Basic Skills - SafetyBasic Skills - SafetyTerm One VN ProgramMs. Loiselle Du

Outline Outline SAFETY • PATIENT

◦ Factors that Threaten the Safety of our Patient and corresponding interventions Latex, left handed patients, falls, age group, hospital environment, medications

◦ General Safety Precautions (call bells and patient identification) ◦ Safety Reminder Devices: Restraints

• NURSES◦ Factors that Threaten the Safety of the Nurses

Workplace violence Fire Poisoning/ Mercury Spills Radiation

• Disaster Planning ◦ Disaster Planning ◦ Terrorism ◦ Bioterrorism ◦ Agencies concerned with Disasters

SafetySafetySafe Environment: freedom from injury” • FOCUS: preventing falls, electrical

injuries, fires, burns, and poisoning.

• SENTINEL EVENTS and the JCI

• Nursing Responsibility: ◦Be aware of potential safety problems ◦Know how to report and respond when safety

is threatened.

Safety Safety • Who is responsible in providing and

maintaining a safe environment? ◦the patient, visitors, and members of the

health care team.

• Our Primary Responsibilities: ◦Protection ◦Education

Outline Outline SAFETY • PATIENT

◦ Factors that Threaten the Safety of our Patient and corresponding interventions Latex, left handed patients, falls, age group, hospital environment, medications

◦ General Safety Precautions (call bells and patient identification) ◦ Safety Reminder Devices: Restraints

• NURSES◦ Factors that Threaten the Safety of the Nurses ◦ Workplace violence◦ Fire◦ Poisoning/ Mercury Spills ◦ Radiation

• Disaster Planning ◦ Disaster Planning ◦ Terrorism ◦ Bioterrorism ◦ Agencies concerned with Disasters

Factors that Threaten the Factors that Threaten the Safety of Our Patients and Safety of Our Patients and their Interventions their Interventions

• Latex Sensitivity• Left Handed Patients • Falls• Age Group • Hospital Environment Itself • Medications

Latex Sensitivity Latex Sensitivity • Latex Sensitivity

◦Can precipitate respiratory arrest• Interventions

◦Assess for allergies ◦Use latex free gloves ◦Document the allergy in the patient’s chart.

Risk Factors related to Patient Risk Factors related to Patient SafetySafetyLeft Handed PatientLeft Handed Patient Typical Hospital Set-up: set up to

accommodate the right-handed patient.

Because of this: LH patients may struggle and strain to cope.

Remember Twisting!!!

NR: document in the patient’s record that the patient is left handed.

Nursing Interventions Nursing Interventions for the for the Left-Handed PatientLeft-Handed Patient• Place all articles at the patient’s left side

◦Drainage receptacles ◦ Liquids during meal time .◦Nurse: when assisting the patient to ambulate◦Stand◦Table ◦Call light

• Place on the right◦Patient during back care.◦ IV ◦ Injections

Risk Factors related to Risk Factors related to Patient Safety: Falls Patient Safety: Falls • Majority of falls: occur during transfer either to a

bedside commode or to a wheelchair.

High risk for falls occur in:• The very young• Older adults• Medications: BP meds, antipsychotic

medications, Antihistamine and Anesthesia • Patient condition: Dementia, From Surgery,

Alcohol intoxication, Orthostatic hypotension. • Unfamiliar environment

Risk Factors related to Risk Factors related to Patient Safety: Age Patient Safety: Age • Infants and Children

◦Ensure the safety of the environment ◦Protect the child ◦Educate the parents.

• Accidents involving children are largely preventable

• BUT parents and caregivers need to be aware of specific dangers at each stage of growth and development.

Risk Factors related to Risk Factors related to Patient safetyPatient safetyOlder Adults Changes associated with aging significantly

affect the ability of older adults to protect themselves from injury. Vision Changes: affects the ability to see the height

of the stairs Hearing Changes: deafness and tinnitus Muscle Changes: changes in muscle strength and

joint mobility Diseases: anemia, hypotension Medications

Risk Factors related to Risk Factors related to Patient Safety: Medications Patient Safety: Medications • Hypertension meds• Sedatives• Psychotropics• Narcotics/ Pain medications • Anti-allergy medications • Anesthesia

Nursing Interventions Nursing Interventions To Reduce Falls To Reduce Falls • Assess and document risk factors for falls • Orient the patient and the family to the

environment. • Place bedside table, overbed table and personal

items within reach. • Assist patients out of bed. • Keep the environment free from litter. • Follow side rail policies. • Turn on bed alarm. • Lock wheels on bed, wheelchairs and stretchers. • Keep bed in the lowest position possible. • Dangle before ambulation. WOF dizziness

Nursing Interventions Nursing Interventions To Reduce Falls To Reduce Falls • Place none skid socks or shoes on the patient. • Wipe liquid on the floor. • Encourage the use of hand rails. • Provide adequate lighting. • Place high risk patients in rooms near the nurse’s

station• For Children:

◦ Have any easy bruising on children checked up right away ◦ May wear helmet◦ Pad the furniture and corners ◦ Never leave them alone esp. in the hospital ◦ Orient the family NOT to leave them alone. Let them ask

for your assistance

Risk Factors Related to Risk Factors Related to Safety: Safety: Devices Devices • Medical Equipment itself that is attached

to the patient’s body can cause falls: ◦Sequential Compression Devices: do NOT put

if the patient is able to ambulate ◦Tubes and Drains ◦ IV lines

Nursing Interventions for Nursing Interventions for Medical Devices Medical Devices • Discontinue if the indication is no longer

present. • Keep cables and wires off the floor. • Orient the patient regarding their use. • Check the medical equipment prior to use• Remove tangles from wires and tubings

Outline Outline SAFETY • PATIENT

◦ Factors that Threaten the Safety of our Patient and corresponding interventions Latex, left handed patients, falls, age group, hospital environment, medications

◦ General Safety Precautions (call bells and patient identification) ◦ Safety Reminder Devices: Restraints

• NURSES◦ Factors that Threaten the Safety of the Nurses ◦ Workplace violence◦ Fire◦ Poisoning/ Mercury Spills ◦ Radiation

• Disaster Planning ◦ Disaster Planning ◦ Terrorism ◦ Bioterrorism ◦ Agencies concerned with Disasters

General Safety General Safety PrecautionsPrecautionsPatient Education: Call Bells 1.Place call bells within reach. 2.Orient the patient to its use during

admission. 3.Orient the patient that the nurse is there

to assist and not to stand up alone. 4.Be there within 5 minutes

General Safety General Safety Precautions Precautions Identifying the Right Patient• Use a minimum of two methods to ID

client◦Medical Record Number ◦Patient’s Name ◦Birthdate ◦Ask another nurse ◦Ask the patient

Safety Precautions for Safety Precautions for Nursing Home Nursing Home

The Omnibus Budget Reconciliation Act (OBRA) is a law passed in 1987 that is a checklist for nursing home care facilities

• 1. Each resident must be fully evaluated upon admission and each year thereafter in regards to health, memory, hobbies, habits, etc.

• They must gauge the ability to walk, talk, eat, dress, bathe and understand other people and be able to communicate with them.

• Further, a plan must be drawn up to maintain and potentially improve their condition

Safety PrecautionsSafety Precautions• OBRA • 2. Patients have rights to a doctor and if they can't find

one on their own, the home's medical director will help them find one.

• They have a right to be informed about treatment- and refuse if desired.

• They have a right to privacy and a right to complain without reprisal.

Outline Outline SAFETY • PATIENT

◦ Factors that Threaten the Safety of our Patient and corresponding interventions Latex, left handed patients, falls, age group, hospital environment, medications

◦ General Safety Precautions (call bells and patient identification) ◦ Safety Reminder Devices: Restraints

• NURSES◦ Factors that Threaten the Safety of the Nurses ◦ Workplace violence◦ Fire◦ Poisoning/ Mercury Spills ◦ Radiation

• Disaster Planning ◦ Disaster Planning ◦ Terrorism ◦ Bioterrorism ◦ Agencies concerned with Disasters

Safety Reminder Devices: Safety Reminder Devices: Restrains Restrains

• Any device that can limit a person’s movement

• Types ◦Human Restraints: One-to-one precaution ◦Chemical Restraints: antipsychotics (minor and

major tranquilizers, antidepressants, sedatives and hypnotics)

◦Physical Restraints: wrist restraint, posey jacket and mittens

◦Legal Restrains: hand cuffs

RestraintsRestraints• Uses

◦Medical Reason: To allow for assessment, diagnosis and treatment

of a confused patient to maintain treatment

◦Behavioral Reason: to prevent possibly suicidal px from absconding to prevent injury to self to prevent injury to others Restrict wandering

Restraints: Types Restraints: Types • Wrist• Ankle• Elbow• Vest• Gait

Restraints: Nursing Restraints: Nursing Interventions and PrinciplesInterventions and Principles• Never restrain for staff convenience. • Not all intubated patients require restraints. • Adequate documentation for the necessity,

maintenance and discontinuation of the restrains is important.

• Provide food, water and frequent visits.• Wrist restraints must be tied to the

bedframe NOT the side rails. • Use quick release knots when tying wrist

restraints.

Restrains: Reminders Restrains: Reminders

• Ethical and legal issues surround their use.◦ False imprisonment or illegal detention

• Priority: Patient safety or the safety of others• The use of SRDs can also result in increased:

◦ restlessness, disorientation, agitation, confusion ◦ anxiety, ◦ feeling of powerlessness.

Safety PrecautionsSafety Precautions• OBRA states the following as acceptable

reasons for the use of physical restrains: ◦They can demand not to be restrained. ***

(depends on patient condition)◦All other interventions have been attempted

before the use of restrains. ◦Other disciplines have been consulted for their

assistance.

OBRA continuation OBRA continuation • Supporting documentation has been completed.

◦ Reason for the restraint◦ Explanation to the patient and family ◦ Date and time of the patient’s response to the

treatment◦ Frequency of observation◦ Safety Precautions

Release of restraints q 2 hours ROM of extremities Assessment for circulation and extremities

◦ Assessment for the continued need of the restraints ◦ Patient outcomes

Outline Outline SAFETY • PATIENT

◦ Factors that Threaten the Safety of our Patient and corresponding interventions Latex, left handed patients, falls, age group, hospital environment, medications

◦ General Safety Precautions (call bells and patient identification) ◦ Safety Reminder Devices: Restraints

• NURSES◦ Factors that Threaten the Safety of the Nurses

Workplace violence Fire Poisoning/ Mercury Spills Radiation

• Disaster Planning ◦ Disaster Planning ◦ Terrorism ◦ Bioterrorism ◦ Agencies concerned with Disasters

Risks for the NurseRisks for the Nurse• Workplace Violence • Fire • Chemical: Accidental Poisoning and

Mercury • Radiation• Body Fluids• Contaminated needles• Communicable Diseases

We will not discuss:

STANDARD PRECAUTIons

Risk for the Nurse: Risk for the Nurse: Workplace violence Workplace violence

More assaults occur in health care settings than any other industry. !!!

- Occupational Safety & Health Administration (OSHA)

- Violence: any intense behavior used to frighten, intimidate, threaten, or injure a person or damage or destroy property.◦Types:

Verbal Physical None verbal

• Assault: occur when you feel the fear of being struck

I NEED YOU TO I NEED YOU TO UNDERSTAND THIS!!!UNDERSTAND THIS!!!• 69 homicides occurred in the healthcare

setting from 1996-2000• 48% were assault • Most injuries were NONE FATAL • Most common victims:

◦NURSES◦orderlies ◦attendants

Risk Factors for Work Risk Factors for Work Related AssaultRelated Assault• On-site presence of handguns with the family, friends, co-

workers• Police custody patients • Violent patients• Mentally ill patients • Upset, Agitated, Disturbed family members or visitors • Long emergency department waits• On-site agency pharmacies• Gang members and substance abusers having access to

agencies as patients or visitors • Staff being alone with patients during care or transport• Low staffing levels during meals, emergencies and at night• Poorly lighted parking areas or distant parking areas • Lack of staff training

• http://www.youtube.com/watch?v=tVIwPNOIKUo

• http://www.youtube.com/watch?v=ONXdUu-EpdM

OSHA GUIDELINES FOR OSHA GUIDELINES FOR VIOLENCE PREVENTION VIOLENCE PREVENTION • Goal: eliminate or reduce employee

exposure to situations that can cause death or injury ◦Understand and follow the prevention program. ◦Understand and follow the safety and security

measures. ◦Report violent incidents promptly and accurately. ◦Take part in training programs that focus on

recognizing and managing agitation, assaultive behavior and criminal intent.

Safety Measures when Safety Measures when Dealing with Dealing with Agitated Individuals Agitated Individuals • Stand away from the person.• Keep away in such a way that he will not

be able to hit or kick you. • Position yourself CLOSE TO THE DOOR

BUT DO NOT BLOCK IT NOR CLOSE IT. • Do not allow yourself to be trapped in the

room. • Note the location of panic buttons, call

bells, alarms, closed-circuit monitors and other security devices.

Safety Measures when Safety Measures when Dealing with Dealing with Agitated Individuals Agitated Individuals • If you wear Id badge around your neck,

make sure it will break away if pulled. • Keep your hands out in the open, and open. • Stay calm. Do NOT LAUGH. Talk to the

person in a calm manner. Do NOT raise your voice, argue, scold or interrupt the person.

• Leave the room as soon as you are able. • Notify the supervisor or security officer of

the situation • Make an IR

Fire Fire • 8100 hospital fires and 4300 nursing

home fires each year • Both home and health care facility are at

risk for fires• Causes:

◦Smoking in Bed◦Faulty Electrical Equipment

• No Smoking Laws caused a reduction

Fire SafetyFire Safety• Follow fire prevention plan and evacuation

plan. • Keep the phone number for reporting fires

visible on the telephone at all times. • Enforce “no smoking policy” • Know the location of all alarms, exits,

extinguishers (AEE) • Inspect medical equipment before use. If wires

are exposed or if broken, return to biomedical services and DO NOT USE.

• Participate in fire drills. • Keep fire exits clear of clutter and unlocked.

During Evacuation During Evacuation • Listen to the instructions of the fire

marshall. • Assess the condition of the patient. • Provide clear explanations• Assist with evacuation

◦Types: Vertical: within the floor in the opposite direction of the

fire Horizontal: Up / down several floor

NOTE: DO NOT USE THE ELEVATORS DURING A FIRE!!!

During Evacuation: If with During Evacuation: If with smokesmoke• Keep that door and window to the

affected area closed. • Stay low on the ground. • Get a towel and moisten it and put it

around your nose and mouth.

Steps to Take in Response to Steps to Take in Response to a Firea FireRACE• Rescue: remove patients from immediate

danger• Alarm: Activate the alarm. DO this

BEFORE ATTEMPTING TO EXTINGUISH EVEN THE SMALLEST FLAME

• Contain: Close doors and windows. Turn off oxygen and electrical equipment.

• Extinguish/ Evacuate: Extinguish using an extinguisher

Evacuation: Prioritizing Evacuation: Prioritizing Patients Patients Principles (Ms. Du) Principles (Ms. Du) • “The More The Merrier” • “The Quicker the Better”. • “Be Quick but BE CALM”.• THE RESCUERS PERSONAL SAFETY IS ALWAYS

NUMBER 1• Ambulatory Patients • Assistive Devices: Canes, Walkers, Crutches,

Wheel Chair• Stretchers and Beds (none-complicated) • BED with multiple contraptions

Types of Fire Types of Fire extinguishersextinguishers

Type A◦ For paper, wood, or

cloth firesType B

◦ For flammable liquid fires - grease and anesthetics

Type C◦ For electrical

Type ABC◦ For any type of fire

Halon◦ a heavy gas, sucks all

the oxygen from the immediate area being fogged.

◦ is useful for all Class A, B. & C fires

◦ recommended because leaves no residue

How to Operate the Fire How to Operate the Fire Extinguisher: PASSExtinguisher: PASS• Pull the Pin to unlock the handle• Aim low at the base of the fire • Squeeze the handle• Sweep the unit from side to side.

Fire Interventions: Follow Fire Interventions: Follow Up Up • Listen to the “all clear” announcement

after a drill or follow safety instruction from the fire department or supervisor.

• Evaluate if the immediate environment is free from hazards.

Accidental Poisoning Accidental Poisoning • Poisoning:

◦ the condition or physical state produced by the ingestion, injection, inhalation or exposure to a toxic substances.

• One of the major cause of death in children. • 500 toxic substances in the home. • USING IPECAC IS NO LONGER

RECOMMENDED FOR USE. • FIRST INTERVENTION: Call the poison

control center at 1800-222-1222• At risk: children, older adult, hospitalized

patients

Interventions for Accidental Interventions for Accidental PoisoningPoisoning• Obtain an accurate history. Identify:

◦ Type◦ Amount ◦ Route ◦ Time ingested ◦ Allergy history ◦ Medical history◦ Current condition

• Do NOT induce vomiting if the poison is related to:◦ Furniture polish ◦ Lye◦ Unconscious◦ Grease or Petroleum Products◦ Household cleaner

• Call poison control center and follow the protocol.

Mercury Spill Mercury Spill • Sources: broken thermometers and

sphygnomanometers• Entry: Inhalation or skin exposure• Effect: Neurological and kidney signs and

symptoms • Steps

◦ Evacuate the room except for housekeeping crew. ◦ Do NOT vacuum the spill. ◦ Allow the agency to clean up the skill. ◦ After the clean up, mop the floor with a mercury

specific cleanser ◦ Dispose of mercury according to environmental

safety regulations

RadiationRadiation• Patient may be contaminated by

ingesting or by absorbing it. • < 0.75 Gy: no symptoms • >8 Gy: death • Acute Radiation Syndrome

◦ Blood: Depression of WBC, platelets (infection, bleeding, anemia, impaired wound healing)

◦ GI: Loss of mucosal barrier and cells lining the intestine ( fluid and electrolyte loss, vomiting, hematemesis, diarrhea, melena, loss of normal flora)

◦ Brain: Edema, Fever, hypotension, confusion

◦ Skin: Loss of epidermis and dermis

Radiation Prevention Radiation Prevention Principles Principles • Distance

◦Stay away as much as possible. ◦Only handle patients when necessary. ◦Use tongs when handling radioactive equipment.

• Time ◦ Limit the time spent in contact with the radiation◦Keep your badge with you and check.

• Shielding ◦Wear your lead aprons.

Outline Outline SAFETY • PATIENT

◦ Factors that Threaten the Safety of our Patient and corresponding interventions Latex, left handed patients, falls, age group, hospital environment, medications

◦ General Safety Precautions (call bells and patient identification) ◦ Safety Reminder Devices: Restraints

• NURSES◦ Factors that Threaten the Safety of the Nurses

Workplace violence Fire Poisoning/ Mercury Spills Radiation

• Disaster Planning ◦ Disaster Planning ◦ Terrorism ◦ Bioterrorism ◦ Agencies concerned with Disasters

DisasterDisaster• Uncontrollable, unexpected,

psychologically shocking event that is unique and likely to have a significant impact on a variety of health care facilies

• Ex: Earthquakes, hurricanes, floods, tornadoes, bombings, arson, riots and hostage taking

• http://www.youtube.com/watch?feature=player_detailpage&v=9QkBtxiowiA

• http://www.youtube.com/watch?v=RbMX2A545Wo

• http://www.youtube.com/watch?v=Ruawci7YoFA

Disaster PlanningDisaster Planning• Aka Emergency Preparedness• Allows health care workers to respond

effectively and efficiently when confronted with a disaster situation.

• Disaster Situation◦An uncontrolled, unexpected, psychologically

shocking event◦Ex: Earthquakes, hurricanes, floods, tornados,

bombings, arson, riots, and hostage-taking◦Health care facilities are expected to receive

victims and survivors and to assist rescuers

Factors that Affect a Disaster Factors that Affect a Disaster ResponseResponse• Time of the day • Scope and duration of the event • Readiness of the health care facility,

personnel and equipment • Extend of collaboration

Types of DisastersTypes of Disasters• External Disaster:

◦originates outside the health care facility and◦results in an influx of casualties brought to the

facility.• Internal Disaster:

◦ represents an extraordinary situation that is brought about by events within the health care facility.

Disaster Planning Disaster Planning InterventionsInterventions• Review facility disaster plan. • Know your responsibility. • Participate in drills • Participate in crisis support group after.

The Disaster Plan The Disaster Plan • Identify the type of emergency. • Recognize the code needed to announce it. • Identify patients who need protection. • Assess patients for possible discharge or transfer. • Provide clear explanations to visitors in a clam

manner. • If a disaster occurs when you are off duty, follow

your facility protocol for reporting. • If an internal disaster occurs, assist with planned

evaluation• Wait for an “ All Clear”

• http://www.youtube.com/watch?v=ZFbvx3kkYvk

Disaster Planning for the Disaster Planning for the Nursing Home Nursing Home • Resident will require an ID. • At the triage site, the nurse decides

where the patient will go (e.g. school, church or temporary shelter)

• Notify families and their physician. • Keep a logbook to document the events

including the following: ◦Name of the patient ◦Who and how the patient was transported◦Relocation site

Facility CodesFacility CodesInternal codes• Code blue-cardiac or respiratory arrest• Code red-fire• Code pink-baby/child abduction• Code gray-security/violence• Code silver- weapon• Code black- bomb Vary from facility to facility

Other ThreatsOther Threats• Terrorism

◦A violent or dangerous act used to intimidate or coerce a person or government to further a political social agenda.

◦Department of Homeland Security: created after Sept 11, 2001 to oversee the development of a comprehensive approach to a large domestic event.

◦Concerns: Prevention and management of attacks

Other ThreatsOther Threats• Bioterrorism

◦ The use of biological agents to create fear and threat (E.g. Anthrax, small pox)

◦ Types Overt: Announced Covert: Unannounced

• Recognize the signs and symptoms and report promptly to CDC.

• Treat as diagnosed

Agencies that focus on Agencies that focus on safetysafetyEnvironmental protection• National Institute for Occupational Safety and

Health (NIOSH)◦ Focuses on safety and issues related to health

• Hazard Communication Act of the Occupational Safety and Health Administration (OSHA)◦ A national organization that provides guidelines to

help reduce safety hazards in the workplace◦ Requires hospitals to inform employees about the

presence of or potential for harmful exposures and how to reduce the risk of exposure

Agencies that focus on Agencies that focus on safetysafetyCenters for Disease Control and

Prevention (CDC)• A federal agency that provides facilities

and services for the investigation, identification, prevention, and control of disease

• Provides guidelines for working with infected patients

Nursing diagnosesNursing diagnoses• Nursing Diagnoses• Risk for falls/injury• Impaired physical mobility