Chapter 38: Client Safety Bonnie M. Wivell, MS, RN, CNS.
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Transcript of Chapter 38: Client Safety Bonnie M. Wivell, MS, RN, CNS.
Chapter 38: Client SafetyChapter 38: Client Safety
Bonnie M. Wivell, MS, RN, CNSBonnie M. Wivell, MS, RN, CNS
JCAHO 2010 National Patient JCAHO 2010 National Patient Safety GoalsSafety Goals
Identify patients correctly – 2 identifiersIdentify patients correctly – 2 identifiers Improve staff communication – read back, not using certain Improve staff communication – read back, not using certain
abbreviations, SBARabbreviations, SBAR Uses medicines safely – label, look alike/sound alike, blood Uses medicines safely – label, look alike/sound alike, blood
thinnersthinners Prevent infection – hand hygiene, NO HAIsPrevent infection – hand hygiene, NO HAIs Reconcile medications across the continuum of careReconcile medications across the continuum of care ID patient safety risks – suicideID patient safety risks – suicide Prevent fallsPrevent falls Help patients to be involved in their careHelp patients to be involved in their care Watch patients closely for changes in their health and Watch patients closely for changes in their health and
respond quickly if they need help – Rapid response teamsrespond quickly if they need help – Rapid response teams Prevent errors in surgeryPrevent errors in surgery
Environmental SafetyEnvironmental Safety
A safe environment includes meeting A safe environment includes meeting basic needs, reducing physical hazards, basic needs, reducing physical hazards, reducing the transmission of pathogens, reducing the transmission of pathogens, maintaining sanitation, and controlling maintaining sanitation, and controlling pollution.pollution.
A safe environment also includes one A safe environment also includes one where the threat of attack from biological, where the threat of attack from biological, chemical, or nuclear weapons is prevented chemical, or nuclear weapons is prevented or minimized.or minimized.
Environmental SafetyEnvironmental Safety
Basic NeedsBasic Needs OxygenOxygen
CO2 poisoningCO2 poisoning
NutritionNutrition Keeping perishable foods freshKeeping perishable foods fresh
Temperature and HumidityTemperature and Humidity Extreme cold and heatExtreme cold and heat
Physical HazardsPhysical Hazards
Fractures are the most serious health Fractures are the most serious health consequence of fallsconsequence of falls
Almost 90% of all fractures among older adults Almost 90% of all fractures among older adults are due to fallsare due to falls
LightingLighting ObstaclesObstacles Bathroom Hazards – burns, poisoning, fallsBathroom Hazards – burns, poisoning, falls Security – fire safety, lead poisoning, Security – fire safety, lead poisoning,
contaminated soil and watercontaminated soil and water
Transmission of PathogensTransmission of Pathogens
Pathogen = any microorganism capable of Pathogen = any microorganism capable of producing an illnessproducing an illness
Hand hygiene most effective method of Hand hygiene most effective method of limiting transmissionlimiting transmission
Immunization = resistance to an infectious Immunization = resistance to an infectious disease is produced or augmenteddisease is produced or augmented
Environment Safety Cont’d.Environment Safety Cont’d.
PollutionPollution Air Air Land Land Water Water Noise Noise
TerrorismTerrorism BioterrorismBioterrorism
Risks at Developmental StagesRisks at Developmental Stages
Infant, Toddler, Preschool: Injuries are the Infant, Toddler, Preschool: Injuries are the leading cause of death in children over leading cause of death in children over age 1age 1
School aged child: Sports injuriesSchool aged child: Sports injuries Adolescent: Risk taking behaviorsAdolescent: Risk taking behaviors Adult: Lifestyle habitsAdult: Lifestyle habits Older Adult: Physiological changes result Older Adult: Physiological changes result
in increased risk for falls, burns, MVAsin increased risk for falls, burns, MVAs
Individual Risk FactorsIndividual Risk Factors
LifestyleLifestyle Impaired MobilityImpaired Mobility Sensory or communication ImpairmentSensory or communication Impairment Lack of Safety AwarenessLack of Safety Awareness
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Risks in the Health Care Risks in the Health Care AgencyAgency
3 Types of medical errors accounted for almost 60% of 3 Types of medical errors accounted for almost 60% of the client safety incidentsthe client safety incidents Post-op infectionsPost-op infections Bed soresBed sores Failure to diagnose and treat in timeFailure to diagnose and treat in time
Medication errors Medication errors FallsFalls Patient-Inherent Accidents: self-inflictedPatient-Inherent Accidents: self-inflicted Procedure-related Accidents: occur during therapyProcedure-related Accidents: occur during therapy Equipment-related Accidents: malfunction, disrepair, or Equipment-related Accidents: malfunction, disrepair, or
misusemisuse
Safety and the Nursing ProcessSafety and the Nursing Process
AssessAssess Activity and exerciseActivity and exercise MedicationsMedications History of fallsHistory of falls Home maintenance and safetyHome maintenance and safety
Nursing DiagnosisNursing Diagnosis Risk for injuryRisk for injury
Related to:Related to: General weaknessGeneral weakness Right or Left sided weaknessRight or Left sided weakness Side effects of medicationSide effects of medication Poor eyesightPoor eyesight
As evidenced by:As evidenced by: Recent fallsRecent falls New CVANew CVA ConfusionConfusion Macular degenerationMacular degeneration
ImplementationImplementation
Nursing DiagnosisNursing Diagnosis Risk for injury related to (r/t) generalized weakness as Risk for injury related to (r/t) generalized weakness as
evidenced by recent fallsevidenced by recent falls GoalGoal
Pt. will ask for help to the bathroomPt. will ask for help to the bathroom Pt. will remain free from injury during hospitalizationPt. will remain free from injury during hospitalization
InterventionsInterventions Nurse will ensure call light is in reachNurse will ensure call light is in reach Nurse will work with other care providers to make Nurse will work with other care providers to make
sure patient is seen every hoursure patient is seen every hour Nurse will work with other care providers to ensure pt. Nurse will work with other care providers to ensure pt.
receives required assistance with ADLs/activitiesreceives required assistance with ADLs/activities
Use of Restraints in the Health Use of Restraints in the Health Care SettingCare Setting
Physical or chemical means of stopping a Physical or chemical means of stopping a patient from being free to move.patient from being free to move. 4 bedrails up is considered a restraint4 bedrails up is considered a restraint
Used only in emergency situations to Used only in emergency situations to ensure the patient’s safety.ensure the patient’s safety.
Restraint orders must be specific and Restraint orders must be specific and time-limited.time-limited.
Other Mechanisms to Other Mechanisms to Prevent FallsPrevent Falls
Tab AlarmsTab Alarms Arm BandsArm Bands ID outside of Patient roomID outside of Patient room Notice Inside the Patient roomNotice Inside the Patient room Colors of gowns, slippers, blanketsColors of gowns, slippers, blankets Bed AlarmsBed Alarms Chair AlarmsChair Alarms
Restraint UseRestraint Use
Must have a physician orderMust have a physician order
Order must be rewritten every 24h.Order must be rewritten every 24h.
Restraint policies are specific to health Restraint policies are specific to health care setting care setting
Nursing documentation must occur at least Nursing documentation must occur at least every two hoursevery two hours
Complications from RestraintsComplications from Restraints
Skin breakdownSkin breakdown ConstipationConstipation PneumoniaPneumonia IncontinenceIncontinence Urinary retentionUrinary retention Nerve damageNerve damage Circulatory damageCirculatory damage
Other Safety IssuesOther Safety Issues
FiresFires PoisoningPoisoning Electrical HazardsElectrical Hazards Seizure precautionsSeizure precautions Radiation safetyRadiation safety Bioterrorist attackBioterrorist attack Bomb threatsBomb threats
Patient HygienePatient Hygiene
Oral CareOral Care BathingBathing ShavingShaving Hair careHair care Perineal carePerineal care Foot careFoot care Bed making Bed making
Occupied/unoccupiedOccupied/unoccupied
GoalGoal What is the goal of hygiene in the health What is the goal of hygiene in the health
care setting?care setting?a)a) Moving the patient to a higher level of healthMoving the patient to a higher level of health
b)b) Check the box on the nursing Check the box on the nursing documentation sheetdocumentation sheet
c)c) Prevent InfectionPrevent Infection
d)d) All of the aboveAll of the above
Self-AssessmentSelf-Assessment
Have you ever Have you ever bathed another bathed another adult person?adult person?
Someone not in Someone not in your family?your family?
Why is Hygiene Important?Why is Hygiene Important?
Personal hygiene affects a patient’s Personal hygiene affects a patient’s comfort, safety, and sense of well-being.comfort, safety, and sense of well-being.
A variety of personal, social, and cultural A variety of personal, social, and cultural factors influence hygiene practices.factors influence hygiene practices.
Factors Influencing HygieneFactors Influencing Hygiene
Physical ConditionPhysical Condition Ability to care for selfAbility to care for self Energy levelEnergy level Sensory deficitsSensory deficits Incontinence of urine and/or stoolIncontinence of urine and/or stool Dexterity and ROMDexterity and ROM Sedation, Pain levelSedation, Pain level Chronic illnessesChronic illnesses Psychiatric conditionsPsychiatric conditions
Factors Cont’d.Factors Cont’d.
Social practicesSocial practices Personal preferencesPersonal preferences Body imageBody image Socioeconomic statusSocioeconomic status Health beliefs and Health beliefs and
motivationmotivation Cultural variablesCultural variables
AssessmentAssessment Skin: wounds, infectionSkin: wounds, infection Feet and Nails: PVD, diabetic patient with foot Feet and Nails: PVD, diabetic patient with foot
issues, foot fungus around toe nailsissues, foot fungus around toe nails Patients with poor circulation to the feet and lower Patients with poor circulation to the feet and lower
legs needs close assessment of those areaslegs needs close assessment of those areas
Oral Cavity: condition of the mouth and teethOral Cavity: condition of the mouth and teeth Hair: tangles, liceHair: tangles, lice Eyes, Ears, and Nose: Does the patient have Eyes, Ears, and Nose: Does the patient have
any sensory deficits?any sensory deficits?
Critical EvaluationCritical Evaluation
What is the ability of the person to care for What is the ability of the person to care for themselves?themselves? Physical disabilitiesPhysical disabilities Mental disabilitiesMental disabilities
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Specific Issues Needing to be Specific Issues Needing to be Addressed at Bath TimeAddressed at Bath Time
Foot careFoot care Normal vs DiabeticNormal vs Diabetic Do not soak feet of patients with DM and/or Do not soak feet of patients with DM and/or
vascular insufficiencyvascular insufficiency
Sensitive skinSensitive skin InfestationsInfestations InfectionsInfections IncontinenceIncontinence
Types of BathsTypes of Baths
Complete bed bathComplete bed bath Partial bed bathPartial bed bath Sponge at the sinkSponge at the sink Tub bathTub bath ShowerShower Bath in a bagBath in a bag
Critical EvaluationCritical Evaluation
Are there any cultural issues that need to be Are there any cultural issues that need to be addressed prior to bathing?addressed prior to bathing?
What is your patient’s developmental status?What is your patient’s developmental status? Teen, Young adult, Adult, Older Adult, ElderlyTeen, Young adult, Adult, Older Adult, Elderly
How does that affect their hygiene needs and How does that affect their hygiene needs and attitudes?attitudes?
What do you do with this information about the What do you do with this information about the patient?patient? Care PlanCare Plan
Critical EvaluationCritical Evaluation Involve patient as much as possible in Involve patient as much as possible in
bathing decisionsbathing decisions WhenWhen WhereWhere TypeType
TubTub ShowerShower Bed bathBed bath
Nursing DiagnosisNursing Diagnosis
BATHING/HYGIENE SELF-CARE DEFICIT: BATHING/HYGIENE SELF-CARE DEFICIT: R/T CONFUSION: AEB POOR PERSONAL R/T CONFUSION: AEB POOR PERSONAL HYGIENEHYGIENE
BATHING/HYGIENE SELF-CARE DEFICIT: BATHING/HYGIENE SELF-CARE DEFICIT: R/T DECREASED CEREBRAL CIRCULATION R/T DECREASED CEREBRAL CIRCULATION (RECENT CVA) AEB RIGHT SIDED (RECENT CVA) AEB RIGHT SIDED WEAKNESSWEAKNESS
Oral CareOral Care
Oral care is an essential nursing interventionOral care is an essential nursing intervention Assess for decreased saliva, infection, coated Assess for decreased saliva, infection, coated
tongue, cracked lipstongue, cracked lips Brush all tooth surfaces using a soft bristle brushBrush all tooth surfaces using a soft bristle brush Observe for complications such as bleeding gumsObserve for complications such as bleeding gums
Oral care for the patient who is not consciousOral care for the patient who is not conscious Oral care for the patient with partial paralysis of Oral care for the patient with partial paralysis of
the mouththe mouth Oral care for the patient who has had mouth Oral care for the patient who has had mouth
surgery or injurysurgery or injury
OtherOther Hair Care:Hair Care: Gather supplies (plastic trough, Gather supplies (plastic trough,
towels, shampoo, drainage wash basin)towels, shampoo, drainage wash basin) Shaving:Shaving: Check doctor’s orders Check doctor’s orders
AnticoagulantsAnticoagulants Perineal CarePerineal Care (see page 877) (see page 877)
IndependentIndependent Needs assistNeeds assist Dependent Dependent
Foot Care Foot Care (see page 880)(see page 880) Do not soak feet of patients with DM and/or vascular Do not soak feet of patients with DM and/or vascular
insufficiencyinsufficiency
Care of Patient with Sensory AidsCare of Patient with Sensory Aids
Glasses/Contacts (pg. 894)Glasses/Contacts (pg. 894) Dentures (pg. 891)Dentures (pg. 891) Hearing Aids (pg. 895)Hearing Aids (pg. 895) Prosthetic EyesProsthetic Eyes
Basic PrinciplesBasic Principles
Remember body mechanicsRemember body mechanics Raise the bed to a comfortable heightRaise the bed to a comfortable height
Follow medical asepsis when making a Follow medical asepsis when making a bedbed Wear gloves if linen is soiledWear gloves if linen is soiled Keep linen away from uniformKeep linen away from uniform Do not place soiled linen on the floorDo not place soiled linen on the floor
Bed Making – Bed Making – Occupied/UnoccupiedOccupied/Unoccupied
LinenLinen Use appropriate linen for the patientUse appropriate linen for the patientChucks and linen saversChucks and linen saversDraw sheetsDraw sheetsTherapy bedsTherapy beds
Learn to place a bottom flat sheet when there Learn to place a bottom flat sheet when there are no fitted sheetsare no fitted sheets