Chapter 19 Safety

Safety Major nursing responsibility Hospital errors: ranked as sixth leading cause of death by Centers for Disease Control and Prevention

Age-Related Safety Factors Infants Falling off changing tables Unrestrained in automobiles Toddlers Climbing; accidental poisoning; falling downstairs or from high chairs; burns; electrocution; drowning

Age Related Safety Factors (cont’d) School-aged children and adolescents School-aged children: play-related injuries Adolescents: sports-related injuries Adults: ignoring safety issues, fatigue, sensory changes, effects of disease

Environmental Hazards Latex sensitization Thermal burns Asphyxiation Electrical shock Poisoning Falls

Question Is the following statement true or false? Poisoning is a common hazard found only in homes.

Answer False. Poisoning is a common hazard found in the home and health care environment.

Environmental Hazards (cont’d) Latex sensitization is an allergic response to the proteins in latex Latex is natural rubber sap Component of many household items Predisposition to latex sensitivity

Environmental Hazards (cont’d) Types of latex reactions Contact dermatitis Immediate hypersensitivity Possible cross-reaction to fruits or vegetables

Environmental Hazards (cont’d) Preparing a latex-free room Stock room with latex-free equipment, including gloves, client care equipment, and resuscitation equipment Wipe room clean of glove powder Communicate with other departments the need to use only latex-free equipment

Question Is the following statement true or false? People with latex allergy may develop a cross-reaction to certain foods.

Answer True. People with latex allergy may develop a cross-reaction to certain fruits and vegetables.

Environmental Hazards (cont’d) Safeguarding clients and personnel Prevent latex sensitization If using latex gloves, avoid oil-based hand creams Wash hands thoroughly after removing gloves

Question Is the following statement true or false? When using latex gloves, a nurse should use oil-based hand creams.

Answer False. When using latex gloves a nurse should avoid the use of oil-based creams.

Environmental Hazards (cont’d) Burns Thermal burns or chemical burns Burn prevention: exits identified, lighted, unlocked; ensure functioning sprinkler system Fire plans

Environmental Hazards (cont’d) Burns (cont’d) Fire management: RACE Rescue Alarm Contain Extinguish

Environmental Hazards (cont’d) Burns (cont’d) Roles and responsibilities at and away from fire’s origin Use of fire alarm system Agency fire plan concepts

Environmental Hazards (cont’d) Burns (cont’d) Rescue and evacuation; proper use of equipment Building compartmentalization for containing smoke and fire Fire extinguishers

Environmental Hazards (cont’d) Burns (cont’d) Fire extinguishers Class A: wood, paper Class B: liquids, grease Class C: electrical Class ABC: combination

Evacuation of Clients

Environmental Hazards (cont’d) Asphyxiation Airway obstruction Carbon monoxide (CO) CO binds with hemoglobin CO poisoning: symptoms similar to flu, except for cherry-red skin color

Environmental Hazards (cont’d) Drowning Fluid occupies airway, interferes with ventilation Accidental drownings Resuscitation Immediate CPR CPR certification in nurses

Environmental Hazards (cont’d) Electrical shock Body prone to electric shock Macroshock; microshock Grounded equipment reduces electrical shock potential Measures to prevent electrical shock

Environmental Hazards (cont’d) Poisoning Caused by ingestion, inhalation, or absorption of toxic substance More common in homes than in health care institutions Accidental poisonings; medication errors

Environmental Hazards (cont’d) Poisoning prevention Educate children; teach parents Cognitive-impaired adults: use prefilled medication containers American Association of Poison Control Centers

Environmental Hazards (cont’d) Falls Most common accident with the most serious consequences in older adults Contributing factors: visual impairments; disorders affecting gait, balance, and coordination; medications to lower blood pressure

Environmental Hazards (cont’d) Falls (cont’d) Contributing factors (cont’d) Urinary urgency Social, environmental factors Accumulation of clutter Hospitalization Confusion, impaired judgment

Environmental Hazards (cont’d) Assessment Determine risk factors Fall prevention measures Keep emergency numbers near phone Daily phone tree Personal response services

Restraints Restraints: methods of restricting a person’s freedom of movement, physical activity, or normal access to his or her body Fall-prevention measures Use of restraints is closely regulated Restraints may be used for disciplinary reasons Last intervention used after all others exhausted

Restraints (cont’d) Risks of use: Increase client confusion Cause chronic constipation, incontinence, infections (pneumonia) May cause pressure ulcers Experience progressive decline in ability to perform ADLs independently

Restraints (cont’d) Legislation Law incorporated; compliance mandatory since 1990 Accreditation standards Restraint protocol; medical orders; monitoring and documentation

Restraints (cont’d) Restraint alternatives: protective or adaptive devices that promote client safety and postural support which the client can release independently

Nursing Implications Recognize safety hazards Identify clients at greatest risk for injury Identify several nursing diagnoses Client safety; allegations of malpractice

General Gerontologic Considerations Number of falls and severity of injury Falls robs independence Well-fitting enclosed shoes, nonskid soles Most falls occur in clients 65 years or older, at home

General Gerontologic Considerations (cont’d) Factors contributing to falls in older adults: health conditions; situations such as environmental hazards, inadequate lighting, general clutter, assistive devices Osteoporosis Fear of falling; history of falling Cognitive impairment