Suzonne McLean RN MSN October 2009

Client Safety Safety and Security is a basic human need It is 2 nd highest priority on Maslow Hierarchy Safety is freedom from physical or psychological injury

Client Safety Nurses are responsible to understand all the different threats to client safety Nurses are responsible to teach clients to recognize threats and teach ways to reduce threats (smoke detectors)

Client Safety In the healthcare setting, nurses must always assume client can’t protect self and provide that protection for them (prevent falling, prevent medication error)

A Safe Home Environment 1. Basic needs are met 2. Physical hazards are reduced 3. Transmissions of pathogens are reduced 4. Sanitation is maintained 5. Noise, Air, Land, Water pollution is controlled 6. The threat of terrorist attack is minimized

Environmental Threats: Loss of Oxygen Supply Carbon Monoxide – colorless, odorless, poison that is commonly caused by: Improperly functioning heating systems Car left running in a closed garage Generators not properly placed on the outside of the home

Environmental Threats: Loss of Oxygen Supply Carbon Monoxide binds with hemoglobin No oxygen is being delivered to the tissues  hypoxia Small concentrations of carbon monoxide – nausea, dizziness, fatigue  concentrations of carbon monoxide - death

Environmental Threats: Loss of Oxygen Supply Prevention Requires: Yearly inspection of heating systems, chimneys, and fuel burning appliances Carbon Monoxide Detector for home use Public education about the correct use of a generator (never used inside home or partially closed garage)

Food Poisoning Food not properly stored or contaminated by unsanitary handling susceptible to bacterial infestations which cause food poisoning Common bacteria: Salmonella Hepatitis A contracted by ingesting food, water, milk that has been exposed to fecal contamination

Food Poisoning Client and Restaurant Worker Education is key to prevention All households should have a working refrigerator with freezer compartment Clean running water for kitchen and bathroom All dishes must be thoroughly cleaned before next use

Food Poisoning All surfaces and utensils that touch raw meat must be thoroughly cleaned before being used with other foods All food must be thoroughly cooked and stored (no undercooked eggs, no rare meats) Wash vegetables/fruit carefully

Food Poisoning Adequate garbage disposal No handling of animal or human waste products in the food preparation area Careful disinfecting of hands after handling raw meat, going to bathroom, changing diapers, handling animal waste

Hypothermia Hypothermia – Core body temp is 95° or below Caused by prolonged exposure to severe cold Most at risk are those who can’t take care of themselves:

Hypothermia 1. Children 2. Older adults (especially those with Alzheimer's, dementia) 3. Adults with cardiac conditions 4. Clients with extreme psychiatric disorders (does not have reality-based, rational thought process, can’t recognize danger)

Hypothermia 5. Client who has ingested large amounts of alcohol or drugs (judgment impaired) 6. Homeless, Illegal Aliens (no physical protection from the elements)

Hyperthermia Hyperthermia – Core body temp is ° Caused by prolonged exposure to severe heat Most at risk are those who can’t take care of themselves : 1. Infants (left in cars in extreme heat)

Hyperthermia 2. Older adults with chronic medical problems (Renal Failure, Asthma those with Alzheimer's, dementia) 3. Clients with extreme psychiatric disorders (does not have reality-based, rational thought process) 4. Homeless, Illegal Aliens

Accidental Death Leading cause of accidental deaths: 1. MVA’s 2. Poisonings 3. Falls (90% of all fractures in older adult r/t falls – 50% never regain full mobility) 4. Drowning

Accidental Death 5. Fires 6. Burns 7. Risk for injuries and injury prevention strategies are based on growth and development, i.e. Toddlers at greater risk for choking on marble than school age child because of smaller airway

Physical Hazards: Falls Most common cause of trauma admissions for the older adult is falls, especially hip fractures Risk of falls in home for older adult is caused by intrinsic factors (illness, drug therapy)and extrinsic factors (hazards in home)

Physical Hazards: Falls Common reasons older adults fall at home are: Poor balance/coordination r/t aging Urgency to get to bathroom, especially at night (Most common reason people fall)

Physical Hazards: Falls use of some meds can cause dizziness if standing up too quickly tripping over small rugs, clutter on floor, small pet, or electrical cords, slipping on ice or spilled water from tub bath

Physical Hazards: Falls Outside steps, handrails, walkways in disrepair, Uneven surfaces in house/porch/yard No grab bars for toilet or tub (falls in/out of tub common) Poor lighting in/around house

Physical Hazards: Falls History of falls most significant risk factor for predicting future falls!!!!! Other factors: confusion, age over 65, impaired judgment, incontinence

In-Home Fall Prevention Risks of falls from home can be minimized by assessing the home environment for several hazards: Need for adequate soft, non-glaring lighting(75 watts or lower)

In-Home Fall Prevention Adequate lighting of stairs and halls Adequate outdoor lighting of walkways Adequate night lighting to allow client to see way to bathroom or phone

Preventing Falls in the Home Repair uneven surfaces, broken steps, poor lighting Add grab bars to toilet area Gripper-type shoes, slippers

Preventing Falls in the Home Non-slip floor mats where water may collect on floor Skid-resistant strips or mats for the tub Keep clutter-free environment