Chapter 37 Safety Pp

Chapter 37

Client Safety

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Objectives for Safety  

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State safety measures to be implemented in the laboratory setting Describe safety issues to note in the client’s room; include lighting, temperature, obstacles, hazards, bathroom hazards. Describe safety issues involved with the use of restraints Discuss the influence JCAHO and the state have on the use of restraints and patient safety Describe the restraint free environment and the alternatives to traditional restraints List measures to prevent falls; specific measures to use for older adults and the physiological conditions associated with aging that put these clients at risk Mosby items and derived items © 2005 by Mosby, Inc.

Objectives (con’t) 

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State measures employed to reduce risk of injury in the patient with seizures; with procedure, accidents, and the use of equipment Discuss the threats to patient safety resulting for fatigued nurses (article) Describe fatigue State what nursing can do to improve patient safety National patient safety goals Mosby items and derived items © 2005 by Mosby, Inc.

Safety Management Plan       

Life safety Fire safety Utilities EMP (Emergency Management Plan) Hazardous Waste Security Medical Equipment Mosby items and derived items © 2005 by Mosby, Inc.

Patient Safety 

Evaluation of Sentinel events •

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An occurrence that caused or had the potential to cause permanent loss of function of death.

Evaluation of system issues relating to the sentinel event (root cause analysis) Review of policies and procedures relating to patient safety Mosby items and derived items © 2005 by Mosby, Inc.

Environmental Safety 

Basic needs  Oxygen  Optimum temperature and humidity  Call light

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Environmental Safety (cont'd) 

Physical hazards     

Accidents Lighting Obstacles Bathroom hazards Security: fires, lead, carbon monoxide, break-ins

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Environmental Safety (cont'd) 

Transmission of pathogens  Exposures  Immunizations

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Life Safety  

Injuries Building issues

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EMP (Disaster Plan) Bioterrorism     

Anthrax—not contagious Botulism—not contagious Small pox—very contagious Plague--contagious Neurotoxic gases

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EMP (Emergency Prepardness)    

Practiced twice a year Influx of patients 1 time a year Must be community wide Must participate with the federal government

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Anthrax Inhalational anthrax  Flu like symptoms BUT: rhinorrhea and sore throat with flu, unlikely with anthrax 

Treated with Cipro and doxycycline Mosby items and derived items © 2005 by Mosby, Inc.

Botulism 

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“I am going numb from my face to my toes and I know it” Interferes with nerve conduction Treatment with respirator/ventilator likely—ties up healthcare resources

May treat early with antitoxin, but mostly supportive treatment for weeks. Mosby items and derived items © 2005 by Mosby, Inc.

Plague (pneumonic/bubonic) 

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Black death (Yersinia pestis— bacterium) Coughing up of blood Transmitted by fleas and contact with body fluids Treatment: ANTIBIOTICS Pneumonic for bioterrorism Bubonic– host- rat, vector-- flea Mosby items and derived items © 2005 by Mosby, Inc.

Small Pox Deep seated pustules  All lesions are in same stage  Centrifugal: face and arms  Very sick- very contagious  Supportive measures and airborne precautions Therer is an immunization for small pox- only supportive treatment 

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Sarin is a human-made chemical warfare agent classified as a nerve agent. Nerve agents are the most toxic and rapidly acting of the known chemical warfare agents.

All nerve agents cause their toxic effects by preventing the proper operation of the chemical that acts as the body’s “off switch” for glands and muscles. Without an “off switch,” the glands and muscles are constantly being stimulated. They may tire and no longer be able to sustain breathing function.

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Sarin/other gases If p eop le thi nk t hey ma y ha ve b een ex posed , t hey sho uld remo ve thei r c lo thin g, r ap id ly was h t heir entir e b od y wi th soap an d wat er , a nd get m edi cal c ar e as q uic kl y a s p ossi ble. Remov in g an d disp osi ng o f c lo thin g:  Quic kl y t ake o ff c lot hin g th at has li quid sar in on i t. Any clot hin g t hat has to be pull ed ov er t he head shou ld b e c ut off the bo dy in st ead o f pull ed ov er t he hea d. If p ossi ble, se al the clot hin g i n a plast ic ba g. T hen se al the f ir st pla st ic bag in a sec ond p last ic b ag. Remov in g a nd seali ng t he clo thi ng in t his way wil l h elp p rot ec t peop le fr om an y c hemi cal s t ha t m igh t be on t heir clot hes.  If c lot hes wer e p lac ed i n p la st ic bags, i nfor m eit her t he lo cal or st ate heal th dep artmen t o r em ergen cy p er son nel upon thei r a rriva l. D o n ot ha ndle the p last ic b ag s.  If hel pin g o ther peop le remo ve t heir clo thi ng, t ry t o av oi d tou chin g an y contami nat ed a rea s, a nd remov e t he clo thi ng as quic kly as possib le. Mosby items and derived items © 2005 by Mosby, Inc.

Decontamination Procedure: Washing the body: As quickly as possible, wash any liquid sarin from the skin with large amounts of soap and water. Washing with soap and water will help protect people from any chemicals on their bodies. Rinse the eyes with plain water for 10 to 15 minutes if they are burning or if vision is blurred. If sarin has been swallowed, do not induce vomiting or give fluids to drink.

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General Safety Risks at Developmental Stages 

Infant, toddler, preschooler—little common sense  

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Exploration of the environment Accidents and injuries

School-age child—industry vs. inferiority – Activities: sports, bicycles

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General Safety Risks at Developmental Stages 

Adolescent  Greater independence  Risk-taking behaviors (feeling invincible!!) STD’s, Drugs, Driving Mosby items and derived items © 2005 by Mosby, Inc.

General Safety Risks at Developmental Stages 

Adult  

Lifestyle habits Stress

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Risks at Developmental Stages (cont'd) 

Older adult  

Physiological changes; such as?? P. 979 Box 37—6 (Focus on Older-Adults)

Hip Fractures major cause of disability, functional impairment, and death. P. 982: Research Highlight

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Individual Risk Factors    

Lifestyle Impaired mobility Sensory or communication impairment Lack of safety awareness

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Risks in the Health Care Environment       

Medical errors (IOM) 1999 Falls (90% of reported incidents) Procedure-related occurrences Equipment-related occurrences Medication-related occurrences Failure in communication Failure in patient identity Mosby items and derived items © 2005 by Mosby, Inc.

Patient Assessment for Safety      

Nursing history Client’s home environment Health care environment Risk for falls Risk for medication errors Client expectations

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Nursing Diagnoses     

Risk for injury Deficient knowledge Risk for poisoning Disturbed sensory perception Risk for trauma

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Planning  

Goals and outcomes Examples  

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Client does not suffer a fall or injury Client identifies risks associated with visual impairment

Setting priorities Continuity of care

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Implementation 

Developmental interventions for injury prevention:     

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Infants- mainly preventable School-age– instruction Adolescents- instruction Adults– instruction on risk factors Older Adult– decreasing environmental factors

Page 963-965 Mosby items and derived items © 2005 by Mosby, Inc.

SAFETY CONCERNS ACROSS THE LIFE SPAN Age Group Infant

Specific Safety Concern

Preventive Measures/Teach ing

Toddler/Preschool Child School-age Child Adolescent Adult Older Adult

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Implementation: Acute Care  

Fall prevention-- protocols Restraints  

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Legal guidelines (specific state to state). Restraint-free environment

Side rails Fire safety (RACE) National Patient Safety Goals Mosby items and derived items © 2005 by Mosby, Inc.

National Patient Safety Goals 2006  

Have 2 Patient Identifiers Care Giver Communication    

Read back all verbal orders Standardize “Do Not Use” Abbreviations Critical result timeliness Standardize “hand-off” communicationverbal reports, standardized medicationreconciliation forms Mosby items and derived items © 2005 by Mosby, Inc.

NPSG 2006 (con’t) 

Medication Safety   

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Limit available drug concentrations Review annually look-alike/sound-alike drugs Label medications/medication containers/solutions in perioperative and procedural settings

Prevent Risk of Hospital Infections 

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Follow CDC guidelines for handwashing and hand hygiene guidelines Review nosocomial deaths as sentinel events Mosby items and derived items © 2005 by Mosby, Inc.

NPSG’s 2006 (con’t) 

Reconcile Patient Medications 

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Get complete list of home medications on admission Send a complete list of medications for next provider

Reduce Patient Falls 

Institute and implement falls reduction program and evaluate effectiveness.

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You can delegate application of restraints to UAP’s. Which CNA demonstrates correct understanding of restraints? A.

B.

C.

The one who fastens the restraints to the side rail The one who applies a vest restraint to a confused client who tries to pull out the iv The one who ties the restraint to the bed frame with a quick release tie

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Your client is very confused and increasingly aggressive. Your correct first and second action after exhausting all other options is A.

B.

C.

1.Restrain him and 2.notify the physician for a face to face physician assessment 1.Notify the physician and 2.wait to restrain him until the physician has seen him 1.Restrain him and 2.notify the physician within 24 hours Mosby items and derived items © 2005 by Mosby, Inc.

Implementation: Home Environment      

Temperature and humidity Lighting Safety features Security measures Nutrition: food preparation Asepsis: cleanliness

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Evaluation

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Prevention of injury Client expectations Outcome management Hazard Analysis FMECA

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