Transcript Safety in Nursing

Fundamental Concern of
Nurses
Prevention of Harm
• Harm from accidents & injury
-Prevent falls, fires, etc
• Harm by the spread of infection
-Control infectious organisms
Safety Needs
To Meet Safety Needs of Patients consider:
• Physical Factors in Environment
• Psychological State
• Physiologic State
Hospital Safety
Disaster Planning
• Emergency Codes
-Code Red
-Code Blue
-Code Pink
• Emergency Nursing
-CPR
Patient Safety
Factors Affecting Safety
• Age & Development
• Mobility
• Health Status
• Sensory-Perceptual
Alterations
• Cognitive Awareness
• Emotional State
• Ability to
Communicate
• Safety Awareness
Safe and Comfortable Environment
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Space
Lighting
Temperature
Ventilation
Comfortable sound
levels
• Furniture: Bed Safety
• Food and Water
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Hazardous Products
Waste Management
Organization of time
Privacy
Individualized Care
Information and
Teaching
• Safety Precautions
-fall prevention
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Poor Vision
Confused
Disoriented
Impaired memory
Impaired gait/balance
Difficulty walking
Difficulty getting in
and out of bed
• Orthostatic
hypotension
• Urinary frequency
• Weakness
• Medications
-sedatives, hypnotics,
tranquilizers, narcotic
analgesics, diuretics
Fall Risk Assessment
• Mr. Jackson is a 73-yr-old stroke patient
with recent mental status changes,
admitted for prostate surgery. He has
right-sided weakness and has fallen once
at home while trying to go to the bathroom.
He has difficulty initiating a urinary stream,
dribbling of urine, and nocturia. He has a
history of hypertension, for which he takes
hydrochlorothiazide (diuretic).
Fall Prevention
• List specific interventions to ensure the Mr.
Jackson’s safety in the hospital?
Fall Prevention
• Risk Assessment
• Indicate fall risk on door &
chart
• Bed in low position
• Wheels locked
• Call light
• Side rails
• Bed alarms
• Bedside commode
• Shower chair
• Night light
• Sitters
• Room closer to nursing
station
• Water, tissues, bedpan
within reach
• Monitor changes in
cognitive status
• Eliminate clutter
• Non skid footwear
• Ambulatory devices
• Dangle
• Secure tubes, drains
If a Fall Occurs
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Assess for injury
Check vital signs
Assist back to bed, if safe
Notify MD
Monitor frequently
Incident Report
Fire Safety
• A family member reports a lit cigarette
dropped on the client’s mattress, but they
were able to put out the small fire. What
actions are needed to ensure the safety of
the patients?
Fire Safety
• Immediately Assess
pt’s room
-surface fire maybe
out
-smoldering inside
mattress
• Assess pt for injury
• Call for Help
• Rescue patient’s
• Activate the alarm
• Contain fire
-close doors
-turn off oxygen
• Extinguish the fire
How To Use A Portable
Fire Extinguisher
Remember the acronym “PASS”
• P…Pull the Pin
• A…Aim at the base of the flames
• S…Squeeze the trigger
• S…Sweep from side to side
Fire Safety
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Thorough assessment of patient’s
Notify physician
Thank the family
Review “No Smoking Policy”
Alternative means for smoking
-nicorette gum
Electrical Safety
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Equipment is checked by biomed dept
Pt’s personal devices
Read warning labels
No smoking
Check for frayed electrical cords
Avoid overloading circuits
Report any shocks to biomed dept
Electrical shock
-turn off & remove source before touching
pt, √ vital signs, √ skin for burns, notify MD.
Infection Control
Microorganisms
• Bacteria
• Viruses
• Fungi
• Parasites
Harmless Organisms
• Resident flora
-E Coli (intestine)
-Staph aureus (skin)
• Colonization
-microorganisms
become resident flora
Harmful Actions of Microorganisms
Infections or disease
occur
• # of organism present
• Ability of organism to
cause disease
• Person’s immune
system
• Length of contact
between person &
organism
Risk Factors for Infection
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Age
Heredity
Stress
Nutrition
Medication
Diseases
-burns, PVD, DM
• Invasive techniques
-surgical wounds
-↓ immunity
-trachs, ventilators
-foley cath
-IV therapy
-venipuncture sites
-TPN
-Implanted devices
Chain of Infection
• Infectious agent
-The Bug
• Reservoir
-Hiding Places
• Portal of Exit
-Way out
• Mode of transmission
-Getting around
• Portal of entry
-Way in
• Susceptible host
-Another sick person
The Spread of Infection
• An elderly pt, admitted with a GI disorder, is on
bedrest and requires assistance with adls. The
pt has frequent uncontrolled diarrhea stools and
the nurse provided excellent care to maintain
cleanliness and comfort. After one episode of
cleaning the pt and changing the bed linen, the
nurse went over to a second pt to adjust foley
cath tubing. The nurse’s hands were not washed
before assisting the second patient.
Spread of Infection
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Infectious agent-E Coli
Reservoir-Large Intestine
Portal of Exit-Feces
Mode of transmission-Contaminated
hands
• Portal of entry-foley cath tubing
• Susceptible host-elderly, chronic illness,
foley cath
Breaking the Chain
• A patient assigned for morning care has
an open wound on her left lower leg. The
wound is draining and when last cultured,
the organism MRSA was identified. What
steps would you take to break the chain of
infection while changing the patients bed.
Breaking the Chain
• Infectious agent-MRSA
• Reservoir-infected wd
• Portal of exit-Break the chain
-Handwashing, gloves, handle linen
properly
• MRSA is commonly transferred on the
hands of the nurse by indirect contact.
Nosocomial Infections
Drug Resistant Organisms
• Clostridium difficile (C Diff)
• Methicillin-resistant Staph aureus (MRSA)
• Vancomycin-resistant enterococcus (VRE)
C Diff
MRSA
Nosocomial Infections
• Urinary Tract
-E Coli
-Poor cath care
• Surgical Site
-Enterococcus
-Improper dsg change
POOR HAND HYGIENE
APPLIES TO ALL
• Bloodstream
-Staph aureus
-Improper IV site care
• Pneumonia
-Pseudomonas
-Improper suctioning
technique
Preventing Nosocomial Infections
Controlling Microorganism in the
Environment
Medical Asepsis
• Clean technique
• Limit #, growth, &
transmission of
microorganisms
• Handwashing
• Barrier techniques
• Environmental
cleaning
Surgical Asepsis
• Sterile technique
• Completely free of
microorganisms
Transmission Based Precautions
• Infected or colonized
• Airborne (measles, TB)
-Private neg airflow room 6 air exchanges/hr
-Mask
• Droplet (pneumonia, meningitis)
-Private room/mask <3 ft from pt
• Contact
-gloves/gown
-Direct (kissing, bathing, toughing)
-Indirect (instruments, needles, dressing)
• Protective Isolation
Safety of Healthcare Workers
Occupational Safety
and
Health Administration
(OSHA)
• Federal Agency
• Dept of Labor
• Safe environment for
all workers
• Violations
-Fines
Hospital Specific
• Safety needles
• Sharp containers
• Exposure to TB, Hep
B, HIV, Radiation
• Latex allergies
• PPE
• Electrical
Latex Allergies
• Assess for allergies to avocados, bananas, kiwi
or chestnuts for cross sensitivity to latex
• S/S of latex allergy
-Contact dermitis
-Facial swelling, itching, hives, rhinitis, eye
symptoms
-Potentially dangerous bronchospasms,
generalized edema, difficulty breathing, cardiac
arrest
• Latex cart at bedside
Latex Allergy Precautions
• Mrs. Smith tells you she has allergic
reactions when she eats bananas,
seafood, eggs. Based on this information
what would you ask Mrs. Smith, and what
actions would you take?
Isolation Room
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Isolation Cart
Isolation Signs
Equipment
Donning PPE
Removing PPE
Psychological Interventions
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Explain isolation procedure
Encourage verbalization of feelings
Be empathic
Permit visitors
Support coping mechanisms
Visit pt