chapter 10 safety

Types of fire extinguishers

-A: wood, paper, trash -B: Chemical -C: Electrical -ABC - most common

gait belts

Apply gait belt securely around patient's waist. Walk to the side of the patient, one arm around waist and hand on the belt. Walk on the weaker side. Determine the client's weight bearing status before transferring. Nurse should walk with his or her closest leg just behind the patient's knee.

patient safety and fall prevention especially on older adults

Changes associated with aging significantly affect the ability of older adults to protect themselves from injury. Unsteadiness in gait causes falls. Vertigo may occur due to disease and/or medications. Assist patients when drinking hot liquids. Fill cup only half full.

safety for older adults

Changes associated with aging significantly affect the ability of older adults to protect themselves from injury. Unsteadiness in gait causes falls. Vertigo may occur due to disease and/or medications. Assist patients when drinking hot liquids. Fill cup only half full.

accidental poisoning

Childhood poisoning is one of the major causes of death in children under 5 years of age. Preventing Poisoning Toxic or poisonous substances should not be removed from their original containers. Poisonous substances should be labeled conspicuously and stored appropriately. Notify poison control center at 1 800 222-1222 and follow facility protocols. (Even ER nurses must call before starting interventions) Do not induce vomiting if poisoning is related to household cleaners which is corrosive. Vomiting increases esophageal burns.

internal/ external disaster

Disaster Situation An uncontrolled, unexpected, psychologically shocking event Earthquakes, hurricanes, floods, tornados, bombings, arson, riots, and hostage-taking Health care facilities expected to receive victims and survivors and to assist rescuers Disasters are referred to as external or internal: External disaster originates outside the health care facility and results in an influx of casualties brought to the facility. Example: - airplane crash / car accident Internal disaster represents an extraordinary situation that is brought about by events within the health care facility. Example: fire inside the hospital

what nursing interventions should be implemented to avoid the use of physical restrains ?

Orient patient and family to surroundings, explain all procedures and treatments. Encourage family and friends to stay with patients or use sitters Assign confused patients to rooms near the nurses' station. Provide appropriate visual and auditory stimuli (family pictures, clocks, radio) Ensure effective pain management Attend to the needs for toileting

Fire Safety PASS

P-pull A-aim S-squeeze S-sweep

restrains padding

Paddings of restraints should be placed against the patient's bony prominences to protect the skin

plan of care for patient who is a risk for falls

Provide information about home safety checks Reinforce teaching about balance and strengthening exercises Lock beds and wheelchairs during transfers. Placing the bedside table and call light within the client's reach. Keep a night light on in the client's room.

Fire Safety: RACE

R-rescue: protect/evacuate clients in danger A-alarm: activate alarm/report the fire C-contain: close doors/windows E-Extinguish: use the correct extinguisher to eliminate the fire

Triage

Triage - to sort out patients according to who are treatable and untreatable Red - most urgent - life threatening injuries Yellow - second priority - injuries with systemic effects and complication - fractures Green - minor injuries Black - dying or dead - no hope for survival or no treatment Codes: Blue -distress ; Red - fire, Yellow - bomb threat ; Pink - infant abduction, Purple - child abduction ; Orange - hazardous material spill

when do you use restraints?

When the danger presented by the acting-out individuals outweighs the risks of physical intervention.

precautions to promote safety

• Orient patient and family to surroundings; explain all procedures and treatments. • Encourage family and friends to stay, or use sitters for patients who need supervision. • Assign confused or disoriented patients to rooms near the nurses' station. Observe these patients frequently. • Provide appropriate visual and auditory stimuli (e.g., family pictures, clocks, radio). • Eliminate bothersome treatments as soon as possible. For example, discontinue tube feedings and begin oral feedings as quickly as the patient's condition allows. • Use relaxation techniques (e.g., massage). • Institute exercise and ambulation schedules as the patient's condition allows. • Encourage participation in diversional activities (e.g., long-term care facilities typically have daily activities planned for the residents, such as games, movies, entertainment). • Maintain toileting routines. • Consult with physical and occupational therapists to enhance patient's abilities to carry out activities of daily living. • Evaluate all medications patient is receiving to determine whether the medication is having the desired therapeutic effect. • Conduct ongoing assessment and evaluation of patient's care and patient's ongoing response to care.

applying safety reminder devices

Safety reminder device (SRD) (Restraints) Any one of numerous devices used to immobilize a patient or part of the patient's body, such as arms or hands Used for various reasons Patient safety Maintain treatment Prevent wandering Prevent or reduce the risk of falls Restrict movement of an aggressive patient to protect other patients and staff The use of SRDs can also result in increased restlessness, disorientation, agitation, anxiety, and a feeling of powerlessness. These problems may also increase because of use of SRD's" - skin impairment, impaired circulation, incontinence and immobility. Focus on attempting alternate strategies before using the SRD's. (Designing a Restraint Free Environment) Orient patient and family to surroundings, explain all procedures and treatments. Encourage family and friends to stay with patients or use sitters Assign confused patients to rooms near the nurses' station. Provide appropriate visual and auditory stimuli (family pictures, clocks, radio) Ensure effective pain management Attend to the needs for toileting Ethical and legal issues surround their use. Most require a physician's order. Never PRN. Restraining a patient without an order can result in charges of false imprisonment. The focus is on using alternative strategies before SRDs are applied. Patient safety or the safety of others must be the priority reason why an SRD is applied. Documentation about the need for the SRDs, the type of device used, and the patient response is crucial.

restrains- slip knot/ quick release knot

Secure a quick release knot (slip knot and not a double knot) rather than a regular knot to secure the SRD to bed frame or wheelchair Paddings of restraints should be placed against the patient's bony prominences to protect the skin Secure ties at the movable part of the bed frame not on the side rails. Use a quick release knot (slip knot)

wrist restraints assessment

Secure ends of ties to the movable part of the bed frame (NOT TO SIDE RAILS) Palpate pulses below SRD - check capillary refill Secure a quick release knot (slip knot and not a double knot) rather than a regular knot to secure the SRD to bed frame or wheelchair Paddings of restraints should be placed against the patient's bony prominences to protect the skin

designing a restraint free environment/ alternate strategies before using restraints

The focus is on using alternative strategies before SRDs are applied. Patient safety or the safety of others must be the priority reason why an SRD is applied. Reorient patient frequently. Eliminate bothersome treatments as soon as possible. Use relaxation techniques. Institute exercise and ambulation schedules as the patient condition allows. Maintain toileting routines. Consult with PT and OT to enhance patient to carry out ADLs Evaluate all medications patient is receiving to determine if the medication is having the desired therapeutic effect