Safety

Importance stressed by organizations such as the FBI, the Emergency Nurses Association, and the Joint Commission (TJC).
Facilities must have action plans that include staff training on active shooter scenarios.

Priority Actions: The training should emphasize three main priority actions:
- Run: Escape the premises if possible.
- Hide: If escape is not safe, find a secure location to hide until help arrives.
- Fight: As a last resort, if neither running nor hiding is feasible, confront the shooter to protect oneself and others.

Staff should validate their knowledge of crisis procedures:
- Acute Care Settings: Every two years.
- Long-term Care Settings: Annually.
Regular emergency drills are mandated by the Centers for Medicare & Medicaid Services (CMS).
- These drills are critical for identifying weaknesses in the emergency response plan and allow for necessary adjustments.

The effects of discrimination and bias on client health can be significant.
Common barriers to healthcare include:
- Access to care
- Age
- Level of education
- Gender identity
- Race and ethnicity
- Language proficiency
- Religion
- Sexual orientation
- Economic status
- Physical or mental ability
Clients are entitled to:
- Care that is timely and free from discrimination.
- Respectful treatment and effective communication methods, such as access to interpreters.

TJC has established standards to guide healthcare facilities in eliminating bias and discrimination.
Clients who experience discrimination are encouraged to report their experiences.
The Speak Up Initiative provides resources and is accessible on the TJC website for further information.

Regulatory Requirement: CMX mandates all hospitals receiving Medicare and Medicaid reimbursements to establish emergency preparedness plans for potential disasters in the area.
Staff Familiarity: It's crucial for both new and existing staff to understand facility disaster policies and their specific roles during emergencies. This involves comprehensive training.
- Training should occur during new hire orientation and annually.

Training Verification: Staff must regularly validate their knowledge of crisis procedures per their facility's training and disaster plan.
- Biannual validation for acute care settings, annual for long-term care settings.
Emergency Drills: Conduct emergency drills as required by CMS to identify issues in emergency plans and improve upon them.

The necessity for emergency preparedness has increased due to:
- Rising frequency of severe weather incidents (tornadoes, hurricanes).
- Increased scenarios of mass shootings.
- Incidents involving infectious diseases (measles, H1N1, Ebola, COVID-19).
Collaboration with local and state governments is essential for beneficial disaster planning.

Understanding Radiation Exposure: Can be accidental or man-made. Responding effectively requires identifying the type of radiation and the extent of radioactivity on the body for rapid decontamination.
Categories of Radiation:
- Alpha Radiation: Low risk, does not penetrate clothing, traveling only a few centimeters.
- Beta Radiation: Moderate risk, needs protective clothing but minimal health hazards.
- Gamma Radiation: High risk, penetrates clothing and tissues, requires lead shielding.
Accidental Causes: Nuclear incidents, dirty bombs, or chemical contamination can lead to mass exposure.
Decontamination Measures: Immediate washing with garden hoses or showers; discarding contaminated clothing; physical and mental assessments are crucial after exposure.
- Symptoms include nausea, diarrhea, alopecia, and skin burns.

Definition: Occurs when individuals are exposed to biological toxins (e.g., anthrax, smallpox, Ebola).
Transmission: Can happen through direct contact (touch) or airborne dispersal in mass casualty events.
Response Goals:
- Recognize disease processes and minimize toxin spread.
- Ensure proper PPE usage for unknown toxins available to medical staff.
Protection Measures: Cut off and properly dispose of contaminated victim clothing, and shower for decontamination.
Symptoms: Onset varies; initial signs may appear within hours.

Nature: Involves dispersal of harmful chemicals potentially due to accidents or terrorist attacks.
Symptoms: Initial manifestations may occur minutes to hours post-exposure, necessitating quick decontamination.
Immediate Treatment: Involves thorough rinsing (with water or shower), disposing of clothing, and using appropriate PPE based on identified chemicals.
Long-Term Effects: Potential for anxiety, depression, respiratory issues.

Definition of a Fall: An unplanned descent to the floor, with or without injury.
Statistics: Significant incidence of falls in healthcare facilities, with an extensive economic impact per incident.
- Older adults have a higher likelihood of lasting complications from falls.
Fall Risk Assessment: All clients should undergo fall risk screening upon admission. Environmental safety measures should be in place to prevent falls.
Safety Measures: Include using non-skid footwear, maintaining a clutter-free environment, and offering fall prevention education.

Restraint Types: Includes physical, mechanical, chemical, barrier, and seclusion restraints.
Guidelines for Use:
- Emphasis on restraint being a last resort; alternatives must be exhausted first.
- Maintain client dignity and comfort while restraining.
- Regular assessments required to ensure building safety and health status are maintained.

Definition: Abnormal electrical activity in the brain that can lead to temporary dysfunction.
Precautions: Identify seizure-prone clients upon their arrival.
Nursing Interventions: Setup suction and oxygen at the bedside, monitor vital signs, provide supportive care during seizures, and ensure safety by protecting the client from injury.

Incidence: Nurses are at high risk for MSDs due to physically demanding tasks.
Preventive Measures: Utilizing lifting devices, like ceiling lifts and slide sheets, can reduce incidence of back injuries. Training on proper use is essential to prevent injuries.
Zero Handling Policy: Advocated in some institutions to ensure safety in manual patient handling.