Safety Chapter 13

Patient Safety in Nursing

Importance of Caring for Unresponsive Patients

• Advocacy for patient safety and proper care standards

• Risk for potential negligence and lawsuits against facilities and nurses

Role of Nurses in Mass Casualty Events

• Importance of rapid response in emergencies (e.g., natural disasters, large-scale injuries)

• Use of body mechanics for effective patient handling to prevent further injury

• Communication with other healthcare professionals during emergencies

Safety Hazards in Nursing

• Exposure Risks:

  • Continuous exposure to communicable diseases: flu, COVID-19, RSV, etc.

  • Handling blood and body fluids increases risk of infection

  • Recognition of drug abuse issues, where some nurses may misuse narcotics and medications, highlighting the need for effective monitoring and support mechanisms.

National Safety Standards

• Healthcare facilities must comply with regulations

• Goals include improving staff communication, using medications safely, preventing infections, and reducing surgical errors

• Role of Joint Commission:

  • Monitors compliance with safety standards and incidents (e.g., falls, wrong-site surgeries)

  • Facilities required to identify patients using two identifiers: name and birthdate

Patient Identification

• Importance of using two identifiers for accurate patient identification

• Many patients share common names; identification systems minimize errors

• Methods include scanning wristbands and verifying medical records

Factors Affecting Patient Safety

• Patient Age and Understanding:

  • Young and elderly patients may struggle with anxiety and confusion

  • Importance of contextual familiarization for older patients with cognitive impairments

• Impaired Mobility:

  • Patients at risk for falls due to unsteady gait or disorientation

  • Compounding factors include delirium from medication, pain management delays, or severe discomfort

• Environmental Risks:

  • Cluttered rooms can lead to falls; all equipment should be organized and out of foot traffic

  • June barriers to bathroom access or positioning nightlights for visibility

Strategies for Preventing Patient Falls

• Fall Reduction Programs:

  • Must be established within facilities, including individual fall assessments

  • Use of visual identifiers (e.g., flags, arm bands) for high-risk patients

• Implementing Patient-Specific Strategies:

  • Avoid leaving at-risk patients alone, especially during ambulation

  • Keep beds at a low position to minimize injury from falls

Restraint Protocols

• Restraints as a last resort; must document all alternative strategies tried

• Types of physical restraints: vest, wrist, ankle, mittens

• Requirements for restraint orders: specific times, monitoring requirements, and evaluation requirements

• Importance of Regular Monitoring:

  • Checking patient conditions every 30 minutes and releasing restraints every 2 hours to ensure comfort and safety

  • Staff should be trained to recognize signs of restraint-related injuries and understand the psychological impact on patients.

Emergency Protocols in Nursing

• Responding to Patient Falls:

  • Initial assessments to check for obvious injuries (e.g., broken limbs, bleeding)

  • Vital signs monitoring, calling for assistance, and documenting the incident

• Documentation:

  • Keep detailed logs per facility policy

  • Incident reports should not be part of patient charts

Fire Safety in Healthcare Settings

• Emergency Response Plan:

  • Familiarity with fire codes (e.g., Code Red) in your facility

  • Use of RACE (Rescue, Alarm, Confine, Extinguish) approach during fire emergencies

• Types of fire extinguishers correspond to different fire classes and their applications

Understanding Chemical and Biological Hazards

• Chemical Hazards:

  • Caution with anti-cancer drugs and cleaning agents

  • Awareness of radiation exposure in treatment settings

  • Required use of protective gear (e.g., gloves, gowns, lead aprons)

Promoting Safety for Nursing Staff

• Awareness of physical, chemical, and biological hazards in nursing

• Need for safe patient lifting and moving strategies to avoid injuries

• Addressing Issues of Workplace Violence, Bullying, and Harassment:

  • Establishing protocols for reporting and handling incidents effectively

  • Support systems for staff who experience or witness violence

• The Handle With Care Program:

  • Initiative for safer patient handling, reducing manual lifting requirements

  • Incorporates assistive devices and education for staff on proper body mechanics

Conclusion

• Drawing on the outlined best practices for patient care, nurses should prioritize safe environments through effective communication, utilization of safety protocols, and regular evaluations of patient conditions to enhance patient safety and welfare.