Chapter 27 Safety, Security, and Emergency preparedness

National initiatives encourage health care providers to ask these three questions at every encounter with older adults:

Have you fallen in the past year? Do you feel unsteady when standing or walking? Do you worry about falling?

Using Side rails

In the past, side rails were used to provide support and aid equilibrium, but it is now recognized that they can pose serious risks for a confused or agitated patient A person of small stature has a greater risk for entrapment or injury. Death from asphyxiation has occurred when patients have become wedged between the mattress and the bed frame or side rail. Although patient entrapment is uncommon, it can be fatal. Most of the victims of side rail fatalities are frail, of advanced age, or confused, and many exhibit uncontrolled body movement. Most incidents of entrapment occur in a long-term care setting.

The Morse Fall Scale

Institutions can use the score on the Morse Fall Scale, derived from the answers to six questions, to identify patients at risk for falls.

Major causes of falls in the home include:

Major causes of falls in the home include slippery surfaces, poor lighting, clutter, and improperly fitting clothing or slippers

Accidents in the home frequently result from careless use of equipment or from malfunctioning or poorly maintained equipment

Many injuries and deaths from electric shock can be prevented. Overloaded electrical circuits, faulty appliances, frayed wires, careless use of electrical equipment, and handling of electrical devices and cords with wet hands or while wearing wet shoes can result in injury or death.

The ANA describes the attributes of a positive safety culture as:

(1) openness and trust, without individual blame; (2) appropriate resource allocation; (3) a learning environment for health care professionals where errors are explored and systemic weaknesses identified; and (4) transparency and accountability

It is a serious threat to national security and very difficult to identify a perpetrator who resides in cyberspace. Cyberspace is particularly difficult to secure due to many factors including:

(1) the ability of perpetrators to operate from anywhere in the world (2) the linkages between cyberspace and physical systems, especially those involving critical infrastructure (3) and the difficulty of reducing vulnerabilities and minimizing consequences in complex cyber networks

Choosing alternatives to restraints (1)

- 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.

Choosing alternatives to restraints (2)

- 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.

Choosing alternatives to restraints (3)

- 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).

Procedures related to accidents/possible errors:

-Administrating medications or intravenous solutions -Transferring a patient -Changing a dressing -Applying external heat to a patient's extremity

Some expected outcomes for patients that promote safety and prevent injury are as follows. The patient will:

-Identify unsafe situations in his or her environment -Identify potential hazards in his or her environment -Demonstrate safety measures to prevent falls and other accidents -Establish safety priorities with family members or significant others -Demonstrate familiarity with his or her environment -Identify resources for safety information -Remain free of injury during hospitalization

Decreasing Equipment-Related Accidents

-Use equipment only for the use for which it was intended. -Do not operate equipment with which you are unfamiliar. -Handle equipment with care to prevent damaging it. Use three-prong electric plugs whenever possible. -Do not twist or bend electric cords. The wires inside the cord may break. -Be alert to signs that indicate equipment is faulty such as breaks in electric cords, sparks, smoke, electric shocks, loose or missing parts, and unusual noises or odors. Report signs of trouble immediately. -Make certain that electric cords are not in a position to be trapped as beds are raised or lowered. This can strip insulation covering the electric wires. -Be alert for wet surfaces on areas where electric cords or connections are present. -Make certain when charging defibrillator batteries that charging indicator light is on. -Implement a process for reporting and addressing problems with equipment.

Restraints must be:

-Used as last resort -Used only to protect patient, staff and others -Do not prevent falls

Falls are the leading cause of nonfatal injuries for all children of ages:

0 to 19. Climbing equipment on public playgrounds and swings on home playgrounds are responsible for the majority of pediatric fall injuries. Older adults are not the only population at high risk for falling.

Falls can be categorized as:

1. Accidental (clutter or a spill cause a person to trip) 2. Anticipated physiologic fall (a direct consequence of gait imbalances 3. Effects of medication, or dementia) 4. Unanticipated physiologic falls (caused by unknown or unexpected medical issues such as a stroke or seizure) 5. Intentional falls (occur when patients act out behaviorally with intent to fall)

Several categories of chemicals can be used as weapons of mass destruction:

1. Biotoxins—poisons from plants or animals 2.Blister agents/vesicants—chemicals that severely blister the eyes, respiratory tract, and skin on contact 3. Blood agents—poisons that are absorbed into the blood 4. Caustics (acids)—chemicals that burn or corrode the skin, eyes, and mucous membranes on contact 5. Choking/lung/pulmonary agents—chemicals that cause severe irritation or swelling of the respiratory tract 6. Incapacitating agents—drugs that affect the ability to think clearly or that cause an altered state of consciousness or even unconsciousness 7. Long-acting anticoagulants—poisons that cause bleeding by preventing blood from clotting properly 8. Metals—agents that consist of metallic poisons 9. Nerve agents—highly poisonous chemicals that prevent the nervous system from working properly 10. Organic solvents—agents that damage the tissues by dissolving fats and oils 11. Riot control agents/tear gas—highly irritating agents normally used by law enforcement for crowd control or by individual people for protection 12. Toxic alcohols—poisonous alcohols that can damage the heart, kidneys, and nervous system 13. Vomiting agents—chemicals that cause nausea and vomiting

Nurses must evaluate the effectiveness of their interventions to promote environmental safety, prevent injury, and promote emergency preparedness. If the expected patient outcomes have been met and evaluative criteria have been satisfied, the patient should be able to accomplish the following:

1. Correctly identify real and potential unsafe environmental situations 2. Implement safety measures in the environment 3. Use available resources to obtain safety information 4. Incorporate accident prevention practices into activities of daily living 5. Remain free of injury

Recommendations: To ensure safe, quality care for all patients in the least restrictive environment, ANA supports nursing efforts to:

1. Educate nurses, nursing students, unlicensed personnel, other members of the interdisciplinary team, and family caregivers on the appropriate use of restraint and seclusion, and on the alternatives to these restrictive interventions; 2. Ensure sufficient nursing staff to monitor and individualize care with the goal of only using restraint when no other viable option is available; 3. Ensure policies and environment support services are in place to provide feasible alternatives to physical and chemical restraints; 4. Move progressively toward a restraint-free environment while providing a therapeutic sanctuary for all; 5. Enforce documentation requirements and education about what should be documented; 6. Explore the ethical implications of restraining patients with nursing students and discuss the need for institutional policy that clarifies when, where, and how patients are to be restrained and monitored while restrained; 7. Be aware of all implications of allowing the application of restraints in health care settings. The nurse administrator should make consultation available to nurses, including ethical consultation about decisions to restrain; and 8. Develop clear policies based on accepted national standards to guide decision making regarding restraints.

In response to The Joint Commission's mandate that accredited health care organizations must reduce the risk of harm to patients resulting from falls, hospitals have implemented effective programs to safeguard their patients from falls. Examples of these improvement strategies include:

1. Preventing Falls Targeted Solutions Tool (TST): An online application from The Joint Commission for Transforming Healthcare (2018) that provides a systematic approach to reduce the rate of falls. 2. Falls Toolkit: A comprehensive toolkit that contains elements such as a falls notebook (with instructions, policies, and training materials), post-fall huddle guides, hospital/staff/community assessment tools, podcasts, website links, and other tools (United States Department of Veterans Affairs, 2018). 3. Falls Prevention Training Program: A program focused on action planning that involves creating a falls management team, establishing a policy, assessing risks, reviewing medications, incorporating interventions and staff education, evaluating the environment, responding to falls, and addressing falls (ECRI Institute, 2016). 4. Root Cause Analysis (RCA): A tool used to study health care-related (actual) adverse events and close calls. The RCA process is designed to find out what happened, why it happened, and how to prevent it from happening again. The RCA process supports the development of a culture of safety at an institution (United States Department of Veteran Affairs, 2017).

Most hospital procedures emphasize the following priorities and recommend that staff members remember the acronym RACE as a guide:

1. Rescue anyone in immediate danger 2. Activate the fire code system and notify the appropriate person 3. Confine the fire by closing doors and windows 4. Evacuate patients and other people to a safe area Rescue Alarm Contain Extinguish

In an emergency, the physical restraint can be applied, but an order from

A provider must be obtained immediately or within a few minutes according to Joint Commission Standards. -The order must state the intended duration of use. -The patient must be monitored and assessed at least every hour or according to facility policy. (An inpatient psychiatric patient in restraints requires continual observation, including specific assessments every 15 minutes). -Documentation must reflect the date and time the restraint is applied, the type of restraint, alternatives that were attempted (including their results), and notification of the patient's family and health care provider. -Include the frequency of assessment, your findings, regular intervals when the restraint is removed, and nursing interventions. -Constant reevaluation of the need for the restraint is vital.

Hendrich II Fall Risk Model

A simple evaluation tool can help identify hospitalized patients at risk for falling. According to accreditation standards Can be administered quickly, evaluates eight independent risk factors. This tool also includes the Get Up and Go Test that measures a person's ability to rise from a seated position. Performance on each physiologic factor merits a specific score and identifies those most at risk for falls.

A nurse is assessing the following children. Which child would the nurse identify as having the greatest risk for choking and suffocating? A. A toddler playing with his 9-year-old brother's construction set B. A 4-year-old eating yogurt for lunch C. An infant covered with a small blanket and asleep in the crib 4. A 3-year-old drinking a glass of juice

A. A toddler playing with his 9-year-old brother's construction set

A nurse is teaching parents in a parenting class about the use of car seats and restraints for infants and children. Which information is accurate and should be included in the teaching plan? A. Booster seats should be used for children until they are 4′9″ tall and weigh between 80 and 100 lb. B. Most U.S. states mandate the use of infant car seats and carriers when transporting a child in a motor vehicle. C. Infants and toddlers up to 2 years of age (or up to the maximum height and weight for the seat) should be in a front-facing safety seat. D. Children older than 6 years may be restrained using a car seat belt in the back seat.

A. Booster seats should be used for children until they are 4′9″ tall and weigh between 80 and 100 lb.

When a fire occurs in a patient's room, what would be the nurse's priority action? A. Rescue the patient. B. Extinguish the fire. C. Sound the alarm. D. Run for help.

A. Rescue the patient.

Some of the safety devices used in health care facilities and in the home to prevent falls

A. Side rails on bed raised at the patient's request; the patient must be able to raise and lower the side rail without help. B. Locking devices on wheeled equipment. C. Nonskid slippers.

Most common extinguishers used in health care facilities.

ABC (universal, dry chemical) fire extinguishers

Adolescents face great dangers when they:

Abuse drugs or alcohol or engage in high-risk sexual activity. Devastating outcomes of these unsafe behaviors include alcohol-related motor vehicle accidents, pregnancy, sexually transmitted infections (STIs), and suicide.

Most disaster survivors experience normal stress reactions, but some may exhibit

Acute stress disorder or posttraumatic stress disorders that require treatment. Emergency preparedness education and planning must also address mental health issues.

Guidelines for restraint and duration: 4 hours for

Adults 18 years of age or older

Focus on the Older Adult Teaching tips to prevent medication related poisoning

Age-Related Changes (Confusion) • Do not hesitate to call the provider, nurse, or pharmacist with any questions. • Develop good communication with your provider, nurse, and pharmacist. • Use a medication calendar or diary to keep track of your dosing schedule. • Use a pill dispenser as a reminder tool. (Reduced vision) • Request large-print labels from your pharmacist. (Polypharmacy) • Report side effects from medications to your health care provider. • Do not share medications with others or take their pills. • When a drug is discontinued, throw away any remaining medication. • Fill all of your prescriptions at one pharmacy. (Effect of drugs in the aging body) • Keep the telephone numbers for your health care providers and the PCC in a readily accessible place. • Do not stop taking any prescription drug or change the dose without first consulting the provider or nurse. • Avoid doubling a dose if you forget a medication. Check with the health care provider or nurse first. • Avoid mixing alcohol with medicines without first checking with the pharmacist.

Filing a Safety Event Report

An accident or incident that compromises safety in a health care facility requires the completion of a safety event report. This is a confidential document, formerly referred to as an incident report, which objectively describes the circumstances of the accident or incident. The report also details the patient's response and the examination and treatment of the patient after the incident. The nurse completes the event report immediately after the incident, and is responsible for recording the circumstances and the effect on the patient in the medical record. The safety event report is not a part of the medical record and should not be mentioned in the documentation. Because laws vary in different states, nurses must know their own state law regarding safety event reports. All safety event reports are reviewed carefully to detect any potentially threatening situation or pattern.

Facility policy, The Joint Commission, and state and federal guidelines require

An order from a provider permitted to provide specific oversight of restraints, such as a physician or nurse practitioner (in some states). The order should include the type of restraint, justification for the restraint, and criteria for removal. The order must never be written for PRN (as needed) use.

Preventing Suffocation As a result of suffocation, unconsciousness, respiratory failure, and cardiac arrest can occur. Emergency measures must start without delay, beginning with the removal of any obstruction and administration of cardiopulmonary resuscitation (CPR).

As a result of suffocation, unconsciousness, respiratory failure, and cardiac arrest can occur. Emergency measures must start without delay, beginning with the removal of any obstruction and administration of cardiopulmonary resuscitation (CPR).

The nurse caring for patients in a long-term care facility knows that there are factors that place certain patients at a higher risk for falls. Which patients would the nurse consider to be in this category? Select all that apply. A. A patient who is older than 50 B. A patient who has already fallen twice C. A patient who is taking antibiotics D. A patient who experiences postural hypotension E.A patient who is experiencing nausea from chemotherapy F. A 70-year-old patient who is transferred to long-term care

B. A patient who has already fallen twice D. A patient who experiences postural hypotension F. A 70-year-old patient who is transferred to long-term care

The Joint Commission issues guidelines regarding the use of restraints. In which case is a restraint properly used? A. The nurse positions a patient in a supine position prior to applying wrist restraints. B. The nurse ensures that two fingers can be inserted between the restraint and patient's ankle. C. The nurse applies a cloth restraint to the left hand of a patient with an IV catheter in the right wrist. D. The nurse ties an elbow restraint to the raised side rail of a patient's bed.

B. The nurse ensures that two fingers can be inserted between the restraint and patient's ankle.

A school nurse is teaching parents about home safety and fires. What information would be accurate to include in the teaching plan? Select all that apply. A. Sixty percent of U.S. fire deaths occur in the home. B. Most fatal fires occur when people are cooking. C. Most people who die in fires die of smoke inhalation. D. Fire-related injury and death have declined due to the availability and use of smoke alarms. E. Fires are more likely to occur in homes without electricity or gas. F. Fires are less likely to spread if bedroom doors are kept open when sleeping.

C. Most people who die in fires die of smoke inhalation. D. Fire-related injury and death have declined due to the availability and use of smoke alarms. E. Fires are more likely to occur in homes without electricity or gas.

While discussing home safety with the nurse, a patient admits that she always smokes a cigarette in bed before falling asleep at night. Which nursing diagnosis would be the priority for this patient? A. Impaired gas exchange related to cigarette smoking B. Anxiety related to inability to stop smoking C. Risk for suffocation related to unfamiliarity with fire prevention guidelines E. Deficient knowledge related to lack of follow-through of recommendation to stop smoking

C. Risk for suffocation related to unfamiliarity with fire prevention guidelines

Key to identifying appropriate alternatives to restraint use and finding an individualized solution

Careful nursing assessment Nursing interventions may be used to reduce confusion or agitation and provide a safe environment.

Most common causes of hospital fires

Careless smoking, faulty electrical equipment, and combustion of anesthetic agents

Guidelines for restraint and duration: 2 hours for

Children and adolescents 9 to 17 years of age;

Guidelines for restraint and duration: 1 hour for

Children under 9 years of age

The risk of falling is noticeably higher for:

Children. Toddlers are increasingly active and need appropriate safeguards to prevent falls in the home.

Nursing interventions focus on meeting these safety needs:

Consider the various factors and the environment that affect the patient's safety, and formulate expected outcomes uniquely suited to each situation and circumstance. Many accidental injuries and deaths are preventable.

What consideration should the nurse keep in mind regarding the use of side rails for a patient who is confused? A. They prevent confused patients from wandering. B. A history of a previous fall from a bed with raised side rails is insignificant. C. Alternative measures are ineffective to prevent wandering. D. A person of small stature is at increased risk for injury from entrapment.

D. A person of small stature is at increased risk for injury from entrapment.

When discussing emergency preparedness with a group of first responders, what information would be important to include about preparation for a terrorist attack? A. Posttraumatic stress disorders can be expected in most survivors of a terrorist attack. B. The FDA has collaborated with drug companies to create stockpiles of emergency drugs. C. Even small doses of radiation result in bone marrow depression and cancer. D. BLI is a serious consequence following detonation of an explosive device.

D. BLI is a serious consequence following detonation of an explosive device.

A nurse working in a pediatrician's office receives calls from parents whose children have ingested toxins. What would be the nurse's best response? A. Administer activated charcoal in tablet form and take child to the ED. B. Administer syrup of ipecac and take child to the ED. C. Bring the child in to the primary care provider for gastric lavage. D. Call the PCC immediately before attempting any home remedy.

D. Call the PCC immediately before attempting any home remedy.

A nurse orients an older adult to the safety features in her hospital room. What is a priority component of this admission routine? A. Explain how to use the telephone. B. Introduce the patient to her roommate. C. Review the hospital policy on visiting hours. D. Explain how to operate the call bell.

D. Explain how to operate the call bell.

An older resident who is disoriented likes to wander the halls of his long-term care facility. Which action would be most appropriate for the nurse to use as an alternative to restraints? A. Sitting him in a geriatric chair near the nurses' station B. Using the sheets to secure him snugly in his bed C. Keeping the bed in the high position D. Identifying his door with his picture and a balloon

D. Identifying his door with his picture and a balloon

Based on the statistics for the leading cause of hospital admission for trauma in older adults, what would be the nurse's priority intervention to prevent trauma when caring for older adults in a nursing home? A. Checking to make sure fire alarms are working properly. B. Preventing exposure to temperature extremes. C. Screening for partner or elder abuse. D. Making sure patient rooms are decluttered.

D. Making sure patient rooms are decluttered.

A nurse is filing a safety event report for a confused patient who fell when getting out of bed. What action is performed appropriately? A. The nurse includes suggestions on how to prevent the incident from recurring. B. The nurse provides minimal information about the incident. C. The nurse discusses the details with the patient before documenting them. D. The nurse records the circumstances and effect on the patient in the medical record.

D. The nurse records the circumstances and effect on the patient in the medical record.

Factors that affect safety:

Developmental level, lifestyle, mobility, sensory perception, knowledge level, communication ability, physical health state, and psychosocial state allows nurses to identify potential hazards and promote wellness.

What are some concerns for Middle-aged adults?

Drug and/or alcohol abuse are concerns for young and middle-aged adults employed in stressful work environments.

Chemical restraints

Drugs that are used to control behavior and are not included in the person's normal medical regimen

The severity of Radiation burn injury depends on a variety of factors including:

Duration of the exposure and the distance between the source and the person. A higher dose increases the likelihood of developing later effects such as bone marrow depression and cancer. Lymph tissue and bone marrow are the tissues most sensitive to radiation while the skin, kidneys, intestines, and gonads are the most radiation-sensitive organs. Although the likelihood of a nuclear attack may be small, nurses need to be well informed, familiar with their facility's emergency response plan, and prepared to deal with a nuclear emergency.

Policy protects the patient and the nurse and specifies guidelines for application as well as the type of restraint and duration.

Each order for restraint or seclusion used for the management of violent or self-destructive behavior that jeopardizes the immediate physical safety of the patient, a staff member, or others may only be renewed in accordance with the following limits for up to a total of 24 hours. After 24 hours, before writing a new order for the use of restraint or seclusion for the management of violent or self-destructive behavior, a physician or other licensed independent practitioner who is responsible for the care of the patient must see and assess the patient

Older adults experiencing altered balance or decline in cognitive abilities are increasingly vulnerable to:

Falls and episodes of confusion

Nurses are responsible for patients' safety and need to be familiar with the facility's

Fire safety plan, exits, the location and operation of fire extinguishers, and any special instructions for reporting a fire.

Emergency Preparedness Resources ORGANIZATIONS:

National Disaster Medical System (NDMS) -Has responsibility for managing and coordinating the federal medical response to major emergencies and federally declared disasters Federal Emergency Management Agency (FEMA) -Works to build and support the national emergency management system Centers for Disease Control and Prevention (CDC) -Acts as the lead federal facility for disease prevention and control activities; provides backup support to state and local health departments The Joint Commission -Accredits facilities according to established safety and quality standards; revises the emergency management standards for health care facilities American Red Cross -Acts as the lead nongovernmental facility that provides safety information and disaster response Department of Homeland Security -Protects the nation against further terrorist attacks and coordinates the response for future emergencies

Nurses need to adhere to:

Nurses need to adhere to standards, guidelines, recommendations, and policies to promote safety and minimize preventable injury.

Factors that put 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

Nurses serving on a radiologic emergency response team must:

Protect themselves and wear the necessary equipment, including a radiation detection device. They will assess patients in a radiation emergency area (REA) designated by the hospital's emergency response plan. If patients have not been decontaminated at the scene of the attack, decontamination will occur at the medical facility.

Poison control center:

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

Emergency preparedness requires the swift transfer of

Portable decontamination units, equipment, and trained personnel to the site of the chemical attack.

Using a restraint on an older adult who tends to wander is unjustified because a variety of alternative options can be used to keep such patients safe. For example:

Position-sensitive electronic device that is an alternative to using restraints. A variety of electronic alarms and monitors are available for chairs, beds, and doors.

GOAL:

Prevent accidents through preventative measures

Blast lung injury (BLI)

Recognized as a direct consequence of the blast wave from a high explosive detonation. Once the condition is diagnosed, the patient may require complex care and should be admitted to an intensive care unit. Key signs include a low blood pressure (hypotension), a slow heartbeat (bradycardia), and temporary pause in breathing (apnea).

Regular exercise has a positive effect on:

Regular exercise has a positive effect on bone and muscle strength, balance, and flexibility of joints. Exercise has been proven to reduce the risk of falls by 13% to 40% Research appears to support the positive role that calcium supplementation and vitamin D play in promoting skeletal health and reducing fall risk for this population. The martial art of tai chi is another exercise routine that has proved particularly effective. It involves slow, deliberate movements that can be practiced almost anywhere. Tai chi helps to prevent falls by developing balance control and stability in older adults

If a family member requests the use of side rails for a patient, it is the nurse's responsibility to

Review benefits and risks associated with their use and periodically evaluate the reason for their use. Side rails are not routinely recommended for all situations. It is the responsibility of health care facilities to evaluate existing bed systems for entrapment risks and investigate corrective actions that may be necessary to provide a safe environment for patients.

Preventing accidents and promoting safety at varying developmental stages: Developmental Stage/Safety Risks Infant Falls Injuries from toys Burns Suffocation or drowning Inhalation or ingestion of foreign bodies

Teaching Tip • 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. Why This Is Important Infants progress from rolling over to sitting, crawling, and pulling up to stand. They are very curious and will explore everything in their environment that they can.

Negative outcomes of restraint use include

Skin breakdown and contractures, incontinence, depression, delirium, anxiety, aspiration and respiratory difficulties, and even death.

The focus of emergency treatment of poisoning is to

Stabilize vital body functions, prevent the absorption of the poison, and encourage excretion of the toxic substance.

STEADI stands for:

Stopping Elderly Accidents, Deaths & Injuries

Preventing accidents and promoting safety at varying developmental stages: Developmental Stage/Safety Risks Fetus Abnormal growth and development

Teaching Tip • 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. Why This Is Important Fetus Any factors, chemical or physical, can adversely affect the fertilized ovum, embryo, and developing fetus. A fetus is extremely vulnerable to environmental hazards.

Preventing accidents and promoting safety at varying developmental stages: Developmental Stage/Safety Risks Toddler Falls Cuts from sharp objects Burns Suffocation or drowning Inhalation or ingestion of foreign bodies/poisons

Teaching Tip • 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. Why This Is Important Toddlers accomplish a wide variety of developmental tasks and progress to walking and talking. They become more independent and continue to explore their environment.

Preventing accidents and promoting safety at varying developmental stages: Developmental Stage/Safety Risks School-Aged Child Burns Drowning Broken bones Concussions (TBI) Inhalation or ingestion Guns and weapons Substance abuse

Teaching Tip • 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. Why This Is Important School-aged children have developed more refined muscular coordination, but increasing involvement in sports and play activities increases their risk for injury. TBI can cause disruption in brain function and death. Cognitive maturity improves their ability to understand safety instructions.

Preventing accidents and promoting safety at varying developmental stages: Developmental Stage/Safety Risks Preschooler Falls Cuts Burns Drowning Inhalation or ingestion Guns and weapons

Teaching Tip • 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. Why This Is Important Though more independent, preschoolers still have an immature understanding of dangerous behavior. They may strive to imitate adults and thus attempt dangerous behavior.

Preventing accidents and promoting safety at varying developmental stages: Developmental Stage/Safety Risks Adolescent Motor vehicle accidents Drowning Guns and weapons Inhalation and ingestion

Teaching Tip • 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. Why This Is Important Adolescence is a critical period in growth and development. The adolescent needs increasing freedom and responsibility to prepare for adulthood. During this time, the mind has a great ability to acquire and use knowledge. The teen's peer group is a greater influence than parents during this stage.

Preventing accidents and promoting safety at varying developmental stages: Developmental Stage/Safety Risks Neonate (first 28 days of life) Infection Falls ASSB

Teaching Tip • 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. Why This Is Important Physical care for the newborn includes maintaining a patent airway, protecting the baby from infection and injury, and providing optimal nutrition.

Preventing accidents and promoting safety at varying developmental stages: Developmental Stage/Safety Risks Older Adult Falls Motor vehicle accidents Elder abuse Sensorimotor changes Fires

Teaching Tips • 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. Why This Is Important Accidental injuries occur more frequently in older adults because of decreased sensory abilities, slower reflexes and reaction times, changes in hearing and vision, and loss of strength and mobility. Collaboration between family and health care providers can ensure a safe, comfortable environment and promote healthy aging.

Preventing accidents and promoting safety at varying developmental stages: Developmental Stage/Safety Risks Adult Stress Domestic violence Motor vehicle accidents Industrial accidents Drug and alcohol abuse

Teaching Tips • 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. Why This Is Important As people progress through the adult years, visible signs of aging become apparent. Lifestyle behaviors and situational or family crises can also impact an adult's overall health and cause stress. Preventive health practices help adults improve the quality and duration of life.

Focus of Safety Assessments

The Person: -Assess for history of falls or accidents -Note assistive devices -Be alert to history of drugs or alcohol abuse -Assess mobility status -Assess level of awareness or orientation -Assess sensory perception -Recognize manifestations of domestic violence or neglect The environment -Identify potential safety hazards Specific risk factors -Falls -Fires -Poisoning -Choking -Firearms

Although not usually required with biologic agents, decontamination may be necessary if a patient's exposure status is uncertain

The patient may need to bathe or shower with soap and place his or her clothing in sealed plastic bags.

Outdoor play and the associated injuries become an issue in the years between:

Toddlerhood and adolescence. Strategies to reduce the risk and severity of playground injury to children, especially traumatic brain injury (TBI) in children aged 5 to 9, include attentive adult supervision, employing methods to reduce high-risk behavior, designing age-appropriate playground equipment, and creating an environment that is well-designed and maintained

Polypharmacy has long been listed as a risk factor for falls. Research indicates that

adverse effects related to the specific medication categories of antiepileptics and benzodiazepines are more predictive of falling. A history of a previous fall has consistently been identified as a predictor of another fall. If a fall occurred as a direct result of a risk factor that has been resolved, one fall may not necessarily indicate that another fall is likely.

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

Disaster preparedness is imperative at all levels. In order to reduce confusion and lessen the impact of a disaster, people need to take responsibility, include the family in all discussions, and develop a personal disaster plan. The American Red Cross (2018) recommends a very straightforward plan of action for emergency preparedness:

get a kit, make a plan, and be informed. Emergency food, supplies, and medications should be assembled; a communication routine should be established, and sources for reliable information should be monitored when disaster strikes.

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"

Bioterrorism

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

When performing a safety assessment, the nurse focuses on three categories:

the person, the environment, and specific risk factors.

Cyber terror:

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

Chemical agents act rapidly, and immediate decontamination is crucial before

patients are transported to a hospital.

Asphyxiation (suffocation)

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

A side rail is not considered a restraint if the patient requests

that it be raised to aid in getting in or out of bed. Some patients may request that side rails be used at night while they sleep so that they feel more secure. Patients requesting side rails must be able to raise and lower the side rails themselves.