Nursing Management of Clients with Stressors that Affect Safety

1. Nursing Management of Clients with Stressors that Affect Safety NUR101 Fall 2010 LECTURE # 3 K. Burger, MSEd, MSN, RN, CNE PPP By: Sharon Niggemeier RN MSN Revised kburger806,707

2. Therapeutic Environment • Safe environment = where one is protected from physical and psychological harm – A basic human need according to ____________? • Place where participants can feel safe to move toward common goals • Nurses need to identify potential risks and unsafe situations.

3. Client Factors that Affect Safety • Developmental • Mobility • Sensory Perception • Knowledge • Communication • Physical Health • Mental state • Lifestyle

4. Common Safety Hazards in Health Care Facilities • Falls- accidental injury from pt. falls • Equipment misuse - injury from improper use of equipment: Hoyer lifts/IV pumps etc. • Procedural errors – medication errors, nosocomialinfections, misidentification • Client-inherent accidents – seizures, smoking, self-inflicted injuries

5. Safety @ the Bedside • Bed lowest position; wheels locked • No spills • Clutter-free • Good lighting • Necessary articles within reach • Call bell within reach • Side-rails up as appropriate

6. Fall Prevention Measures • Every client MUST be assessed for their RISK for FALLS upon admission and daily • Utilize a Fall Risk Assessment Tool • Fall Risks= history of falls, certain medications, urinary/bowel urgency, in addition to factors listed above. • JCAHO National Patient Safety Goals

7. ???????????? What is the first step in preventing falls and injury? • Determine who is a greatest risk Who are the people @ greatest risk? • Hx of falls • Impaired vision / hearing • Impaired gait • Hx of CVA • CV disease ( postural hypotension )

8. Fall Prevention Measures • Assist with transferring and ambulating • Reduce visual/hearing impairments • Orient client frequently • Maintain adequate lighting • Use assistive devices and staff prn • Proper footwear and clothing

9. Fall Prevention Measures • Anticipate needs – toileting/bathing • Educate client and family • Exercise to strengthen muscles • Change client position slowly

10. ?????????????? • Identify OTHER fall prevention measures • Check medication schedules (diuretics?) • Clutter free environment • Keep needed items in reach • Staff should move slowly around ambulatory patients • Frequent reassessment

11. Last resort Used when client may cause harm to self or others Used when alternative methods have failed MD order needed Must check 15min after applying Must check every 30 min Must REMOVE every 2 hours Must DOCUMENT behavior justifying restraint & failure of alternative methods Protective Devices(Physical Restraints)

12. Posey vest Limb immobilizer Belt Mitts Elbow Mummy wrap Geri chair Side rails Chemicals Any device that prevents the pt. from freely moving is considered a restraint or protective device !! Types of Protective Devices

13. Alternatives to Restraints • Move client closer to nurse’s station • One-to-one monitoring • Re-orient frequently • Change/eliminate bothersome treatments • Make environment safe for exercise and ambulation • Electronic alarm devices

14. Fall Risk AssessmentThink-Pair-Share • Complete Fall Risk Assessments on Case-Study Handout. • Pair with a partner • Share and discuss your assessments

15. Oxygen Safety • Avoid open flames • Post no smoking signs • Advise client and visitors of O2 safety measures • Avoid oil based petroleum and synthetic fabrics • Check electrical equipment doesn’t emit sparks

16. Fire Safety • A fire requires 3 elements • Oxygen • Fuel • Spark

17. Fire Safety • Greatest danger in a fire is PANIC so stay calm!!!!! • Your ability/knowledge to think and act quickly will save lives • Don’t yell FIRE • Remember : R A C E

18. Fire Safety-RACE R- Remove patients, visitors and staff from immediate area A- Alarm. Pull the fire alarm C–Contain the fire. Close doors and windows E- Extinguish the fire only if it is safe and practical

19. Fire SafetyOperating a Fire Extinquisher P- Pull the pin A- Aim at base S- Squeeze trigger S- Sweep from side to side

20. Fire safety • Type ABC fire extinguishers (common in health facilities) used on any type of fire • Know how to report a fire; each facility differs • Be aware of fire alarms/fire exits/ fire extinguishers • Listen to the sound of the alarm bells; this tells the location of the fire • Don’t use elevators- use stairs

21. Fire SafetyWhen the Fire Alarm Sounds • Close all doors • Clear hallways • Avoid unnecessary talking so instructions can be heard • Place wet towels /sheets at the bottom of closed doors to contain fire/smoke • Turn on all lights

22. Fire Safety-Evacuation • Horizontal evacuation- move across from one area to another • Vertical evacuation is moving down from one floor to another • Have ambulatory clients hold hands and form a chain evacuating using stairs. Always escorted by staff • Nonambulatory pt. need to be carried or dragged using sheets

23. Chemical Safety • Exposure to hazardous chemicals • Material Safety Data Sheets (MSDS) • You have the right to know what chemicals you could be exposed to and how to be treated if exposed

24. Radiation Safety • Private lead-lined room • Staff and visitors are restricted in amount of time spent in room • Distance is also maintained between client & staff/visitors • Use of dosimeters

25. Safety Precautions Latex Allergy • Health care workers at risk • Frequently hospitalized clients at risk • Clients with hx of allergy to banana higher risk • Types of reaction – immediate versus delayed hypersensitivity • Latex alert labeling • Awareness of latex content

26. Bioterrorism Preparedness • Emergency Management PlanA JCAHO mandate • Epidemiologic Awareness:AnthraxSmallpoxPlagueBotulism • NYS DOH FACT SHEETS

27. ????????????????? What are the (4) major components of an Emergency Management Plan? • Mitigation – vulnerability, types of emergencies that might occur • Preparedness – resource stockpile • Response – triage, reporting • Recovery – restoring essential svcs

28. Seizure Precautions • Airway and suction at bedside of all clients with history and/or potential for seizures • If seizure occurs; Protect Client!Lower to floor if necessaryClear surroundingsProtect headAirway in

29. Bacteriologic Safety • Preventing the spread of microorganisms from person to person • The most effective way to prevent the transmission of microbes is by:

30. HAND HYGIENE HAND HYGIENE HAND HYGIENE

31. Chain of Infection • Process through which infection occurs: • Infectious agent • Reservoir • Exit from reservoir • Means of transmission • Portals of entry • Susceptible host

32. Nursing Interventions to Break the Chain of Infection • Control/Elimination of Infectious Agents • Control/Elimination of Reservoirs • Control portals of exit and entry • Controlling/Preventing transmission • Protecting susceptible host • Promoting normal defense mechanisms with personal hygiene and good nutrition • Encouraging proper immunizations

33. ???????????????? What immunizations are routinely recommended for the elderly? • Pneumococcal • Flu What immunizations are routinely recommended for HCWs? • Hepatitis B • Flu

34. Stages of Infection • Incubation • Pro-dromal (latent) • Full stage of illness • Convalescent Period

35. Asepsis Asepsis -All activities to prevent infection or break the chain of infection • Medical Asepsis– “Clean Technique” practices that decrease the number and transfer of pathogens • Surgical Asepsis - “Sterile Technique” practices that keep objects free from microbes

36. Medical Asepsis • HAND HYGIENE!!!!!!!!!!!!!!!! • Personal grooming • Cleanest to dirtiest • Disposal practices • Conscientiously follow barrier precautions

37. Surgical Asepsis • Object is sterile when all microbes and spores have been destroyed • Contamination occurs when a non-sterile object touches a sterile object • Objects brought into contact with broken skin should be sterile

38. Nosocomial Infections • Exogenous • Endogenous • Iatrogenic

39. Infection Control • Standard precautions • Transmission Based precautions • Contact • Airborne • Droplet

40. Practices used when caring for ALL patients when coming in contact with body fluids or secretions(except sweat), non-intact skin or mucous membranes Handwashing PPE Sharps Disposal Practices Safe injection practices Respiratory Hygiene/Cough Etiquette(CDC 2007 update) Standard Precautions

41. Transmission Based Precautions In addition to using Standard Precautions • Airborne- used for client with infection spread through the air. (measles, varicella,TB, SARS) • Droplet-used for client with infection spread thru large particles/droplets (Influenza, pertussis, Group A strep) • Contact used for client with infection spread by direct or indirect contact (VRE, MRSA, C-dificile)

42. ?????????????????? What PPE is required for:Airborne?Droplet ?Contact ? What type of room is required for:Airborne?Droplet ?Contact ?

43. Isolation Precautions • MD orders isolation • Based on how pathogen is transmitted • Remain in isolation till 3 negative C&S • Meet the client’s psychological needs due to isolation • Role of Infection Control Nurse

44. Isolation-Nursing Responsibilities • Explain to client why isolation is needed • Post signs outside door • Gather supplies • Teach family proper donning of PPE

45. Critical Thinking Mrs. Niles is 83 years old and lives alone. She has difficulty walking and relies on a church volunteer group to deliver lunches during the week. Her fixed income limits her ability to buy food. Last week, Mrs. Niles’ sister died. The two sisters had been very close. As a home care nurse, explain the factors that might increase Mrs. Niles risk for infection

46. Critical ThinkingA NOSOCOMIAL STORY Ms Smiley was admitted to the hospital for foot surgery. Her roommate, Mrs. Sneezy, was in the hospital for an appendectomy. No one ever came to visit Mrs. Sneezy, yet she came down with the flu while in the hospital. None of the hospital personnel had the flu. Three days later, Ms Smiley was recuperating from her foot surgery. The wound on her foot is warm, red, and oozing pus. Nurse Sensitive calls the physician and informs him that the wound looks infected. He tells the nurse that during the surgery his glove tore, and he orders antibiotics for Ms Smiley. The next day, Nurse Sensitive calls in sick to work. She has the flu.

47. Critical ThinkingA NOSOCOMIAL STORY Fill in the blank with either: Exogenous OR Endogenous OR Iatrogenic Ms Smiley has a ________________nosocomial infection. Mrs. Sneezy has a ______________nosocomial infection. Nurse Sensitive has a ____________nosocomial infection.