Safety
Page 1: Title Page
Title: SAFETY
Note: Copyright © 2017, Elsevier Inc. All Rights Reserved.
Page 2: Objectives
Objectives Overview
Discuss the National Patient Safety Goals and their relationship to the national safety standards.
Explain the nurse’s role in maintaining client safety in home and clinical settings.
Describe personal environmental hazards that pose risks to a client’s safety.
Discuss methods to reduce the risk of client injury.
Identify risk factors associated with client falls and recognize clients at risk of falling.
Propose methods to prevent falls in home and clinical settings.
Analyze types and appropriate use of restraints.
Discuss maintaining safety for clients in restraints.
Identify potential safety hazards in the healthcare agency.
Describe nursing interventions for maintaining client safety.
Page 3: QSEN
Quality and Safety Education for Nurses (QSEN)
Project developed to ensure future nurses possess knowledge, skills, and attitudes needed to improve healthcare quality and safety.
QSEN Competency Areas
Patient-centered care
Teamwork and collaboration
Evidence-based practice
Quality improvement
Safety
Informatics
Page 4: Focus of Safety Assessments
Assessment Areas
The Person
The Environment
Specific Risk Factors
Page 5: Safety Assessment Components
Nursing History Assessment
Assess for history of falls or accidents.
Note assistive devices used (e.g., cane, walker).
Be alert to history of drug or alcohol abuse.
Gather knowledge of family support systems and home environment.
Identify lack of safety awareness.
Recognize risks in the healthcare agency.
Physical Assessment
Assess mobility status.
Evaluate ability to communicate.
Assess level of awareness or orientation.
Assess sensory perception.
Identify potential safety hazards.
Recognize signs of domestic violence or neglect.
Page 6: Risk Factors for Client Injury
Factors Influencing Safety
Developmental considerations
Lifestyle factors
Environmental aspects
Home and workplace considerations
Community influences
Mobility and balance issues
Sensory perception challenges
Knowledge about safety hazards
Communication ability
Physical and psychosocial health state
Page 7: Safety Priority
Prioritizing Client Safety
Determine hazards related to the client.
Protect the client through appropriate nursing interventions.
Educate clients and their families about safety.
Page 8: Patient Safety Risk Factors in Healthcare
Types of Risks
Fall-Related
Patient-inherent accidents: e.g., seizure disorder.
Procedure-related accidents: e.g., restraints.
Equipment-related accidents: e.g., home oxygen use.
Page 9: Promoting Safety
Initiatives and Campaigns
“Speak Up”: A campaign by The Joint Commission (TJC) and Centers for Medicare and Medicaid Services (CMS) to encourage patient participation in healthcare.
Hospital National Patient Safety Goals
Correctly identify patients.
Improve staff communication.
Use medications safely.
Use alarms safely.
Prevent infection.
Identify patient safety risks.
Prevent mistakes in surgery.
Page 10: Promoting Safety: Environmental
Environmental Safety in Home
Falls Prevention
Food Safety
Fire Safety
Carbon Monoxide Safety
Page 11: Carbon Monoxide Awareness
Key Points
Install a carbon monoxide (CO) monitor at home.
CO is odorless and can lead to death.
Mild symptoms may include headache and nausea.
Page 12: Fire Safety Protocol: RACE
RACE Protocol
Rescue: Ensure no one is in immediate danger.
Alarm: Activate alarm to get help.
Contain: Close doors to contain fire/smoke if safe.
Evacuate: Evacuate ambulatory patients first, then wheelchair-bound, lastly bed-bound individuals.
Page 13: Fire Extinguishers
Fire Safety Resources
Knowledge of fire extinguishers and their proper use is critical for safety in healthcare settings.
Page 14: Case Study
Situation Overview
Patient GM, an 83-year-old woman, admitted to rule out a hip fracture following falls at home.
X-ray is negative, discharge planned for next day.
Family concerns: GM lives alone, cluttered home, confused, and forgetful.
Questions to Consider
What safety risk factors are present?
Write a nursing diagnosis statement for this patient.
How should the nurse handle this situation?
Describe nursing interventions for hospital and home settings.
Page 15: Promoting Safety: Falls
Procedures for Fall Prevention
Screen for fall risk at admission and during the stay.
Use the Morse scale for assessment.
Implement hourly rounding and use color-coded bands for identification.
Develop falls reduction programs focusing on recognizing and managing fall risks.
Page 16: Factors Contributing to Falls
Key Contributing Factors
Lower body weakness.
Poor vision.
Gait and balance issues.
Footwear issues.
Use of psychoactive medications.
Postural dizziness.
Environmental hazards in home and community.
Page 17: Fall Prevention Strategies
Key Preventive Measures
Ensure call bell is within reach.
Keep bed in lowest position.
Use fall risk identification methods (bracelets, alarms).
Provide non-skid shoes.
Conduct frequent checks (every 1-2 hours) with assistance personnel.
Page 18: Safety: Restraints
Overview of Restraint Use
Used only temporarily when a patient is a threat to self or others.
Criteria for Application
To prevent falls, interruption of therapy, or removal of life-saving equipment.
Conduct after alternative interventions have been attempted.
Involve family in the decision-making process.
Restraints are generally not allowed in long-term care (LTC).
Page 19: Physiologic Hazards of Restraints
Associated Risks
Increased possibility of serious injury due to falls.
Skin breakdown, contractures, incontinence, depression, delirium, anxiety, aspiration, respiratory difficulties, and death.
Page 20: Restraints: Nursing Considerations
Important Guidelines
Be familiar with facility’s policy and procedure.
Must have a physician’s order for restraints.
Restraints require face-to-face evaluation by a provider within an hour of ordering.
Need for restraints should be continuously re-evaluated and orders renewed every 24 hours.
Application Guidelines
Use a slip knot to secure restraints to non-movable parts of the bed or chair.
Documentation must include:
Need for restraints.
Behaviors observed.
Procedure followed.
Condition of restrained body part (skin and circulation).
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Page 22: Types of Restraints
Restraint Types for Adults and Children
Wrist restraint.
Mummy restraint.
Elbow restraint.
Page 23: Promoting Safety: Fires
Key Safety Responsibilities
Protect patients from immediate injury by knowing staff responsibilities regarding:
Exits
Oxygen supply
Evacuation plan
Use of extinguishers
Electrical Safety
Regular inspection of electrical equipment and immediate removal of malfunctioning devices.
Page 24: Promoting Safety: Seizures
Seizure Safety Protocols
Implement seizure precautions to protect patients from injury.
During Seizures
Ensure environment is safe for the patient during an episode and prepare for post-seizure care.
Radiation Safety
Understand guidelines surrounding radiation safety applicable in healthcare settings.
Page 25: Seizure Care: Precautions
Necessary Equipment
Keep rescue equipment at bedside (e.g., oxygen, padding, suction, IV access).
Provide family teaching on seizure safety:
Never put anything in the client's mouth during a seizure.
Do not restrain the client during seizures.
Page 26: Seizure Care: During Episode
Care Protocol
Stay with the client and call for help.
Maintain an open airway.
Document onset, duration, and symptoms.
Administer medications as needed.
After the seizure, assess neurological status, vital signs, and provide a quiet environment.
Document pre-, during, and post-seizure activity.