Patient Safety & Positioning

1. Patient Safety & Positioning

2. Patient Safety: Falls may occur due to • Misjudging distance • Feeling weak/dizzy • Position changes too fast • Hazards while walking • Walking in poor lit area Patients at risk: • Impaired mobility due to injury, disease • Receiving medications that alter mental status • Be disoriented due to change in environment or medical disorder • Impaired hearing/vision

3. Preventing falls: • Leave bed In lowest horizontal position • Keep brakes locked • Keep side rails elevated • Check for protruding objects • Do not clutter/block open ears with supplies • Wipe up skills immediately • Encourage patients to use rails along corridor when walking • Monitor patients for signs of weakness, fatigue, dizziness and loss of balance • Monitor patient for safety if they are independent • Can they: propel their wheelchair, transfer OOB, ambulate

4. Physical Restraints • Research show restraints do NOT necessarily reduce falls or prevent injuries – it may actually cause serious injuries and death

5. 2 types of restraints • Medications that affect the patient’s mood and behavior • Any technique or device that is attached or next to the patient’s body that the patient cannot easily remove and that restricts freedom of movement and normal access to the body Chemical Physical OBRA (1987) states when and how chemical and physical restraints may be used in a long-term care facility. Physical restraints are to be used ONLY when the safety of the patient or other persons are at risk.

6. OBRA says: • Documentation of all patient behavior that indicates the need for restraints • Documents all actions taken as alternative prior to restraints • Consults the patient/family when alternatives are not successful • If cause of patient’s problem can be identified and corrected, the need for restraints can be eliminated • If restraints are required, the least restrictive restraint is required to be selected • Must have MD order

7. Types of Physical Restraints Geriatric chairs Jacket restraint Hand mitt Vest restraint Limb restraint Wheelchair belt

8. Vail bed • Alternative for confused patients who try to climb over side rails • NOT used for mentally alert patients • Netting surrounds bed to keep patient safe, but not considered a barrier to movement

9. Enablers • Devices that empower patients to assist themselves to function • Wheelchair to sit upright • Postural supports: devices used to assist w/ posture • Lap tray • Lap buddy • Side rails are, by definition, restraints • Make sure space between rail and bed is small

10. Alternatives to restraints • Care for patient’s personal needs promptly • Know wh/ patients are at risk • Observe patient’s walk • Report mental changes • Maintain safe environment • Provide comfortable chairs • Use security devices • Keep bed in lowest position • Keep bed wheels locked • Place mat on floor if patient tries to get out of bed • Meet patient needs promptly: water, hunger, pain, etc. • Use side rail cushions • Pressure-sensitive chairs or chair alarms

11. Guidelines for using restraints • Explain procedure to patient • Check fit after applying restraint • Tie restraints with slip knot • Make sure call light is accessible • Release restraint q2h for 10 min • Maintain patient body alignment • Avoid restraints in moving vehicles and toilets • Obtain MD order • Try least restrictive device first • Use correct type/size of restraint • Apply restraints according to instructions • Avoid restraint if frayed, torn, or missing parts • Apply restraint over clothing, not skin

12. Types of other injuries • Make sure food in bedside table will not spoil • Keep chemicals and cleaning solutions in locked cupboards • Store personal food items in refrigerator w/ label and date expired • Follow procedures accurately • Check water temperatures before bathtub or shower • Check food temps before feeding patient • Store smoking materials in safe, locked area Accidental poisoning Thermal injuries

13. Store knives, scissors, razors and tools in locked area • Store syringes in locked area • Clean up broken glass immediately • Be aware of patients that have swallowing difficulty • Cut food into small pieces • Feed slowly • Offer liquids between bites • Place food in unaffected side of the mouth (if stroke) • Use thickeners for liquids • Keep patient in upright position 30 min. after meals • Give oral care at the end of the meal • Know choking procedure Skin injuries Choking

14. Positioning • Body alignment: • Maintaining a person in a position in which the body can properly function

15. Complications • Occurs when body alignment is not maintained or when the patient’s position is not changed often enough • Pressure ulcer (bedsores) result when unrelieved pressure on a bony prominence interferes with blood flow to the area • Contractures occurs when a joint is allowed to remain in the same position for too long

16. Supportive devices • Used to maintain body alignment and position • Pillows • Splints (orthotic devices) • Special boots/shoes • Bed cradles • footboards

17. Positioning • Prone – on the abdomen • Supine – on the back • Lateral – on either side • Sims’s – left lateral (slight variation) • Fowlers – upright; variation include high fowlers (90°) and semi-fowlers (45°)

19. Moving/Lifting • Major responsibility of the CNA • Use turning sheet/draw sheet to assist in lifting and make moving easier • Sheet must extend from above the shoulders to below the hip • Remember body mechanics rules