NEO111 M. Jorgenson, RN BSN Patient Safety, Comfort, & Mobility

Patient Safety

FALLS are the fifth leading causes of death among Americans aged 75 years and older are the fifth leading causes of death among Americans aged 75 years and older the second leading cause of mortality from related injuries in adults >65 years the second leading cause of mortality from related injuries in adults >65 years Elderly person who sustains a fall are more likely to die within a year’s time of the fall. Considine J, Botti M. Who, when and where? Identification of patients at risk of an in-hospital adverse event: implications for nursing practice. Int J Nurs Pract. 2004;10(1):21–31. Fall Prevention: Everyone’s Responsibility

Physical restraints considered as a last resort after other care alternatives have been unsuccessful considered as a last resort after other care alternatives have been unsuccessful The least restrictive restraint should be used and it should be removed at the earliest possible time The least restrictive restraint should be used and it should be removed at the earliest possible time Must be ordered by a MD or other licensed independent practitioner Must be ordered by a MD or other licensed independent practitioner Special monitoring/ assessment Special monitoring/ assessment Must be reassessed by ordering MD in 24 hours and new order obtained Must be reassessed by ordering MD in 24 hours and new order obtained Restraints

Ask family to stay with patient Rule out physical causes for agitation Reduce stimulation Use electronic alarm system Check for environmental hazards Offer diversion activities Consider relocation closer to nurse’s station Conceal tubes and tubing necessary for care Alternatives to Restraints

Extremity restraintsJacket or vest restraintHand MittElbow restraintsLeather restraintsMummy restraintsBed alarms Types of Restraints

Must be able to insert 2 fingers between restraint and pt’s ankle or wrist Restraint must be fastened on moveable part of bed frame, NEVER side rail Use a quick-release knot to tie Must be able to insert a fist between vest restraint and patient When assessing a restraint, must assess CMS Circulation Circulation Motor Motor Sensation Sensation Call bell must be within reach Restraints cont.

Mobility

Cardiovascular system Increased cardiac workload, orthostatic hypotension and venous thrombosis Increased cardiac workload, orthostatic hypotension and venous thrombosis Respiratory system Decreased ventilatory effort and increased secretions Decreased ventilatory effort and increased secretions Gastrointestinal system Poor digestion and utilization of food Poor digestion and utilization of food Constipation Constipation Urinary system UTI and renal calculi UTI and renal calculi Effects of Immobility

Musculoskeletal system Atrophy, osteoporosis Atrophy, osteoporosis Metabolic system Decrease in metabolism Decrease in metabolism Integument system Skin breakdown Skin breakdown Psychological well-being Diminished self-esteem, social disturbances Diminished self-esteem, social disturbances Effects of Immobility cont.

Be organized and plan ahead Anticipate changes/complications Prevention versus treatment Develop good habits Proper alignment Proper alignment Preparing for Activity.

Check MD orders, Nursing plan of care, PT notes, and history for any limitations on mobility Conduct a pain assessment and provide appropriate interventions Talk with the patient Talk with other members of the team Gather equipment Develop a plan Planning

Know policies and procedures for facility Ensure adequate assistance for nurse and patient safety Prepare for smooth, coordinated transfer-only one leader Engage brakes on equipment Planning cont.

Comfortable working height Good posture Feet shoulder width apart (wide base of support) Use large leg/arm muscles (not back) Gluteal and abdominal muscles engaged (internal girdle) Low center of gravity Body Mechanics

Flex knees (and hips) Head up Back straight –no twisting Smooth, coordinated movements Position self close to object Rocking motion (forward-push/back-pull) Body Mechanics cont.

Bed position Arms across chest Arms across chest Knees flexed and feet flat Knees flexed and feet flat Ensure proper body alignment Trapeze bar Avoid friction/shearing Patient Positioning

Change patients positions frequently Smoothe clothes and linens Encourage deep breathing and coughing Apply antiembolism stockings Pad bony prominences Bed in lowest position Special Considerations

PillowsMattresses Side rails Adjustable beds Trapeze bar Hand splints Trochanter rolls Heel boot Foam pads Hand rolls Footboard Positioning & Protective Equipment

Range of Motion Promotes circulation, prevents contractures, and provides joint mobility. Move each joint until there is resistance but not pain Incorporate into ADLs Teach patient and family Encourage pt to do as much as possible

Anti-embolism Stockings Used to enhance blood flow and venous return Patient should be measured for the correct size. Assess extremity for pulses, edema, movement, sensation (CMS) Remove and check skin q 8 hours