Safety and Mobility in Patient Care Environment PDF

Safety and Mobility in the Patient Care Environment NURS 1090  Unit Outcomes  Demonstrate correct  Discuss the importance of application of restraints promoting comfort and  Demonstrate principles of safety in the health ca...

Safety and Mobility in the Patient Care Environment NURS 1090  Unit Outcomes  Demonstrate correct  Discuss the importance of application of restraints promoting comfort and  Demonstrate principles of safety in the health care safe ambulation for a environment. patient using the following  Identify environmental assistive devices: gait hazards in the health care belt, walker, cane and environment. crutches.  Identify patients at risk for  Identify transfer injury. techniques.  Describe the safe use of  Demonstrate correct restraints for a patient at risk techniques for safe use of for injury. wheelchair and transfer  Safety  Definition: freedom from psychological and physical injury  Safety in health care settings:  Reduces incidence of illness/injury  Prevents extended treatment/hospitalization  Improves/maintains patient’s functional status  Increases patient’s sense of well being  One of the Universal Steps for a procedure   Medical errors (adverse events)  An unintentional harm to a Safety in patient arising from any aspect of the Health healthcare management Care  The Joint Commission (TJC) Setting  Centers for Medicare and Medicaid Services (CMS)  May deny hospital reimbursement  National Quality Forum  Serious Reportable Events List  Never Events  Serious Reportable Events in Healthcare Settings  Death or serious injury associated with  Electric shock  Burn  Use of physical restraints or bedrails  Falls  Nurse-sensitive indicators  Events impacted by the delivery of patient care by nurses  QSEN- Quality and Safety Education for Nurses  Clinical Facilities Safety Policies  Patient safety (falls, medication errors, etc.)  Equipment  Fire  Security  Exposure hazards  Needle sticks   Causes of hospital fires  Location of fire extinguishers and alarms, exits Environmenta  Emergency numbers  In case of fire l Hazards to  RACE Safety: FIRE  Rescue/Remove, Activate alarm, Confine the fire, Extinguish if possible  Using Fire Extinguisher  PASS: Pull, Aim, Squeeze, Sweep  PASS  Pull  Aim  Squeeze  Sweep  Environmental Hazards to Safety: Electrical  Operation of equipment  Be knowledgeable in operation of devices – best way to avoid accidents  Evaluate equipment  All electrical equipment must have three pronged plugs  Outlets with red covers or dots/supply emergency power  Prevention  Remove damaged equipment immediately  Tag item for repair  Use only hospital approved equipment   Identify Risk factors that can contribute to fall in patients.  What is important for the nurse to Hazards to assess? Safety:  1.  2. Falls  3. Assessment &  4. Risk Factors  5.  6.  7.  8.  9.  Patient Safety: Older Adult Physiologic Changes  What physiological 1. changes in the 2. older adult can 3. cause safety 4. concerns? 5. 6. 7. 8.  Falls  May extend patient’s length of stay in hospital  May not be reimbursable by Medicare/Medicaid  Reporting  Hospital physician to examine patient  Incident reporting system  Follow up  Discharge planning  Morse Fall Scale: Measures fall risk factors to determine Prevention Interventions Fall Prevention Interventions  Environment  Provide adequate lighting  Reality orientation  How do we meet these needs in the hospital?  Fall Prevention Interventions  Mobility aids  Treaded socks/nonskid slippers or shoes  Exit bed toward stronger side  Use of grab bars  Crutches, canes, walkers  Transport  Lock beds and wheelchairs  Use of siderails  Fall Prevention Interventions: Treaded Socks  Slip resistant tread  Non-slip  Non-skid  Yellow indicates fall risk  Fall Prevention Interventions  Review of medications  Instruct patient in time/dose, side effects, interactions with food/medications  Hourly Rounding  Use of devices  Ambularm Bed/chair exit alarm system  Color coded wristband: yellow for fall risk  Safety Checklist: ALWAYS  Before exiting the patient’s room:  Leave bed in low position  Keep siderails up  Keep the nurse call light within easy reach so that help can be summoned if needed.  Discharge Planning: Avoiding Safety Hazards in the Home Assess lifestyle factors Inadequate nutrition, stress, firearms, substance abuse Environmental factors Review homegoing medications Use of medication organizers  Restraints  Physical: A device applied to a person’s body to limit voluntary movements  Chemical: Pharmacologic agents administered to manage a patient’s behavior.  Assessment for use of physical restraints  Reduce risk of injury from falls  Prevent interruption of therapy  Reduce risk of injury to others by the patient  Types  Limb, vest, mitt or mitten  Geri-chairs  Full side rails, reclining chairs  Vest Restraint  Used to reduce risk of patient injury from falls  Secure to bed frame using quick release tie  Limb Restraint  Used to prevent interruption of therapy  Secure to bed frame using quick- release tie  Leave one fingerbreadth space between the restraint and patient’s limb  Maintain proper body alignment Mitt Restraint – least restrictive if not tied to bedframe  Fastening a Restraint  Use quick-release tie  Always tie restraint to bedframe; NOT the siderail Geri-Chair  Restraint Monitoring /Documentation  Assess continued need for restraint  Evaluate alternatives: companionship, supervision, diversion, environmental modifications  Know agency restraint policy  HCP order needed to maintain restraint  RN may initiate /depends on agency policy  Ongoing assessment of patient  Assess proper placement of restraint, skin integrity, pulses, temperature, color and sensation of restrained body part at least every 2 hours  Provide range of motion  Use of Restraints in Long Term Care  Different policies than acute care settings. Review facility policies.  Examples:  No siderails or only partial siderails unless indicated  Use of low beds for easy access  Non-rolling/working brakes or stabilizers  Use of alarms  Bedside Floor Mat  Cushioned pad  Placed on floor along the side of the bed  Reduces injury Used for impaired mobility Goal: increase mobility without injury Types Gait/Transfer Belts Mobility Crutches Aids to Canes Safety Walkers Wheelchairs Mechanical lift Transfer/sliding board  Gait/Transfer Belt An assistive device used to assist patient to safely transfer and ambulate  Used for patients that are slightly weak and unstable  Fasten belt securely around patient’s waist  Grasp belt at patient’s back  Walk behind or slightly to one side of patient  Crutches  Safety  Assistive devices used for:  Do not lean on  Post-surgery crutches  Disability affecting feet,  Inspect crutch ankles, knees or legs. tips  Used to increase and  Keep crutch tips provide support for dry mobility  Wear a shoe with a low heel  Spare crutches Types of Crutches Crutches  Measure and fit  2” below axilla, hand grip at level of greater trochanter  15-30 degree bend at elbow  Basic Crutch Stance (Tripod Position)  6 inches (15 cm) in front of and 6 inches (15 cm) to the side of each foot  Crutch Gaits  Four-Point Alternate Gait  Each leg moves alternately with each opposing crutch  Gives stability  Requires weight bearing on both legs  Crutch Gaits  Three-Point Gait  Requires all weight bearing on one leg  Bears weight on both crutches and then on uninvolved leg  Repeat sequence  Crutch Gaits  Two-Point Alternate Gait  Partial weight bearing on each foot  Move crutch at the same time as opposing leg Crutch Walking Video: 2 point, 3 point, 4 point  https://www.youtube.com/watch?v=jcKJMCbQrL0 Gaits  Crutch Gaits  “Swing to” and “Swing through”  Weight placed on supported legs  Place crutches one stride in front  Swing to or through the crutches Crutches: Stairs Crutches: Chairs Hold both crutches in one hand on affected side, grasp arm of chair, lower body into chair  Canes  Indications for use  Provide support  Improve balance  Provide safety  Types  Single (standard)  Quad  Measurement  Hand grasp at level of greater trochanter  Quad Cane  Similar to a standard cane  Metal base with 4 small feet  Helps provide more support and stability when ambulating   Cane Walking  Hold cane with hand on stronger Cane side of body Walking and  Move cane forward 6-10 inches Safety  Keep body weight on both legs  Weaker leg moves forward  Stronger leg advances past the cane  Safety  Rubber tip  Proper footwear  Walkers  Types  Standard, wheeled, folding, stair  Measurement  Wrist at level of hand grips  Use  Move walker, take a step, repeat  Move weaker leg first, then stronger  Or move weaker leg and walker together  Safety features  May not support weight > 230 lbs  Walk slowly with head up  Wheelchairs  Features  Uses  Safety measures  Brakes (wheel locks)  Footrests  Anti-tip bar  Keep in locked position  Transfers: Bed to Chair/Wheelchair  Lower bed  Assist patient to a sitting position on the side of the bed (dangle)  Use transfer belt or position hands on each side of patient  Assist patient to standing position  Pivot or take a few steps to the chair  Assist the patient to sit  Give clear instructions during the procedure  Transfer Device: Mechanical Lift (Hydraulic Lift)  Manual or battery powered  Hoists patient for patient transfer using sling  Patient is log-rolled onto sling and lifted to chair  Sling remains under patient until patient returned to bed  Important Points for Use of a Mechanical Lift  Safety Considerations  Explain procedure to the patient  Consider patient weight prior to use—assess weight guidelines for the device  Assistance from other caregivers required  Move patient slowly (to avoid dizziness/falling)  Assistant must maintain ‘hands-on’ contact with the sling during transfer  Important Points for Use of a Mechanical Lift  Safety Considerations, cont  Never leave a patient unattended in a lift  For greatest stability, spread the lift base to the widest position before lifting the patient  Slowly lower the patient to the chair  Leave the device sling under the patient for easier access for return to the bed  Ensure patient in correct sitting alignment  Place call light within reach Transfer Assistive Devices: Mechanical Lift Sit to Stand Transfer Device  Transfer Assistive Device: Transfer Board/Sliding Board  Assists in transfer from bed to bed/stretcher  Reduces friction  Requires at least 2 caregivers  Procedure:  1) Place patient in lateral position  2) Position board under patient  3) Roll patient onto board  4) Pull patient and board across bed to stretcher