Kozier Ch 32

  1. Factors Affecting Safety
    • •Age and development
    • •Lifestyle
    • •Mobility and health status
    • •Sensory-perceptual alterations
    • •Cognitive awareness
    • •Emotional state
    • •Ability to communicate
    • •Safety awareness
    • •Environmental factors
  2. Assessing clients at risk for injury
    • •Nursing history and physical examination
    • •Risk assessment tools
    • •Assessment of client’s home environment
  3. National Patient Safety Goals for Hospitals
    • •Establish by the Joint Commission on the Accreditation of Hospital (JCAHO) in response to the IOM report.
    • •The Goals were established in 2002 to help accredited organizations address specific areas of concern in regards to patient safety
    • •Goals are reviewed each year and either continue, go on to become a “standard”, or are deleted.

    • GOALS:
    • 1.Improve the accuracy of patient identification.
    • 2.Improve the effectiveness of communication among caregivers.
    • 3.Improve the safety of using medications.
    • 7. Reduce the risk of health care–associated infections.
    • 8. Accurately and completely reconcile medications across the continuum of care.
    • 15. Identify safety risks inherent in the patient population.

    • Long Term Care:
    • 1, 3, 7, 8 similar but use “Resident”
    • 9. Reduce the risk of resident harm resulting from fall.
    • 14.Prevent health care–associated pressure ulcers (decubitus ulcers).

    • –Read back & verify verbal & phone orders
    • –Use only approved abbreviations
    • –Standardize look-alike, sound-alike meds
  4. Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery™
    • • Preoperative verification process
    • –Verify correct patient, procedure, site
    • –Standardized checklist to verify relevant documentation

    • •Site marking
    • –Mark the site, preferably with patient involvement

    • •Time-out
    • –Standardized checklist
    • –Performed by members of immediate surgical team
  5. Common Potential Hazards: Developing Fetus
    • •Exposure to maternal smoking, alcohol consumption, addictive drugs
    • •X-rays (first trimester)
    • •Certain pesticides
  6. Common Potential Hazards: Newborns and
    • •Falling
    • •Suffocation in cribs
    • •Choking from aspirated milk or ingested objects
    • •Burns from hot water or other spilled hot liquids
    • •Motor vehicle crashes
    • •Cribs or playpen injuries
    • •Electric shock
    • •Poisoning
  7. Common Potential Hazards: Toddlers
    • •Physical trauma from falling, banging into objects, or getting cut by sharp objects
    • •Motor vehicle crashes
    • •Burns
    • •Poisoning
    • •Drowning
    • Electric shock
  8. Common Potential Hazards:
    • •Injury from traffic, playground equipment, and other objects
    • •Choking, suffocation, and obstruction of airway or ear canal by foreign objects; poisoning
    • •Drowning
    • •Fire and burns
    • •Harm from other people or animals
  9. Common Potential Hazards: Adolescents
    • •Motor vehicle or bicycle crashes
    • •Recreational injuries
    • •Firearms
    • •Substance abuse
  10. Environmental Factors relating to Patient safety
    • •Hospital & nursing involve complex tasks:
    • –Rapidly changing exchange of information
    • –Being in a hurry. Fast paced
    • –Multi-tasking & multiple demands
    • –Interruptions
    • –Stress
    • –Fatigue
    • –General environment- noise, distractions, long work
    • hours, inconsistent staffing, shift work
  11. Common Potential Hazards:
    Older Adults
    • •Falling
    • •Burns
    • •Motor vehicle crashes and pedestrian injuries
  12. Nursing Diagnoses for Clients
    at Risk for Injury
    • •Risk for Injury
    • –Risk for Poisoning
    • –Risk for Suffocation
    • –Risk for Trauma
    • –Latex Allergy Response
    • –Risk for Contamination
    • –Risk for Aspiration
    • –Risk for Disuse Syndrome
    • •Deficient Knowledge (Injury Prevention)
  13. Nursing Interventions for Clients at risk for Injury
    • •Helping the client and family accomplish the following:
    • –Identify environmental hazards in home and community
    • –Demonstrate safety practices appropriate to the home health care agency, community, and workplace
    • –Experience a decrease in the frequency or severity
    • of injury
    • –Demonstrate safe childrearing practices or lifestyle
    • practices
  14. Desired Outcomes for Client Safety
    • •Prevention of injury
    • •Change health behavior
    • •Modify environment
    • •Client individualized
  15. Potential Hazards in the Heath Care Setting
    • •Thermal injuries (scalds & burns)
    • •Fires
    • •Electrical hazards
    • •Radiation
    • •Falls
    • •Seizures
    • •Suffocating or choking
    • •Excessive noise
    • •Procedure & equipment accidents
    • •Restraints
  16. Preventing Thermal Injuries
    • •Bath water should not be excessively hot
    • •Monitor clients with impaired skin sensitivity
    • •Use care when using therapeutic applications of heat
    • Home
    • •Pot handles should not protrude over edge of stove
    • •Electrical appliances should be out of reach of crawling infants and young children
  17. Preventing Home Fires
    • •Teach fire safety
    • •Keep emergency numbers near the telephone, or stored for speed dialing
    • •Be sure smoke alarms are operable and appropriately located
    • •Teach to change batteries in smoke alarms annually on a special day
    • •Have a family “fire drill”
    • •Keep fire extinguishers available and in working order
  18. Preventing Agency Fires
    • •Be aware of fire safety regulations and fire prevention
    • practices of the agency

    • •If fire occurs:
    • –R- rescue, remove person from immediate danger
    • –Alarm- activate it
    • –Contain the fire
    • –Extinguish the fire
  19. Preventing Poisoning
    • •Teaching parents to “childproof” the environment
    • •Providing information and counseling about insect, snake bites and drugs used for recreational purposes
    • •Safeguarding the environment and monitoring the underlying problems to prevent accidental ingestion of toxic substances
    • •Teaching the telephone number of poison control centers
    • •Educating the public about what to do in the event of poisoning
  20. Reducing Electrical Hazards
    • •Properly grounded electrical equipment
    • •Using machines in good repair
    • •Wearing shoes with rubber shoes
    • •Standing on a nonconductive floor
    • •Using nonconductive gloves
  21. Protection against Radiation
    • •Used in diagnostic & therapeutic procedures
    • •Limit time near source
    • •Provide as much distance as possible from source
    • •Use shielding devices
    • •Be familiar with agency protocols
  22. Preventing choking and suffocation
    •Teach universal distress signal

    •Teach Heimlich maneuver
  23. Firearm Safety
    • •Store all guns in sturdy locked cabinets without glass
    • •Make sure the keys are inaccessible to children
    • •Store the bullets in a different location
    • •Tell children never to touch a gun or stay in a friend’s house where a gun is accessible
    • •Teach children never to point the barrel of a gun at anyone
    • Ensure the firearm in unloaded and the action open when handing
    • •Don’t handle firearms while affected by alcohol or drugs of any kind, including pharmaceuticals
    • •When cleaning or dry firing a firearm, remove all ammunition to another room
    • •Double-check the firearm when entering the room used to clean the firearm
    • •Have firearms that are regularly used inspected by a qualified gunsmith at least every 2 years
  24. Planning for Bioterrorism
    •Important health care personnel and facilities plan and prepare for the unknown

    •Healthcare organizations are expected to address disaster planning

    •Should participate annually in at least one community-wide practice drill
  25. Lifespan Considerations: Preventing Falls
    1. Assess for potential causes of falls - hypotension, unsteady gait, altered mental responsiveness, poor vision, foot pathologly, cognitive changes, and fear

    • 2. Assess for Environmental causes of falls:
    • Inadequate lighting -inaccessable switches
    • •Floors - Presence of electrical cords, loose rugs, clutter and slippery floors
    • •Stairs - Absent or unsteady railings, uneven step height or surfaces
    • •Furniture -Unsteady base on furniture
    • Bathroom - inappropriate toilet height, slippery floors or tub, absence of grab bars
  26. Ways to prevent falls
    • •Orient client to surroundings
    • •Encourage to use the call bell to request assistance
    • •Keep bell in easy reach
    • •Place bedside tables and overbed tables near the bed or chair so that clients do not overreach
    • •Provide walking aids and assistance as needed
    • •Always keep hospital beds in the low position and wheels locked
    • •Encourage clients to use grab bars mounted in toilet and bathing areas and railings along corridors
    • •Make sure nonskid bath mats are available in tubs and showers
    • •Encourage the clients to wear nonskid footwear
    • •Keep the environment tidy, especially keeping light cords from underfoot and furniture out of the way
    • •Use individualized interventions, e.g. electronic devices, rather than side rails for confused client
  27. Seizure Precautions
    •Pad the bed by securing blankets, linens around the head, foot, and side rails of the bed

    •Put oral suction equipment in place and test to ensure that it is functional

    •Children who have frequent seizures should wear helmets for protection.
  28. Alternatives to Restraints
    • •Assign nurses in pairs
    • •Place unstable clients in an area that is constantly or closely supervised
    • •Prepare clients before a move to limit relocation shock
    • -Stay with a client using a bedside commode or bathroom if confused, sedated or has a gait disturbance or a high risk score for falling
    • •Monitor all the client’s medication and if possible lower or eliminate dosages of sedatives or psychotropics
    • •Position beds in lowest position
    • •Replace full-length side rails with half- or three-quarter length rails
    • •Use rocking chairs to help confused clients expend some energy
    • •Wedge pillows or pads against the sides of wheelchairs
    • •Place a removable lap tray on a wheelchair
    • •Try a warm beverage, soft lights, a back rub or a walk
    • •Use “environmental restraints” -furniture or large plants as barriers to keep patients from wandering
    • •Place a picture or other personal item on the door to the client’s room - help identify their room
    • •Try to determine the causes of the client’s sundowner syndrome
    • -Establish ongoing assessment
  29. Restraints
    • •Restraints restrict the individual’s freedom
    • U.S. Centers for Medicare and Medicaid Services standards
    • –Behavior management standard
    • •Nurse may apply restraints but the physician or other licensed independent practitioner must see the client within 1 hour for evaluation
    • •Written restraint order for an adult, following evaluation, valid for only 4 hours.
    • *Must be continual visual and audio monitoring if client restrained and secluded

    • –Acute medical and surgical care standard
    • •Up to 12 hours for obtaining the physician’s written order
    • •Orders renewed daily
    • •Order must state the reason and time period
    • •PRN order prohibited
    • •In all cases, restraints used only after every possible means of ensuring safety unsuccessful and documented
    • *Nurses must document need for the restraint made clear both to client and family
  30. Criteria for Selecting a restraint
    • 1. It restrict's the clients movement as little as possible
    • 2. It does not interfere with the client's treatment or health problem
    • 3. It it readily changable
    • 4. It is safe for the particular client
    • 5. It is the least obvious to others
  31. Practice Guidelies: Applying Restraints
    • -Obtain consent from client or guardian
    • - Ensure Dr order has been provided or get one within 24 hours
    • - Client & support people should know restraint is temporary
    • - Give client as much freedom to move as possible w/o defeating purpose of restraint
    • -Limb restraints should not cut off circulation
    • -Pad bony prominences
    • -Tie limb restraint with knot that will not tighten when pulled
    • -Tie body restraint to part of bed that moves when head is elevated
    • -Assess restraints per agency protocol time
    • - Assess skin integrity per agency protocol
    • - Assess and assist with basic needs
    • -Reassess the continued need for restraints
    • - When restraint is temporarily removed, do not leave client unattended
    • - Immediately report & chart persistant redness or broken skin areas under restraint
    • - Loosen restaint & exercise limb IMMEDIATELY if: cyanosis, pallor, coldness of skin area, client complains of tingling, pain, or numbness
    • - Apply restraint so it can be released quickley
    • -Provide emotional support verbally and through touch
  32. Desired Outcomes for Injury Prevention
    • •Nurse’s role largely educative
    • •Desired outcomes reflect:
    • –Acquisition of knowledge of hazards
    • –Behaviors that incorporate safety practices
    • –Skills to perform in the event of certain emergencies

    • Examples of Desired Outcomes:
    • •Describe methods to prevent specific hazards
    • •Report use of home safety measures
    • •Alter home physical environment to reduce risk of injury
    • •Describe emergency procedures for poisoning and fire
    • •Describe age-specific risks or work safety risks or community safety risks
    • •Demonstrate correct use of child safety seats
    • •Demonstrate correct administration of cardiopulmonary resuscitation
Card Set
Kozier Ch 32
Powerpoint & Notes for Ch 32 Safety