Unit 4 Physical Safety

Safety

Freedom from risk or occurence of injury

Importance of Safety

Most accidents are preventable, safety for both the patient and the nurse, hospitals pay for the costs of patients who fall during their hospitalization

Initiatives to Provide For Patient Safety

Institute of Medicine (IOM) reports, National Patient Safety Goals 2024 (NPSG), Rapid Response Teams, Hospital Incident Command System (HICS), NIOSH (Safe Patient Handling Guidelines)

Institute of Medicine Report (IOM)

Create policies and reports for hospital accidents (which decrease healthcare costs when there are no injuries)

National Patient Safety Goals (2024)

Ex; using 2 identifiers with patient, SBAR (the standard for hospital communication), 3 checks when giving medication, decreasing risk of injury for falls

Rapid Response Team

Created to improve response to patients’ condition

HICS (Hospital Incident Command System)

Created to organize a plan during a disaster- Interval and External Disasters

NIOSH (Safe Patient Handling Guidelines)

Keeps nurses safe, ex; no lifting patients over 25 pounds » must use Hoyer lift

Contributing Factors

Chemical, Developmental, Physical/Enviornmental, Physiological, Psychosociocultural

Chemical

Inhaling or skin contact, ex; medications- opiods, sedatives, diuretics, oxygen, anti-hypertensive (orthostatic hypo), anticoagulants, recreational drugs, anesthesia

Developmental

Very young and very old, individuals w/ cognitive issues

Physical / Environmental

Ex; unsafe equipment (wheelchairs, stretcher), confusing unit floor plan, cluttered room — (Beware of fires)

Physiological

Ex; impaired mobility (paralysis, poor balance, in pain, fatigued, seizure, orthostatic hypo, poor sensory perception)

Ex; Unable to communicate (aphasia, aspiration)

Psycho-socio-cultural

Ex; depression, language barrier, cultural preferences, decreased attention span, anxiety or panic state

Clinical Manifestations

Physical Injury, Health Setting, Psychological Response

Physical Injury

Tissue trauma (identify with LAS & look for entry port)

Bleeding

Burns » diaper rash » urine can cause burn

Airway obstruction » Position in bed (supervised meal times)

Compromised circulation

Health Setting

Not always the safest (a lot of bacteria)

Psychological Response

Fear, Anxiety, Dependency

Analysis

Use nursing judgment based on critical thinking and clinical reasoning to identify relevant nursing diagnosis. What nursing diagnoses can you identify based on contributing factors?

Nursing Interventions (Safety)

Basic Measures, Specific Measures

Basic Measures

Ongoing risk identification, orient and educate patient and family, use correct “body mechanics”, implement safety measures based on specific contributing factors

Ongoing risk identification

By hourly rounding, using 2 patient identifiers

Correct Body Mechanics

Lift with legs, NOT back.

No BLT (bending, lifting, and twisting). If lifting, lift with your core

Implementing a Safe Environment

Correct footgear when ambulating (nonskid socks), wear corrective eyewear (if possible), hearing aids, use adequate lighting, all equipment should have tag/sticker (indicates if it has been serviced and is in good working condition), floor free of spills and clutter, call bell within reach, bed is in lowest position always, safe handling of sharps, 3 side rails on the bed (all 4 is considered a restraint)

Specific Measures

What would the nurse include in a plan of care to maintain safety for a patient dealing with certain issues

Confusion

Continually orient patient (ex. — you are in the hospital, here is your call bell, my name is… I am your nurse. Etc) Remove harmful objects

Impaired Mobility

Keep necessary objects within their reach (glasses, dentures, etc.), asess vitals — could have orthostatic hypo, use nonskid socks, walker, assistive devices, Hoyer lift

Impaired Sensory Perception

Don’t use too hot or too cold water, limit use of heating pad, make sure glasses and hearing aids are in use (if applicable)

Increased Risk of Bleeding

Patients on anti-coagulants, aspirin at risk. Monitor for ecchymosis (bruising), hematoma (blood clotting, bulging under the skin), hematuria (blood in urine), melena (blood in stool), and petechial spots (pen prick-sized clots on the skin). Avoid puncturing the skin (use a soft toothbrush because gums can bleed)

Restraints

Definition: Protective device to limit physical activity of patient or part of the body. Used to prevent falls, keep in IV therapy, prevent scratching, or combative patients. They can cause more agitation and skin tears.

Restraint Types

Physical, Chemical

Physical Restraints (Level 1)

Wrist, mitts (depends on hospital) vests (Posey), leathers, waist, etc.

Chemical Restraints (Level 2)

Medication (ex; Ativan), narcotics, sedatives

Level 1 — nondestructive / nonviolent (Physical)

Used to allow for medical treatment, used for safety when patients is unable to follow directions, MD order needed every 24 hours (indication, behavioral criteria, start/end time, type of restraint)

Level 2 — destructive/violent/dangerous (Chemical)

4 point leathers, usually used in psych, MD must reorder every 4 hours

Restraint Alternatives

Assessment, put call bell within reach, ask family to come in and talk to patient (usually therapeutic and calms patient if they are non-compliant), re-orientation of patient to surrounding.

Restraint Interventions

Use minimal restraint necessary, observe every 15-30 minutes, release every 2 hours to assess site, and re-position, BLS certification is required, Assess respiration with vest restraint, Attach to bed frame (use slipknot), educate family and patient, provide nutrition, fluids, and toileting document according to hospital policy

Release every 2 hours to assess site and re-position

Assess skin, ROM, and circulation

Assess respirations with vest restraint

Could affect thorax region and respiratory expansion

Provide nutrition, fluids, and toileting

If restrained, they cannot readily do these things without help

Fire Safety

Prevention, institute fire response education, RACE, extinguish, evacuation

Prevention

Ex; if patient is on O2 — DON’T use oil-based lubricants, no smoking, cotton blankets only, all outlets in hospital are grounded (no fraying of wires), all equipment (especially electrical) is functioning properly

Institute fire response education

Code Red

Know where the fire extinguisher and fire exits are

RACE (Important)

Remove patients in immediate danger

Activate Alarm Contain the fire

Extinguish fire/Evacuate

R (RACE)

Remove patients in immediate danger

A (RACE)

Activate alarm

C (RACE)

Contain the fire

E (RACE)

Extinguish

Extinguishers

Classes; A B C

Class A Extinguishers

Paper, wood, trash

Class B Extinguishers

Liquids and gases

Class C Extinguishers

Electrical

Operation of Extinguishers

PASS; pull, aim squeeze, sweep

P (PASS)

Pull

A (PASS)

Aim

S (PASS)

Squeeze

Last S (PASS)

Sweep

Evacuation

Stay low to the ground — fire/heat rises, don’t use elevators

Evaluation (Quality Assurance / Important)

Ongoing and systematic process to improve the quality of patient care. Involves occurrence reports, sentinal event reporting, root cause analysis, and MEWS (Modified Early Warning Score)

Occurrence Reports

Documentation of all occurrences and near misses, document objectively, punitively (cannot put blame on others)

Sentinal Event Reporting

Unexpected events — serious physical and psychological injury, maybe even death. Ex; Joint Commission put into effect a list of DO NOT USE abbreviations because enough medical errors occurred due to mistaken abbreviations

Root Cause Analysis

Process of identifying deviations in practice (System and process for which the hospital carries out certain protocols and situations)

MEWS: Modified Early Warning Score

Early warning system built into the EMR. Views and ranks patient’s vital signs. Picks up or detects subtle changes in patient’s vital signs. Allows for every intervention to manage changes in vital signs. Prevents a delay in early interventions. Prevents unstable vital signs resulting in a rapid response.