FUNDAMENTALS OF NURSING
LESSON 6
SAFETY
KNOW YOUR SAFETY
VOCABULARY!!
SAFETY ISSUES
1.
A BASIC HUMAN NEED
SAFETY ISSUES:
SAFE ENVIRONMENT
1.
SAFETY IS THE RESPONSIBILITY OF EVERYONE
1.
2.
3.
LEFT HANDED PATIENT
IN HOSPITAL SETTING
PREVENTING FALLS

4.
THE YOUNG

5.
CHILDREN CAN’T READ, CURIOUS
THE ELDERLY

6.
MAJOR ACCIDENTAL INJURY TO HOSPITALIZED PATIENT
DECREASED BALANCE
MEDICAL WORKERS

DO NOT RECAP NEEDLES
SAFETY ISSUES:
SAFE ENVIRONMENT
8.
NURSING INTERVENTIONS TO
PREVENT INJURY
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EDUCATION—ENVIRONMENT, CALL
BELL, BED CONTROLS, BATHROOM,
SMOKING
BED IN LOWEST POSITION
USE OF HANDRAILS
NON-SKID SHOES
CALL FOR ASSIST
SAFETY ISSUES:
SAFE ENVIRONMENT
9. CHILDREN
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CAR SEATS
PROPER WATER TEMP
DON’T LEAVE UNATTENDED
DEVELOPMENTAL LEVEL IS KEY IN SAFETY
PREPARATION
10. NURSING SAFETY
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HANDWASHING
EDUCATE YOURSELF—KNOW WHAT TO DO
Morse Fall Scale
Variables
Numeric Values
1. History of falling
No
0
2. Secondary diagnosis
Yes
No
25
0
Yes
15
Score
_______
_______
3. Ambulatory aid
None/bed rest/nurse assist
Crutches/cane/walker
Furniture
15
_______
4. IV or IV Access
No
30
0
Yes
20
_______
5. Gait
Normal/bed rest/wheelchair
Weak
Impaired
0
0
10
20
6. Mental status
Oriented to own ability
Overestimates or forgets limitations
_______
0
15
_______
Marianjoy Fall Risk Assessment

Altered elimination patterns 10

Unilateral neglect

Impaired cognition

Sensory deficits (hearing,
sight, touch)

Lower extremity hemi paresis
10

Activity intolerance
10

Episodes of dizziness/seizures
10

Special medications (narcotics,
psychotropic, hypnotic,
antidepressants etc.)
5
10
20
5

Agitation
20

Impaired mobility

History of previous falls
20

Impulsiveness
20

Communication deficits
20
5

Diuretics and drugs that
increase GI motility
5

Upper extremity paresis
5

Age greater than 65 or less
than 16
•High Risk: >60 points
Place Patient in Caution Club
5
Study Results

Six items found to separate fall groups
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History of falls
Unilateral neglect
Episodes of dizziness / seizures
Special medications
Diuretics and drugs that increase GI motility
Sensory deficits
INSTITUTIONS

NIOSH
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
OSHA
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
FOCUS ON SAFETY ISSUES
TRIES TO ENSURE A SAFE HEALTH CARE ENVIRONMENT
PROTECTS EMPLOYEES
SET RULES FOR EMPLOYERS
GOAL TO DECREASE RISK OF INJURYOR EXPOSURE
CDC
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INVESTIGATES, IDENTIFIES, PREVENTS, CONTROLS
DISEASE
SETS GUIDELINES “UNIVERSAL PRECAUTIONS”
APPLYING SAFETY REMINDER DEVICES
(RESTRAINTS)

GUIDELINES
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
ALWAYS LEAST RESTRICTIVE, ALWAYS LAST
RESORT
PATIENT SAFETY MAJOR CONSIDERATION
FOR DETERMINING USE OF RESTRAINTS
TYPES—SOFT RESTRAINT, POSEY
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USED FOR




PREVENTION OF FALLS
WANDERING
PROTECTING OTHER PATIENTS
PROTECT INTERVENTIONS
APPLYING SAFETY REMINDER DEVICES
(RESTRAINTS)

DOCUMENTATION BEFORE APPLYING:
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BEHAVIOR
ACTIVITY
SKIN ASSESSMENT
TEACHING OR INSTRUCTION TRIED
PATIENT NEEDS
ENVIRONMENT
APPLYING SAFETY REMINDER DEVICES
(RESTRAINTS)

CONSEQUENCES:
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DISORIENTATION
AGITIATION, ANXIETY, HUMILIATION
FEELING POWERLESS, ANGRY
LOSS OF CONTROL, FEAR
IMMOBILITY
PRESSURE ULCERS
INCONTINENCE, DEHYDRATION
NOSOCOMIAL INFECTIONS
INJURY AND DEATH
APPLYING SAFETY REMINDER DEVICES
(RESTRAINTS)

PHYSICIAN ORDER AND SPECIFICATION
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
MUST BE OBTAINED WITHIN 24 HRS
NEED CONSENT FROM PT OR GUARDIAN
WITHOUT MD ORDER—FALSE IMPRISONMENT
LEGAL CONCERN
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OBRA—SETS GUIDELINES THAT



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PROHIBIT ROUTINE USE
REGULATES USE OF RESTRAINTS
DEMAND DR. ORDER WITH SPECIFIC DETAIL
FACILITY POLICY


NEOR—VERY STRICT NO RESTRAINT POLICY
4 SIDE REAILS IS CONSIDERED A RESTRAINT
APPLICATION/TYPES
 SIDERAILS
 MITTENS
 ELBOW
 GAIT
BELT
 POSEY VEST
 WEDGE
APPLICATION/TYPES

SIDERAILS
*KNOW POLICY
•More than 2 up = restraint
APPLICATION/TYPES

Posey Mitts
– PREVENT
SCRATCHING,
RUBBING, OR
PULLING AT
TUBES/LINES
APPLICATION/TYPES

GAIT BELT
–
SHOULD FIT SNUGLY
•WEDGE
PREVENTS
FALLING
FORWARD
•ELBOW
CAN’T REACH
FACE
APPLICATION/TYPES

Soft wrist restraints

CLOVE HITCH
–
QUICK RELEASE KNOT
APPLICATION/TYPES

POSEY VEST
–
MONITOR
RESPIRATIONS
Pt found dead!!!
Last month we had a patient die at our hospital, he was strangled from
his Posey vest.
The nurse who admitted the pt from ER was overwhelmed with 7 pts,
this admit made her 8th patient. She made an admit note, placed him in a
Posey.
Her next entry in the chart is 4 hrs later, the patient was dead.
Needless to say, they have now discontinued the use of Poseys at our facility,
and all staff is required to attend a 2-hr in-service on use of restraints. This is on
top of our already annual mandatory on restraints.
How awful is this?? I have heard the family is not going to pursue legal
action.
The nurse caring for the pt received no counseling or support from the
hospital. The hospital lawyer questioned her and wanted to know why she
removed the restraint when she found him dead.
NURSING GUIDELINES FOR SRD’S
ASSESS CLIENT NEED FOR DEVICE
– SECURE TO BED FRAME, NOT
BEDRAILS
 CHECK AGENCY POLICY
 EDUCATE CLIENT/FAMILY
 PLACE IN PROPER BODY ALIGNMENT
 ENSURE PROPER FIT

NURSING GUIDELINES FOR
SRD’S

ASSESS Q 30 MINUTES
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CORRECT APPLICATION
SKIN INTEGRITY
PRESENCE OF PULSES DISTAL TO RESTRAINT
COLOR, SENSATION, TEMPERATURE OF BODY PART
PROMOTE CLIENT COMFORT
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TOILETING
HYDRATION
REMOVE Q 2 HRS AND ASSESS SKIN, CIRCULATION,
AND DOCUMENT
DO NOT LEAVE UNATTENDED
SPECIFIC SAFETY CONSIDERATIONS
THROUGHOUT LIFESPAN
LEADING CAUSES OF DEATH
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NEONATE--PREMATURITY, LOW BIRTH WT.
INFANT--SIDS
TODDLER—AUTO ACCIDENTS
PRESCHOOL—AUTO ACCIDENTS
SCHOOL AGE—AUTO ACCIDENTS
ADOLESCENT—AUTO ACCIDENTS (SUICIDE BEGINS
HERE
ADULT—18-45 AUTO ACCIDENTS 60% RT ALCOHOL
ELDERLY—HEART DISEASE, ACCIDENTS, FALLS
ACCIDENTAL POISONING
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LONG LIST OF HOUSEHOLD POISONS
DEFINITION OF POISONING
ASSESSMENTOF TOXIC SUBSTANCE
ASSESS PATIENT
ALWAYS HAVE SYRUP OF IPECAC
NURSING INTERVENTIONS
TO PREVENT: TEACH TO LABEL AND
STORE CLEANING PRODUCTS, TOXIC
SUBSTANCES APPROPRIATELY.
SEIZURES

TYPES
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
GENERALIZED
PARTIAL
STATUS EPILEPTICUS
CAUSES
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SUDDEN WITHDRAWAL OF ANTICONVULSANTS
HYPOGLYCEMIA
TUMOR OF BRAIN
HEAD INJURY
HIGH FEVER
POISONING
SEIZURES
A generalized
tonic clonic seizure
(a) there is a cry and loss of
consciousness, arms flex up then extend
(b) and remain rigid (the tonic phase) for a
few seconds. A series of jerking
movements take place (the clonic phase)
as muscles contract and relax together.
(c) the jerking is slowing down and will
eventually stop.
(d) the man has been placed on his side to
aid breathing and to keep the airway clear.
SEIZURES

INTERVENTIONS
–
AIRWAY



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AIRWAY CLOSE TO BED AS PRECAUTION
PAD SIDERAILS AND HEADBOARD
SUCTION EQUIPMENT
PROTECT FROM INJURY

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IF STANDING, HELP TO FLOOR
MOVE OBSTACLES (FURNITURE, ETC)
PILLOWS AROUND HEAD
ALL SIDE RAILS UP IF IN BED
BED IN LOWEST POSTION
PROVIDE PRIVACY
SEIZURES
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TURN PATIENT TO SIDE
 RECOVERY POSITION WHEN SEIZURE OVER
NOTE START AND END TIME
POST ASSESSMENT
 STAY WITH PATIENT
 ASSESS PATIENT
STATUS EPILEPTICUS
 INSERT AIRWAY BETWEEN SEIZURES
 SUCTION
 OXYGEN
 IV
 NEVER RESTRAIN
FIRE SAFETY

FIRE REQUIREMENTS
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
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HEAT OR ENERGY
COMBUSTIVLE MATERIAL
OXYGEN
FOLLOW INSTITUTION’S FIRE PLAN
DAY-TO-DAY
FIRE EXTINGUISHERS
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TYPE A –PAPER, WOOD, CLOTH
TYPE B –FLAMMABLE LIQUID
TYPE C –ELECTRICAL
TYPE ABC –ANY FIRE
FIRE SAFETY:RACE

RESCUE
–

ALARM
–

SOUND ALARM
CONFINE
–

PATIENTS IN IMMEDIATE DANGER
CLOSE DOORS, WINDOWS, TURN OFF OXYGEN
EVACUATE
–
PTS AND SELF
DISASTER PLANNING


DEFINITION
TYPES
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–


INTERNAL
EXTERNAL
DISASTER MANUAL/PLAN
RESPONSES TO DISASTER
AFFECTED BY
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TIME OF DAY
DURATION
SEVERITY
READINESS OF FACILITY
DISASTER PLANNING

COMMON CODES
– RED—FIRE
– BLUE—
RESPIRATORY OR
CARDIAC ARREST
– BLACK—DISASTER
– GREY—TORNADO
– DR. STRONG—
SECURITY
NEEDED
Always be alert
for a new and
creative idea...
You never
know what’s in
your grasp
THE END
Questions
????