Patient Safety 3

Active Shooter

• Definition: An active shooter is defined by the FBI and the Department of Homeland Security as a person actively murdering or attempting to murder multiple individuals in a group setting.

• Rising Incidence: Workplace shootings, including in healthcare settings, are on the increase across the United States.

• Preparedness Training:

  • Facilities are urged to implement action plans including active shooter training for staff.

  • Focused on three critical actions: Run, Hide, Fight.

• Training Frequency: Staff should validate their knowledge of crisis procedures at least:

  • Biannually in acute care settings

  • Annually in long-term care settings

• Emergency Drills: Conducted regularly as mandated by CMS to identify any deficiencies in the facility’s emergency response plan.

Active Shooter Priority Actions

• Run: Evacuate the area if safe to do so.

• Hide: If escape is not possible, find a secure hiding place.

• Fight: If confronted by the shooter, fight back as a last resort.

Evacuation Procedures

• When Ordered: Evacuations are initiated only if a fire cannot be extinguished immediately or if individuals are in immediate danger.

• Types of Evacuations:

  • Lateral Evacuation: Move individuals to a safe location on the same floor (preferred method).

  • Vertical Evacuation: Move individuals to another floor. Those closest to danger should be evacuated first.

• Safety Precautions:

  • Close all doors to contain fire.

  • Wrap clients in blankets with face coverings.

  • Stay low to the ground to avoid smoke inhalation.

  • Do not run or create panic.

Types of Fire Extinguishers

• Class A: For combustible materials (paper, wood, plastics).

• Class B: For flammable liquids (oils, gasoline).

• Class C: For electrical fires (computers, wiring).

• Class D: For metal fires (titanium, magnesium).

• Class K: For kitchen fires (fats and oils).

• Multipurpose: Class A, B, C extinguishers are suitable for various fires.

• Warning: Using the wrong type of extinguisher can make a fire worse (e.g., Class A on electrical fires).

Fire Safety Plan Roles

• Staff Training: Employees must understand their roles in case of an alarm, including:

  • Training on activating alarms and locating extinguishers.

  • Familiarity with emergency response procedures.

• R.A.C.E. Response:

  1. Rescue: Evacuate those in immediate danger.

  2. Alarm: Activate the fire alarm.

  3. Contain: Close doors and windows.

  4. Extinguish: Attempt to extinguish small fires with proper extinguishers.

• P.A.S.S. for Extinguisher Use:

  1. Pull: Pull the pin.

  2. Aim: Point at the base of the fire.

  3. Squeeze: Squeeze the handle.

  4. Sweep: Sweep from side to side.

Oxygen Use Safety for Clients

• Home Assessment: Nurses must assess home environments for oxygen safety risks (e.g., smoking materials, open flames).

• Education Topics:

  • Risks associated with oxygen use.

  • Importance of "No Smoking" signs.

  • Keeping ignitable materials away from oxygen sources.

  • Emergency exit plans in case of fire while oxygen in use.

Fire Safety and Rescue in the Home

• Statistics: In 2021, 353,500 residential fires caused 2,840 deaths in the U.S.

• Common Causes: Cooking, heating, electrical issues, smoking, carelessness.

• Fire Safety Guidelines:

  • Install smoke detectors and fire extinguishers on every floor.

  • Regular maintenance and battery changes for detectors.

  • Identify and practice two exit routes per room.

  • Electrical safety awareness and care.

Home Hazard Assessment

• Purpose: To evaluate safety hazards in the home and reduce risks of injury or death.

• Assessment Teams: May include nurses, occupational therapists, or physical therapists.

• Recommendations:

  • Install grip bars, non-slip strips, and use waterproof mats in bathrooms.

  • Reduce water heater temperatures to prevent scalding.

  • Keep harmful substances locked away from children.

Screening Tools for Risk Assessment

• Purpose: Identify early risk factors for diseases or injuries in clients.

• Use: Across various healthcare settings (primary, acute, long-term, palliative care).

• Common Tools:

  • Morse Fall Scale to assess fall risk.

  • Braden Scale for risk of pressure injuries.

• Advantage: Easy integration into care practices, with valid and reliable measures to minimize false positives.

Clients at High Risk for Injury

• Identification: Clients with increased risk factors include elderly individuals, those with cognitive or communication disabilities.

  • Examples: Stroke, neurodegenerative disorders, substance abuse disorders.

• Importance: Effective identification leads to safer healthcare environments and improved outcomes for at-risk clients.

Hospital-Acquired Injury

• Definition: Occurs when clients experience harm during hospitalization that was not present at admission.

• Common Types:

  • Surgical site infections (SSIs)

  • Catheter-associated urinary tract infections (CAUTIs)

  • Falls and trauma

• Goal: Create a culture of safety to prevent harm through training, education, and system improvements.