CH. 13 - Safety

Joint Commission Safety Goals for patients

1. identify the patient by name & DOB 2. Improve staff communication 3. use medicines safely 4. use alarms safely (prevent falls) 5. prevent infections 6. identify patient safety risks 7. prevent mistakes in surgery

Unsafe patient environment

1. age & ability to understand 2. impaired mobility (unsteady gait) 3. communication (language barrier) 4. pain & discomfort 5. delayed assistance 6. equipment

call light

answer ASAP

restraints

must have an order from the physician; must be removed every 2 hrs; order only good for 24 hrs., check on the patient every 30 minutes

fall assessment

done upon admission; high risk, moderate risk, low risk; put the patient by the nurse's desk if pt. is at risk for falls

vest restraint

A type of restraint that consists of a sleeveless jacket with tails; the

tails are tied to the bed frame under the mattress or to the back of a

chair

waist restraint

used to protect a pt. from getting out of the wheelchair and falling

extremity restraint

-Foam padding that is applied to wrist or ankle

-Wrap around limb with soft part facing skin; use Velcro strap to support device

-Make sure you can sleep 2 fingers between restraint and patient's wrist/ankle

-Secure to stationary part of bed

mitt restraint

applied to the person's hand to restrict finger movement; prevents the person from grasping tubes or catheters, but allows for more freedom of arm movement than a wrist restraint

restraint alternatives

monitors, soft devices, stratgies

patient in restraints

must stay with patient the whole time they are out of their restraints; can be delegated to a CNA if they are supervised; during the time they are out of restraints see if they need to go to the bathroom, change position in the bed, skin assessment, ambulate if possible; make sure to check for 2 fingers between the skin & restraint, use a quick release knot

chemical restraints

prevent anxiety or restlessness in the patient

R.A.C.E.

R-rescue the patient; A-alarm sounded; C-confine the fire; E-extinquish with a fire extinquisher

P.A.S.S.

P-pull the pin; A-aim at the base of the fire; S-squeeze the handle; S-sweep back & forth; know the fire codes for your facility

Type A fire extinquisher

paper, wood, fabric, trash

Type B fire extinguisher

Fire extinguisher used for flammable substances such as grease, oil, or gas fires.

Type C fire extinguisher

electrical fires

Type D fire extinguisher

Combustible metals

Type K fire extinguisher

Kitchen fires due to combustible cooking fluids such as oils and fats

when to start CPR

1. call a code blue 2. start CPR & keep doing it until the code team arrives

Mass Casualty Incident (MCI)

An influx of patients that overwhelms a hospital and affects its capability to care for patients.

Bioterrorism

the use of biological and chemical weapons in the water or air

Nursing Hazards

blood borne pathogens, needles, assault, emotional abuse, chemicals, back injuries

body mechanics

the proper use of the body to facilitate lifting and moving and prevent injury; feet shoulder width apart, use your center of gravity, bend knees

Radiation Hazard

implantable radiation; minimize exposure

MSDS (Material Safety Data Sheet)

Provides communication to workers regarding chemicals used in the office

oxygen

no smoking; static electricity can start a fire; sheets & gowns burn; fire burns hotter & faster

Biological Hazards

wear gloves & googles if necessary, be careful for needle sticks this is how HIV & HEP B spread in the healthcare arena; NEVER recap a used needle; wash hands before and after patient exposure; use SHARPS containers for needles

Actions to restart the heart or breathing in an unresponsive victim who has no pulse or respirations

Cardiopulmonary resuscitation (CPR)

A monitor that attaches to the patient and generates an alarm when the leg is in a dependent position

Leg monitor

Less restrictive ways to help patients remember not to get up or to alert the nursing staff if the patient is attempting to do so

Restraint alternatives

Walk

Ambulate

Public health or medical emergency that involves thousands of victims

Mass casualty event (MCE)

Breathing for a person in respiratory arrest who still has a pulse

Rescue breathing

Pressure-sensitive device that generates an alarm when the patient's weight is no longer sensed

Chair or bed monitor

An action to relieve choking by thrusting just below the xiphoid process

Heimlich maneuver

The _____________ is the organizational responsible for evaluation and accrediting health-care organizations and programs in the United States

The Joint Commission

A form that gives a numerical rating for each patient's risk for falls is called a _________________

Fall assessment rating scale

__________ are vests, jackets, or bands with connected straps that are tied to the bed, chair, or wheelchair to keep the patient safe

Restraints

A group of specially trained personnel designated to response to codes throughout the hospital is the _____________

Code team

__________________ refers to the movement of the muscles of the body for balance and leverage

Body mechanics

The middle point of the body, below the umbilicus and above the pubis, around which its mass is distributed is the ____________

Center of gravity

The _____________ refers to the feet and lower legs

Base of support

A document that contains information about potential harm caused by exposure to a chemical and the directions for what to do if the product gets on your skin or in your eyes or your mouth is called a __________________

Safety data sheet

If you were assigned for care for Mrs. Lloyd, the patient described in the Clinical Connection, which of the following would be your first priority?

Assessing risks to her safety and implementing strategies to minimize them

You have delegated the checks and releases of a patient who requires wrist restraints to an unlicensed assistive personnel (UAP). You have been very busy with other patients all morning. The patient's wife finds you and says that her husband is very restless and has not been to the bathroom for 6 hours. What action will you take?

Go yourself and assess the situation as you release the patient and assist him to the bathroom

Even if you delegate checks and releases, what are your responsibilities when a patient must be restrained?

Follow up every 2 hours to be sure the patient is released from restraints and has been checked on every 30 minutes

If you were at a hospital for clinical experience and a mass casualty event (MCE) occurred in your city, how could you and your fellow nursing students be of help?

By participating in the hospital's disaster plan, performing duties as assigned, within your scope as a student

When injured people come into the hospital after an MCE, if they are unable to provide you identification, what information can be used to help others identify them?

Hair color

Clothing

Approximate age

Gender

When a patient in a home setting uses supplemental oxygen, what teaching should you provide?

No one can smoke in the same room as the oxygen source

No candles can be burned in the same room as the oxygen source

Patients using oxygen should not use wool blankets or wear wool sweaters

If a patient who is at risk for falls has a bad or chair alarm in place, you will:

Check on the patient frequently, ensuring it is in place and turned out

Before applying restraints to any patient, you must first take which steps?

Try using restraint alternatives without success

Identify the need for restraints to prevent harm to the patient

Obtain a health-care provider's order for the type of restraint and the length of time it is to remain in place

The National Patient Safety Goals are established by what organization?

The Joint Commission

Hospitalized patients often have impaired mobility, causing risk for injury because of what reason(s)?

They may be weak as a result of surgery or bedrest

Which of the following factors contribute to an unsafe environment for hospitalized patients?

Age

Impaired mobility

Communication

Pain and discomfort

Equipment in the room

How are fall assessment scales used?

To predict the patient's risk for falls while in the hospital

Pressure-sensitive device generating an alarm when the patient's weight is no longer sensed

Monitor

A device that fits across the patient's lap while he or she is sitting in the wheelchair

Soft device

Providing backrubs, music, or television as a distraction for a patient who should remain seated or in bed

Strategy

Bolsters placed on either side of the patient to prevent entrapment between the side rails

Soft device

Keeping the bed at the lowest level at all times except when the staff is at the bedside

Strategy

Placing an overbed table across the wheelchair like a tray to keep the patient from getting up

Strategy

A device that attaches to the patient's upper leg and generates an alarm when the leg is in a dependent position

Monitor

You walk into a patient's room and discover that he has fallen in the bathroom. What will you do first?

Check the patient for any obvious injuries, including hip fracture and paralysis

How often must you or an assistant check on a patient who is restrained?

Every 30 minutes

When a patient is released from wrist restraints, which assessments will you make?

Assess the hands and wrists for edema

Check capillary refill time in the fingers bilaterally

Assess the patient's ability to move and feel sensations in the arm and hand

Assess the skin of the wrists for any open areas

Assess the skin under the restraints for redness

What has been a cause of death for patients who were retrained?

The restraint was applied incorrectly, which caused choking

What must you always do when you apply restraints?

Tie them in a quick-release knot

If you are in the hospital for clinical experience and you hear "Code Red" called over the intercom followed by a location in another wing of the hospital, what will you do?

Close the patient room doors and remain in your area, following facility policy

If you needed to extinguish a fire in the motor of an electric hospital bed, the type of fire extinguisher you obtain would need to be marked with which classification of fire?

Type C

In the event of an MCE, guidelines have been established for shifting standards of care. What do these include?

Treating those most likely to survive first

To practice good body mechanics, you would:

Turn your whole body or pivot on one foot, but avoid twisting

Bend your knees, not your back, to life an object from a low shelf

How can nurses avoid being harmed by radiation exposure?

Wear a lead apron during x-ray and fluoroscopy procedures

Limit the time you spend with patients who have internal or implanted radiation