Comprehensive Study Notes on Safety in Healthcare Settings (copy)

SAFETY IN HEALTH CARE SETTING

  • SAFETY HAZARDS IN THE HEALTHCARE SETTING
      - Client Hazards
        - Falls
        - Seizures
        - Restraints
        - Medication errors
        - Treatment errors
      - Nurse Hazards
        - Back injury
        - Needle stick injuries
        - Violence
        - Blood-borne pathogens

  • Fire Safety

A SAFE ENVIRONMENT

  • BASIC HUMAN NEEDS (PAGE 410)
      - A safe environment must ensure that basic human needs are met, which include:
        - Oxygen
        - Nutrition and Water
        - Temperature and Humidity
      - Additionally, a safe environment must:
        - Reduce physical hazards
        - Minimize pathogen transmission
        - Maintain sanitation
        - Ensure population control

MASLOW'S HIERARCHY OF NEEDS

  • Self-Actualization: The need for development and creativity.

  • Ego Needs: Includes the need for self-esteem, power, recognition, and prestige.

  • Social Needs: Encompass the need for love, belonging, and inclusion.

  • Security Needs: The need for safety, shelter, and stability.

  • Physical Needs: Comprised of the need for air, water, food, rest, and health.

COMMON ENVIRONMENTAL HAZARDS (PAGE 411-413)

  • Motor Vehicle Accidents (MVA)

  • Poison

  • Falls

  • Fire

  • Disasters

COMMUNITY HAZARDS

  • Motor Vehicle Accidents (MVA)
      - Contributing factors include:
        - Failure to wear seatbelts
        - Use of alcohol/medications
        - Pedestrian accidents
        - Non-deployment of airbags
      - Prevention Strategies:
        - Be a cautious pedestrian
        - Utilize a designated driver
        - Wear seatbelts
        - Use proper age-dependent restraints for children

TAKE HOME TOXINS

  • Examples: Asbestos, lead, mercury, arsenic, and microorganisms.
      - Prevention:
        - Be aware of workplace preventive measures
        - Remove work clothing and shower if appropriate
        - Use gloves
      - Note: Lead is often present in paint in older homes, posing significant poisoning risks to young children and can cause delayed mental and cognitive development.

HAZARDS IN THE COMMUNITY

  • Vector-borne Diseases:
      - Examples include West Nile virus, malaria, and encephalitis.
        - Prevention:
            - Drain standing water
            - Use insect repellents
            - Protect skin from insect contact
            - Remove breeding areas.

  • Food Borne Hazards:
        - Prevention:
            - Proper storage, cleaning, and cooking of foods and water
            - Sanitation efforts are needed to ensure a clean, safe water supply.

  • Water Borne Hazards:
        - Concerns regarding substandard housing impacting clean water access
        - Risks associated with well water in rural areas
        - Contamination from hurricanes or floods can disrupt water supply.

FACTORS INFLUENCING PATIENT SAFETY (PAGE 413)

  • Developmental Stages and Risks:
      - Infant, toddler, and preschooler
      - School-age child
      - Adolescent
      - Adult
      - Older adult

FIREARMS IN THE HOME

  • Safety Concerns:
      - Home access to firearms often leads to suicides, domestic violence, and accidental injuries.
      - Prevention and Firearm Safety:
        - Never point firearms at others or handle them recklessly.
        - Clean firearms only with the action open, and finger off the trigger.
        - Educate parents and children about firearm safety.
        - Store firearms in a locked location and keep ammunition separate.

OLDER ADULT SAFETY (PAGE 415)

  • Focus on Dementia:
      - Types of dementia include Alzheimer's and vascular dementia, which cause decreased information processing and necessitate a safe living environment.

RISK IN HEALTH CARE AGENCIES (PAGE 416)

  • Types of Risks:
      - Procedure-related accidents
      - Equipment-related accidents
      - Chemical exposure
      - Falls in health care settings
      - Workplace safety issues.

STANDARDS FOR SAFETY

  • Key Organizations:
      - American Nurses Association (ANA)
      - Quality and Safety Education in Nursing (QSEN)
      - The Joint Commission (JC)
      - Institute of Medicine (IOM)
      - Centers for Medicare and Medicaid Services (CMS)

THE JOINT COMMISSION

  • National Patient Safety Goals:
      - Developed to target areas at particular risk of harm to clients.
      - Health care facilities are required to institute policies and procedures to mitigate identified risks.
      - Sentinel Events: Define any unanticipated event in a healthcare setting resulting in death or serious physical/psychological injury, such as loss of a limb or gross motor function.

NATIONAL PATIENT SAFETY GOALS

  1. Patient Identification: Improve accuracy in patient identification.

  2. Improve Communication: Enhance effectiveness of communication among caregivers.

  3. Medication Safety: Ensure safety in medication administration.

  4. Clinical Alarm Safety: Reduce harm associated with clinical alarm systems.

  5. Healthcare Associated Infections: Minimize risks of infections associated with healthcare.

  6. Reduce Falls: Lower the risk of patient harm from falls.

  7. Pressure Injury Prevention: Prevent healthcare-associated pressure injuries.

  8. Risk Assessment: Identify safety risks inherent in the organization’s patient population.

SENTINEL EVENTS

  • Purpose: Triggers a root cause analysis to determine the cause of the event in order to:
      - Prevent recurrence
      - Improve care
      - Protect clients

MEDICARE NEVER EVENTS

  • Examples of events that should never occur:
      - Leaving a foreign object after surgery
      - Air embolisms
      - Administering wrong blood types
      - Severe pressure ulcers
      - Falls and trauma
      - Infections associated with urinary and IV catheters
      - Poorly controlled blood glucose levels
      - Surgical site infections following orthopedic and bariatric procedures, particularly DVT or PE after total knee or hip surgeries.

REDUCING PROCEDURE ERRORS USING “TIME OUT”

  • Definition: “Time Out” is a strategy employed to prevent errors.

  • Implementation: It is a standard part of all procedures across healthcare.

  • Personnel Responsibilities: Pause to confirm:
      - Right procedure
      - Right client
      - Right site of the procedure.

SUFFOCATION / ASPHYXIATION

  • Leading cause of death for infants under 1 year from smothering.

  • Children aged 0-4 years are at high risk: close supervision is crucial.

  • Prevention Strategies:
        - Watch for small, removable parts in toys and other items.
        - Cut food into small, manageable pieces.
        - Exercise caution with popcorn, hotdog, and peanuts.
        - Be alert to hazards like mobiles, strings, cords, and plastic bags.
        - Provide barriers to swimming pools.
        - Know the Heimlich maneuver and CPR techniques.
        - Have emergency numbers readily available.

FOCUS ON OLDER ADULTS

  • Safety Considerations:
      - Alterations in vision and hearing
      - Slowed reaction times and reflexes
      - Impaired memory or cognition
      - Decreased muscle strength and balance
      - Impaired bowel or bladder continence:
        - Nocturia
        - Frequency
        - Urgency
      - Polypharmacy issues.

ENVIRONMENTAL INTERVENTIONS (PAGE 430)

  • Ensuring Basic Safety Needs:
      - Oxygen availability
      - Fire safety
      - Food safety
      - Fall safety within the home environment.

HOME FIRE SAFETY

  • Key Components:
      - Addressing oxygen safety to prevent fire risks.
      - Identifying potential fire sources.
      - Ensuring fire extinguishers are available.
      - Establishing smoke detector coverage throughout the home.
      - Planning and practicing escape routes from the residence.
      - Teaching children the fire safety rule of “Stop, Drop, and Roll” and the importance of remaining calm.

SCALDS AND BURNS

  • Common Causes: Hot water, grease, sunburn, cigarettes.

  • Prevention: Proactive measures to avoid such injuries are crucial.

CORRECT USE OF A FIRE EXTINGUISHER (BOX 27.9)

  • PASS Technique:
      - P - Pull the pin
      - A - Aim at the base of the fire
      - S - Squeeze the handles
      - S - Sweep from side to side

ELECTRICAL SAFETY (BOX 27.8)

  • Electrical equipment must be well-maintained and grounded:
      - Use a three-pronged electrical cord that includes a grounding prong.
      - Never remove the grounding prong.
      - Inspect brought-in equipment for safety before use.
      - Regularly check electrical cords and outlets for frayed or damaged wires.
      - Read warning labels on equipment; never operate unfamiliar equipment.
      - Extension cords should not be used in healthcare settings due to safety risks.

FOOD SAFETY

  1. Clean

  2. Separate

  3. Cook

  4. Chill

FALL RISK FACTORS

  • Highest Risk Factor: A history of previous falls.

  • Other contributing factors include:
      - Dementia or memory problems
      - Incontinence of bowel or bladder
      - Sensory changes such as sight, hearing, and tactile sensation
      - Decreased muscle strength, range of motion, stamina, and balance.
      - Environmental hazards: slippery floors, uneven surfaces, insufficient lighting, etc.
      - Medication side effects.

FALLS IN THE HEALTHCARE FACILITY

  • Increased Risk Factors:
        - Age
        - Sensory impairment
        - Mobility problems
        - Use of assistive devices
        - Urinary/bladder dysfunction
        - Specific medical conditions (e.g., cardiac or neurological diseases, certain medications)
        - A key indicator for risk includes a history of prior falls.

NURSE ALERT

  • In the event of an accident, it is mandatory to file an incident report documenting the event, the client's assessment, and the interventions undertaken by the nursing staff.

RESTRAINTS

  • Definition: Restraint refers to a protective device used to limit physical activity or restrict access to certain parts of the body. They should only be used as a last resort or when there's an immediate risk of harm.
      - Types:
        - Physical Restraints: Devices that restrict client movement.
        - Chemical Restraints: Medications intended to control specific behavior or movement.

TYPES OF PHYSICAL RESTRAINTS

  • Examples:
        - Jacket or Posey vest restraints (less commonly used)
        - Belt restraints
        - Mitten restraints
        - Mummy restraints
        - Elbow restraints
        - Extremity restraints (ankle or wrist)

RESTRAINT DOCUMENTATION

  • Key details to document include:
      - Reason for restraint
      - Method of restraint
      - Date and time of application
      - Duration of use
      - Client response
      - Release from restraint with periodic assessments regarding circulatory, neurovascular, and skin health.
      - Provision for food, drink, and toileting.
      - Ongoing assessment of continued need for restraint.

ALTERNATIVES TO RESTRAINTS

  • Suggested interventions include:
        - Frequent reminders and reorientation for clients
        - Encouraging family presence
        - Assigning confused clients to rooms near the nurse’s station for closer supervision.
        - Providing visual and auditory stimuli such as clocks and boards.
        - Implementing relaxation techniques and maintaining toileting routines.
        - Assessing individual needs for comfort, food, and liquids.
        - Employing ambulation alarms.
        - Evaluating the client’s medication profile.

DELEGATION CONSIDERATIONS

  • The application of restraints may be delegated to trained assistive personnel (UAP), but the nurse remains responsible for assessing client safety.

FIRE IN HEALTHCARE FACILITIES

  • Emergency response instructions: FEUERMELDER
        - Scheibe einschlagen (break the glass)
        - Knopf tief drücken (press the button hard)

RACE (Fire Response Protocol)

  • R: Rescue and remove all clients in immediate danger.

  • A: Activate the fire alarm; this must be done before attempting to extinguish the fire.

  • C: Confine the fire by closing doors and windows, and turn off any oxygen sources.

  • E: Extinguish the fire using the appropriate methods.

FIRE EXTINGUISHERS

  • Types of Fire Extinguishers:
      - Type A: For ordinary combustibles (wood, cloth, paper, and plastic items).
      - Type B: For flammable liquids (gasoline, oil, grease, tar, and oil-based paint).
      - Type C: For electrical equipment.

  • Use PASS: Refer to Figure 27.6 for guidance.

SEIZURES (PAGE 436)

  • Definition: A seizure arises from hyper-excitation and disorderly discharge of neurons in the brain, leading to involuntary muscle contractions.
      - Precautions:
        - Pad rails and have suction available.
        - Move the client to a safe area to prevent injury.
        - Do not place anything in the client's mouth or restrain them; stay with the client and observe events.
        - Position the client in the recovery position post-seizure to ensure safety.

ADDITIONAL RISKS

  • Important factors to be aware of include:
      - Suicide: Increased risk among individuals receiving behavioral health treatment.
      - Abuse: Awareness is crucial as clients at all developmental stages can experience various forms of abuse.
      - Passive Smoking: Recognizing the risks from environmental exposure to smoking.

SUICIDE

  • Intervention: For individuals undergoing treatment for behavioral health conditions, it is vital to screen for suicide risk using validated tools, minimize environmental risks, and develop a supportive mitigation plan.

  • Follow established policies for counseling and follow-up care.

ABUSE

  • Types: Child abuse, domestic violence, and elder abuse. Nurses must be vigilant and ensure the immediate safety of clients, adhering to mandatory reporting guidelines.

CONTENT FROM ATI

  • Primary Survey:
      - A: Airway
      - B: Breathing
      - C: Circulation
      - D: Disability
      - E: Exposure

  • Basic First Aid Topics:
      - Bleeding management
      - Fracture and splinting techniques
      - Treatment for sprains
      - Responses to heat strokes
      - Handling frostnip and frostbite
      - Burn treatment
      - Addressing altitude-related illnesses
      - Performing CPR.