Safety

NUR 101 Unit Four Student Learning Outcomes (SLO)

  • 1. Describe factors that maintain a culture of physical safety: Understanding the organizational and clinical elements that foster a safe environment.

  • 2. Value the contributions of standardization and reliability to safety: Recognizing how uniform procedures and reliable systems prevent errors.

  • 3. Identify factors that compromise a patient’s physical safety: Pinpointing specific risks and barriers to safe outcomes.

  • 4. Include common nursing interventions in planning and administering care to promote physical safety: Integrating safety protocols into daily nursing practice.

  • 5. Describe the benefits and limitations of selected safety-enhancing technologies: Evaluation of technological tools used to prevent harm.

  • 6. Demonstrate effective use of strategies to reduce risk of harm to self or other: Applying techniques to protect health care providers and colleagues as well as patients.

  • 7. Identify the role and function of the nurse in preventing fire and providing for patient safety in the event of a fire: Understanding specific emergency protocols and preventative measures for fire hazards.

Introduction to Physical Safety

  • Definition of Safety: Safety is defined as freedom from risk or the occurrence of injury.

  • Preventability: It is noted that most accidents are preventable through proper assessment and intervention.

  • Basic Human Need: Safety is considered a basic human need that encompasses both physical and psychological dimensions.

  • Importance: Maintaining safety is of critical importance to both the patient and the nurse.

  • Required Course Materials: Students are instructed to download the Morse and Hendrich II Risk Scales and bring them to class.

Guidelines and Regulatory Agencies

  • National Academy of Medicine (NAM): Formally known as the Institute of Medicine (IOM); involved in initiatives to provide for patient safety.

  • The Joint Commission: Responsible for establishing National Patient Safety Goals (specifically referenced for 2020/2021).

  • QSEN: Quality & Safety Education for Nurses, which provides framework for nursing safety competencies.

  • Rapid Response Teams: Clinical teams designed to intervene at the first sign of patient deterioration to ensure safety.

  • Hospital Incident Command System (HICS): A system used for managing incidents and emergencies within the healthcare setting.

  • National Institute for Occupational Safety and Health (NIOSH): Provides Safe Patient Handling Guidelines to protect healthcare workers.

  • Occupational Safety & Health Administration (OSHA): Federal agency that sets and enforces protective workplace safety and health standards.

Nursing Assessment: Contributing Factors and Manifestations

  • Contributing Factors (Assessment Categories):
        - Chemical: Risks associated with medications, cleaners, or hazardous substances.
        - Developmental: Risks based on the patient's age and stage of life.
        - Physical/Environmental: Hazards within the literal physical space.
        - Physiological: Bodily functions or conditions that increase vulnerability.
        - Psycho-socio-cultural: Mental health, social, and cultural factors affecting safety behaviors or risks.

  • Environmental Factors of Concern:
        - Healthcare Setting.
        - Workplace.
        - Home.
        - Community.
        - Bioterrorism.
        - Disaster Planning.

  • Clinical Manifestations of Physical Injury:
        - Tissue Trauma.
        - Bleeding.
        - Burns.
        - Airway obstruction.
        - Compromised circulation.

  • Clinical Manifestations of Psychological Response:
        - Fear.
        - Anxiety.
        - Dependency.

Analysis of Data and Planning

  • Data Analysis: Nurses must use nursing judgment based on critical thinking and clinical reasoning to identify relevant nursing diagnoses.

  • Nursing Diagnoses: The nurse must identify specific diagnoses based on identified contributing factors (e.g., "Risk for Injury").

  • Setting Goals: Planning requires establishing appropriate goals for patients with specific diagnoses, such as identifying a meaningful goal for a patient with a "Risk for Injury" diagnosis.

Nursing Interventions: Basic Measures and Body Mechanics

  • Basic Measures:
        - Ongoing risk identification.
        - Orienting and educating the patient and their family.
        - Utilizing correct "Body Mechanics."
        - Implementing safety measures based on specific identified contributing factors.

  • Principles of Good Body Mechanics:
        - Maintain a wide base of support.
        - Keep the back straight to ensure proper spinal alignment.
        - Bend from the hips and knees (hinging).
        - No BLTs: Avoid bending, lifting, and twisting at the waist.
        - Lift objects using the arm and leg muscles rather than back muscles.
        - Work at your height (adjust surface levels).
        - Hold objects close to the body at waist level.
        - Do not work against gravity.
        - Move in the direction you are going.
        - Size up the load before moving: use mechanical lifts or extra help when needed.
        - Have the patient do as much as possible to assist.

Specific Safety Measures and Fall Prevention

  • Plan of Care Considerations: The nurse must tailor the plan of care for specific patient conditions, including:
        - Confusion.
        - Impaired mobility.
        - Impaired sensory perception.
        - Increased risk of bleeding.

  • Fall Prevention Interventions:
        - Assess risk factors using standardized scales.
        - Educate and reinforce safety instructions to the patient.
        - Familiarize the patient with the environment.
        - Keep the call bell within reach and reinforce its use.
        - Keep personal belongings within easy reach.
        - Ensure proper use of side rails.
        - Provide nonskid, well-fitting footwear.

  • Post-Fall and High-Risk Management ("The Patient has Fallen"):
        - Ensure proper lighting/use of night lights.
        - Maintain a clutter-free environment.
        - Perform hourly rounds.
        - Place the patient close to the Nurse’s station.
        - Use a yellow band or ID chip for identification.
        - Utilize an alert sign, such as a "Falling Star."
        - Use a tele-sitter (remote monitoring technology).

Use of Restraints

  • General Considerations:
        - Definition: Restraints are devices or medications used to restrict movement.
        - Types: Physical and Chemical.
        - Level I: Used for nonviolent / non-self-destruction behaviors.
        - Level II: Used for violent / self-destructive behaviors.
        - Alternatives: These must be considered before applying restraints.

  • Nursing Interventions and Assessments for Restraints:
        - Use the minimal restraint necessary to achieve safety.
        - Observe the patient every 15 to 30 minutes.
        - Release the restraint every 2 hours.
        - Assess skin integrity, Range of Motion (ROM), and circulation.
        - BLS Certification is required for staff managing restraints.
        - Assess respiration specifically when using a vest restraint.
        - Attach restraints to the bed frame (not the side rails) and use a slip knot for quick release.
        - Educate the patient and the family regarding the purpose and use of restraints.
        - Provide for the patient's needs: nutrition, fluids, and toileting.
        - Document all aspects of restraint use according to hospital policy.

Fire Safety and Emergency Response

  • Prevention: Institute fire response education for all staff.

  • RACE Acronym:
        - R (Remove): Remove patients in immediate danger.
        - A (Activate): Activate the fire alarm.
        - C (Contain): Contain the fire by closing doors.
        - E (Extinguish/Evacate): Extinguish the fire if possible, or evacuate patients.

  • Fire Extinguisher Classes:
        - Class A: For Paper, Wood, and Trash.
        - Class B: For Liquids and Gases.
        - Class C: For Electrical fires.

  • PASS Acronym (Operation of Extinguishers): Used to remember how to operate the device.

  • Principles of Fire Management:
        - Listen to the fire bell sequence to determine the location of the fire.
        - Confine the fire: close doors and clear hallways.
        - Hot air rises: Instruct to crawl if smoke is present.
        - Do not use elevators during a fire.
        - Ensure microwave safety.
        - Recognizing Oxygen is combustible/flammable.
        - Electrical equipment issues: remove and tag malfunctioning equipment.
        - Evacuation Priority: Evacuate ambulating patients first.

Quality Assurance and Clinical Hazards

  • Evaluation Definitions: Quality can always be improved.

  • Occurrence Reports: Documentation used to track accidents or near misses.

  • Sentinel Event Reporting: Reporting significant events that result in death or serious injury.

  • Root Cause Analysis: A process for identifying the underlying cause of safety incidents.

  • Various Hazards in Health Care Settings:
        - Seizures.
        - Scalds and Burns.
        - Poisoning/Hazardous waste spills.
        - Suffocation/Choking.
        - Excessive Noise.
        - Electrical Hazards.
        - Firearms.
        - Radiation.
        - Bioterrorism attack.