Safety, Security, and Emergency Preparedness

Factors Affecting Safety and Developmental Considerations

  • Safety is influenced by three primary categories:

    • Developmental considerations.

    • Patient environments.

    • Functional ability.

  • Neonate and Infant Safety

    • Fetal considerations remain a priority during the early stages of life.

    • Mobility issues and the proper use of car seats are critical safety factors.

  • Toddler and Preschooler Safety

    • Environmental safety is paramount as mobility increases.

    • Key risks include poisoning and asphyxiation.

    • Caregivers must be vigilant regarding signs of child abuse.

  • School-Age Safety

    • Emphasis is placed on preventing accidents.

    • Social safety concerns include child abduction and bullying.

  • Adolescent Safety

    • Driving safety becomes a major concern.

    • Risks involve substance use, misuse, and abuse.

    • Health and safety considerations include piercings, tattoos, and firearms.

    • Digital and social safety includes internet monitoring, social media usage, and the risk of sex trafficking.

Indications of a Concussion

  • Physical Indicators

    • Headache.

    • Vomiting.

    • Problems with balance.

    • Fatigue.

    • Dazed or stunned appearance.

  • Cognitive Indicators

    • Mental fogginess.

    • Difficulty concentrating.

    • Difficulty remembering.

    • Confusion.

    • Forgetting recent activities.

  • Emotional Indicators

    • Irritability.

    • Nervousness.

    • Highly emotional behavior.

  • Sleep-Related Indicators

    • Drowsiness.

    • Difficulty falling asleep.

    • Sleeping significantly more or less than is usual for the individual.

Safety throughout Adulthood

  • Adult Safety Considerations

    • Risks include drug use and poisoning.

    • There is a significant concern regarding intimate partner violence.

    • Adults should be reminded of the effects of stress on their lifestyle and overall health.

    • Enrollment in defensive driving courses is recommended.

    • Counseling should address unsafe health habits, such as over-reliance on drugs and alcohol.

    • Workplaces should be evaluated for safety hazards.

  • Safety Plan for Victims of Domestic Abuse

    • Plans must address safety while living with an abusive partner.

    • Safety planning must extend to children and pets.

    • Specialized safety planning is required during pregnancy.

    • Specific protocols should be established for safely leaving a relationship.

  • Older Adult Safety Considerations

    • Falls represent the leading cause of injury fatality in this demographic.

    • Other risks include motor vehicle accidents, fire, and elder abuse.

    • Polypharmacy (the use of multiple medications) significantly increases the risk of poisoning.

    • Environmental hazards should be identified and modified as necessary.

    • Defensive driving courses or those specifically designed for older drivers are encouraged.

    • Regular vision and hearing tests are essential.

    • Functional hearing aids and eyeglasses must be available and used correctly.

    • Smoke detectors must be operational.

    • Signs of neglect and abuse must be objectively documented and reported.

Patient Environments and Functional Ability

  • Patient Environments

    • Safety assessment must include the work environment, social environment, and home environment.

  • Functional Ability and Health Status

    • Functional ability is determined by mobility, sensory perception, ability to communicate, and knowledge.

    • Safety is also predicated on physical health state and psychosocial health state.

Fall Risk Assessment and Prevention

  • Factors Contributing to Falls

    • Poor gait and balance.

    • Issues with physical strength.

    • Visual impairment.

    • Problems with the feet.

    • Coexisting medical conditions (comorbidities).

    • Use of medications that increase fall risk.

    • Orthostatic hypotension (a drop in blood pressure when standing).

    • Environmental hazards located in the home or community.

    • Vitamin D deficiency.

  • Assessing Fall Risk in Older Adults

    • Assess for a history of falls or previous accidents.

    • Identify the use of assistive devices.

    • Be alert for a history of drug or alcohol abuse.

    • Evaluate family support systems and the home environment.

  • Safety Improvement Strategies

    • Preventing Falls Targeted Solutions Tool (TST).

    • Falls Toolkit.

    • Falls Prevention Training Program.

    • Root Cause Analysis (RCA) to determine why safety events occur.

  • Patient Outcomes for Safety

    • Patients should identify real and potential unsafe environmental situations.

    • Safety measures should be implemented within the environment.

    • Patients should use available resources for safety information.

    • Accident prevention practices should be incorporated into Activities of Daily Living (ADLs).

    • The ultimate goal is for the patient to remain free of injury.

Restraints and Facility Safety

  • Healthcare Facility Safety Management

    • Orientation of the person to their surroundings.

    • Prevention of falls within the facility.

    • Managing fire safety and alarm systems.

    • Preventing equipment-related and procedure-related accidents.

  • Physiologic Hazards of Restraints

    • Increased risk of serious injury due to falls.

    • Skin breakdown and contractures.

    • Incontinence.

    • Psychological impacts: depression, delirium, and anxiety.

    • Aspiration and respiratory difficulties.

    • Death.

  • Types of Restraints

    • Wrist restraint.

    • Mummy restraint (often used for infants).

    • Elbow restraint.

  • Fire Safety: The RACE Acronym

    • R—Rescue: Rescue anyone in immediate danger.

    • A—Activate: Activate the fire code and notify the appropriate person.

    • C—Confine: Confine the fire by closing doors and windows.

    • E—Evacuate: Evacuate patients and others to a safe area.

  • Procedure-Related Accidents and Errors

    • Errors in administering medications or intravenous (IV) solutions.

    • Improper techniques when transferring a patient.

    • Errors during dressing changes.

    • Inappropriate application of external heat to a patient's extremity.

  • Safety Event Reports

    • Reports must be completed following any accident or incident that compromises safety.

    • The report describes the circumstances of the incident and the patient's response to examination and treatment afterward.

    • The nurse must complete the report immediately after the incident.

    • These reports are NOT part of the medical record and should not be mentioned in patient documentation.

Emergency Preparedness

  • Maintaining Preparedness

    • Addressing biologic, chemical, and radiation threats.

    • Protecting against cyber terror.

    • Preparing for mass trauma terrorism and pandemics.

    • Identifying disaster resources and addressing the psychological aspects of disasters.

  • Chemicals Used for Mass Destruction

    • Biotoxins.

    • Blister agents/vesicants.

    • Blood agents.

    • Choking/lung/pulmonary agents.

    • Incapacitating agents.

    • Long-acting anticoagulants.

    • Metals.

    • Nerve agents.

    • Organic solvents.

    • Riot control agents/tear gas.

    • Toxic alcohols.

    • Vomiting agents.

  • Health Teaching in Schools

    • Monitoring children's internet use.

    • Parental involvement in school activities and safety committees.

    • Ensuring school emergency preparedness plans are current.

Questions & Discussion

  • Question 1: Tell whether the following statement is true or false: Among older adults, fires are the leading cause of injury fatality.

    • Answer: False.

    • Rationale: Among older adults, falls are the leading cause of injury fatality.

  • Question 2: Tell whether the following statement is true or false: A nurse whose behavior is reasonable and prudent and similar to the behavior that would be expected of another nurse in similar circumstances is still likely to be found liable if a patient falls.

    • Answer: False.

    • Rationale: A nurse whose behavior is reasonable, prudent, and similar to expected professional standards is unlikely to be found liable if a patient falls, even if injury occurs.

  • Question 3: Tell whether the following statement is true or false: A side rail is considered a restraint even if the patient asks for it to be raised to assist in getting into and out of bed.

    • Answer: False.

    • Rationale: A side rail is not considered a restraint if the patient requests it for aid in getting in or out of bed or to feel more secure. The patient must be able to raise and lower the rail independently.

  • Question 4: Which action is a priority emphasized in the RACE acronym guide to fire safety?

    • A. Run to the nearest fire alarm.

    • B. Act in a calm manner to prevent panic.

    • C. Confine the fire by opening doors and windows.

    • D. Evacuate patients and other people to a safe area.

    • Answer: D. Evacuate patients and other people to a safe area.

    • Rationale: The RACE priorities are Rescue, Activate, Confine, and Evacuate.