Transcript Safety presentation

Safety
https://www.youtube.com/watch?v=cUvOwZYbdYs
April Martin, BSN, RN
Objectives
Following this Presentation on Safety, the Nursing Students will:
• Describe how unmet basic physiological needs for oxygen, fluids, nutrition, and
temperature can threaten a client’s safety.
• Discuss methods to reduce physical hazards and transmission of pathogens and
parasites in the health care agency as well as in the community.
• Discuss the specific risks to safety as they pertain to the client’s developmental age.
• Discuss cultural aspects of care associated with safety.
• Describe nursing interventions specific to the client’s age for reducing the risk of injury
• Describe methods to evaluate interventions designed to maintain or promote client
safety.
• Discuss nursing interventions utilized in the use of restraints.
• Recognize the importance of safety in the home and healthcare environments
• Identify the role of the nurse in educating a client about threats to safety.
• Discuss safety issues impacting today’s society and the nurse’s role.
• Discuss the purpose of the National Patient Safety Goals.
• Identify factors to assess when it becomes necessary to physically restrain a patient.
• Discuss the legal/ethical considerations in caring for a client in restraints.
• Identify national organizations that focus on safety concerns of patients and healthcare
workers.
Maslow's Hierarchy of Needs
What is Safety?
• Safety is the state of being free from harm or danger.
• The nurse is responsible for assessing the patient and the
environment, formulating a nurse diagnosis to provide
appropriate safe care that includes injury control and
maintaining a safe environment.
Newborn/Infant/Toddler/Preschooler
Newborn/Infant/Toddler/Preschooler
• Falls, choking, burns, and other traumatic injuries
• Depends on caregiver for safe environment
• Hospital Environment
• Maintain comfortable temperature range, bulb syringe/suction
device, ID bracelets, Security Tag with alarm system
• Home Environment
• Maintain comfortable temperature range, nonrestrictive,
nonflammable, adequate clothing; warm bathwater with nonskid
mats in bathtub; clean air; safe toys; guard rails at staircases and
steps; rails for crib; covered electrical outlets; and appropriate car
seats for automobiles
School-Age Child/Adolescent
• Developing fine motor control allow them to start completing
complex tasks: swimming, driving, riding bikes/horses, skiing,
playing sports
• Adult Caregivers Must:
• Enforce proper fitted helmets, use of life jackets in boats, seatbelts
while driving
• Use alcohol moderately
• Lock guns and ammunition separately
• Ensure adequate amounts of sleep
• Teach about safe and unsafe behaviors
Adults
Safety habits, no longer reinforced by watchful adults, can
become rusty; disregard of judgment, overconfidence, or
ignorance can place adults in danger’s path. Great examples
include the use of alcohol/drugs, driving motor vehicles without
seatbelts, the lack of helmet use, and texting/talking while
driving.
Older Adults
• Advancing Age
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Physical function loss
Limited ROM
Inability to respond to multiple stimuli
Inability to respond to a specific stimulus
Sensory changes
Nocuturia
Incontinence
Inability to regulate temperature
Slower reflexes
Loss of flexibility and strength
Chronic illnesses
Medications
• The following are principles of a safe environment for older adults: comfortable
temperature range; adequate clothing; bathwater of the right temperature;
adequate ventilation; lighting that allows for safe navigation throughout the
house/hospital; nonskid surfaces on stairs, floors; stable supports for climbing and
walking
• Although many of these developmental stages are known to have bruises, cuts etc.,
always ask how the injury occurred!
Cultural Considerations
• Personal Space
• Ethnic Remedies
• Low Educational Levels and Poverty
• Family Patterns
Question
The nurse is completing the admission histories for the newly
admitted patients on the unit. The nurse is alert that the patient
with the greatest risk of injury:
A.
B.
C.
D.
Is 84 years of age
Uses corrective lenses
Has a history of falls
Has arthritis in the lower extremities
Question
A parent with three children has come to the outpatient clinic.
The children range in age from 4 to 15 years old. The nurse is
discussing safety issues with the parent. The nurse evaluates
that further teaching is required if the parent states:
A. “I have spoken to my teenager about safe sex practices.”
B. “I make sure that my child wears a helmet when he rides his
bicycle.”
C. “My 8-year old is taking swimming classes at the local
community center.”
D. “Now, my 4-year-old can finally sit in the front seat of the
car with me.”
Factors Affecting Safety
• Physiologic Factors
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Lifestyle
Impaired Mobility
Sensory Impairments
Cognitive Impairments
Safety Awareness
• Environmental Factors
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Pollution
Radiation
Terrorism
Home
Workplace
Community
Healthcare Setting
Home Hazard Assessment
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Throw Rugs
Smoke Detector
Fire Extinguisher
Hand Rails
Non-skid Mat in Shower/Tub
Stairs
Clutter
Burglar Alarm
See Box 22-1 p. 573 of Craven
Altered Safety
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Motor Vehicle Incidents
Falls
Poisoning
Suffocation/Drowning
Fires/Burns
Pathogen Transmission
Firearms
Electrical Hazards
Radiation Injury
Temperature
Nutrition
Medication Errors
Seizure Precautions
Respiratory Diseases
Self Harm
Falls
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Orient on admission and as needed
Assess ability to ambulate, transfer, etc.
Supervise those at risk for falls
Use call bell, within reach
Bedside tables nearby
Bed in low position, locked
Mental status assessment
Hendrich II Fall Risk Model
Fires
• Remember the acronym RACE
• Rescue anyone in the immediate area of the fire or
danger first.
• Activate the alarm by pulling fire alarm pull stations and
calling the hospital operator to report exact location of
fire.
• Contain if possible. Close the fire-close doors and
windows in the immediate fire area. Cut off O2.
• Extinguish the fire with the proper fire extinguisher.
Electrical Hazards
• All hospital equipment is maintained
by the hospital’s maintenance
department.
• To avoid patient harm, suspected
problems with equipment should
always be reported.
• All household appliances/equipment
should be visually inspected for any
damaged cords or parts.
Nursing Diagnosis: Risk for Falls
• Risk Factors:
– a history of falls
– postoperative state
– sensory disturbances
– confusion, delirium, dementia
– incontinence
– impaired physical mobility, neglect
Interventions:
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Lock the bed; non-skid footwear; bed at a low height.
Use grab bars if needed
Walkway is CLEAR
Communication board at the bedside to identify mobility status
Ensure that “Fall Risk” is clearly seen in the Chart
Use a “high-risk fall” armband which will alert staff for increased
vigilance for mobility assistance
Re-orientate the client to environment with call bell in reach and
remind how to use it and answer call light promptly.
Routinely assist with toileting. (ie. take client to bathroom on
awakening, before bedtime, and before administering sedatives.)
Quickly identify new onset delirium which is usually physiological and is
a medical emergency.
Place a fall risk patient near the nursing station (if possible).
Balance, gait training, and strengthening exercises performed by
Physiotherapy
When patients attend to another task while walking ie. reaching,
changing directions, carrying things, or even IV poles, the client is at an
increased risk of falling.
Nursing Diagnosis: Risk for Self Harm
• Risk Factors:
– family history of mental disorder/suicide
– history of previous suicide attempts
– psychiatric illness/disorder
– alcohol /drug abuse
– access to potentially lethal means
– economic instability
– elderly, young adult males, adolescent
Interventions:
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Monitor Mood
Establish Therapeutic Relationship
Routinely Ask About Suicidal Thoughts, Ideas, Impulses
Identify and Acknowledge Daily Stressors
Build Coping Strategies
Close Monitoring by Staff
Safety Checks Every Hour
Place Patient in Room Near Nurse’s Station
Remove Dangerous Objects
Verify Medication is Swallowed
Document Suicidal Signs
Effects of Nursing Rounds
• Nursing rounds at set intervals positively affect client
satisfaction and safety and lead to fewer distractions for staff.
• The nurse’s ability to meet the client’s needs affects the
client’s perception of the quality of care.
• Anticipate client needs by performing rounds, including
specific actions, at one hour intervals.
Alternatives to Restraints
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Orient, Orient, Orient
Use Sitters
Diversionary Activities
Room Close to Nurse’s Station
Use Calm, Simple Statements
Deescalate (if needed)
Appropriate Stimuli
Remove Cues to Leaving
Promote Relaxation
Exercise and Ambulate (as permitted)
Attend to Needs such as Toileting, Food, Liquids
Camouflage IV lines, etc.
Evaluate all Medications
Reassess Physical Status and Review Lab Findings
Definitions
Restraint is:
Medical
(Non-behavioral)
Restraint:
Behavioral Health
Restraint:
Restraint is not:
 Any method of physically restricting a person’s
freedom of movement, physical activity or normal
access to his or her body.
 Patient immobilization that is a normal
component of a procedure is not considered
restraint.
 A manual method, physical or mechanical device,
material, or equipment that immobilizes or reduces
the ability of a patient to move his or her arms,
legs, body or head freely.
 A drug used solely as a restrictions to manage the
patient’s behavior or restrict freedom of
movement.
 The restriction of patient movement in response to
severely aggressive, destructive, violent or suicidal
behaviors that place the patient or others in
imminent danger.
 Forensic restriction used by law enforcement for
security purposes.
Restraint Use
 Attempt Alternatives
 Use safe, effective and least restrictive method of restraint
 Clinical Justification based on observed patient actions or behaviors
 Interference with therapy or patient care
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Activity or thoughts with a reasonable probability of harm to self
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Pulling tubes
Picking at wounds
Removing dressings
Wandering
Unsteady gait (high risk for falls)
Suicidal
Activity or thoughts with a reasonable probability of harm to others
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Confused patient striking out at others
Homicidal attempt or talks about killing/harming someone
Violent patient in alcohol or drug withdrawal
Steps Taken with Restraints
• ALWAYS USE AS A LAST RESORT! If restraints are needed, use least
amount necessary.
• Apply, document, call physician for order.
• Initiate specific charting for use of restraints.
• ORIENT OFTEN. Use of restraints further increases disorientation.
• Mitt restraint is least restrictive.
• Do not attach to side rails.
• Use quick release tie.
• Check tightness with two fingers if using wrist and/or ankle
restraints.
• Remove at least every two hours. ROM every two hours.
• Circulation checks per institution policy. (pulses, cap. refill,
temperature of extremity, etc.) (Prefer every 15-30 minutes)
http://home.nwciowa.edu/videos/nursing/mosby/basic/skill/I002.html
Restraints cont.
• All side rails in up position are considered a restraint. Side
rails have a potential to cause entrapment, death, or injury.
• An Amublarm device may be used for clients that may wonder
away from the unit. This device warns nursing staff if the
person tries to leave the unit without permission.
Question
An older adult patient in the extended care facility has been
wandering outside of the room during the late evening hours.
The patient has a history of falls. The nurse intervenes initially
by:
A. Placing an abdominal restraint on the patient during the
night.
B. Keeping both the light and the television on in the patient’s
room all night.
C. Reassigning the patient to a room close to the nursing
station.
D. Having the family members check on the patient during the
night.
Safety Regulations in Healthcare
• Joint Commission Hospital National Safety Goals for 2013/2015
• Identify patients correctly with two identifiers (not room number)
(Name and DOB), doing treatments, collecting specimens, etc. Also
remember to recheck allergies. The nurse may have failed to list all of
them or the patient may have not disclosed all of them.
• Improve staff communication
• Develop written procedures for managing the critical results of tests.
• Use medications safely
• Use only oral unit-dose products, prefilled syringes, or premixed infusion
bags when available for anticoagulation therapy
• Prevent Infection or Reduce the risk of health care-associated infections.
Comply with the current CDC guidelines.
• Identify patient safety risks (risk for suicide)
• Prevent mistakes in surgery such as wrong site, wrong procedure, and
wrong person surgery.
• Obtain information on the medications that patient is currently taking
when he or she is admitted to the hospital or is seen in an outpatient
setting. (medication reconciliation)
• See p. 567 Table 22-1 for 2010 Safety Goals
Safety Regulations in Healthcare
• Reporting Sentinel Event
• Sentinel Event-safety errors that result in death or serious injury.
• Teams at the hospital analyze the environment and the factors
that contributed to these events and develop solutions to help
eliminate the event in the future.
Question
Which of the following occurrences would be classified as a
sentinel event?
A. A postpartum patient who elects to breastfeed only twice
daily develops mastitis.
B. A newly diagnosed diabetic patient self-injects insulin in the
abdominal area rather than the upper thigh as instructed by
the patient educator.
C. A nurse assisting with the delivery of twins places the “Twin
1” name tag on the second-born twin, causing the first-born
twin to undergo surgery that was scheduled for the other
twin.
D. A nurse administers 3 units of regular insulin rather than 3
units of NPH insulin subcutaneously, resulting in a drop in the
patient’s serum glucose from 160 mg to 100 mg.
Transferring from Bed to Chair
https://www.youtube.com/watch?v=OBVqxwggZ3U
Transporting Patient on a Stretcher
https://www.youtube.com/watch?v=xOentFaY4jk
Review
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What is Safety?
Unmet Basic Needs
Keeping Others Safe
Developmental Age
Interventions
Recognizing Safety Issues
Safety Issues Today
Purpose of The Joint Commission’s National Patient Safety
Goals
• Sentinel Events
• Restraints
Resources
• 4yourCNA. (2012, Jan 23). Transfer from bed to wheelchair [Video file]. Retrieved from
https://www.youtube.com/watch?v=OBVqxwggZ3U
• Castaldi, P. A. (2007). Basic nursing: Essentials for practice (6th ed.). St. Louis, MI: Mosby
Elsevier.
• Craven, R., Hirnle, C., & Jensen, S. (2013). Fundamentals of nursing: Human health and
function (7th ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins.
• Hendrich, A. (2006, May/June). Inpatient falls: Lessons from the field. Patient Safety &
Quality Care. Retrieved from http://psqh.com/mayjun06/falls.html
• Kaiser Permanente. (n.d.). The safe use of patient restraints [PowerPoint slides]. Retrieved
from www.sdnsec.org
• LutheranHealth. (2014, Mar 31). Be safe [Video file]. Retrieved from
https://www.youtube.com/watch?v=cUvOwZYbdYs
• Mosby’s Nursing Video Skills-Basic. (n.d.). Restraints and alternatives [Video file]. Retrieved
from http://home.nwciowa.edu/videos/nursing/mosby/basic/skill/I002.html
• Oglesby, K. (2012, November 26). Patient transport: Transporting a patient on a stretcher
[Video file]. Retrieved from https://www.youtube.com/watch?v=xOentFaY4jk
• Rosdahl, C. B., & Kowalski, M. T. (1999). Basic nursing (9th ed.). Retrieved from
https://books.google.com/books?id=tB1YiYj_kdkC&pg=PA1533&lpg=PA1533&dq=ambular
m&source=bl&ots=xDMNBubMLz&sig=5OC7rcOc2zmkloDWpUu9VMSfsCg&hl=en&sa=X&v
ed=0ahUKEwjXm• Rosin, T. (2014, October 2). The 10 most common sentinel events . Becker’s Infection
Control & Clinical Quality. Retrieved from
http://www.beckershospitalreview.com/quality/the-10-most-common-sentinel-events.html
• Valente, S. M. (2010, May). Assessing patients for suicide risk. Nursing, 40, 36-40.
http://dx.doi.org/10.1097/01.NURSE.0000371125.53758.2f