Saftey

Safety

NURSE’S RESPONSIBILITY

It is the nurse’s responsibility to assess each patient for real and potential risks associated with safety and include injury prevention in each client’s plan of care. Injuries and accidents can be minimized with appropriate assessment, precaution, planning, intervention, and evaluation.

BASIC NEEDS

Physiologic needs sufficient amounts of: Oxygen – The Client requires adequate

oxygen for cell metabolism, this can be decreased by air pollution or disease like lung disease

Carbon Monoxide poisoning would also result inadequate oxygen

Nutrition – the correct amount of calories, protein, carbohydrates, fats, vitamins and minerals to avoid over or underweight and deficiencies

Temperature – temperature that are either too hot or two cold pose threats to clients in hypo or hyperthermia

Humidity – too much humidity can make it difficult to breath and too little can result in dryness

Consider the following:

PHYSICAL HAZARDS

Lighting needs to be sufficient so the client can see where they are stepping and potential obstacles

Obstacles are objects which can trip clients like light cords, step stools, area rugs

Bathroom hazards result when clients attempt to get in and out of the bathtub or toilet resulting in falling

Security hazards occur when intrusion threatens a client

What about the environment?

TRANSMISSION OF PATHOGENS

Immunizations stop the transmission

Hand washing breaks the chain of infection

Asepsis maintains sterility of essential patient care supplies to prevent infection

Personal Protection Equipment when used correctly decreases the transmission of germs from client to client and client to care provider

TRANSMISSION CONTINUED

Cleanliness should be maintained daily and between clients so pathogens do not have an opportunity to grow

Isolation precautions should be adhered to so pathogens do not migrate from one client to the next

Infection Control initiatives should be adhered to minimize nosocomial infections

POLLUTION

Air –including passive exposure to smoke can promote disease

Land through improper disposal of waste and use of pesticides which threaten to make clients ill

Water from recreation emissions from water craft along with agricultural, industrial, and improper disposal of human waste

Noise with exposure to sounds like traffic, lawn mowers jet plans elevate blood pressure and result in loss of sleep

DEVELOPMENTAL FACTORS

Safety concerns vary by type and incidence according to developmental level.

The nurse must evaluate the specific age of any client to ensure the developmental and actual ages are consistent.

Groups include Infant/toddler, Preschooler, School-age child, adolescent, adult and older adult.

INFANT AND TODDLER

Choking – they are curious and put most things in their mouths to explore.

Falling- they are initially unsteady on their feet as they learn to walk, once toddlers they climb and wander to explore their world.

OLDER ADULT

Physiological changes associated with aging place the older adult at risk of injury which include decreased muscle strength, joint immobility's, slowing reflexes, decreased ability to respond to multiple stimuli, sensory loss like hearing and vision.

OLDER ADULT

These physiological changes increase risk for:

Falls related to these factors, most common cause of accidents after the age of 50

Area rugs leads to tripping or sliding Inadequate lighting where they are unable to see

obstacles and trip Electrical cords that get tangled in their feet Urgency to get to the bathroom for elimination

Burns related to leaving the stove on or slow reactions

MORSE FALL SCALE

Tool used to assess if a client is at risk of falling. 1. Does the person have a history of falling? 2. Does the person have more than one medical

diagnosis? 3. Does the person use ambulatory aids like crutches

or a walker? 4. Does the person have an IV or saline lock? 5. Is the person’s gait normal or stooped or otherwise

impaired? 6. What is the person’s mental status? Disoriented?

TJC PATIENT SAFETY INITIATIVES

Body site marking for operative site while the patient is awake by the surgeon to avoid wrong site surgery

“Time out "when all members of the surgical or procedural team must stop and acknowledge the right patient, right side, right procedure

Medication reconciliation to review all medications and supplements the patient is taking so the provider takes a comprehensive look

Aggressive Hand Hygiene to avoid infections

Needless systems to avoid needle stick of health care providers

RACE – FIRE RESPONSE

R – rescue and remove clients in immediate danger of fire

A – activate alarm C – confine the fire –

close doors and windows and turn off oxygen

E – extinguish fire using fire extinguisher or escape

SPEAK-UP

A patient safety campaign by TJC to decrease medical errors

S- Speak –up if you have questions or concerns P- Pay attention to the care you are receiving E- Educate yourself about your situation A- Ask a trusted person to be your advocate K- Know your medications U-Use a hospital, clinic, care center that is surveyed

and meets high standards P-Participate in all of the decisions about your

treatment

USE OF RESTRAINTS

Restraint – anything used to restrict freedom of movement or access to a person’s body

Potentially very dangerous, patients injured or strangled getting tangled in restraint– Avoid use unless client at risk of injury

Least restrictive measures – many types select the restraint that limits their movement the least while keeping them safe

All restraints require a physician order The physician order must be renewed at least every 24 hours The nurse must assess the patient and document every 2 hours Behavioral restraint use more restrictive with every 15 minute

assessment and documentation

EQUIPMENT-RELATED ACCIDENTS

Appropriate use of equipment should include:

Thorough knowledge from training how to use it

Ensure it is properly inspected

Ensure it is functioning properly

In the event it is not functioning properly remove it from service and tag it

Make sure the client’s room is free from clutter and equipment not in use is removed promptly

NEVER EVENTS LISTED

Foreign objects left in a patient after surgery Air embolism Administration of the wrong kind of blood Severe pressure ulcers Falls and trauma Infections related to urinary catheters Infections associated with intravenous catheters (continue on next slide)

Safety first at all times

NEVER EVENTS CONTINUED

Symptoms resulting from poorly controlled blood sugar levels

Surgical site infections following certain elective procedures (orthopedic and bariatric)

Deep vein thrombosis or pulmonary embolism following total knee or hip replacement

SAFETY AT ALL TIMES!