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Safety

Factors Affecting Ability to Protect Self from Injury


Age and development Lifestyle Mobility and health status Sensory-perceptual alterations Cognitive awareness Emotional state Ability to communicate Safety awareness Environmental factors

National Patient Safety Goals (NPSGs)


1. Improve the accuracy of patient identification. 2. Improve the effectiveness of communication among caregivers. 3. Improve the safety of using medications. 4. Reduce the risk of health careassociated infections. 5. Accurately and completely reconcile medications across the continuum of care. 6. Reduce the risk of patient harm resulting from falls.

National Patient Safety Goals (NPSGs)


7. Reduce the risk of influenza and pneumococcal disease in institutionalized older adults. 8. Reduce the risk of surgical fires. 9. Implement applicable National Patient Safety Goals and associated requirements by components and practitioner sites. 10. Encourage the active involvement of patients and their families in the patients care as a patient safety strategy. 11. Prevent health careassociated pressure ulcers (decubitus ulcers).

National Patient Safety Goals (NPSGs)

Common Potential Hazards: Developing Fetus


Exposure to maternal smoking, alcohol consumption, addictive drugs X-rays (first trimester) Certain pesticides

Common Potential Hazards: Newborns and Infants


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

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

Lead Poisoning Animation

Click here to view an animation on lead poisoning.


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Common Potential Hazards: Preschoolers


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

Common Potential Hazards: Adolescents


Motor vehicle or bicycle crashes Recreational injuries Firearms Substance abuse

Common Potential Hazards: Older Adults


Falling Burns Motor vehicle crashes and pedestrian injuries

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 Aspiration Risk for Disuse Syndrome

Deficient Knowledge (Injury Prevention)

Desired Outcomes for Clients with Safety Risks


Prevent injury Often need to change health behavior Modify their environment Desired outcomes depend on individual client

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

Preventing Thermal Injuries


Pot handles should not protrude over edge of stove Electrical appliances should be out of reach of crawling infants and young children Bath water should not be excessively hot Monitor clients with impaired skin sensitivity Use care when using therapeutic applications of heat

Preventing Agency Fires


Be aware of fire safety regulations and fire prevention practices of the agency If fire occurs:
Protect and evacuate clients who are in immediate danger Report the fire Contain the fire Extinguish the fire

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

Preventing Home Fires


If fire occurs:
Close windows and doors, if possible Cover mouth and nose with damp cloth Avoid heavy smoke by assuming bent position with head close to floor as possible

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

Preventing Choking and Suffocation


Teach universal distress signal Teach Heimlich maneuver

Minimizing Excessive Noise


Minimize noise in the hospital setting Encourage clients to protect hearing as much as possible Noise can be minimized in several ways:
Acoustic tile on ceilings, walls, and floors Drapes and carpeting absorb

Background music

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

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 friends 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 to someone else

Firearm Safety
Dont 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

Protecting Against Radiation


Limit time near source Provide as much distance as possible from source Use shielding devices Be familiar with agency protocols

Planning for Bioterrorism


Important health care personnel and facilities plan and prepare for the unknown Healthcare organizations expected to address four specific phases of disaster planning
Mitigation Preparedness Response Recovery

Should participate annually in at least one community-wide practice drill

Measures to Prevent Falls


Orient clients to surroundings and explain the call system Carefully assess the clients ability to ambulate and transfer Provide walking aids and assistance as required Closely supervise the clients at risk for falls, especially at night

Measures to Prevent Falls


Encourage the client to use the call bell to request assistance and ensure that the bell is within easy reach Place bedside tables and overbed tables near the bed or chair so that clients do not overreach Always keep hospital beds in the low position and wheels locked when not providing care so that clients can move in or out of bed easily

Measures to Prevent Falls


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

Measures to Prevent Falls


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

Potential Environmental Causes of Falls


Inadequate lighting Presence of electrical cords, loose rugs, clutter and slippery floors Absent or unsteady railings Uneven step height or surfaces Unsteady base on furniture Lack of armrests on chairs Cabinets that are too high or too low Inappropriate toilet height Slippery floors in the bathroom Absence of grab bars

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.

Seizure Precautions
In the home, safety precautions if seizures are not well-controlled include restriction or direct supervision by others for certain activities:
Tub bathing Swimming Cooking Using electrical equipment or machinery Driving

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

Alternatives to Restraints
Monitor all the clients 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

Alternatives to Restraints
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

Alternatives to Restraints
Try a warm beverage, soft lights, a back rub or a walk Use environmental restraints Place a picture or other personal item on the door to the clients room Try to determine the causes of the clients sundowner syndrome Establish ongoing assessment

Use and Legal Implications of Restraints


Restraints restrict the individuals freedom U.S. Centers for Medicare and Medicaid Services standards
Behavior management standard Acute medical and surgical care standard

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

Medical Surgical Care Standard


Up to 12 hours for obtaining the physicians 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

Use and Legal Implications of Restraints

Use and Legal Implications of Restraints

Desired Outcomes for Injury Prevention


Nurses 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

Examples of Desired Outcomes


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

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