safety & security

Factors effecting safety

Developmental considerations

Patient environments

Functional ability

Developmental considerations with safety

• Neonates (still in the womb): diet, environment, teratogens

• Infants: have more mobility which enhances chance for accidents because they are unsteady; car seats (rear-facing)

• Toddler & preschoolers: environmental, poisoning (medications), asphyxiation (drowning), abuse, choking hazards

• School age: accidents, child abduction, bullying (indirect or direct)

• Adolescents: driving, substance abuse, piercings, tattoos, firearms, social media, sex trafficking, bullying (which can cause depression, low self-esteem, eating disorders)

• Adults: drug use (look for poor judgement, personality change), poisoning, intimate partner violence.

• Older Adults: falls, motor vehicle accidents, fires, polypharmacy, poisoning, elder abuse.

Safety plan for people in an abusive situations

• keep car keys handy and car full of gas

• gather important documents and medications

• remove guns and weapons

Safety considerations for older adults

• Identify safety hazards in the environment

• Modify the environment as necessary

• Attend defensive driving courses or courses designed for older drivers

• Encourage regular vision and hearing tests

• Ensure hearing aids and eyeglasses are available and functioning

• Have operational smoke detectors in place

• Objective document and report any signs of neglect and abuse

functional abilities

mobility, sensory perception, communication, knowledge

health encompasses

physical and psychosocial

Assessing fall risk in adults

• history of falls

• assistive devices

• gait

• knowledge of the home environment (layout)

• vision and hearing

• medications (side effects can be orthostatic hypotension)

• cognition (AOX4)

• Do they live by themselves? Is family close by?

Patient outcomes for safety

• Identify real and potential unsafe environmental situations

• Implement safety measures in the environment

• Use available resources for safety information

• Incorporate accident prevention practices into ADLs

• Remain free of injury

• Orienting the Person to Surroundings

• Preventing Falls in the Health Care Facility

• Using Restraints in Health Care Facilities

Physiologic Hazards Associated With Restraints

• Increased possibility of serious injury due to fall

• Skin breakdown

• Contractures

• Incontinence

• Depression

• Delirium

• Anxiety

• Aspiration and respiratory difficulties

• Death

Restraints

• limit movement of the patient

• ties on ankle and wrists

• chemical restraints like drugs

• Side rails, geriatric chairs with attached trays, and appliances tied at the wrist, ankle, or waist are types of physical restraints

RACE

R—Rescue anyone in immediate danger.
A—Activate the fire code and notify appropriate
person.
C—Confine the fire by closing doors and windows.
E—Evacuate patients and other people to safe area.

Procedure-Related Accidents/Possible Errors

• Administering medications or intravenous solutions

• Transferring a patient

• Changing a dressing

• Applying external heat to a patient’s extremity

Safety Event Reports

• Must be completed after any accident or incident in a health care facility that compromises safety

• Describes the circumstances of the accident or incident

• Details the patient’s response to the examination and treatment of the patient after the incident

• Completed by the nurse immediately after the incident

• Is not part of the medical record and should not be mentioned in documentation

Health teaching in schools

• Monitor the child’s use of the Internet

• Get involved in school activities and ask pertinent questions

• Volunteer for safety committees that include staff and parents

• Ensure that the school’s emergency preparedness plan is current