Safety

Foundations of Nursing Christensen Kockrow Mosby

Sharon L. Kinley Schwing BSN 2006 Leslie Lehmkuhl RN 2009

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.

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.

FACTORS AFFECTING SAFETY

• Age • Lifestyle/occupation • Sensory/perceptual changes • Mobility • Emotional state

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.

Safety Is for Every Age

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.

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.

IDENTIFY CLIENT

• Checking the client’s ID band ensures that the correct person receives care.

• Client identification is essential before rendering any care.

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.

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.

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.

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.

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.

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.

Elderly Safety

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 .

Extremity (ankle or wrist) Restraint (From Potter, P.A., Perry, A.G. [2005].

Fundamentals of nursing

. [6 th ed.]. St. Louis: Mosby.)

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

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.

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.

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

Safety within the Hospital/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

Work Place Safety

• Employee Right to Know Laws: • Regulation Relation to Hazardous Materials • Material Safety Data Sheets

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.

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

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

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.

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.

• 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.

Safety Promotion

• Education is the key to safety in and out of the hospital !

What are some examples of safety education ?

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.

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

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

PREVENT FIRE

• Make sure fire exits are clearly marked.

• Identify the locations and demonstrate the operation of fire extinguishers.

• Practice fire evacuation procedures.

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.

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?

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.

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

OTHER IMPLEMENTATIONS

• Prevent poisoning.

• Prevent choking.

• Prevent suffocation.

• Prevent drowning.

• Reduce noise pollution.

Hygiene and Care of the Patients Environment

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.

• 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.

• 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.

Factors that Influence a Patient’s Personal Hygiene

• Social practice.

• Body Image.

• Socioeconomic status.

• Knowledge.

• Personal preference.

• Physical condition • Cultural variables.

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.

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.

Components of Patient’s Hygiene

• Care of the skin • Oral hygiene • Hair care • Perineal care • Eye, ear, and nose care

PROVIDE FOR CLIENTS’ BATHING NEEDS • Cleansing baths–routine for personal hygiene: – Shower – Tub Bath: Self help/Complete bed /Partial bath – Therapeutic Bathes

PROVIDE FOR CLIENTS’ BATHING NEEDS (continued) • Therapeutic baths–require a physician’s order stating type of bath, body surface to be treated, type of medicated solutions to be used: – Hot, warm, or tepid – Soak or sitz – Oatmeal, cornstarch, sodium bicarbonate

OTHER HYGIENE IMPLEMENTATIONS

• Provide clean bed linen.

• Provide perineal care.

• Offer back rubs.

• Provide foot and toenail care.

• Provide oral care.

• Provide hair care.

• Provide eye, ear, and nose care.

Sitz Bath

Personal Hygiene for Nurses

• Daily bath or shower.

• Strong, odorless and effective deodorant everyday.

• Clean undergarments.

• Clean uniform daily.

• Shampoo hair as necessary to maintain cleanliness.

• Keep hair off collar.

• Wear hose or socks.

• Wear white comfortable shoes. • Short , clean fingernails.

• Minimal to moderate make-up.

• Small earrings.

• Very light cologne, perfume, aftershave.

• Standard departmental uniform. • Facial hair, clean and short, neatly trimmed.

• Breath mints.

Patient’s Room Environment

• Patients with sever illnesses may be restricted to prolonged bed rest.

• Patients with limitations such as traction, casts, or monitoring equipment.

• Rooms should be comfortable and safe, increases the sense of well-being.

• The patients illness can not be controlled, however something can be controlled. • Emptying and rinsing bedpans, and bedside commodes keep the room order free, and encourages a restful environment. • A patients energy must be directed toward recovery, keeping environment stimuli to a minimal will encourage this.

A typical hospital room. (From Potter, P.A., Perry, A.G. [2005].

Fundamentals of nursing

. [6 th ed.]. St. Louis: Mosby.)

Room Equipment

• Bedside stand.

• Over bed table.

• Chairs, lounge and straight back.

• Lights.

• Call bell.

• Beds.

• Water repellent mattresses.

• Bed controls.

Bathing

• The extent of the patient's bath and methods used for bathing depend on t e patient's capabilities, and degree of hygiene required.

• Sitz bath • Cool water tub bath • Warm water tub bath • Hot water tub bath • Other baths • Back care/Bath rub

Bed bath.

(From Potter, P.A., Perry, A.G. [2005].

Fundamentals of nursing

. [6 th ed.]. St. Louis: Mosby.)

Bed bath.

(From Potter, P.A., Perry, A.G. [2005].

Fundamentals of nursing

. [6 th ed.]. St. Louis: Mosby.)

Nursing Process for Hygiene

• Determine if the patient can tolerate hygienic procedures • Nursing diagnoses: – Oral mucous membrane, impaired – Mobility, impaired physical – Skin integrity, impaired – Self-care deficit – bathing/hygiene, dressing/grooming

Care of the Skin

• Normal skin has the following characteristics: Intact without abrasions.

Warm and Moist.

Localized changes in texture across surface.

Good turgor, generally smooth and soft.

Skin color variations from body part to body part.

• Prevention is the ultimate goal, when not possible, interventions can result in: Healing Decrease discomfort Decrease length on hospitalization.

Stages of Pressure Ulcers

•

I –

Nonblanchable erythema of the intact skin.

•

II –

Partial-thickness skin loss involves epidermis and or dermis.

•

III –

Full-thickness skin loss involves damage or necrosis of subcutaneous tissue that may extend down to but not through underlying fascia.

•

IV –

Full-thickness skin loss occurs with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures.

Diagram of shearing force exerted against sacral area.

(From Potter, P.A., Perry, A.G. [2005].

Fundamentals of nursing

. [6 th ed.]. St. Louis: Mosby.)

Stage I pressure ulcer. (From Potter, P.A., Perry, A.G. [2005].

Fundamentals of nursing

. [6 th ed.]. St. Louis: Mosby.) Stage II pressure ulcer.

Stage III pressure ulcer . Stage IV pressure ulcer .

Stage IV Pressure Ulcer

Oral Hygiene

• Oral hygiene • Dentures • Oral care must be provided on a regular basis.

• Beneficial outcomes of oral hygiene may not be seen for several days.

• Repeated cleansing is often needed to remove tenacious dried, including the tongue.

Conditions that Place Patients at Risk for Oral Disorders • Lack of knowledge about oral hygiene.

• Inability of perform oral care.

• Alteration in the integrity of teeth and mucosa resulting from disease or treatments.

• Lack of aggressive care.

Patients who are particularly at risk:

Paralysis Diabetes Being seriously ill NPO Status Upper extremity activity limitations Radiation therapy Unconsciousness Chemotherapy drugs Disorientation Oral surgery

Hair Care

• Proper hair care is important to the patient’s self image.

• Bed ridden patients hair may soon become tangled.

• Patients are aware of their appearance.

• Good hair care must be completed daily.

• Shampoo, and cleansing might have to be completed for the bed ridden patients in bed.

• Shaving the patient.

• Hand, foot and Nail Care.

• Perineal Care.

• Perineal care, Indwelling catheter.

• Eye, Ear, and Nose Care.

Contact lens Hearing aids

Hearing aid. (From Elkin, M.K., Perry, A.G., Potter, P.A. [2004].

Nursing interventions and clinical skills

. [3 rd ed.]. St. Louis: Mosby.)

Assisting the Patient with Elimination

• The nurse should offer the bedpan or urinal frequently.

• This procedure is personal and the patient should be afforded as much privacy as his or her condition allows.

• It is not unusual for the patient to procrastinate using the bedpan because it is uncomfortable and embarrassing.

• Poor cleaning after elimination leads to skin break down.

Care of the Incontinent Patient

• Incontinence characterized by urine of fecal slow at unpredictable times.

• Incontinence is a very common problem, especially among older adults.

• Incontinence is due to pressure in the bladder, or sphincter is weak.

• Incontinence may be a small leak.

• Products to guard against incontinence must be kept discreet for the alert patient.

Care of the Comatose Client

• Eye Care: Wipe gentle every four hours.

Keep moist / Liquid tears.

Shields or tape gently closed.

• Oral Care: Never used fingers or tongue blade Assess gag reflex.

Small amount of liquids / have suction on.

Prevent aspiration.

Patient Teaching: Hygiene

• Initiated at the beginning of hospitalization and though out.

• Independence should be taught and encouraged.

• Explain steps.

• Teach elderly how to evaluated water temperatures.

• Teach proper cleaning.

• Hand washing.

• Use of sunscreen • Prevention or healing of chapped, dry lips.

• Teach care and cleaning of dentures.

Home Health Considerations Hygienic Care

• Bathing • Skin Care • Oral Care • Hair care • Shaving • Nail and Feet • Bed making

Nursing Process

• Assessment • Nursing Diagnosis • Expected Outcome/Planning • Implementation • Evaluation

Nursing Process

• Using the nursing process, nurses can reduce the risk of injury to patients • Diagnoses: – Risk for falls – Impaired physical mobility • Interventions: – Health promotions – Developmental considerations – Environmental protection

Questions ?