Safety

Chapter 27: Safety

Objectives

  • Define Safety

  • Discuss assessing safety for patients living at home

  • Discuss safety in acute care settings and hospitals

What is Safety in Nursing?

  • A culture of safety emphasizes safety over competing goals, focusing on reducing physical and psychological injury.

  • Essential for all healthcare providers; falls are the second leading cause of accidental death globally (WHO, 2018).

  • Nurses must identify safety issues and educate patients to enhance safety.

Factors Affecting Safety

  • Developmental Considerations: Tailored interventions based on patient age and development.

  • Lifestyle: Occupations and hobbies can increase risk.

  • Social Behavior: Stress and the status of vulnerable populations.

  • Environment: Risks present in both home and community settings.

  • Mobility: Limitations increase the risk of hazards.

  • Sensory Perception: Impaired senses increase risk.

  • Knowledge: Educated patients tend to be more compliant with safety protocols.

  • Communication Ability: Affects understanding and adherence to safety measures.

Nursing History

  • Assessment: Look for a history of falls, assistive device use, and substance abuse.

  • Physical Assessment for Safety: Evaluate mobility, communication abilities, and the environment for potential hazards.

Additional Assessment of Safety

  • Important questions for patients:

    • Have you fallen in the past year?

    • Do you feel unsteady when standing or walking?

    • Do you worry about falling?

  • Assess for fire hazards, poisoning risks, choking, and suffocation.

Factors Contributing to Falls

  • Lower body weakness, poor vision, and balance issues.

  • Foot and shoe problems; use of psychoactive medications.

  • Environmental hazards in both home and hospital settings.

Nursing Responsibilities in Home Safety

  • Focus on education and counseling for patients and families regarding safety measures.

Safety Devices to Prevent Falls

  • Assess safety devices regularly to mitigate fall risks.

Safety Considerations in Acute Care

  1. Orient patients to their surroundings to reduce accidents.

  2. Prevent falls by adhering to protocols; falls in hospitals are deemed preventable events.

    • Incident reports are necessary for any falls that occur.

  3. Implement safety measures such as locking beds and raising side rails.

Fire Safety: RACE and PASS

  • RACE: (1) Rescue anyone in danger, (2) Activate fire alarm, (3) Confine the fire, (4) Evacuate.

  • PASS: (1) Pull the pin, (2) Aim at the base, (3) Squeeze the handle, (4) Sweep side to side.

Safety Event Reports

  • Must be documented after any incident affecting safety in healthcare settings.

  • Details the incident, patient’s response, and is completed by the nurse immediately.

  • Reports are confidential and not part of the patient’s medical record.

Restraints

  • Defined as devices or medications that limit patient movement for safety.

  • Alternatives include orienting patients, providing supervision, and using de-escalation strategies.

Types of Restraints Used for Adults and Children

  • Elbow restraints

  • Wrist restraints

  • Mummy restraints