and repetitive motion
 Chemical hazards: exposure to cytotoxic
medications and treatments
 Biological hazards: exposure to contaminated
blood and body fluids
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Body Mechanics
 Understand location of center of gravity and
base of support—stability and balance
 Keep feet shoulder width apart
 Plan work carefully to do it safely—pg. 244,
Figure 13-4
 Elevate work to comfortable level
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Body Mechanics (cont.)
 Avoid twisting-turn whole body or pivot on
one foot instead of twisting
 Bend knees when lifting heavy objects-back
straight-use leg muscles
 Carry objects close to body with elbows bent
 Push, pull, or slide heavy objects instead of
lifting them
 Get help when you need to move a patient
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Influences Contributing
to Unsafe Practice




Lack of rest
Abuse of alcohol
Use of some prescription medications
Use of illegal drugs
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Minimizing Exposure to Radiation
 Wear a lead apron during procedures
involving x-rays or fluoroscopy
 Wear a film badge if working in radiology
areas on a regular basis
 Limit amount of time spent caring for patients
with implanted radiation
 Do not care for these patients if you are
pregnant
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Chemical Hazards
 Exposure to toxic chemicals
 Chemotherapy
 Cleaning fluids
 Mixing, spilling, or splashing of fluids
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Material Safety Data Sheet
 Requirement of every facility
 Lists
 Type of chemical
 Potential harm caused by exposure
 Directions for what to do if chemical gets in eyes
or mouth or on skin
Copyright © 2011 F.A. Davis
Fundamentals of Nursing Care: Concepts, Connections, & Skills
Biological Hazards
 Possibility of exposure to contaminated blood
and body fluids
 Standard precautions
 Transmission based precautions
 Needless access systems
 Never recap a needle
Copyright © 2011 F.A. Davis