Transcript Safety Needs

Nursing Management of Clients with
Stressors that Affect
Safety
NUR101
Fall 2008
LECTURE # 3
K. Burger, MSEd, MSN, RN, CNE
PPP By: Sharon Niggemeier RN MSN
Revised kburger806,707
Therapeutic Environment



Safe environment = where one is
protected from physical and psychological
harm – A basic human need according to
____________?
Place where participants can feel safe to
move toward common goals
Nurses need to identify potential risks
and unsafe situations.
Client Factors that Affect Safety
 Developmental
 Mobility
 Sensory
Perception
 Knowledge
 Communication
 Physical Health
 Mental state
 Lifestyle
Common Safety Hazards in
Health Care Facilities
 Falls-
accidental injury from pt. falls
 Equipment misuse - injury from
improper use of equipment: Hoyer
lifts/IV pumps etc.
 Procedural errors – medication
errors, nosocomial infections,
misidentification
 Client-inherent accidents – seizures,
smoking, self-inflicted injuries
Safety @ the Bedside
 Bed
lowest position; wheels locked
 No spills
 Clutter-free
 Good lighting
 Necessary articles within reach
 Call bell within reach
 Side-rails up as appropriate
Fall Prevention Measures
 Every
client MUST be assessed for their
RISK for FALLS upon admission and
daily
 Utilize a Fall Risk Assessment Tool
 Fall Risks= history of falls, certain
medications, urinary/bowel urgency, in
addition to factors listed above.
 JCAHO National Patient Safety Goals
????????????
What is the first step in preventing falls and
injury?
• Determine who is a greatest risk
Who are the people @ greatest risk?
• Hx of falls
• Impaired vision / hearing
• Impaired gait
• Hx of CVA
• CV disease ( postural hypotension )
Fall Prevention Measures
 Assist
with transferring and
ambulating
 Reduce visual/hearing impairments
 Orient client frequently
 Maintain adequate lighting
 Use assistive devices and staff prn
 Proper footwear and clothing
Fall Prevention Measures
 Anticipate
needs –
toileting/bathing
 Educate client and family
 Exercise to strengthen muscles
 Change client position slowly
??????????????
 Identify
•
•
•
•
•
OTHER fall prevention measures
Check medication schedules (diuretics?)
Clutter free environment
Keep needed items in reach
Staff should move slowly around
ambulatory patients
Frequent reassessment
Protective Devices
(Physical Restraints)
Last resort
 Used when client
may cause harm to
self or others
 Used when
alternative
methods have
failed
 MD order needed

Must check 15min
after applying
 Must check every
30 min
 Must REMOVE every
2 hours
 Must DOCUMENT
behavior justifying
restraint & failure of
alternative methods

Types of Protective Devices
Posey vest
 Limb immobilizer
 Belt
 Mitts
 Elbow
 Mummy wrap
 Geri chair
 Side rails
 Chemicals

Any device
that prevents
the pt. from
freely moving
is considered a
restraint or
protective
device !!
Alternatives to Restraints
 Move
client closer to nurse’s station
 One-to-one monitoring
 Re-orient frequently
 Change/eliminate bothersome
treatments
 Make environment safe for exercise
and ambulation
 Electronic alarm devices
Fall Risk Assessment
Think-Pair-Share
 Complete
Fall Risk Assessments on
Case-Study Handout.
 Pair
with a partner
 Share
and discuss your assessments
Oxygen Safety

Avoid open flames

Post no smoking signs

Advise client and visitors of O2 safety
measures

Avoid oil based petroleum and synthetic
fabrics

Check electrical equipment doesn’t emit
sparks
Fire Safety
A
fire requires 3
elements
 Oxygen
 Fuel
 Spark
Fire Safety
 Greatest
danger in a fire is PANIC so
stay calm!!!!!
 Your
ability/knowledge to think and
act quickly will save lives
 Don’t
yell FIRE
 Remember
:
R A C E
Fire Safety-RACE
R- Remove patients, visitors and staff
from immediate area
A- Alarm. Pull the fire alarm
C –Contain the fire. Close doors and
windows
E- Extinguish the fire only if it is safe
and practical
Fire Safety
Operating a Fire Extinquisher
P- Pull the pin
A- Aim at base
S- Squeeze
trigger
S- Sweep from
side to side
Fire safety
 Type
ABC fire extinguishers (common
in health facilities) used on any type of
fire
 Know how to report a fire; each
facility differs
 Be aware of fire alarms/fire exits/ fire
extinguishers
 Listen to the sound of the alarm bells;
this tells the location of the fire
 Don’t use elevators- use stairs
Fire Safety
When the Fire Alarm Sounds
 Close
all doors
 Clear hallways
 Avoid unnecessary talking
so instructions can be heard
 Place wet towels /sheets
at the bottom of closed doors
to contain fire/smoke
 Turn on all lights
Fire Safety-Evacuation
 Horizontal
evacuation- move across
from one area to another
 Vertical evacuation is moving down
from one floor to another
 Have ambulatory clients hold hands
and form a chain evacuating using
stairs. Always escorted by staff
 Nonambulatory pt. need to be carried
or dragged using sheets
Chemical Safety
 Exposure
to hazardous
chemicals
 Material Safety Data Sheets
(MSDS)
 You have the right to know what
chemicals you could be exposed
to and how to be treated if
exposed
Radiation Safety
Private
lead-lined room
Staff and visitors are
restricted in amount of time
spent in room
Distance is also maintained
between client & staff/visitors
Use of dosimeters
Safety Precautions
Latex Allergy
 Health
care workers at risk
 Frequently hospitalized clients at risk
 Clients with hx of allergy to banana
higher risk
 Types of reaction – immediate versus
delayed hypersensitivity
 Latex alert labeling
 Awareness of latex content
Bioterrorism Preparedness
 Emergency
Management Plan
A JCAHO mandate
 Epidemiologic Awareness:
Anthrax
Smallpox
Plague
Botulism
 NYS DOH FACT SHEETS
?????????????????
What are the (4) major components of
an Emergency Management Plan?
•
•
•
•
Mitigation – vulnerability, types of
emergencies that might occur
Preparedness – resource stockpile
Response – triage, reporting
Recovery – restoring essential svcs
Seizure Precautions
 Airway
and suction at bedside of all
clients with history and/or potential
for seizures
 If seizure occurs; Protect Client!
Lower to floor if necessary
Clear surroundings
Protect head
Airway in
Bacteriologic Safety
 Preventing
the spread of
microorganisms from person to
person
 The most effective way to prevent
the transmission of microbes is by:
HAND HYGIENE
HAND HYGIENE
HAND HYGIENE
Chain of Infection
 Process
through which infection
occurs:
 Infectious agent
 Reservoir
 Exit from reservoir
 Means of transmission
 Portals of entry
 Susceptible host
Nursing Interventions to Break the
Chain of Infection
Control/Elimination of Infectious Agents
 Control/Elimination of Reservoirs
 Control portals of exit and entry
 Controlling/Preventing transmission
 Protecting susceptible host
 Promoting normal defense mechanisms
with personal hygiene and good nutrition
 Encouraging proper immunizations

????????????????
What immunizations are routinely
recommended for the elderly?
• Pneumococcal
• Flu
What immunizations are routinely
recommended for HCWs?
• Hepatitis B
• Flu
Stages of Infection
Incubation
Pro-dromal
(latent)
Full stage of illness
Convalescent Period
Asepsis
Asepsis -All activities to prevent infection
or break the chain of infection
 Medical Asepsis – “Clean Technique”
practices that decrease the number and
transfer of pathogens
 Surgical Asepsis - “Sterile Technique”
practices that keep objects free from
microbes
Medical Asepsis
HAND
HYGIENE!!!!!!!!!!!!!!!!
Personal grooming
Cleanest to dirtiest
Disposal practices
Conscientiously follow barrier
precautions
Surgical Asepsis
 Object
is sterile when all
microbes and spores have been
destroyed
 Contamination occurs when a
non-sterile object touches a
sterile object
 Objects brought into contact with
broken skin should be sterile
Nosocomial Infections
 Exogenous
 Endogenous
 Iatrogenic
Infection Control

Standard precautions
 Transmission
– Contact
– Airborne
– Droplet
Based precautions
Standard Precautions
Practices used when
caring for ALL patients
when coming in contact
with body fluids or
secretions
(except sweat), nonintact skin or mucous
membranes
Handwashing
 PPE
 Sharps
 Disposal Practices
 Safe injection
practices
 Respiratory
Hygiene/Cough
Etiquette

(CDC 2007 update)
Transmission Based
Precautions
In addition to using Standard Precautions
 Airborne- used for client with infection
spread through the air.
(measles, varicella,TB, SARS)
 Droplet-used for client with infection
spread thru large particles/droplets
(Influenza, pertussis, Group A strep)
 Contact used for client with infection
spread by direct or indirect contact
(VRE, MRSA, C-dificile)
??????????????????
What PPE is required for:
Airborne?
Droplet ?
Contact ?
What type of room is required for:
Airborne?
Droplet ?
Contact ?
Isolation Precautions
 MD
orders isolation
 Based on how pathogen is
transmitted
 Remain in isolation till 3
negative C&S
 Meet the client’s psychological
needs due to isolation
 Role of Infection Control Nurse
Isolation-Nursing Responsibilities
 Explain
to client why isolation is
needed
 Post signs outside door
 Gather supplies
 Teach family proper donning of
PPE
Critical Thinking
Mrs. Niles is 83 years old and lives alone.
She has difficulty walking and relies on a
church volunteer group to deliver lunches
during the week. Her fixed income limits
her ability to buy food. Last week, Mrs.
Niles’ sister died. The two sisters had
been very close.
As a home care nurse, explain the factors
that might increase Mrs. Niles risk for
infection
Critical Thinking
A NOSOCOMIAL STORY
Ms Smiley was admitted to the hospital for foot
surgery. Her roommate, Mrs. Sneezy, was in
the hospital for an appendectomy. No one ever
came to visit Mrs. Sneezy, yet she came down
with the flu while in the hospital. None of the
hospital personnel had the flu. Three days
later, Ms Smiley was recuperating from her foot
surgery. The wound on her foot is warm, red,
and oozing pus. Nurse Sensitive calls the
physician and informs him that the wound looks
infected. He tells the nurse that during the
surgery his glove tore, and he orders antibiotics
for Ms Smiley. The next day, Nurse Sensitive
calls in sick to work. She has the flu.
Critical Thinking
A NOSOCOMIAL STORY
Fill in the blank with either:
Exogenous OR Endogenous OR Iatrogenic
Ms Smiley has a ________________nosocomial
infection.
Mrs. Sneezy has a ______________nosocomial
infection.
Nurse Sensitive has a ____________nosocomial
infection.