Davis Advantage Basic Nursing Module 15 Safety (PDF)

Davis Advantage Basic Module 15 Nursing, 3eChapter 21 Safety Introduction to Health Concepts Myra Thompson, RN, MSN Copyright ©2022 F.A. Davis Company  Lear...

Davis Advantage Basic Module 15 Nursing, 3eChapter 21 Safety Introduction to Health Concepts Myra Thompson, RN, MSN Copyright ©2022 F.A. Davis Company  Learning Outcomes 1. Discuss developmental and individual factors that create safety risks. 2. Identify safety hazards in the home environment and community with interventions to prevent injury. 3. Describe and give examples of safety hazards encountered in the healthcare agency. Give strategies to prevent these hazards. 4. Apply soft limb restraints correctly. a) Identify alternatives to restraints. b) Assess soft limb restraints properly. c) Explain a restraint-free environment. d) What you should know about using restraints (Clinical Insight 21-3 p. 728.) 5. Identify characteristics of “Never Events.” List examples of “Never Events.” 6. Use the nursing process to promote safety and prevent injury for clients, across the lifespan, who are at home and in the healthcare setting. 7. Describe strategies to prevent falls at home and in the healthcare setting. 8. Define standard precautions and describe how they reduce risks to nurses and clients. 9. Incorporate JCAHO’s National Patient Safety Goals for 2024 into the client’s plan of care. Copyright ©2022 F.A. Davis Company  Safety  The condition of being safe from undergoing or causing hurt, injury, or loss (Webster’s)  Basic human need  Nurses attend to the safety needs of Clients in all healthcare settings Healthcare workers, including themselves Copyright ©2022 F.A. Davis Company  Developmental Factors Affecting Safety  Infants/toddlers Cannot recognize danger Tactile exploration of environment Totally dependent  Preschoolers Play extends to outdoors More adventurous Copyright ©2022 F.A. Davis Company Developmental Factors Affecting Safety (2)  School-age children Try new activities without practice More time outside the home Stranger danger  Adolescents False confidence; feel indestructible Risk-taking behaviors Most lack adult judgment Copyright ©2022 F.A. Davis Company Developmental Factors Affecting Safety (3)  Adults May be exposed to injury in the workplace Lifestyle choices impact health Some decline in strength and stamina; others maintain fitness  Older adults Loss of muscle strength, joint mobility; slowing reflexes; sensory losses Copyright ©2022 F.A. Davis Company  Question In meeting the safety needs of the adolescent client, it would be most important for the nurse to focus their teaching on: A. Smoking cessation B. Sports injuries C. Alcohol abuse D. Driver’s education Copyright ©2022 F.A. Davis Company  Individual Factors Affecting Safety  Lifestyle  Cognition  Sensory perception status  Ability to communicate  Mobility status  Physical and emotional health  Safety awareness Copyright ©2022 F.A. Davis Company  Safety Hazards in the Home (1)  Poisoning Household chemicals, lead, medicines, cosmetics Prevention: Cabinet locks, store poison high, keep Poison Control telephone number available Treatment: Depends on type of poison ingested; antidotes, charcoal, and so forth Copyright ©2022 F.A. Davis Company  Safety Hazards in the Home (2)  Carbon monoxide poisoning Produced by burning fuel: Gas, wood, oil, kerosene Prevention: Carbon monoxide detector Treat: 100% humidified oxygen Copyright ©2022 F.A. Davis Company  Safety Hazards in the Home (3)  Scalds and burns Hot water, grease, sunburn, cigarettes Prevention ‒ Guardrails by fireplace ‒ Turning pot handles ‒ Care with candles ‒ Sunscreen ‒ Care when warming food in microwave Copyright ©2022 F.A. Davis Company  Safety Hazards in the Home (4)  Fires Cooking fires, smoke inhalation, home heating equipment Prevention ‒ Smoke alarms ‒ Caution with cigarettes ‒ Fire extinguisher ‒ No candles unattended ‒ Safety with holiday lights ‒ Care with electrical cords Copyright ©2022 F.A. Davis Company  Safety Hazards in the Home (5)  Falls Prevalent in those older than 65 years Slippery floors, stairs, tubs; low toilet seat; high bed Prevention: Nonskid shoes, tidy clothes, proper lighting, grab bars/rails, no scatter rugs Copyright ©2022 F.A. Davis Company  Safety Hazards in the Home (6)  Firearms injuries Youth suicides; domestic violence Prevention: Firearms safety education for parents and children, proper locked storage, keep ammunition separate Copyright ©2022 F.A. Davis Company  Safety Hazards in the Home (7)  Suffocation/asphyxiation Drowning, choking, smoke/gas inhalation Children 0 to 4 years old are high risk Prevention ‒ Watch for small, removable parts. ‒ Cut food into tiny pieces. ‒ Pay attention to mobiles, strings, cords, and plastic bags. ‒ Apply a barrier to a pool. ‒ Know the Heimlich maneuver. Copyright ©2022 F.A. Davis Company  Safety Hazards in the Home (8)  Take-home toxins Pathogenic microorganisms, asbestos, lead, mercury, arsenic Prevention ‒ Be aware of workplace preventive measures. ‒ Remove work clothing. ‒ Shower if appropriate. ‒ Use gloves. Copyright ©2022 F.A. Davis Company  Question A child has had hiccups for 2 hr. Is this a sign of suspected ingestion of poison? A. Yes B. No Copyright ©2022 F.A. Davis Company  Safety Hazards in the Community (1)  Motor vehicle injuries Causes: Failure to use seat belts; use of alcohol; pedestrian accidents; non-deployment of airbag Prevention: Avoid distractions in car (cell phone, text messages, loud music); use designated driver; use seat belts, proper age-dependent restraints for children Copyright ©2022 F.A. Davis Company  Safety Hazards in the Community (2)  Pathogens Foodborne, vector-borne Prevention: Proper storage, cleaning, and cooking of foods; clean cooking surfaces; attention to folk remedies Prevention: Drain standing water; insect repellents; protect skin contact with insects; wipe out breeding areas Copyright ©2022 F.A. Davis Company  Safety Hazards in the Community (3)  Pollution Air, water, noise, soil Prevention ‒ Proper disposal and recycling of solid wastes ‒ Environmentally safe products ‒ Carpool, public transport ‒ Ear plugs Copyright ©2022 F.A. Davis Company  Safety Hazards in the Community (4)  Weather hazards Prevention ‒ Be aware of weather events. ‒ Develop a disaster plan. ‒ Identify a place to take shelter. Copyright ©2022 F.A. Davis Company  Safety Hazards in Home Care Settings Environmental improvements that address safety risks in home settings​ Handrails on walls, grab bars in bathroom​ Wider hallways, doorways for using walkers, wheelchairs​ Easy-grip door handles​ Removal of scatter rugs​ Easily accessible bell or other way to call for help​ Adequate lighting​ Chair-height toilets or raised toilet seats​ Ability to control room temperature for comfort​ Fire and disaster plans​ Smoke detectors​ Copyright ©2022 F.A. Davis Company  Safety in Healthcare Facility- Handoff Reporting​ Handoff reporting: communication of patient information between nursing units, between shifts, other departments, staff, physicians​ Critical but also a common cause of error​ If not all patient information is given​ If there is not enough time and information about patient is fragmented​ Many facilities using SBAR​ Situation​ Background​ Assessment​ Recommendations​/Questions Copyright ©2022 F.A. Davis Company  Safety in Healthcare Facility Adverse Drug Events​ In some facilities, safety may not be high priority → complacency, tolerance of low performance​ Can contribute to poor quality, patterns of unsafe behaviors, uncaring attitudes​ Nurses can provide safe medication administration by using the seven rights of medication administration​ 1. Right assessment​ 2. Right drug​ 3. Right dose​ 4. Right patient​ 5. Right route​ 6. Right time​ 7. Right documentation​ Copyright ©2022 F.A. Davis Company  Safety Hazards in Healthcare Settings- Falls Common in healthcare facilities and homes​ Nursing interventions decrease the risk​ Prevention: Fall risk assessment Remove obstacles from walking paths​ Patient rooms, corridors, stairwells​(Clean dry floors) Keep frequently used items within easy reach​ Ensure that rooms are well lit​ Make sure patients wear shoes with soles that provide traction, not slippers or barefoot​ Assess patient’s vision and eyewear use​ Use 2 side rails on patient beds​. Avoid 4 side rails. Be aware of patient’s medical regimen, side effects, and interactions​ Copyright ©2022 F.A. Davis Company Safety Hazards in the Healthcare Facility (1)  Never events  Root cause analysis  Culture of safety Copyright ©2022 F.A. Davis Company Safety Hazards in the Healthcare Facility (2)  Alarm fatigue  Equipment-related accidents  Fires/electrical hazards  Restraints  Mercury poisoning Prevention: Yearly facility training, following facility policy Copyright ©2022 F.A. Davis Company  Guidelines for the Use of Restraints​ Assessment at least every 2 hours​ Including skin and circulation status, patient’s response, effects of restraints​ New HCP prescription needed every 24 hours ​ Periodic removal of restraints for patient to freely move body part, range-of-motion (ROM) exercises, repositioning of patient​ (every 2 hr) Periodic offering of toileting, food, fluids​(every 2 hr) Evaluation to determine whether continued restraint needed, reapplication of restraints if needed​ Appropriate, complete documentation of restraint intervention​ Copyright ©2022 F.A. Davis Company  Alternatives to the Use of Restraints​ Having family member or sitter stay with patient​ Using bed or chair alarms​ Distractions or diversional activities​ Limiting number of staff working with patient​ De-escalation strategies​(large # of people gather around) Portable electronic GPS to locate patient​ Reorienting confused patient​ Assessing/addressing problems causing agitation​ Offering therapeutic self and reassurance​ Copyright ©2022 F.A. Davis Company  Safety Hazards for Healthcare Workers  Back injury  Needlestick injury  Radiation injury  Violence  Prevention Body mechanics Sharps awareness, proper disposal Radiation precautions Environmental awareness of personal safety Copyright ©2022 F.A. Davis Company  Safe, Effective Nursing Care How would you, as the nurse, support a culture of safety? Select all that apply. A. Completing incident reports when appropriate B. Completing incident reports for a near miss C. Communicating product concerns to an immediate supervisor D. Identifying the person responsible for an incident Copyright ©2022 F.A. Davis Company  Socratic Reasoning  Do you think teamwork and collaboration is important in assuring a culture of safety in the workplace?  Explain your thinking.  Identify any previous experiences that have led to your answer. Copyright ©2022 F.A. Davis Company  Assessment  Client environment  Home safety  Risk for violence  Morse Fall Scale  Incomplete assessments, skipping a step during a procedure, or even unintentional mistakes can result in​: Longer hospital stays​or accidents Injuries​ Infections​ Functional decline​ Death​ Catastrophic adverse effects may serve as motivators for prevention​ Copyright ©2022 F.A. Davis Company Assessment/Patient Interview R/T Safety Observe constantly for age-appropriate assessment data​ Ability to communicate​ Ability to provide self-care​ Cognitive ability, memory deficiencies​ Bowel, bladder elimination and control​(can fall if its in the floor) Susceptibility to falls, other safety risks​ Sensory deficits​(Visual, hearing, peripheral neuropathy) Mobility deficiencies​(amputation, weakness) Use of assistive devices​(Cane, crutches, walker, wheelchair) Presence of Foley catheter, PEG tube, colostomy, tracheostomy​ Skin integrity​ Vulnerability to injury​ Nutritional status​ Developmental considerations​ Copyright ©2022 F.A. Davis Company  Analysis/Nursing Diagnosis  Examples of nursing diagnoses  Hyperthermia  Hypothermia  Aspiration Risk  Contamination Risk  Falls Risk  Injury Risk  Poisoning Risk  Suffocation Risk  Physical Trauma Risk Copyright ©2022 F.A. Davis Company  Planning Outcomes/Evaluation Depends on the nursing diagnoses Copyright ©2022 F.A. Davis Company  Planning Interventions/Implementation  General safety interventions Assessing Educating Evaluating Removing hazards Using technology Establishing goals Reporting accidents Considering patients as members of the healthcare team Copyright ©2022 F.A. Davis Company  Teaching for Safety Self-Care  Motor vehicle safety  Food safety  Fighting vector-borne pathogens  Reducing pollution  Weather hazard safety measures Copyright ©2022 F.A. Davis Company Promoting Safety in the Healthcare Facility  Preventing falls  Reducing electrical hazards  Responding to fires  Preventing the need for restraints  Responding to mercury spills  Keeping equipment safe  Reducing alarm fatigue  Coping with violence Copyright ©2022 F.A. Davis Company  Workplace Violence Protection​ Workplace violence: any physical assault, threatening behavior, or verbal abuse occurring in the workplace​ Violence can come from patients, families, visitors, other healthcare workers​ Inadequate workplace security​ Unrestricted movement by visitors​ Personal relationship altercations​ Bullying by coworker​ Higher risk in emergency departments, mental health units​ No department immune​ Potential injuries​ Being scratched, hit, kicked, bitten​ Being beaten​ Being threatened by weapons such as knife, gun​ Copyright ©2022 F.A. Davis Company  Delegation  Restraints  Other measures Wheelchair safety Stretcher safety Copyright ©2022 F.A. Davis Company