Transcript File

Safety and Comfort
Patient Safety
• Safety is the prevention of errors and
adverse effects to patients associated with
health care
Factors affecting safety
Age and Development
Selected safety hazards throughout the lifespan
Developing fetus: Exposure to maternal x-rays(1st trimester), certain
pesticides, maternal smoking or alcohol consumption, addictive drugs
Newborns & Infants: Falling, suffocation in crib, choking(aspirated
milk/ingested objects), burns from hot liquids, automobile accidents, play pen
injuries, electric shock, poisoning
Toddlers: Falling, banging into objects, getting cut by sharp objects,
automobile accidents, electric shock, poisoning, drowning
Preschoolers: Falling, playground equipment, choking, suffocation, obstruction
of airway or ear canal by foreign objects, fire and burns, harm from other
people or animal, poisoning, drowning
Adolescents: automobile accidents, recreational accidents, fire, substance
abuse
Older adults: Falling, burns, automobile accidents
Lifestyle
• Unsafe work environments
• Residence neighborhoods with high crime
rate
• Access to guns and ammunition
• Insufficient income to buy safety
equipment or make necessary repairs
• Access to illicit drugs
• Accidents at home
Mobility and health status
• Impaired mobility due to paralysis, muscle
weakness, poor balance/coordination –
Prone to injury
• Spinal cord injury and paralysis of both
legs
• Hemiplegic clients or with leg casts – Falls
• Weakened by illness/surgery
Sensory – perceptual alterations
• Impaired touch perception, hearing, taste,
smell, and vision – highly susceptible to
injury
Cognitive awareness
• Impaired awareness – People with lack of
sleep, unconscious/semiconscious
• Disoriented people
• People with altered judgment by
disease/medications
Emotional state
• Extreme emotional state – alter ability to
perceive environmental hazards
• Stressful situations – reduce a person’s
level of concentration, cause errors of
judgment, decrease awareness of external
stimuli
Ability to communicate
• Individuals with diminished ability to
receive and convey information – aphasic
clients, people with language barriers,
unable to read
Safety Awareness
• Clients in unfamiliar environments
Environmental factors
• At home: flooring and carpets, bathrooms,
swimming pools, light.
• At workplace: Machinery, chemicals,
worker fatigue, noise, air pollution, working
at height.
• Community: Street lights, sewage
treatment, Handling foods at eateries,
noise, crime, roads
Health care setting
• Limited short term memory – Systems rely on
human memory are prone to failure.
• Being late or in a hurry – contributes to miss
the important detail of information cause
harm
• Limited ability to multitask – people perform
better at single task. E,g: using cell phone
while driving
• Interruptions: Occurs in complex
environments (e.g; alarms, call lights,
telephone calls)
• Stress: Stress causes anxiety, anxiety
affects performance
• Fatigue and other physiological factors:
affects a person’s ability to process
complex environment
• Environmental factors: Heat, noise,
distractions, visual stimuli, lighting, work
place design
Nurses’ work environment and
client safety
• Inconsistent staffing levels
• Long work hours
• Some nursing work processes eg:
medication administration, hand washing
• Inefficient nurse work processes Consume large work hours for
documentation and paper work
• Physical design of the workplace
Safety measures throughout the
life span
Newborns and Infants
Use an approved car seat at all times in travelling.
Crib/cot should be in appropriate height, lead free paint, height if sides, tight of
mattress to crib and no pillow should be used.
Never leave an infant unattended on a raised surface.
Check the temperature of the infant’s bath water and formula prior to using.
Hold the infant upright during feeding. Do not prop the bottle. Cut food in small
pieces, and do not feed the infant peanuts or popcorn.
Provide large soft toys
Use guard gates on stairs and screens on windows. Supervise the infant in
swings and highchairs.
Cover electric outlets.
Place plants, house hold cleaners, and waste baskets out of reach. Lock away
potential poisons, such as medicines, paints and gasoline.
Toddlers
Continue to use car seats all the time in travelling. Place children in back seats
when traveling in car.
Teach children not to put objects in the mouth, including pills(unless given by
parent)
Keep objects with sharp edges out of children's reach and sight.(knives)
Place hot pots on back burners with handles turned inward.
Keep cleaning solutions, insecticides, and medicines in locked cupboards.
Keep windows and balconies screened.
Supervise toddlers in the tub.
Fence the pools. Supervise when in/near the pool.
Teach children not to run/ride a tricycle into the street.
Obtain a low bed when the child begins to climb.
Cover outlets with safety covers/plugs.
Preschoolers
Do not allow children to run with candy/any objects in the mouth.
Teach children not to put small objects in to mouth, ears and nose.
Always supervise them on road rules, especially in crossing roads.
Teach children to play in safe areas.
Teach preschoolers the dangers of playing with matches, fire and heating
appliances.
Teach children to avoid strangers and keep parents informed of their
whereabouts.
Teach preschoolers not to walk in front of swings and not to push others off
playground equipment.
School-aged children
Teach children safety rules for recreational and sport activities; never swim
alone and wear protective helmet and knee and elbow pads when needed.
Teach children to obey traffic rules.
Teach children to use stove, tools, and electric appliances in safe ways.
Teach children the health hazards of smoking, the effects of drugs and alcohol.
Adolescents
Have adolescents a complete driver’s course and allow them to drive.
Have them free of alcohol and drugs consumption before driving.
Encourage them to use proper equipment when participating sports and with
groups.
Teach safety measures to use power tools.
Be alert to changes in adolescent's mood and behavior.
Young adults
Reinforce them to use traffic rules, using seat belts while driving, and to test
visual acuity periodically.
Reinforce water safety; while driving near lake or rivers.
Discuss evaluating the potential for workplace injuries/death when making
decisions about a career/occupation.
Encourage young adults who are unable to cope with the pressures,
responsibilities and expectations of adulthood to seek counseling.
Middle-aged adults
Reinforce to obey traffic rules and test visual acuity periodically.
Make certain stairways are well lighted and uncluttered.
Equip bathrooms with hand grasps and nonskid bath mats.
Keep all machines and tools in good working condition at work and at home.
Follow safety precautions when using machinery.
Elders
Encourage the client to have regular vision and hearing tests.
Assist the client to have a home hazard assessment.
Encourage the client to keep active as possible.
Preventive Measures for elders
Ensure eyeglasses are functional.
Ensure appropriate lighting.
Mark doorways and edges of steps as needed.
Set safe limits to activities.
Keep environment tidy.
Set safe limits to activities.
Remove unsafe objects.
Wear shoes/well-fitted slippers with nonskid soles.
Use ambulatory devices as necessary (cane, crutches, walker, braces,
wheelchair)
Provide assistance with ambulation as needed.
Monitor gait and balance.
Adapt living arrangements to one floor if necessary.
Encourage client to request assistance.
Keep bed in the low position.
Install grab bars in bathroom.
Provide raised toilet seats in bathroom.
Preventive Measures for elders Cont.…
Instruct client to rise slowly from a lying to sitting to standing position, and to
stand in a place for several seconds before walking
Provide a bedside commode as needed.
Assist with voiding on a frequent and scheduled basis.
Monitor activity tolerance.
Attach side rails to the bed.
Monitor orientation and alertness.
Encourage annual/more frequent review of all medications prescribed.
• The incidence of suicide in elders is increasing
due to hidden self-destructive behaviors, such as
starvation, overdosing with medications, and
noncompliance with medical care, treatments,
and medications.
• Important factors regarding suicide of the older
adult due to, uncontrollable pain, loss of a loved
one, major depression social isolation.
• Domestic violence is an increasing rate and
involving all the ages of individuals. (Includes
child abuse, intimate partner abuse and elder
abuse)
Promoting safety in health care setting
• Establishing a National center for patient safety
for improvements of safety and knowledge for
preventing errors in health care.
• Establishing a reporting system to help design
systems for the patient safety.
• Promoting effective teamwork and
communication.
• Creating a culture of trust.
• Involving health care workers in the design of
work processes and work spaces to promote
efficiency and safety.
Preventing specific hazards
Specific hazards /injuries
• Burns – Results from excessive exposure to
thermal/chemical/electric/radio active agents.
• Scalds – A burn from a hot liquid/vapor/steam.
• Fires – Result from malfunctioning electric
equipment/combustion of anesthetic gas. Home
fires result from malfunctioning electric equipment,
careless disposal of burning cigarettes/matches,
grease/from faulty wiring.
Nursing interventions for fire safety.
(Preventive measures)
• Keep emergency numbers near the
telephone/stored for speed dialing.
• Keep fire extinguishers available and working
in order.
• Close windows and doors if possible; cover
the mouth and nose with a damp cloth when
exiting through a smoke filled area. Avoid
heavy smoke by assuming a bent position
with the head as close to the floor as
possible.
• When fire occurs,
1. Protect and evacuate clients who are in
immediate danger.
2. Report the fire.
3. Contain the fire.
4. Extinguish the fire.
Electrical Safety in Health Care Facilities
• Regular safety inspections ensure electrical equipment is
safe to operate.
• Performing tests and visually observing the equipment
alerts personnel as to whether safety hazards loom.
• Inspectors to look for worn wires, frayed cords or cracks in
machinery, as these lead to faulty electric functioning and
require immediate repair.
• Knowing how to properly handle electrical equipment
reduces the risk of shock and electrocution.
• Employees should never operate electrical equipment with
wet hands.
• Often charge electrical medical equipment overnight so the
equipment is ready for use in emergencies.
• Leaving electrical equipment plugged into the receptacle
continues electricity generation, which leads the equipment
can still burn, shock and electrocute the people who use it.
Chemical safety in health care facilities
• Set safety policies for the handling and storing hazardous
chemicals.
• All hazardous chemical containers must be labelled
“hazardous”.
• Chemicals must be locked in an area that is inaccessible
to patients.
• It is important that patients are not accidentally exposed
to hazardous substances, or this will become a riskmanagement issue.
• Clean spills immediately.
• Never mix solutions.
• Read labels of solutions three times before using:
1. when removing from shelf
2. when pouring
3. when replacing
Radiation Hazards and safety
• All presence of radioactive material must be identified
with warning signs featuring a radiation symbols.
• Containers that store radioactive material must be
labelled with warning signs.
• Limiting the time in areas around radiation.
• Keeping a distance of at least six feet from materials.
• Maintain a shielding door between a person and the
area.
• Cover the body while undergoing a radiation
therapy/procedures.
Falls
• Infants and elders are prone to falling and
causing serious injury.
• Falls can break bones and selfconfidence, leading to fear of falling
causing a decreased activity level and
decreased muscle strength.
Risk factors and Preventive measures for Falls
Risk factor
Preventive measures
Poor vision
Ensure eyeglass are functional.
Ensure appropriate lighting.
Mark doorways and edges of steps as
needed.
Keep the environment tidy.
Cognitive dysfunction
(Confusion, disorientation, impaired
memory, or judgment)
Set safe limits to activities.
Remove unsafe objects.
Impaired gait/balance and difficulty
walking because of lower extremity
dysfunction (e.g.; arthritis)
Wear shoes/well-fitted slippers with
nonskid soles.
Use ambulatory devices as necessary
(cane, crutches, walker, braces,
wheelchair)
Provide assistance with ambulation as
needed.
Monitor gait and balance.
Adapt living arrangements to one floor
if necessary.
Risk factor
Preventive measures
Encourage exercise and activity as
tolerated to maintain muscle strength,
joint flexibility, and balance.
Ensure uncluttered environment with
securely fastened rugs.
Difficulty getting in and out of chair/in
and out of bed
Encourage client to request
assistance.
Keep bed in the low position.
Install grab bars in bathroom.
Provide raised toilet seats in
bathroom.
Orthostatic hypotension
Instruct client to rise slowly from a
lying to sitting to standing position, and
to stand in a place for several seconds
before walking.
Urinary frequency/receiving diuretics
Provide a bedside commode as
needed.
Assist with voiding on a frequent and
scheduled basis.
Weakness from disease
process/therapy
Encourage client to summon help.
Monitor activity tolerance.
Risk factors
Preventive measures
Current medication regimen that
includes sedatives, hypnotics,
tranquilizers, narcotic analgesics,
diuretics
Attach side rails to the bed if
appropriate.
Keep the rails in place when the bed is
in the lowest position.
Monitor orientation and alertness
status.
Discuss how alcohol contributes to
fall-related injuries.
Encourage client not to mix alcohol.
Encourage frequent review of all
medications prescribed.
When a client falls, the nurse’s first duty is to the client. First, assess for
injuries. Then, notify the physician
Thank You…