Chapter 38: Client Safety

1. Chapter 38: Client Safety Bonnie M. Wivell, MS, RN, CNS

2. JCAHO 2010 National Patient Safety Goals • Identify patients correctly – 2 identifiers • Improve staff communication – read back, not using certain abbreviations, SBAR • Uses medicines safely – label, look alike/sound alike, blood thinners • Prevent infection – hand hygiene, NO HAIs • Reconcile medications across the continuum of care • ID patient safety risks – suicide • Prevent falls • Help patients to be involved in their care • Watch patients closely for changes in their health and respond quickly if they need help – Rapid response teams • Prevent errors in surgery

3. Environmental Safety A safe environment includes meeting basic needs, reducing physical hazards, reducing the transmission of pathogens, maintaining sanitation, and controlling pollution. A safe environment also includes one where the threat of attack from biological, chemical, or nuclear weapons is prevented or minimized.

4. Environmental Safety • Basic Needs • Oxygen • CO2 poisoning • Nutrition • Keeping perishable foods fresh • Temperature and Humidity • Extreme cold and heat

5. Physical Hazards • Fractures are the most serious health consequence of falls • Almost 90% of all fractures among older adults are due to falls • Lighting • Obstacles • Bathroom Hazards – burns, poisoning, falls • Security – fire safety, lead poisoning, contaminated soil and water

6. Transmission of Pathogens • Pathogen = any microorganism capable of producing an illness • Hand hygiene most effective method of limiting transmission • Immunization = resistance to an infectious disease is produced or augmented

7. Environment Safety Cont’d. • Pollution • Air • Land • Water • Noise • Terrorism • Bioterrorism

8. Risks at Developmental Stages Infant, Toddler, Preschool: Injuries are the leading cause of death in children over age 1 School aged child: Sports injuries Adolescent: Risk taking behaviors Adult: Lifestyle habits Older Adult: Physiological changes result in increased risk for falls, burns, MVAs

9. Individual Risk Factors Lifestyle Impaired Mobility Sensory or communication Impairment Lack of Safety Awareness 9

10. Risks in the Health Care Agency • 3 Types of medical errors accounted for almost 60% of the client safety incidents • Post-op infections • Bed sores • Failure to diagnose and treat in time • Medication errors • Falls • Patient-Inherent Accidents: self-inflicted • Procedure-related Accidents: occur during therapy • Equipment-related Accidents: malfunction, disrepair, or misuse

11. Safety and the Nursing Process • Assess • Activity and exercise • Medications • History of falls • Home maintenance and safety

12. Nursing Diagnosis Risk for injury Related to: General weakness Right or Left sided weakness Side effects of medication Poor eyesight As evidenced by: Recent falls New CVA Confusion Macular degeneration

13. Implementation Nursing Diagnosis Risk for injury related to (r/t) generalized weakness as evidenced by recent falls Goal Pt. will ask for help to the bathroom Pt. will remain free from injury during hospitalization Interventions Nurse will ensure call light is in reach Nurse will work with other care providers to make sure patient is seen every hour Nurse will work with other care providers to ensure pt. receives required assistance with ADLs/activities

14. Use of Restraints in the Health Care Setting Physical or chemical means of stopping a patient from being free to move. 4 bedrails up is considered a restraint Used only in emergency situations to ensure the patient’s safety. Restraint orders must be specific and time-limited.

15. Other Mechanisms to Prevent Falls Tab Alarms Arm Bands ID outside of Patient room Notice Inside the Patient room Colors of gowns, slippers, blankets Bed Alarms Chair Alarms

16. Restraint Use Must have a physician order Order must be rewritten every 24h. Restraint policies are specific to health care setting Nursing documentation must occur at least every two hours

17. Complications from Restraints Skin breakdown Constipation Pneumonia Incontinence Urinary retention Nerve damage Circulatory damage

24. Other Safety Issues • Fires • Poisoning • Electrical Hazards • Seizure precautions • Radiation safety • Bioterrorist attack • Bomb threats

25. Chapter 39: Hygiene

26. Patient Hygiene • Oral Care • Bathing • Shaving • Hair care • Perineal care • Foot care • Bed making • Occupied/unoccupied

27. Goal • What is the goal of hygiene in the health care setting? • Moving the patient to a higher level of health • Check the box on the nursing documentation sheet • Prevent Infection • All of the above

28. Self-Assessment • Have you ever bathed another adult person? • Someone not in your family?

29. Why is Hygiene Important? Personal hygiene affects a patient’s comfort, safety, and sense of well-being. A variety of personal, social, and cultural factors influence hygiene practices.

30. Factors Influencing Hygiene Physical Condition Ability to care for self Energy level Sensory deficits Incontinence of urine and/or stool Dexterity and ROM Sedation, Pain level Chronic illnesses Psychiatric conditions

31. Factors Cont’d. • Social practices • Personal preferences • Body image • Socioeconomic status • Health beliefs and motivation • Cultural variables

32. Assessment Skin: wounds, infection Feet and Nails: PVD, diabetic patient with foot issues, foot fungus around toe nails Patients with poor circulation to the feet and lower legs needs close assessment of those areas Oral Cavity: condition of the mouth and teeth Hair: tangles, lice Eyes, Ears, and Nose: Does the patient have any sensory deficits?

33. Critical Evaluation What is the ability of the person to care for themselves? Physical disabilities Mental disabilities 33

34. Specific Issues Needing to be Addressed at Bath Time • Foot care • Normal vs Diabetic • Do not soak feet of patients with DM and/or vascular insufficiency • Sensitive skin • Infestations • Infections • Incontinence

35. Types of Baths Complete bed bath Partial bed bath Sponge at the sink Tub bath Shower Bath in a bag

36. Critical Evaluation • Are there any cultural issues that need to be addressed prior to bathing? • What is your patient’s developmental status? • Teen, Young adult, Adult, Older Adult, Elderly • How does that affect their hygiene needs and attitudes? • What do you do with this information about the patient? • Care Plan

37. Critical Evaluation • Involve patient as much as possible in bathing decisions • When • Where • Type • Tub • Shower • Bed bath

38. Nursing Diagnosis BATHING/HYGIENE SELF-CARE DEFICIT: R/T CONFUSION: AEB POOR PERSONAL HYGIENE BATHING/HYGIENE SELF-CARE DEFICIT: R/T DECREASED CEREBRAL CIRCULATION (RECENT CVA) AEB RIGHT SIDED WEAKNESS

39. Oral Care Oral care is an essential nursing intervention Assess for decreased saliva, infection, coated tongue, cracked lips Brush all tooth surfaces using a soft bristle brush Observe for complications such as bleeding gums Oral care for the patient who is not conscious Oral care for the patient with partial paralysis of the mouth Oral care for the patient who has had mouth surgery or injury

40. Other Hair Care: Gather supplies (plastic trough, towels, shampoo, drainage wash basin) Shaving: Check doctor’s orders Anticoagulants Perineal Care (see page 877) Independent Needs assist Dependent Foot Care (see page 880) Do not soak feet of patients with DM and/or vascular insufficiency

41. Care of Patient with Sensory Aids Glasses/Contacts (pg. 894) Dentures (pg. 891) Hearing Aids (pg. 895) Prosthetic Eyes

42. Remember body mechanics Raise the bed to a comfortable height Follow medical asepsis when making a bed Wear gloves if linen is soiled Keep linen away from uniform Do not place soiled linen on the floor Basic Principles

43. Bed Making – Occupied/Unoccupied Linen Use appropriate linen for the patient Chucks and linen savers Draw sheets Therapy beds Learn to place a bottom flat sheet when there are no fitted sheets