Transcript Patient Safety & Positioning

Patients at risk:
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Impaired mobility
due to injury, disease
Receiving
medications that
alter mental status
Be disoriented due to
change in
environment or
medical disorder
Impaired
hearing/vision
Falls may occur due
to
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Misjudging distance
Feeling weak/dizzy
Position changes too
fast
Hazards while
walking
Walking in poor lit
area
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Leave bed In lowest horizontal position
Keep brakes locked
Keep side rails elevated
Check for protruding objects
Do not clutter/block open ears with supplies
Wipe up skills immediately
Encourage patients to use rails along corridor
when walking
Monitor patients for signs of weakness, fatigue,
dizziness and loss of balance
Monitor patient for safety if they are independent
◦ Can they: propel their wheelchair, transfer OOB,
ambulate
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Research show restraints do NOT necessarily
reduce falls or prevent injuries – it may
actually cause serious injuries and death
Chemical
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Medications that affect
the patient’s mood and
behavior
Physical
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Any technique or device
that is attached or next
to the patient’s body that
the patient cannot easily
remove and that restricts
freedom of movement
and normal access to the
body
OBRA (1987) states when and how chemical and physical
restraints may be used in a long-term care facility. Physical
restraints are to be used ONLY when the safety of the patient
or other persons are at risk.
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Documentation of all patient behavior that
indicates the need for restraints
Documents all actions taken as alternative prior
to restraints
Consults the patient/family when alternatives are
not successful
If cause of patient’s problem can be identified
and corrected, the need for restraints can be
eliminated
If restraints are required, the least restrictive
restraint is required to be selected
Must have MD order
Geriatric
chairs
Jacket
restraint
Hand mitt
Vest
restraint
Limb
restraint
Wheelchair belt
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Alternative for
confused patients
who try to climb over
side rails
NOT used for
mentally alert
patients
Netting surrounds
bed to keep patient
safe, but not
considered a barrier
to movement
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Devices that empower
patients to assist
themselves to function
◦ Wheelchair to sit upright
◦ Postural supports: devices
used to assist w/ posture
 Lap tray
 Lap buddy
◦ Side rails are, by definition,
restraints
 Make sure space between rail
and bed is small
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Keep bed in lowest
position
Keep bed wheels
locked
Place mat on floor if
patient tries to get out
of bed
Meet patient needs
promptly: water,
hunger, pain, etc.
Use side rail cushions
Pressure-sensitive
chairs or chair alarms
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Care for patient’s
personal needs promptly
Know wh/ patients are
at risk
Observe patient’s walk
Report mental changes
Maintain safe
environment
Provide comfortable
chairs
Use security devices
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Obtain MD order
Try least restrictive
device first
Use correct type/size of
restraint
Apply restraints
according to instructions
Avoid restraint if frayed,
torn, or missing parts
Apply restraint over
clothing, not skin
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Explain procedure to
patient
Check fit after applying
restraint
Tie restraints with slip
knot
Make sure call light is
accessible
Release restraint q2h for
10 min
Maintain patient body
alignment
Avoid restraints in
moving vehicles and
toilets
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Make sure food in
bedside table will not
spoil
Keep chemicals and
cleaning solutions in
locked cupboards
Store personal food
items in refrigerator w/
label and date expired
Accidental poisoning
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Follow procedures
accurately
Check water
temperatures before
bathtub or shower
Check food temps
before feeding patient
Store smoking
materials in safe,
locked area
Thermal injuries
Skin injuries
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Store knives, scissors,
razors and tools in
locked area
Store syringes in
locked area
Clean up broken glass
immediately
Choking
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Be aware of patients that
have swallowing difficulty
Cut food into small pieces
Feed slowly
Offer liquids between bites
Place food in unaffected
side of the mouth (if
stroke)
◦ Use thickeners for liquids
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Keep patient in upright
position 30 min. after
meals
Give oral care at the end
of the meal
Know choking procedure
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Body alignment:
◦ Maintaining a person in a position in which the
body can properly function
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Occurs when body alignment is not
maintained or when the patient’s position is
not changed often enough
◦ Pressure ulcer (bedsores) result when unrelieved
pressure on a bony prominence interferes with
blood flow to the area
◦ Contractures occurs when a joint is allowed to
remain in the same position for too long
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Used to maintain body alignment and
position
◦ Pillows
◦ Splints (orthotic devices)
◦ Special boots/shoes
◦ Bed cradles
◦ footboards
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Prone – on the abdomen
Supine – on the back
Lateral – on either side
Sims’s – left lateral (slight variation)
Fowlers – upright; variation include high
fowlers (90°) and semi-fowlers (45°)
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Major responsibility of the CNA
Use turning sheet/draw sheet to assist in
lifting and make moving easier
◦ Sheet must extend from above the shoulders to
below the hip
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Remember body mechanics rules