Chapter 33 Safety

33-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Safety Culture  Safety is a functional concern of nurses from the bedside to the home and community  Excellent nursing care is safe for both the clients receiving the care, and the workers involved in the delivery of health care.

33-3 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Factors Affecting Client Safety  Age: Fetus: maternal exposure e.g. drugs and smoking Infants: falling, suffocation, burns. Poisoning, and electrical shock Toddlers: falling, sharp object injury, automobile accident, poisoning, electrical shock Preschooler: injuries, suffocation, poisoning, burn, automobile accidents Adolescent: Vehicle accident, Suicide, sport injuries, substance abuse Adults: accidents (occupational or vehicle), fire burns, suicide Elderly: falling, burns, automobile accidents

33-4 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Factors Affecting Client Safety  Lifestyle: Work environment Residence Risk Talking behaviors Income  Sensory and Perceptual Alterations: problem in senses  Mobility and health status: paralysis, patient after surgery  Emotional State: stress, or depressed  Cognitive awareness: unconscious under narcotic  Ability to communicate: unable to read

33-5 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Types of Incidents  Client behavior incidents  Therapeutic procedure incidents  Equipment incidents

33-6 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Safety and the Environment of Care  Each nurse is responsible for following the facility’s established safety guidelines.  It is the nurse’s responsibility to report promptly and to document a mishap.

33-7 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Focus of Safety Assessments  The individual  The environment  Specific risk factors Falls Fires Poisoning Suffocation and choking Firearm injuries

33-8 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Potential Occupational Hazards  Chemical and biological exposures  Physical exposures (lasers, ionizing radiation, noise)  Psychosocial stressors (shift work, overtime, threat of workplace violence)  Ergonomic stressors (lifting and moving clients)

33-9 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Potential Occupational Hazards  Routes of Exposure Methods by which chemical and biological substances are assimilated into the body -Inhalation -Ingestion -Injection -Skin contact -Skin absorption

33-10 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Potential Occupational Hazards  Latex Allergy Irritant contact dermatitis Allergic contact dermatitis

33-11 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Potential Occupational Hazards  Hand Hygiene Any dermatitis should be promptly reported to Employee Health. Barrier creams or special soaps are available. Strict guidelines on nail care and nail coverings should be implemented and followed.

33-12 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Factors that Contribute to Falls  Age >65  History of falls  Impaired vision or balance  Altered gait or posture, impaired mobility  Medication regime  Postural hypotension  Slowed reaction time  Confusion or disorientation  Unfamiliar environment

33-13 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Diagnosis  Risk for Injury Risk for Suffocation Risk for Poisoning Risk for Trauma Risk for Aspiration Risk for Disuse Syndrome Latex Allergy Response

33-14 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Diagnosis  Risk for Infection Related to (RT) Inadequate primary defenses Inadequate secondary defenses Tissue destruction and increased environmental exposure Chronic diseases and malnutrition

33-15 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Diagnosis  Risk for Infection Related to Invasive procedures Pharmaceutical agents Trauma Rupture of amniotic membranes Insufficient knowledge to avoid exposure to pathogens

33-16 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Outcome Identification and Planning  Identification of actual or potential hazards  Reduction of the risk of injury and infection  Client/caregiver education regarding safety measures and modification of an unsafe environment

33-17 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Raise Safety Awareness and Knowledge  Bed Safety  Prevent Falls Apply restraints Ensure adequate lighting Remove obstacles

33-18 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Types of physical restraints A.Jacket B.Belt C.Mitten or Hand D.Elbow E.Limb or Extremity F.Mummy

33-19 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Reduce Bathroom Hazards  Prevent Fire Common causes of fire Fire prevention Protection of clients during a fire Institutional policies and procedures for fire containment and evacuation

33-20 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Ensure safe operation of electrical equipment. Three-pronged electrical plug that is grounded Warning labels on all equipment Electrical shock

33-21 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Reduce exposure to radiation. Both the client and the nurse are at risk for injury. Radiation injury can occur from overexposure or exposure to untargeted tissues. General principles of radiation exposure and protection are based on time, distance, and shielding.

33-22 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Prevent poisoning. A poison is any substance that causes an alteration in the client’s health when inhaled, injected, ingested, or absorbed by the body. Antidotes and treatments are available for some but not all types of poisonings. Poison control center Client education

33-23 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Implementation  Reduce Noise Pollution. Sensory overload can alter a client’s recovery by increasing anxiety, paranoia, hallucinations, and depression. Safety measures include maintaining a quiet environment, traffic control, and providing earplugs.

33-24 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Four E’s of Preventing injury  Engineering: environmental modification  Enforcement: laws and regulations  Education: behaviour modification  Economics: financial incentives