Transcript Nursing assistant III

NURSING ASSISTANT III
Unit 2 Chapter 10: Patient Safety and Restraint
Alternatives

Accident


OBRA defines as an unexpected, unintended event that has the
potential to cause bodily injury
Incident

An occurrence that is considered unusual, undesired, or out of the
ordinary and disrupts the normal routine for the patient, the facility,
or both

Accidents and incidents can involve patients, visitors, or staff

All accidents are considered incidents
ACCIDENTS AND INCIDENTS

OBRA requires that nursing facilities maintain an environment that
lowers the risk of accidents and incidents to the GREATEST EXTENT
POSSIBLE

OBRA requires that residents receive the supervision and
assistance neded to prevent accidents and incidents from
occurring

ALL staff are expected to take appropriate measures to protect
all people in the facility
ACCIDENTS AND INCIDENTS

Risk Factors

Certain groups of people are more at risk than others to have an
accident
ACCIDENTS AND INCIDENTS

Risk Factors


Age

Infants and young children

The elderly
Medication

Pain medication

Antianxilytics

Antidepressants

Blood pressure
ACCIDENTS AND INCIDENTS

Risk Factors


Paralysis

Paraplegia

Tetraplegia (quadriplegia)

Hemiplegia
Sensory Impairment

Vision

Hearing

Touch

Smell

Taste
ACCIDENTS AND INCIDENTS

Risk Factors

Limited Awareness of Surroundings

Confusion

Disorientation

comatose
ACCIDENTS AND INCIDENTS

Avoiding Accidents and Incidents

Preventing Falls

Most common type of accident in health care

Each new patient is evaluated

http://www.networkofcare.org/library/Morse%20Fall%20Scale.pdf
ACCIDENTS AND INCIDENTS

Avoiding Accidents and Incidents

Preventing Falls

Check Clothing

Use had rails

Walking aids

Glasses

No clutter

Beds low

Side rails

Call lights

Clean spills

Offer assistance
ACCIDENTS AND INCIDENTS

Avoiding Accidents and Incidents

Preventing Burns

Always check the water temperature of the bath with a thermometer

Temp should be between 105 degrees F (40.5C) and 115 F (46C)

Best to keep on low end of range

Teach patients who will be bathing themselves to check temperature

Use extreme care with heat applications

Warn people that food or beverage is hot

Follow guidelines for use of electrical appliances
ACCIDENTS AND INCIDENTS

Avoiding Accidents and Incidents

Entrapment

When a person becomes trapped in the side rail or between the side rail
and the mattress

Can cause severe injury or even death

Cover open spaces for certain patients

Use pillows for support
ACCIDENTS AND INCIDENTS
ACCIDENTS AND INCIDENTS

Avoiding Accidents and Incidents

Preventing accidental poisonings

Never store household clearers or other chemicals in containers meant
for food or beverages

Keep household cleaners and chemicals in a locked cabinet

Make sure the contents of all containers are clearly marked on the
outside

Provide help with reading labels as necessary
ACCIDENTS AND INCIDENTS

Reporting Accidents and Incidents

Should be reported to nurse immediately

Follow policy for written reporting

Does not make you “guilty”
ACCIDENTS AND INCIDENTS

Restraints can also be called “Reminder Devices”

Used to restrict a person’s freedom of movement

Prevent a person from reaching a part of their body

Might be used for an agitated or disoriented patient

A device is not considered a restraint if a person has the physical
and mental ability to release the fastener

Lap safety strap in a wheelchair
RESTRAINTS


Physical Restraint

A device attached to or near a person’s body to limit freedom of
movement, or access to his or her body

Can be applied to many different parts of the body
Chemical Restraint

Any medication that alters a person’s modd or behavior

Sedatives

tranquilizers
RESTRAINTS

Chemical Restraint

Any medication that alters a person’s modd or behavior

Sedatives

Tranquilizers

Fine line between using a medication to help calm and anxious or
agitated person and using for staff convenience

Should not be used in such a high dose to make person sleepy or
unable to function
RESTRAINTS

Use of Restraints

Never used for punishment or staff convenience

Used to provide postural support

Protect patient

Protect staff

Only use if ALL other alternatives have failed
RESTRAINTS

Use of Restraints

When restraints may be needed:

A person who is at risk for falling but cannot remember to call for help

A person who is at risk for wandering away

A person who attempts to remove to pull out tubing necessary for
treatment

A person who has overdosed on alcohol or medications, and is
demonstrating combative behavior
RESTRAINTS

Use of Restraints

Clearly defined guidelines for restraint use

Do not use restraints without a written doctor’s order that states the
reason for the restraint

Never use a restraint to “punish” a patient or resident, or for your own
convenience

Use the least restrictive restraint for the least amount of time

Follow the manufacturer’s instructions, nurse’s direction, and facility
policy for applying the restraints
RESTRAINTS

Use of Restraints

Clearly defined guidelines for restraint use

Use a restraint that is the correct size and in good condition

Use commercial restraints. Do not use makeshift restraints, such as bed
sheets or locks

Restraints are always applied over clothing, pajamas, or gown

Restraints are always tied in simple, quick release knots placed out of
reach of the patient

Ensure that you have enough help when applying restraints
RESTRAINTS

Use of Restraints

Clearly defined guidelines for restraint use

Check on the restrained person every 15 minutes to make sure feeling a
blood flow are normal in any restrained extremity

Make sure wheelchair wheels are locked and the front swivel wheels are
facing forward

Side rails should always be raised

Completely remove restraint every 2 hours, for a total of 10 minutes

Record and care given to a restrained person

Used restraints only if you have been properly trained
RESTRAINTS

Complications Associated with Restraint Use

Strangulation can occur if a vest restraint is improperly applied

Bruises, nerve damage, skin abrasions if restraint is too tight or too
loose

Permanent tissue damage as a result of impaired blood flow

Broken bones

Pneumonia, pressure ulcers, blood clots

Incontinence

Mental effects
RESTRAINTS

Restraint Alternatives

Measures taken to avoid the use of restraints

Provide an environment in which the person feels safe and secure

Provide frequent attention to the person’s physical needs

Explain procedures and reassure the person

Get help from family members, volunteers, or other residents

Use methods that are less restrictive


Bed alarms

Wanderer system
Postural supports

pillows
RESTRAINTS

Applying a Vest Restraint

Applied to chest

Opening in back

Never put on backwards
RESTRAINTS
RESTRAINTS

Applying Wrist or Ankle Restraints

Doctor may specify the number of extremities to be restrained
RESTRAINTS
RESTRAINTS
RESTRAINTS
RESTRAINTS