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.