Safety

1. Safety Foundations of Nursing Christensen Kockrow Mosby Sharon L. Kinley Schwing BSN 2006 Leslie Lehmkuhl RN 2009

2. Safety • The need for a safe environment is always present. • A safe environment implies freedom from injury with focus on helping to prevent falls, electrical injuries, fires, burns, and poisoning. • Both protection and education are primary nursing responsibilities, with nurses directly and actively involved in ensuring a safe health care environment.

3. SAFETY continued • The first priority in providing client care. • Constant attention to safety factors enables the nurse to maintain a safe environment for the client. • Safety is associated with health promotion and illness prevention.

4. FACTORS AFFECTING SAFETY • Age • Lifestyle/occupation • Sensory/perceptual changes • Mobility • Emotional state

5. Safe Environment • The need for a safe environment is always needed for every body. • Focus is placed on the: Immediate environment Local concerns National concern • This includes many issues within the environment.

6. Safety Is for Every Age

7. ACCIDENTS IN THE HEALTH CARE SETTING • Client behavior accidents–client’s behavior or actions. • Therapeutic procedure accidents–delivery of medical or nursing interventions. • Equipment accidents–malfunction, improper use of medical equipment.

8. Precautions to Promote Safety • Orient patient to environment. • Place bedside table, and needed items within reach. • Assist patients who have had surgery, receiving narcotics, or are sedated. • Assist all patients during ambulation, or the first time out of bed. • Use bed alarms for the restless, confused patient. • Where non-slip shoes.

9. IDENTIFY CLIENT • Checking the client’s ID band ensures that the correct person receives care. • Client identification is essential before rendering any care.

10. Precautions to Promote Safety continued • Wipe, mop up spills to prevent injury. • Adequate lighting. • Emergency light, call bells in reach. • Answer bells in a timely manner. • Follow all “fall precaution” policies, adopted by your institution.

11. Nurses Responsibilities • Overall safety of the patient. • Safe hospital environment. • Recognition and identification of potential hazards, and threats within the work setting. • Freedom from injury for patients, visitors and staff. • Providing and maintaining a safe environment within the work place. • See JACHO recommended patient safety goals.

12. Left Handed • Unique challenges. • Hospital rooms are typically set up for right handed patients, and nurses ! • 12-30% of the population is a south paw. • Being left handed increases the risk of injury for a patient.

13. Safety for the Left Handed Patient • Place all bathing articles at the patients left. • Left hand may be stronger by nature than the right. • Arrange meal trays, so that silverware, and drinks are at the left. • Ambulate the pt. by walking on the left side. • Adjust the patient room to accommodate the left handed patient.

14. Falls • Common problem. • All patients are at risk for a fall. • Majority of patients fall during a transfer of some type. • Fall are the major , #1 concern for all patients in all institutions. • Very young, older adults, ill, and injured are all at risk for a fall. • Use of Anesthesia, sedatives, and or narcotics increase the risk of falls.

15. Safety Reminder Devices • SRD/ defined as any number of devices used to immobilize a patient, or any part of the patients body part. • When would a SRD be used ? • What is the downside of SRDs ? • Doctors orders must be obtained. Patients must be closely watched. • Documentation includes: Why, How, How long, pts response.

16. Elderly Safety

17. Applying Safety Reminder Devices • Safety reminder device (SRD) is any device that immobilizes the patient or a part of the patient. • Soft restraint (Posey). • Used for patient safety and maintain treatment. • Prevent the disoriented patient from wondering and prevent or reduce risk of patients falling. • May be used with aggressive patient to protect other patients and staff.

18. Extremity (ankle or wrist) Restraint (From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

19. Precautions When Using SRDs • Document the following: • Position of device • Circulation • Physical and mental status • Ongoing need for the device • SRDs should be removed at least every 2 hours and the skin assessed • Know the agency policy and procedures regarding SRD use

21. Use of Gait Belts • Apply gait belt securely around patients waist. • Walk to the side of the patient. • Nurse should walk on the patients weaker side. • Use of hand rail, support systems as needed. • Remove gait belt after ambulation. • Document procedure.

22. Infants and Children • Infants and children require different type of safety within their environment. • These small patient require protection within their environments. • Accidents involving children are largely preventable. • Growth and development skills need to be taken into consideration, during the care of the young patient.

23. Older Adult Considerations • Adults taken many different medications, and have an increase in fall risks. • Use of safety devices are encouraged. • Accidental poisoning/over doses are common in adults. • Changes in: Vision Perception Hearing Muscle strength Joint function Cardiovascular Peripheral vascular system

24. Safety within theHospital/Health Care Environment • Hospital environment is a source of potential hazards. • Use of various biologic, chemical, and physical hazards have been identified. • Use of laser, can cause skin and eye irritation. Fire risks are increased. • Exposure to blood, body fluids, needle, radiation and resp. diseases pose threats to all hospital personnel. • Needle sticks are still the prime source of blood borne pathogens. • “Do not Recap” and needle-less systems are now common practice

25. Work Place Safety • Employee Right to Know Laws: • Regulation Relation to Hazardous Materials • Material Safety Data Sheets

26. USE PROPER BODY MECHANICS • Center of gravity–located in center of body, in pelvic area. All movement should pivot around this central point. • Base of support–feet are base of support. The feet should be kept wide apart when lifting heavy items.

27. Patient Teaching for Infection Control • The nurse will need to educate patient about the nature of infection and the techniques to use in planning or controlling its spread. • Infection control for home and hospice settings. • Prevention of infection. Hand washing Food preparation IV lines Waste containers Body fluid spills

28. Hospital Environment • The hospital environment is a source of potential safety hazards to health care workers: Biological Chemical Physical hazards Blood and body fluids Radiation Contaminated needles Equipment

29. Electrical Hazards • Much of the equipment used in health care are electrical. • Use of properly grounded plugs. • Use of only red plugs for life supportive equipment. • Do not use any equipment that is in poor condition. • Avoid use of electrical equipment , in or near water.

30. REDUCE EXPOSURE TO RADIATION • Minimize time spent in contact with and distance from the radiation source. • Use appropriate radiation shields. • Monitor exposure with a film badge. • Label all potentially radioactive material. • Never touch dislodged implants or body fluids of a client receiving radiation.

31. Radiation: Radiation and radioactive materials are used to treat and diagnosis diseases. Environment related risks are present. Minimize time / Maximize distance Wear monitors / Never touch dislodged implant • Mercury Spill: Mercury is considered a hazardous chemical according to OSHA. Mercury spill cleanup procedures.

32. Safety Promotion • Education is the key to safety in and out of the hospital ! What are some examples of safety education ?

33. Cultural and Ethnic Considerations • Cultural heritage affects all dimensions of health, in and out of the hospital. • Ones culture may influence a persons every day life. • The medical personnel need to understand their own cultural beliefs, prior to taking care of patients. • Planning is as important as implementation when it comes to cultural and ethic differences, and patient care.

34. Ensuring Fire Safety • Both homes and health care facilities are at risk for fire. • Fire in health care facility are most often related to smoking in bed. • Statistics report that approximately 8100 hospital and 4300 nursing home fires occur yearly. • Established fore safety programs are mandatory for health care facilities. • All employees should know hospital policies, escape routes, and location of all fire equipment. • RACE

35. Ensuring Fire Safety Continued • Fires in the health care facility are often related to smoking in bed or faulty electrical equipment. • Established fire safety program is mandatory for all facilities. • Prevention by: Elimination of combustible materials Maintenance of fire protection devices, and equipment Special precautions for cooking and laundry equipment

37. PREVENT FIRE • Make sure fire exits are clearly marked. • Identify the locations and demonstrate the operation of fire extinguishers. • Practice fire evacuation procedures.

38. PREVENT FIRE (continued) • Post emergency phone numbers near all telephones. • Keep open spaces and hallways clear of obstacles. • Check electrical cords for exposed or damaged wires. • Teach clients about fire hazards.

39. Disaster Planning • Disaster planning, or emergency preparedness, enables rescuers to respond. • A disaster situation is and uncontrollable , unexpected, psychologically shocking. • Disaster situations are unique, and directly affects health care facilities. • What thing are considered disasters? • What affects response to disasters?

40. Accidental Poisoning/Interventions • When a poisoning occurs. • Assess for changes in mental status. • Notify the poison control center. • Do not induce vomiting unless directed. • Wash hands • Document • Follow-up • Reduce risk of accidental overdose.

41. Accidental Poisoning • Childhood poisoning is one the major causes of death in children under 5 years of age. • Specific antidotes and treatments are available for all types of poisons. • Potential for accidental poisoning: Cleaning solutions and disinfectants Drugs Substances in unmarked containers

42. OTHER IMPLEMENTATIONS • Prevent poisoning. • Prevent choking. • Prevent suffocation. • Prevent drowning. • Reduce noise pollution.

43. Hygiene and Care of the Patients Environment

44. HYGIENE • The study of health and ways of preserving health. • Provides comfort and relaxation, improves self-image, and promotes cleanliness and healthy skin. • Part of safety in that proper hygiene protects the client against disease.

45. When providing the patient’s hygiene needs, the nurse has a opportunity to observe the patient. • All body systems can be assessed during the days care. • Patients are often place in a dependant role. • Nurse will help the patient remain as independent as possible, teaching health promotion and hygiene.

46. Hygiene, the science of health. Includes care of the whole body. • Conscientious personal hygienic practices are essential for the nurse. Nurses are role models . • Promotion of medical asepsis, clean technique. • Hygiene inhibits the growth and spread of pathogenic microorganisms.

47. Factors that Influence a Patient’s Personal Hygiene • Social practice. • Body Image. • Socioeconomic status. • Knowledge. • Personal preference. • Physical condition • Cultural variables.

48. Cultural and Ethnic considerations Personal Hygiene • Touching or lack of touch has cultural significance and symbolism. • Chinese-Americans, and Vietnamese Americans may view tasks associated with closeness and touch as being offensive. • Nurses must be aware of each patients reaction to touch. • Individual preferences usually do not affect health care, and must be added onto the care plan.

49. CULTURAL CONSIDERATIONS cont. • Bathing hygiene is different within many cultures. Some cultures believe that hot water may be added to cold, however cold may never be added to hot. • Some cultures do not permit women to submerge their bodies in water during menstruation–fear that she may drown. • North Americans typically bathe daily and use deodorant products. • Many Europeans do not bathe daily or use deodorant products.

50. Components of Patient’s Hygiene • Care of the skin • Oral hygiene • Hair care • Perineal care • Eye, ear, and nose care