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Chapter 19 Safety

Chapter 19 Safety. National Patient Safety Goals. Description Purpose Potential methods for implementation. Safety. Major nursing responsibility Death from hospital errors: ranked between 5 th – 8 th leading cause of death by National Center for Health Statistics.

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Chapter 19 Safety

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  1. Chapter 19 Safety

  2. National Patient Safety Goals • Description • Purpose • Potential methods for implementation

  3. Safety • Major nursing responsibility • Death from hospital errors: ranked between 5th – 8th leading cause of death by National Center for Health Statistics

  4. Age-Related Safety Factors • Infants • Falling off changing tables • Unrestrained in automobiles • Toddlers • Climbing; accidental poisoning; falling downstairs or from high chairs; burns; electrocution; drowning

  5. Age Related Safety Factors (cont’d) • School-aged children and adolescents • School-aged children: play-related injuries • Adolescents: sports-related injuries • Adults: ignoring safety issues, fatigue, sensory changes, effects of disease

  6. Environmental Hazards • Latex sensitization • Thermal burns • Asphyxiation • Electrical shock • Poisoning • Falls

  7. Question • Is the following statement true or false? Poisoning is a common hazard found only in homes.

  8. Answer False. Poisoning is a common hazard found in the home and health care environment.

  9. Environmental Hazards (cont’d) • Latex sensitization: allergic response to the latex proteins • Latex is natural rubber sap • Component of many household items • Predisposition to latex sensitivity

  10. Environmental Hazards (cont’d) • Types of latex reactions • Contact dermatitis • Immediate hypersensitivity • Possible cross-reaction to fruits or vegetables

  11. Environmental Hazards (cont’d) • Preparing a latex-free room • Stock room with latex-free equipment, including gloves, client care equipment, and resuscitation equipment • Wipe room clean of glove powder • Communicate with other departments the need to use only latex-free equipment

  12. Question • Is the following statement true or false? People with latex allergy may develop a cross-reaction to certain foods.

  13. Answer True. People with latex allergy may develop a cross-reaction to certain fruits and vegetables.

  14. Environmental Hazards (cont’d) • Safeguarding clients and personnel • Prevent latex sensitization • If using latex gloves, avoid oil-based hand creams • Wash hands thoroughly after removing gloves

  15. Question • Is the following statement true or false? When using latex gloves, a nurse should use oil-based hand creams.

  16. Answer False. When using latex gloves a nurse should avoid the use of oil-based creams.

  17. Environmental Hazards (cont’d) • Burns • Thermal burns or chemical burns • Burn prevention: exits identified, lighted, unlocked; ensure functioning sprinkler system • Fire plans

  18. Environmental Hazards (cont’d) • Burns (cont’d) • Fire management: RACE • Rescue • Alarm • Contain • Extinguish

  19. Environmental Hazards (cont’d) • Burns (cont’d) • Roles and responsibilities at and away from fire’s origin • Use of fire alarm system • Agency fire plan concepts

  20. Environmental Hazards (cont’d) • Burns (cont’d) • Rescue and evacuation; proper use of equipment • Building compartmentalization for containing smoke and fire • Fire extinguishers

  21. Environmental Hazards (cont’d) • Burns (cont’d) • Fire extinguishers • Class A: wood, paper • Class B: liquids, grease • Class C: electrical • Class ABC: combination

  22. Evacuation of Clients

  23. Environmental Hazards (cont’d) • Asphyxiation • Airway obstruction • Carbon monoxide (CO) • CO binds with hemoglobin • CO poisoning: symptoms similar to flu, except for cherry-red skin color

  24. Environmental Hazards (cont’d) • Drowning • Fluid occupies airway, interferes with ventilation • Accidental drownings • Resuscitation • Immediate CPR • CPR certification in nurses

  25. Environmental Hazards (cont’d) • Electrical shock • Body prone to electric shock • Macroshock; microshock • Grounded equipment reduces electrical shock potential • Measures to prevent electrical shock

  26. Environmental Hazards (cont’d) • Poisoning • Caused by ingestion, inhalation, or absorption of toxic substance • More common in homes than in health care institutions • Accidental poisonings; medication errors

  27. Environmental Hazards (cont’d) • Poisoning prevention • Educate children; teach parents • Cognitive-impaired adults: use prefilled medication containers • American Association of Poison Control Centers

  28. Environmental Hazards (cont’d) • Falls • Most common accident with the most serious consequences in older adults • Contributing factors: visual impairments; disorders affecting gait, balance, and coordination; medications to lower blood pressure

  29. Environmental Hazards (cont’d) • Falls (cont’d) • Contributing factors (cont’d) • Urinary urgency • Social, environmental factors • Accumulation of clutter • Hospitalization • Confusion, impaired judgment

  30. Environmental Hazards (cont’d) • Assessment • Determine risk factors • Fall prevention measures • Keep emergency numbers near phone • Daily phone tree • Personal response services

  31. Restraints • Physical restraints • Chemical restraints • Purpose: client or staff safety • Use of restraints is closely regulated • Restraints may not be used for disciplinary reasons • Last intervention used after all others exhausted

  32. Restraints (cont’d) • Risks of use: • Increase client confusion • Cause chronic constipation, incontinence, infections (pneumonia) • May cause pressure ulcers • Experience progressive decline in ability to perform ADLs independently

  33. Restraints (cont’d) • Legislation • Law incorporated; compliance mandatory since 1990 • Accreditation standards • Restraint protocol; medical orders; monitoring and documentation

  34. Restraints (cont’d) • Restraint alternatives: protective or adaptive devices that promote client safety and postural support which the client can release independently

  35. Nursing Implications • Recognize safety hazards • Identify clients at greatest risk for injury • Identify several nursing diagnoses • Client safety; allegations of malpractice

  36. General Gerontologic Considerations • Number of falls and severity of injury • Falls rob client of independence • Well-fitting enclosed shoes, nonskid soles • Most falls occur in clients 65 years or older, at home

  37. General Gerontologic Considerations (cont’d) • Factors contributing to falls in older adults: health conditions; situations such as environmental hazards, inadequate lighting, general clutter, assistive devices • Osteoporosis • Fear of falling; history of falling • Cognitive impairment

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