Safety, Mobility, & Hygiene

Big Picture: Creating a safe, aseptic environment

• patients rights (to be informed and privacy

• patient identification (name and DOB)

• prevent falls

• prevent infection

• use equipment safety & correctly

• know where safety equipment is kept

Which organization follows patient safety and develops the NPSGs?

Joint Commission

Contributing factors with fall prevention

• motor disability

• improperly fitted canes and walkers

• wheelchairs

• environmental hazards

• frailty

• polypharmacy

• multi-morbidities

3 reasons patients get out of bed

1. pain

2. potty

3. position

Postural hypotension

sitting the patient on the side of the bed and slowly getting them to stand this way the patient doesn’t move too quickly and get dizzy

Universal risk reduction

• Call light & physical & sensory assistive devices within reach

• Hourly rounds

• Well-lit patients areas

• Bed/chair wheels locked & in low position

• Clean spills immediately

• Bed rails locked

• Non-skid socks

• Clutter-free room

• Change positions slowly - “dangle”

High Risk Patient risk reductions

• Close to nurse station

• Sitter

• Bed-chair alarms

What do we do if we find a patient that has fallen or if we witness a fall?

Assessment of patient, safety, get help

if activity falling- lowering to the ground

Restraint

any device or substance that limits movement of patients

Restraint order time lengths

Behavioral- good for 4hrs

Surgical/Medical- good for 24hrs

Precautions used to prevent injury in patients that are restrainted

• attach on immobile bed frame

• 2 finger breaths (for circulation)

• Quick release buckle/tie (slipknot)

• every 2hrs, release restraint (one at a time)

Assess: Skin integrity, pulses, skin temp, color, sensation

Interventions: reposition, toileting, hydration & nutrition, re-evaluate need for restraints

Fire Safety: RACE

Rescue

Activate Alarm

Contain

Evacuate

Fire Safety: PASS

Pull Pin

Aim at base

Squeeze

Sweep

Interventions for patient having a seizure

• AIRWAYS

  • position on side

  • nothing in the mouth

• Remove objects that could cause injury

  • glasses

  • tight clothing/scarves

• Time the seizure

• Bed in low position

• Pad side rails

• Suction and Oxygen for after seizure

Importance of using mechanical lifts

• potential for injury is reduced

• lessens patient anxiety

• more comfortable- less forceful

• patient dignity/self-esteem maintained

• equipment can match their own ability

  • contributes to patient autonomy

supine

prone

right lateral recumbent

left lateral recumbent

fowler’s- 90 semi fowler’s- 30-45

trendelenberg

sims’

Skin Integrity

1st line of defense against infection

Assess

• Braden Scale

• Skin condition, nutrition, hydration, age, smoking, medication, co-morbidities

Intervent

• prevention is KEY

• address underlying issue- nutrition, hydration, hygiene, lotion

Evaluate

Reddened areas

non-blanched = pressure related (stays red)

blanched = moisture-related (turns white)

Positioning

• bed controls

• pillows

• wedge pillows

• abductor pillows (after hip replacement)

preventing deconditioning and deep vein thrombosis (DVT)

EBP: Early non-pharm & pharm prophylaxis

• early ambulation

• TED (Thrombo-embolic deterrent) hose

• SCDs (sequential compression device)/ ALPs Alternating leg position

• Heparin (use 2nd)

Performing range of motion exercises: when stable

• move them slowly to a seated position on the bed

• “Dangle”

• Gait belt

• Stand up

• Start slow

Performing range of motion exercises: when unstable

• passive ROM

  • performed by caregiver

  • support extremity

  • never force past comfort level

• active assisted

  • can move with assistance against gravity

• active ROM

  • able to move against gravity

Contraindications for wearing either elastic stocking or SCDs

• dermatitis

• open wounds

• recent skin graft or surgery to legs

• decreased arterial circulation in lower extremities

• signs & symptoms of a DVT

guide lines for providing personal hygiene to patients

• privacy-draping

• cultural sensitivity

• preferences of who, when, what, etc

• encourage participants throughout

• avoid wounds- follow wound care orders

medical aseptic technique for bed bath

• perform hand hygiene & don gloves

• Offer bedpan or urinal FIRST

• do NOT disconnect IV to remove gown

• use new wipe for each area

Chlorhexidine (CHG)

ICU,CVICU, Pre op, Central line

only from neck down (not on face or private areas)

Bathing tips

Female patients: clean front to back

Male patients: replace foreskin

precautions for tub bath or shower

Falls

• call lights

• handles/chair

• grip strips

• towels/needs within reach

Infection Control

• clean between patients

• shower chairs

  • bucket under seat

  • clean the underside

guidelines for oral hygiene

includes teeth, gums, tongue, mucous membrane

• prevent inflammation, infection

• promotes ease of swallowing, comfort & ease of communication

provide based on patient’s need

Oral hygiene of Unconscious Patients

High risk

• dry mucous membrane

• thickened secretions

• inability to eat or drink

• aspiration ex

  • 2 people- 1 for suctioning

  • side-lying position

if unable to keep mouth open, use oral airway- not your fingers

Hair care

Scalp, facial hair, body hair

• traditional shampoo & water

• disposable dry shampoo cap

• combing/shaving

Shaving

be aware of blood thinners & blood disorders

disposable razor= 1 use

• towel over chest

• shaving cream

• 45 degree angle- pull skin taut

• short firm stokes with grain of hair

• rinse with warm water

Nail and Foot care

*don’t cut nails of a diabetic patient*

• hand hygiene & don gloves

• soak nails in warm water

• no sharp corners

• dispose of emery board

• apply lotion- no excess

risk factor for foot and nail problems

*consult Podiatrist*

• peripheral vascular disease (PVD)

• diabetes mellitus (DM)

• Older adults

• Immunocompromised

• Foot disorder

care for eye

Assess

• Protheses- handel with care

• Comatose? No blinking

• Skin near device

Intervene

• Inner to outer canthus

• Irrigation- cool solution x 15 min, don gloves

  • goal is to reduce visual loss

  • position: side lying to side affected eye, supine for both eyes

  • retract eye lids, pt look up- do not touch eye with syringe

• Evaluate

care for ear

Assess

• Risk: tympanic membrane rupture, injury to canal, infection if not dried properly, vertigo and nausea

Intervene

• Position: sitting or lying, toward affected ear

• Pinna: up and back for adults, and for 3yrs or younger

• Gently instill- head towards affected side- allow to drain

• leave cotton ball in place 5-10 min after

Evaluate