NSG 3100 Patient Safety and Restraints

Patient Safety and Restraints

• NSG 3100 course
• Patient safety and restraints are covered
• Restraints are protective devices that limit physical activity
• Three types of restraints: Physical, Chemical, and Seclusion
• Restraints used for two reasons:
  • Prevent purposeful or accidental harm to a client
  • Provide medically necessary treatments
• Restraints should be used as a last resort
• Use less restrictive interventions if possible
• Interventions are used to protect client, staff, or others from harm
• Restraints must be discontinued as soon as possible
• Restraints are used under two situations:
  • Nonviolent behavior, non self-destructive
  • Violent behavior, self-destructive behavior (harm to self, staff or others)
• Primary Care Physician (PCP) order is required and needs to include reason for restraints and specific time frame
• PCP allows for the possible sooner removal of restraints if warranted
• Restraint orders must be renewed every 24 hours
• Restraint orders (PRN) are not allowed
• Continuous monitoring of patients in restraints is needed

Factors Affecting Patient Safety

• Age and development, lifestyle, mobility, and health status influence safety
• Cognitive awareness
• Emotional state
• Ability to communicate
• Safety awareness
• Environmental factors (healthcare settings, workplaces, home, bioterrorism, disaster planning).
• Sensory-perceptual alterations
• Specific factors influencing safety throughout the lifespan
  • Developing fetuses
  • Newborns/Infants
  • Toddlers
  • Pre-schoolers
  • Adolescents
  • Older adults

Risk Factors for Falls

• Poor vision
• Cognitive dysfunction
• Mobility restrictions
• Orthostatic hypotension
• Urinary frequency
• Weakness from disease process or therapy
• Current medication regimen (sedatives, hypnotics, tranquilizers, narcotic analgesics, diuretics)

Universal Fall Precautions

• Familiarize the client with the environment
• Teach back use of call light
• Keep call light within reach
• Keep personal possessions within reach of the client
• Handrails in room, bathroom, and hallways
• Bed in low position and locked
• Non-skid, well-fitting footwear
• Nightlights
• Keep floor clean and dry
• Keep areas uncluttered

Seizure Precautions

• Pad the side rails
• Put oral suction equipment at the bedside
• Remain with client and call for assistance during a seizure
• Do not restrain client
• if not in bed lower the client to the floor and pad surroundings for safety
• Turn the client to the lateral position if possible
• Move items in environment to ensure there is no injury
• Loosen any restrictive clothing
• Do not put anything in the client's mouth
• Provide oxygen and suction as needed
• Prepare seizure medications
• Time and record any movements of seizure
• Document seizure in a timely manner after it occurs

Environmental Hazards

• Fires & Burns
• Poisoning (Carbon Monoxide, Suffocation, Choking)
• Excessive Noise
• Electrical Hazards
• Firearms
• Radiation
• Bioterrorism Attack
• Procedure/Equipment related accidents

Fire Considerations

• Check batteries in smoke detectors regularly
• Keep fire extinguisher in kitchen and handy
• No smoking inside the home

Prevent Poisoning

• Store harmful agents away from children
• Store in locked cabinets
• Do not store in different containers or remove labels
• Teach children not to eat unknown substances
• Do not refer to medications as "candy"
• Always read product labels before using medication
• Have poison control phone numbers readily available
• Contact county's cooperative extension agency for poisonous plants

Steps to Take for Child Poisoning

• Identify the poison and remove it from the child's reach
• Try to make the child spit out any remaining substances
• Do not induce vomiting
• If unconscious or with severe reactions, call 9-1-1
• If conscious and not severe, contact your local poison center

Gun Safety

• Store guns in locked cabinets without glass and keys inaccessible to children
• Store bullets separately from the gun
• Teach children never to touch a gun or enter a home with accessible guns
• Teach children to never point a gun barrel at anyone
• Ensure firearms are unloaded and action is open when handing them to someone else
• Do not use firearms while impaired by alcohol or drugs
• Keep all ammunition separate for cleaning and in another room
• Inspect regularly used firearms at least every 2 years

Reducing Electrical Hazards

• Check cords for fraying or damage
• Avoid overloading outlets with too many appliances
• Use only grounded outlets and plugs
• Never use appliances near sinks, tubs, showers, or wet areas
• Keep cords and appliances out of reach of young children
• Use protective covers over outlets

Medical Errors/Sentinel Events

• Reports released in 1999 from Institute of Medicine, on errors, are typically not due to individual error, but system process error.
• Healthcare errors are preventable
• Encourage reporting without retribution
• Implement strategies to promote a safety culture
• "Near miss" reporting: an event or situation that did not produce client injury, but could have
• Examples: putting wrong ID band on a client, errors in drug preparation

Number of Deaths in the United States

• Leading causes of death: Heart disease, Cancer, Respiratory Disease, Accidents, Stroke, Alzheimer's disease, Diabetes, Influenza and Pneumonia, Kidney disease, Suicide

The National Patient Safety Goals

• Use data to set goals for improvement in safety and updated annually
• Covers various healthcare settings, including ambulatory care, behavioral health, hospitals, laboratories, and nursing care centers

Joint Commission Goals for Patient Safety

• Patient identification
• Improve communication
• Improve safety of using medications
• Reduce HCAIs
• Reduce risk of harm from falls
• Prevent pressure ulcers
• Identify safety risks in patient population

Activity - Go to NPSG

• Group work on National Patient Safety goals
• Review different healthcare settings and associated goals
• Discuss these goals with colleagues

This quiz covers key concepts of patient safety and the use of restraints in the NSG 3100 course. It discusses the types of restraints including physical, chemical, and seclusion, emphasizing their application as a last resort to ensure the safety of clients and staff. Understanding both the ethical and legal implications of restraints is crucial for nursing practice.