1. Chapter 19: Safety

2. National Patient Safety Goals
Description-established in 2003 by Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Purpose
Assist health care organizations in obtaining/retaining their accreditation.
Revised annually to reduce incidence of deaths/injuries for the health agency clients
Potential methods for implementation(Table 19-1, page 414)

3. Age Related Safety Factors #1
Infants
Falling off changing tables
Unrestrained in automobiles
Toddlers
Climbing; accidental poisoning; falling downstairs or from high chairs; burns; electrocution; drowning

4. Age Related Safety Factors #2
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

5. Environmental Hazards #1
Latex sensitization
Thermal burns
Asphyxiation
Electrical shock
Poisoning
Falls

6. Question #1 Is the following statement true or false?
Poisoning is a common hazard found only in homes.

7. Answer to Question #1
False. Poisoning is a common hazard found in the home and health care environment.

8. Environmental Hazards #2
Latex sensitization: allergic response to the latex proteins
Latex is natural rubber sap
Component of many household items
Predisposition to latex sensitivity

9. Environmental Hazards #3
Types of latex reactions
Contact dermatitis
Immediate hypersensitivity
Possible cross-reaction to fruits or vegetables

10. Common Items Containing Latex (Text: p415)
Medical gloves IV ports
Band-aids Bulb syringes Urinary catheters Wound drains (JP) Tourniquets Endoscopes Mattress covers BP cuffs & tubing - Stethoscope tubing Jobst stockings

11. Environmental Hazards #4
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

12. Question #2 Is the following statement true or false?
People with latex allergy may develop a cross-reaction to certain foods.

13. Answer to Question #2
True. People with latex allergy may develop a cross-reaction to certain fruits and vegetables.

14. Environmental Hazards #5
Safeguarding clients and personnel
Prevent latex sensitization
If using latex gloves, avoid oil-based hand creams
Wash hands thoroughly after removing gloves

15. Question #3 Is the following statement true or false?
When using latex gloves, a nurse should use oil-based hand creams.

16. Answer to Question #3
False. When using latex gloves a nurse should avoid the use of oil-based creams.

17. Environmental Hazards #6
Burns
Thermal burns: caused by fire, hot liquids, steam and is the most common form for burns
Chemical burns: result from lye, electric wires, lightning
Burn prevention: exits identified, lighted, unlocked; ensure functioning sprinkler system
Fire plans

18. Environmental Hazards #7
Burns (cont’d)
Fire management: RACE
Rescue
Alarm
Contain
Extinguish

19. Environmental Hazards #8
Burns (cont’d)
Roles and responsibilities at and away from fire’s origin
Use of fire alarm system
Agency fire plan concepts

20. Environmental Hazards #9
Burns (cont’d)
Rescue and evacuation; proper use of equipment
Building compartmentalization for containing smoke and fire
Fire extinguishers

21. Evacuation of clients. (A) Human crutches—rescuers secure a weak but ambulatory client’s arm and waist. (B) Seat carry—rescuers interlock arms and carry a nonambulatory client. (C) Body drag—rescuer drags an unconscious victim or one who cannot assist on a blanket or sheet.

22. Environmental Hazards #10
Burns (cont’d)
Fire extinguishers
Class A: wood, paper
Class B: liquids, grease
Class C: electrical
Class ABC: combination

23. Environmental Hazards #11
Asphyxiation
Airway obstruction
Carbon monoxide (CO)
CO binds with hemoglobin
CO poisoning: symptoms similar to flu, except for cherry-red skin color

24. Box 19-2 Symptoms of Carbon Monoxide Poisoning (Text: 421)
Nausea/vomiting - Muscle Weakness
Headache - Confusion
Dizziness - Shortness of breath
Cherry-red skin color
Lapse into a coma, followed by death

25. What is the treatment of someone suspected of CO poisoning?
Get the victim out of the immediate environment. If you can’t get the victim out, the open windows & door for cross ventilation.

26. Extremely high levels of CO, may be treated with hyperbaric (high-pressure) O2, which delivers 100% O2 at 3x the normal atmospheric pressure within an airtight chamber
Prevention: Have carbon monoxide detectors installed.

27. Asphyxiation

28. Environmental Hazards #12
Drowning
Fluid occupies airway, interferes with ventilation
Accidental drownings
Resuscitation
Immediate CPR
CPR certification in nurses

29. Drowning Prevention
Learn to swim
Never swim alone
Wear an approved flotation device
Do not drink alcohol when participating in water-related sports
Notify law enforcement officer if boaters appear unsafe

30. Environmental Hazards #13
Electrical shock (discharge of electricity through the body)
Body prone to electric shock because we are made up of H2O and electrolytes, both are good conductors of electricity
Macroshock: harmless distribution of low- amperage electricity over a large area of the body. Feels like a slight tingling

31. Electrical shock
Microshock: Low-voltage but high- amperage, intact skin acts as a barrier, usually not felt; can be fatal, especially if delivered directly to the heart
Measures to prevent electrical shock
Grounded equipment reduces electrical shock potential. (3-prong plug)
Do not use extension cords
Other safety measures are in Text p.422

32. Environmental Hazards #14
Poisoning
Caused by ingestion, inhalation, or absorption of toxic substance
More common in homes than in health care institutions
Accidental poisonings; medication errors
Treatment of poisoning

33. Some Common Substance Associated with Childhood Poisonings
Drugs: ASA, Tylenol, Vitamins with Iron, Antidepressants, Sedatives
Cleaning Agents: Bleach, Drain cleaners
Paint Solvents: Turpentine, gas, kerosene
Heavy metals: Lead pain chips
Chemical products: Glue, shoe polish, insecticides
Cosmetics: Hair dye, nail polish remover
Plants: Mistletoe berries, rhubarb leaves, castor beans
(Text: Box 19-3 p.422)

34. Environmental Hazards #15
Poisoning prevention
Educate children; teach parents
See client teaching p 423
Cognitive-impaired adults: use prefilled medication containers
American Association of Poison Control Centers

35. Environmental Hazards #16
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

36. Environmental Hazards #17
Falls (cont’d)
Contributing factors (cont’d)
Urinary urgency
Social, environmental factors
Accumulation of clutter
Hospitalization
Confusion, impaired judgment

37. Environmental Hazards #18
Assessment
Determine risk factors
Fall prevention measures
See client teaching p 424
Keep emergency numbers near phone
Daily phone tree
Personal response services

38. Restraints #1
Physical restraints-protect a client from falling out of bed or permit the client to participate in activities
Chemical restraints-manage a client’s behavior or freedom of movement
Purpose: client or staff safety
Use of restraints is closely regulated
Restraints may not be used for disciplinary reasons
Last intervention used after all others exhausted

39. Restraints #2 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

40. Restraints #3 Legislation
Law incorporated; compliance mandatory since 1990
Accreditation standards
Restraint protocol; medical orders; monitoring and documentation

41. Restraints #4
Restraint alternatives: protective or adaptive devices that promote client safety and postural support which the client can release independently. Seat belts / Harnesses with front releasing Velcro or buckle closures, support pillows, seat inserts

42. Other Supplementary Measures
Improve client gait training
Provide physical exercise
Reorient clients
Encourage ambulatory aids (walkers)
Electronic seat & bed monitors (bed alarm)
Position wheelchair bound clients correctly

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