Patient Safety, Fall Prevention, and Restraints Lecture
1. Equipment and Electrical Safety
General Equipment Handling
Inspect all items prior to use for cracks, chips, sharp edges, or fraying.
Report broken or malfunctioning equipment to the nurse immediately; do not attempt repairs.
Clean floor spills immediately to prevent slips and falls without waiting for housekeeping.
The Safe Medical Devices Act mandates reporting equipment-related illnesses, injuries, and deaths.
Electrical Safety Guidelines
Three-Prong Plugs: Two prongs conduct electrical current; the third prong serves as the ground, directing stray electricity safely to the earth.
Do not use two-prong adapters, frayed cords, or overloaded outlets.
Hospital bed power cords must connect directly to a wall outlet (avoid extension cords and power strips for critical care devices).
Turn off appliances prior to unplugging; grasp the plug body rather than pulling the cord.
Never handle electrical equipment with wet hands or near standing water.
Bariatric Equipment
Standard hospital equipment typically has a weight capacity of .
Bariatric equipment is labeled as EC (Expanded Capacity) and designed to accommodate patients weighing from to over .
2. Hazardous Chemicals and OSHA Standards
Hazard Classification
Physical Hazards: Chemicals causing fires or explosions.
Health Hazards: Chemicals causing systemic toxicity, organ damage, skin/eye damage, or cancer (carcinogens).
OSHA Hazard Communication Standard
Focuses on worker and workplace safety through container labeling, Safety Data Sheets (SDS), and employee training.
Safety Data Sheets (SDS) contain chemical ingredients, hazards, emergency first-aid measures, spill handling, and required personal protective equipment (PPE).
Chemical containers must be labeled with hazard pictograms; never transfer chemicals into unmarked containers or beverage bottles.
Never mix chemical cleaning products (e.g., combining bleach and ammonia creates lethal toxic gases).
3. Disaster, Fire Safety, and Elopement
Fire Fundamentals
Fire requires three elements: heat/spark, fuel (flammable material), and oxygen.
Oxygen precautions: place "Oxygen in Use" signage, ban smoking and open flames, remove wool/synthetic fabrics prone to static, and dress the patient in cotton garments.
Emergency Response Acronyms
RACE (Fire Action Protocol):
R (Rescue): Move individuals in immediate danger to safety.
A (Alarm): Activate the fire alarm system and call emergency services.
C (Confine/Contain): Close all doors and windows; turn off oxygen supplies and local electronics.
E (Extinguish): Extinguish small, localized fires if safe to do so.
PASS (Fire Extinguisher Protocol):
P (Pull): Pull the safety pin to unlock the lever.
A (Aim): Aim low at the base of the fire.
S (Squeeze): Squeeze the handle lever to release extinguishing agent.
S (Sweep): Sweep nozzle side to side across the base of the flames.
Elopement Protocols
Definition: When an individual leaves a safe care facility without staff knowledge or supervision.
Prevention includes monitoring high-risk residents (e.g., those expressing an intent to go home or pacing near exits), applying electronic sensor bracelets, posting photos at nursing stations, and conducting regular elopement drills.
4. Workplace Violence, Risk Management, and Identification
Workplace Violence Prevention
Maintain an unblocked path to the door; never let an agitated individual get between you and the exit.
Keep hands free, speak in a calm tone, avoid defensive body language (do not glare, point fingers, or place hands on hips), and avoid touching an agitated person.
Remove dangling items (ties, scarves, lanyards, long jewelry) that could be used for choking or grabbing.
Risk Management
Tracks incident trends, medication errors, and injury patterns to modify facility policies and staffing levels.
Incident reports must be completed promptly after errors, accidents, or falls; they are safety tools rather than punitive records.
Standard Color-Coded Wristbands
Red: Allergy Alert.
Yellow: Fall Risk.
Purple: Do Not Resuscitate (DNR).
Pink: Limb Alert (restricted arm for blood pressure, blood draws, or IV lines).
5. Fall Prevention and Mobility Assistance
Fall Risk Factors
Age over , history of previous falls, cognitive impairment, balance disorders, incontinence/urgency, polypharmacy, and unfamiliar environments.
General Fall Prevention Measures
Maintain the bed in its lowest position; place floor cushions/mats next to the bed if indicated.
Keep personal items, urinals/commodes, and the call light within direct reach.
Keep hallways and rooms well lit and free of clutter or throw rugs; enforce slip-resistant footwear.
Respond immediately to call lights and chair/bed position alarms.
Bed Rails & Enablers
Bed rails can cause severe hazards, such as entrapment and strangulation.
Raising all four bed rails restricts egress and is legally classified as a physical restraint (requires a physician's order).
If bed rails are requested by a competent patient to assist with repositioning, they function as enablers and require written consent.
Transfer and Gait Belts
Always apply the belt over clothing around the natural waist, never on bare skin.
Ensure the buckle is placed off-center (avoid placing directly over the spine) and keep excess strap tucked in.
Never use a gait belt on patients with abdominal incisions, colostomies, gastrostomy tubes, or severe respiratory conditions without explicit nurse authorization.
Assisting the Falling Person
Never try to stop a fall or catch a falling patient; doing so risks severe musculoskeletal injuries to both staff and resident.
Guide the person down: bring the resident close to your center of gravity, ease them down your extended leg to the floor, and shield their head.
Post-Fall Procedure: Keep the resident on the floor. Do not move or transfer them back to bed until a full physical assessment is completed by the nurse.
6. Restraint Guidelines and Safe Use
Regulations & Principles
Restraints are strictly regulated by CMS and the FDA and may never be used for discipline or staff convenience.
Restraints require a specific, time-limited physician's order detailing the medical symptom, type of restraint, body site, and duration.
In an emergency, a nurse can initiate restraint application, but an order must be obtained immediately afterward.
Unlawful or non-indicated restraint constitutes false imprisonment.
Restraint Alternatives (First-Line Measures)
Frequent observation and redirection.
Scheduled toileting and meeting hydration/nutrition needs.
Use of low beds, floor cushions, wandering barriers, and position alarms.
Meaningful social diversion, calming music, back rubs, and family visits.
Restraint Types
Physical: Vest, jacket, belt, wrist/ankle limb holders, and mitts.
Chemical: Medications given outside standard treatment protocols to control behavior or limit movement.
Application and Monitoring Standards
Attach straps to non-movable portions of the bed frame using a quick-release knot or quick-release buckle (never tie to bed rails).
Maintain proper fit: allow a flat hand to fit comfortably beneath chest/waist restraints, or one to two fingers beneath limb restraints.
Observation: Check the resident at least every for circulation, breathing, pulse, skin integrity, and distress.
Release and Care: Release the restraint at least every for a minimum of to provide skin care, toileting, hydration, vital sign checks, and range of motion (ROM).
Emergency Precaution: Keep safety scissors in your pocket to immediately sever straps if strangulation or acute airway compromise occurs.