Ch. 27 Safety

Describe health-teaching interventions to promote safety for adolecents, adults, older adults.

Adolecents- • Teach responsibilities of new freedoms that accompany being a teenager. • Enroll teen in safety courses (driver education, water safety, emergency care measures). • Emphasize gun safety. • Get physical examination before participating in sports. • Make time to listen to and talk with your adolescent (helps with stress reduction). • Follow healthy lifestyle (nutrition, rest, etc.). • Teach about sexuality, sexually transmitted infections, and birth control. • Encourage child to report any sexual harassment or abuse of any kind. Adults-• Practice stress reduction techniques (e.g., meditation, exercise). • Enroll in a defensive driving course. • Evaluate the workplace for safety hazards and utilize safety equipment as prescribed. • Practice moderation when consuming alcohol. • Avoid use of illegal drugs. • Provide options and referrals to domestic violence victims. Older Adult-Identify safety hazards in the environment. • Modify the environment as necessary. • Attend defensive driving courses or courses designed for older drivers. • Encourage regular vision and hearing tests. • If prescribed, ensure that eyeglasses and hearing aids are available and functioning. • Wear appropriate footwear. • Have operational smoke detectors in place. • Objectively document and report any signs of neglect and abuse.

7. Describe nursing interventions to prevent injury to patients in health care settings.

As part of the hospital admission routine, orient the patient to the safety features and equipment in the room. An explanation and demonstration of the adjustable bed and side rails, call system, telephone, television, and bathroom help the patient adjust to the new environment. Specially older patients. Complete a risk assessment. Indicate risk for falling on patient's door and chart. Keep bed in low position. Keep wheels on bed and wheelchair locked. Leave call bell within patient's reach. Instruct patient regarding use of call bell. Answer call bells promptly. Leave a night light on. Eliminate all physical hazards in the room (clutter, wet areas on the floor). Provide nonskid footwear. Leave water, tissues, bedpan/urinal within patient's reach. Move bedside commode out of sight to discourage attempts at independent transfer (as appropriate). Document and report any changes in patient's cognitive status to the health care team at the change of shift. Use alternative strategies when necessary instead of restraints. As a last resort, use the least restrictive restraint according to facility policy. If restraint is applied, assess patient at the required intervals.

8. Identify alternatives to using restraints.

Determine whether behavior pattern exists. Assess for pain and treat appropriately. Rule out causes for agitation. Assess respiratory status, vital signs, blood glucose level, fluid and electrolyte issues, and medications. Use standardized screening tools to evaluate change in function. Involve the family in patient's care. Ask family members or significant other to stay with the patient. Reduce stimulation, noise, and light. Distract and redirect, using a calming voice. Use simple, clear explanations and directions. Check environment for hazards. Use night light. Identify door of room (e.g., use of balloon, sign, patient's picture, ribbon). Use an electronic alarm system on a temporary basis (e.g., bed or position-sensitive alarms) to warn of unassisted activity. Allow restless patient to walk after ensuring that environment is safe. Use a large plant or piece of furniture as a barrier to limit wandering from designated area. Use low-height beds. Place floor mats on each side of the bed. Ensure the use of glasses and hearing aids, if necessary. Use pillows wedged against the side of the chair to keep patient positioned safely. Use full-length body pillows, a swimming pool noodle, or a rolled blanket to indicate the edge of the bed. Assist with toileting at frequent intervals. Arrange for a bedside commode. Make the environment as home-like as possible; provide familiar objects. Provide a warm beverage. Provide comfortable rocking chairs. Use therapeutic touch. Play music or video selections of the patient's choice. Offer diversional activities, such as games and books. Encourage daily exercise/provide exercise and activities or relaxation techniques. Consider relocation of the patient to a room closer to the nursing station. Conceal tubing necessary for care. Anchor tubing securely. Conceal tubing with gauze wrap; unwrap regularly to assess site for complications. Investigate possibility of discontinuing bothersome treatment devices (e.g., intravenous line, catheter, feeding tube).

Describe strategies to decrease the risk for injury in the home. Electrical safety and Posoning

Electrical Safety : ❑ Maintain electrical cords in good condition. ❑ Protect unused electric outlets with safety covers. ❑ Use the proper replacement for a blown fuse. ❑ Keep an electric space heater away from curtains and flammable material. ❑ Turn off appliances before going to bed or leaving the house. ❑ Hire a professional to do electrical repairs. ❑ Never overload wall outlets or extension cords. ❑ Unplug appliances that are not in use. ❑ Do not permit young children to use the microwave. Preventing Poisoning ❑ Keep the phone number for the local poison control center next to the phone. ❑ Color-code medication bottles for those who are visually impaired. ❑ Syrup of ipecac is no longer recommended if poisoning should occur. Immediately contact the Poison Control Center (1-800-222-1222). ❑ Store all medicines in child-resistant containers in a locked medicine cabinet. ❑ Destroy old medicines (flush down the toilet). ❑ Keep all poisonous plants out of a child's reach. ❑ Avoid eating any fresh or prepared foods that look or smell spoiled. ❑ Store cleaning products, insecticides, and corrosives safely out of a child's reach. ❑ Avoid mixing caustic products with any other household product (dangerous chemical reactions may occur). ❑ Keep shampoos and cosmetics in a safe place. ❑ Use safety latches on cabinets. ❑ Store alcoholic beverages out of a child's reach. ❑ Check that paint or finish on furniture and toys is nontoxic. ❑ Install a carbon monoxide detector in your home. ❑ Have your furnace professionally inspected each year. ❑ Keep vents and chimneys clear of debris, and have them checked seasonally. ❑ Don't operate cars, motorized equipment, or charcoal or gas grills in enclosed spaces.

Never Event

Error in medical care that is clearly identifiable, preventable, and serious in its consequences for the patient and that indicates a real problem in the safety and credibility of a health care facility. These errors should never occur. Examples of never events include surgery on the wrong body part, foreign body left in a patient after surgery, mismatched blood transfusion, major medication error, severe pressure ulcer acquired in the hospital, and preventable postoperative death.

1. Identify factors that affect safety in a person's environment.

Factors: developmental level, lifestyle (occupation,safety and social behaviour) mobility, sensory perception, knowledge level, communication ability, physical health state, and psychosocial state.

2. Identify patients at risk for injury.

Falls (picture), Fire- mostly happen at home, no use of fire alarms, smoking, lighting of candles), Poisoning ( medication more prevelant in adults 45-54 yrs old, white,black,hispanic. Children often take medication belonging to granparents.children most at risk for exposure to toxic substances include unsafe storage in the home, spending time in environments other than the home, lack of attention on the part of the caregiver, the rise in multigenerational families, and the presence of multiple pharmaceuticals, vitamins, and dietary supplements in the home. Younger children ingest household chemicals, older children medication, toddler lead base,Adolescents and young adults who experiment with drugs may experience accidental poisoning and death. An older adult may inadvertently take an overdose of a medication because of confusion or forgetfulness. Poor vision is also a factor in accidental poisoning in older adults. CO2 posoning. suffocation: drowning, choking on a foreign substance inhaled into the trachea, and gas or smoke poisoning.Adults aged 85 and older are eight times more likely to die of suffocation than adults aged 65 to 74.An infant may suffocate when a pillow or a piece of plastic inadvertently covers the nose and mouth. Infants are most at risk of suffocation when they are sleeping;A young child may be strangled accidentally by the shoulder harness of a seat belt or become trapped while playing in a discarded refrigerator and suffocate.Approximately one in five people who die from drowning are children aged 14 or younger. firearm injuries: children and teens at higher risk.

3. Describe specific safety risk factors for each developmental stage.

Fetus- Abnormal growth and development Neonate (first 28 days of life)- Infection, Falls ,ASSB Infant- Falls Injuries from toys, Burns, Suffocation or drowning, Inhalation or ingestion of foreign bodies. Toddler- Falls, Cuts from sharp objects, Burns, Suffocation or drowning, Inhalation or ingestion of foreign bodies/poisons. Preschooler- Falls Cuts Burns Drowning Inhalation or ingestion Guns and weapons School-Aged Child- Burns, Drowning, Broken bones ,Concussions (TBI), Inhalation or ingestion, Guns and weapons, Substance abuse Adolescent- Motor vehicle accidents, Drowning, Guns and weapons, Inhalation and ingestion Adult- Stress, Domestic violence, Motor vehicle accidents, Industrial accidents, Drug and alcohol abuse Older Adult- Falls, Motor vehicle accidents, Elder abuse, Sensorimotor changes, Fires

5. Describe health-teaching interventions to promote safety for Fetus, Neonate, Infant

Fetus: • Abstain from alcohol and caffeine while pregnant. • Stop smoking or reduce the number of cigarettes smoked per day. • Avoid all drugs, including OTC drugs, unless prescribed by a health care provider. • Avoid exposure to pesticides and certain environmental chemicals. • Avoid exposure to radiation. Neonate: • Wash hands frequently. • Never leave infant unsupervised on a raised surface without side rails. • Use appropriate infant car seat that is secured in the back seat facing the rear of the car. • Handle infant securely while supporting the head. • Place infant on back to sleep. Infant:• Supervise child closely to prevent injury. • Select toys appropriate for developmental level. • Use appropriate safety equipment in the home (e.g., locks for cabinets, gates, electrical outlet covers). • Never leave child alone in the bathtub. • Childproof the entire house.

6. Describe strategies to decrease the risk for injury in the home. Fire and Burn

Fire and Burn Safety ❑ Have a list of emergency phone numbers posted near the phone. ❑ Install smoke detectors in each room (or at a minimum, on each floor). ❑ Replace smoke detector batteries when you reset your clock. ❑ Have a fire extinguisher available on each floor, and know how to use it. ❑ Practice a fire escape plan with your family. ❑ Teach all family members to stop, drop, and roll if clothing catches on fire. ❑ Keep matches and lighters out of children's reach. ❑ Keep lighted candles out of children's reach. ❑ Buy flame-resistant children's clothing, particularly sleepwear. ❑ Keep bedroom doors closed while sleeping (use monitor to listen for a child). ❑ Have ashtrays readily available if there is a smoker in the house. ❑ Enforce a strict "no smoking in bed" policy. ❑ After a party, check wastebaskets, ashtrays, furniture, and carpets for carelessly discarded cigarettes. ❑ Turn off a kerosene heater when no one is in the room and at bedtime. ❑ Operate your fireplace or wood-burning stove safely (flue open, fire screen covering the opening, annual chimney cleaning, proper disposal of ashes). ❑ Prevent trash or paint-saturated rags from accumulating in your garage. ❑ Store oily rags, gasoline, or other flammables away from heating sources or open flames, such as the pilot light of the water heater. ❑ Cook on back burners, and turn pot handles toward the back of the stove. ❑ Keep hot dishes away from the edges of tables and counters. ❑ Set water heater at a safe temperature (below 120°F). ❑ Check bath water temperature with the back of your wrist before placing a child in bath. ❑ Use sunscreen and protective clothing to minimize exposure to the sun and prevent sunburn.

Near miss event

Medical error that is recognized before any harm is done to patient "good catch", "close call" eg. patient prescribed lethal dose of medication but error is caught by pharmacist

Describe strategies to decrease the risk for injury in the home. Chocking

Preventing Asphyxiation or Choking ❑ Keep plastic bags out of a child's reach. ❑ Check that crib slats are no more than 2 3/8 inches apart. ❑ Ensure that the mattress fits the sides of the crib snugly. ❑ Remove soft pillows or thick blankets from your infant's crib. ❑ Never place an infant on a waterbed to sleep. ❑ Cut food into small pieces before giving it to a young child. ❑ Supervise young children when eating and drinking. ❑ Avoid giving peanuts, hard candy, or other small treats to a young child. ❑ Keep small objects, such as jewelry, buttons, and safety pins, out of a child's reach. ❑ Use toys appropriate for the child's age. ❑ Always watch a child who is in the tub. ❑ Cover wading pools and sandboxes when not in use. ❑ Check that nearby swimming pools are enclosed with a fence that your child cannot easily climb over. ❑ Keep pool rescue equipment nearby. ❑ Supervise your child closely when near water. ❑ Know how to perform cardiopulmonary resuscitation and the Heimlich maneuver.

Describe strategies to decrease the risk for injury in the home. Falls and Fire arms

Preventing Falls and Other Injuries ❑ Keep stairways clear and uncluttered. ❑ Maintain walkways, stairs, and railings in good repair. ❑ Keep stairs, hallways, outside walkways, and working areas well lit. ❑ Install safety gates at tops and bottoms of stairways. ❑ Paint the bottom step of the stairs a different color. ❑ Apply nonslip adhesive strips to the bottom surface of the tub or shower. ❑ Have a raised toilet seat with support arms available if necessary. ❑ Provide grab bars next to the toilet and in the tub or shower area. ❑ Use sturdy chairs that have armrests. ❑ Eliminate scatter rugs, or secure them with adhesive strips on the underside. ❑ Use a handheld device, such as pincers, when reaching for inaccessible items. ❑ Buckle a child into an approved automobile safety seat even when making short trips. Firearm Safety ❑ Keep guns and ammunition stored separately and locked up. ❑ Install trigger locks on all guns. ❑ Make certain that the key to the locked gun storage area is not available to a child. ❑ Discuss the risk for injury from guns and gun safety with your children. ❑ Instruct your child never to touch a gun or remain in a friend's house where a gun is accessible.

Nurse is required to:

Promote safety and prevent injury

the 9 rights of medication safety

Right Medication, Right Patient, Right Dose, Right Route, Right time, Right Reason, Right Assessment, Right documentation, Right response ( Education and Refuse)

4. Select nursing diagnoses for patients in unsafe situations.

The statement of the patient's actual or potential health status must be followed by the appropriate contributing factors or risk factors to individualize the nursing care plan.

Describe health-teaching interventions to promote safety for Toddler, Preschooler, School-age child

Toddler-• Have poison control center phone number in readily accessible location. • Use appropriate car seat for toddler. • Supervise child closely to prevent injury. • Childproof house to ensure that poisonous products, drugs, guns, and small objects are out of toddler's reach. • Never leave child alone and unsupervised outside. • Keep all hot items on stove out of child's reach. Preschooler: • Teach child to wear proper safety equipment when riding bicycles or scooters. • Ensure that playing areas are safe. • Begin to teach safety measures to child. • Do not leave child alone in the bathtub or near water. • Practice emergency evacuation measures. • Teach about fire safety. School-aged Child: Teach accident prevention at school and home. • Teach child to wear safety equipment when playing sports. • Reinforce teaching about symptoms that require immediate medical attention. • Continue immunizations as scheduled. • Provide drug, alcohol, and sexuality education. • Reinforce use of seat belts and pedestrian safety.

disaster:

an emergency event of greater magnitude that requires the response of people outside the involved community

sentinel event:

an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof

restraint:

device used to limit movement or immobilize a patient

safety event report:

documentation describing any injury or potential for injury suffered by a patient in a health care facility

intimate partner violence (IPV):

domestic violence or battering between two people in a close relationship

chemical emergency:

event caused by the release of a chemical compound that has the potential for harming people's health

poison control center:

facility that handles poison exposure and provides poison prevention teaching to the general population

elder abuse:

intentional act or failure to act by a caregiver or another person in a relationship involving an expectation of trust that causes or creates a risk of harm to an older adult; includes physical abuse, sexual abuse/contact, emotional/psychological abuse, neglect, and financial abuse/exploitation

nuclear terrorism:

intentional dispersal of radioactive materials into the environment for the purpose of causing injury and death

bullying:

negative, often repetitive, disruptive behavior; also referred to as horizontal violence, lateral violence, and professional incivility

culture of safety:

organizational environment where "core values and behaviors resulting from a collective and sustained commitment by organizational leadership, management, and workers emphasize safety over competing goals"

Just culture

refers to an organization's commitment to accountability and a focus supporting universal safety in health care ■A concept related to systems thinking which emphasizes that mistakes are generally a product of faulty organizational cultures, rather than solely brought about by the person or persons directly involved (Institute for Healthcare Improvement).

asphyxiation:

stoppage of breathing or the lack of air reaching the lungs; synonym for suffocation

Root Cause Analysis

technique for identifying prevention of error strategies and developing a culture of safety. Tool used to study health care-related adverse events and close calls to ind out what happened, why it happened, and how to prevent it from happening again.

bioterrorism:

the deliberate spread of pathogenic organisms into a community to cause widespread illness, fear, and panic

cyber terror:

the use of high-tech means to disable or delete critical electronic infrastructure data or information

General Safe Practices

■Keep bed locked and in lowest position ■Keep side rails up (top two) ■Keep environment free from tripping hazards ■Follow proper medication safety procedures - Know the 9 rights of medication safety ■Ensure proper safety equipment is present at bedside ■Always leave call light within client's reach ■ALWAYS Follow ALL hospital policies and procedures ■Ask if you don't know for sure! ■Use available safety equipment - Hoyer lift, bed alarms, non-skid socks ■Report all errors and potential errors

Culture of safety

■Safety above all else ■Openness and trust ■No individual blame ■Errors explored ■Appropriate resource allocation ■Systemic weaknesses identified ■Transparency and accountability

Second Victim

■The healthcare provider who makes the medical error and is traumatized by the experience.