Safety

Chapter 14Chapter 14

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

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Safe EnvironmentSafe Environment

• This implies freedom from injury with a focus on preventing falls, electrical injuries, fires, burns, and poisoning.

• The nurse must be aware of potential safety problems and must know how to report and respond when safety is threatened.

• The responsibility for providing and maintaining a safe environment involves the patient, visitors, and members of the health care team.

• Both protection and education are primary nursing responsibilities.

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Safe EnvironmentSafe Environment

• Falls The majority of patient falls occur during transfer

either to a bedside commode or to a wheelchair. High risk

• The very young

• Older adults

• Individuals who become ill or who are injured Unfamiliar environment and various symptoms and

signs associated with the patient’s diagnosis may also place the individual at risk.

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Safe EnvironmentSafe Environment

• Falls (continued) Gait belts

• This is an added safety feature in ambulating patients.

• Apply gait belt securely around patient’s waist.

• Walk to the side of the patient, one arm around waist and hand on the belt. Walk on the weaker side.

• Patient can support him- or herself by leaning or holding onto nurse’s arm.

• Nurse should walk with his or her closest leg just behind the patient’s knee.

• Walk with knees and hips flexed.

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Safe EnvironmentSafe Environment

• Infants and Children Ensuring the safety of the environment of infants and

children requires protection of the child and education of the parents.

Accidents involving children are largely preventable, but parents and caregivers need to be aware of specific dangers at each stage of growth and development.

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Safe EnvironmentSafe Environment

• Older Adults Changes associated with aging significantly affect

the ability of older adults to protect themselves from injury.

• Unsteadiness in gait causes falls.

• Vision changes may affect the ability to see the height of stairs.

• Vertigo may occur due to disease and/or medications.

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Accidental PoisoningAccidental Poisoning

• Childhood poisoning is one of the major causes of death in children under 5 years of age.

• The older adult is also at risk. Changes associated with aging interfere with the

individual’s ability to absorb or excrete drugs. The older adult may share drugs with friends. Changes in eyesight may lead to an accidental

ingestion.

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Accidental PoisoningAccidental Poisoning

• Hospitalized patients and those in other types of health care facilities can be at risk for accidental poisoning because there are many poisonous substances in the environment. Cleaning solutions Disinfectants Drugs

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Accidental PoisoningAccidental Poisoning

• Preventing Poisoning Remove toxic agents from areas where poisoning

could occur. Toxic or poisonous substances should not be

removed from their original containers. Poisonous substances should be labeled

conspicuously and stored appropriately.

• Poison control centers are valuable sources of information when poisoning is suspected or does occur.

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Applying Safety Reminder DevicesApplying Safety Reminder Devices

• Safety reminder device (SRD) Any one of numerous devices used to immobilize a

patient or part of the patient’s body, such as arms or hands

• Used for various reasons Patient safety Maintain treatment Prevent wandering Prevent or reduce the risk of falls Restrict movement of an aggressive patient to protect

other patients and staff

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Applying Safety Reminder DevicesApplying Safety Reminder Devices

• Ethical and legal issues surround their use.

• The focus is on using alternative strategies before SRDs are applied.

• Patient safety or the safety of others must be the priority reason why an SRD is applied.

• The use of SRDs can also result in increased restlessness, disorientation, agitation, anxiety, and a feeling of powerlessness.

• Documentation about the need for the SRDs, the type of device used, and the patient response is crucial.

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Skill 14-1: Step 6a(3)Skill 14-1: Step 6a(3)

Applying safety reminder devices.

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

Slide 13Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

Skill 14-1: Step 6a(4)Skill 14-1: Step 6a(4)

Applying safety reminder devices.

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

Slide 14Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

Skill 14-1: Step 6b(1)Skill 14-1: Step 6b(1)

Applying safety reminder devices.

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

Slide 15Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

Skill 14-1: Step 6c(2)Skill 14-1: Step 6c(2)

Applying safety reminder devices.

Slide 16Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

Skill 14-1: Step 6c(4)Skill 14-1: Step 6c(4)

Applying safety reminder devices.

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

Slide 17Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

Skill 14-1: Step 6d(1)Skill 14-1: Step 6d(1)

Applying safety reminder devices.

(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)

Slide 18Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

Skill 14-1: Step 7Skill 14-1: Step 7

Applying safety reminder devices.

Slide 19Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

Skill 14-1: Step 15aSkill 14-1: Step 15a

Applying safety reminder devices.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

Slide 20Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

Skill 14-1: Step 15bSkill 14-1: Step 15b

Applying safety reminder devices.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

Slide 21Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

Skill 14-1: Step 15cSkill 14-1: Step 15c

Applying safety reminder devices.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

Slide 22Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

Skill 14-1: Step 15dSkill 14-1: Step 15d

Applying safety reminder devices.

(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.]. St. Louis: Mosby.)

Slide 23Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

Hospital/Health Care EnvironmentHospital/Health Care Environment

• The hospital environment is a source of potential safety hazards for health care workers. Biologic, chemical, and physical hazards Lasers Blood and body fluids Contaminated needles Radiation Vaccine-preventable diseases

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Safe EnvironmentSafe Environment

• Left-Handed Patient The typical hospital room environment is set up to

accommodate the right-handed patient. Left-handed patients may struggle and strain to cope

by contorting the body, which creates a “risk for injury” situation.

The discerning nurse will document in the patient’s record the fact that the patient is left-handed.

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Safe EnvironmentSafe Environment

• Safety Features for the Left-Handed Patient Place all bathing articles at the patient’s left. Allow patient to turn to the right during back care. Place the drainage receptacle for the indwelling

catheter to patient’s left. Arrange meal trays by placing liquids on the left side. When ambulating, walk to the patient’s left side. Use the patient’s right hand and arm for IV therapy

and injections whenever possible. Allow more time for the patient to master skills. Adjust the patient’s environment by placing bed stand,

table, and call light to the patient’s left.

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Hospital/Health Care EnvironmentHospital/Health Care Environment

• National Institute for Occupational Safety and Health (NIOSH) Focuses on safety and issues related to health

• Hazard Communication Act of the Occupational Safety and Health Administration (OSHA) A national organization that provides guidelines to

help reduce safety hazards in the workplace Requires hospitals to inform employees about the

presence of or potential for harmful exposures and how to reduce the risk of exposure

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Hospital/Health Care EnvironmentHospital/Health Care Environment

• Centers for Disease Control and Prevention (CDC) A federal agency that provides facilities and services

for the investigation, identification, prevention, and control of disease

Provides guidelines for working with infected patients

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Ensuring Fire SafetyEnsuring Fire Safety

• Fires in health care facilities are often related to smoking in bed or faulty electrical equipment.

• An established fire safety program is mandatory for all health care facilities.

• Fire prevention includes good housekeeping, maintenance, and employee discipline.

• All employees should know the telephone number and procedure for reporting a fire, as well as the location of the nearest firefighting equipment.

• Health care workers must know their roles in the overall evacuation plan.

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Ensuring Fire SafetyEnsuring Fire Safety

• Types of Fire Extinguishers Type A

• For paper, wood, or cloth fires Type B

• For flammable liquid firesgrease and anesthetics Type C

• For electrical Type ABC

• For any type of fire

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Ensuring Fire SafetyEnsuring Fire Safety

• Patients in immediate danger should be rescued, and then the facility’s procedure should be followed for activating the fire alarm and reporting the location and extent of the fire.

• Measures should then be taken to contain or extinguish the fire if there is no immediate threat to safety. Close doors and windows, turn off oxygen and

electrical equipment, and use the appropriate fire extinguisher.

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Ensuring Fire SafetyEnsuring Fire Safety

• Use the mnemonic RACE to set priorities in case of fire RRescue and remove all patients in immediate

danger. A Activate the alarm. C Confine the fire. E Extinguish the fire using an extinguisher.

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Disaster PlanningDisaster Planning

• Disaster Situation An uncontrolled, unexpected, psychologically

shocking event Earthquakes, hurricanes, floods, tornados, bombings,

arson, riots, and hostage-taking Health care facilities expected to receive victims and

survivors and to assist rescuers

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Disaster PlanningDisaster Planning

• External or Internal Disaster External disaster originates outside the health care

facility and results in an influx of casualties brought to the facility.

Internal disaster represents an extraordinary situation that is brought about by events within the health care facility.

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Disaster PlanningDisaster Planning

• Disaster planning represents the means by which health care facilities and personnel meet the responsibilities associated with managing the disaster.

• Disaster Manual Specifies departmental responsibilities; chain of

command; callback procedures; assignment procedure; patient evacuation procedure and routes; procedures for the receipt and management of casualties; and policies related to the overall management of supplies and equipment

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Terrorism/BioterrorismTerrorism/Bioterrorism

• Terrorism A new potential environmental health threat is the

possibility of a terrorist attack.• Biological, chemical, or nuclear weapons

• Bioterrorism This is the use of biological agents to create fear and

threat. Health care facilities must be prepared to treat mass

casualties from an attack.

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Terrorism/BioterrorismTerrorism/Bioterrorism

• Bioterrorism Bioterrorism attacks

• If an attack occurs, it will most likely involve the use of biological agents such as anthrax, botulism, smallpox, or bubonic plague.

Biological attacks may be either overt (announced) or covert (unannounced).

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Terrorism/BioterrorismTerrorism/Bioterrorism

• Features that should alert nurses to the possibility of a bioterrorism-related outbreak include A rapidly increasing incidence of a disease An unusual increase in the number of people seeking

care An endemic disease rapidly emerging at an

uncharacteristic time or in an unusual pattern Lower attack rates among patients who had been

indoors compared with people who had been outdoors Clusters of patients arriving from a single locale Large number of rapidly fatal cases

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Terrorism/BioterrorismTerrorism/Bioterrorism

• Terrorism by Nuclear Exposure Attack on a domestic nuclear weapon facility “Dirty bomb” Source of radiation on the contaminated patient: on

the body or clothing, ingested, or absorbed through a skin opening

Less than 0.75 Gy absorbed: usually no symptoms More than 8 Gy absorbed: fatal

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Terrorism/BioterrorismTerrorism/Bioterrorism

• Terrorism by Nuclear Exposure More than 0.75 Gy absorbed: can develop acute

radiation syndrome• Hematopoietic: deficiency of WBCs and platelets

• Gastrointestinal: loss of mucosal barrier and cells lining the intestine

• Cerebrovascular/central nervous system: cerebral edema, hyperpyrexia, hypotension, confusion, and disorientation

• Skin: loss of epidermis and possibly the dermis

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Nursing ProcessNursing Process

• Nursing Diagnoses Risk for falls/injury Impaired physical mobility