Safety

Raed Ali Jaradat Lecturer Mutah University

Ra'ed Ali Jarada

Factors Affecting Ability to Protect Self from Injury

Age and development: fetus, children, elderly Lifestyle: unsafe work environment, access to gun, access to drugs Mobility and health status: paralysis, muscle weakness, poor balance, hemiplegia, Sensory-perceptual alterations: impaired touch, hearing, taste, smell & vision

Ra'ed Ali Jaradat

Factors Affecting Ability to Protect Self from Injury

Cognitive awareness: ability to perceive environmental
stimuli, ( people who are unconscious or semiconscious, disoriented) or altered bcz of disease or medication

Emotional state: stressful situation can alter concentration, error of judgment Ability to communicate: aphasic pt & unable to read
(cannot read sign of no smoking, O2 in use) Safety awareness: lack of awareness about equipment as O2 tank, IV tube, hot packs, fire precaution

Environmental factors: machinery, industrial belts, noise & air pollution, unsafe work environment for nurses
Ra'ed Ali Jaradat

Assessing Clients at Risk for Injury

Nursing history and physical examination Risk assessment tools Assessment of clients home environment

Ra'ed Ali Jaradat

National Patient Safety Goals (NPSGs)

1. Improve the accuracy of patient identification. 2. Improve the effectiveness of communication among caregivers. 3. Improve the safety of using medications. 4. Reduce the risk of health careassociated infections. 5. Accurately and completely reconcile medications across the continuum of care. 6. Reduce the risk of patient harm resulting from falls.
Ra'ed Ali Jaradat

National Patient Safety Goals (NPSGs)

7. Reduce the risk of influenza and pneumococcal disease in institutionalized older adults. 8. Reduce the risk of surgical fires. 9. Implement applicable National Patient Safety Goals and associated requirements by components and practitioner sites. 10. Encourage the active involvement of patients and their families in the patients care as a patient safety strategy. 11. Prevent health careassociated pressure ulcers (decubitus ulcers).
Ra'ed Ali Jaradat

National Patient Safety Goals (NPSGs)

Ra'ed Ali Jaradat

Common Potential Hazards: Developing Fetus

Exposure to maternal smoking, alcohol consumption, addictive drugs X-rays (first trimester) Certain pesticides

Ra'ed Ali Jaradat

Common Potential Hazards: Newborns and Infants

Falling Suffocation in cribs Choking from aspirated milk or ingested objects Burns from hot water or other spilled hot liquids Motor vehicle crashes Cribs or playpen injuries Electric shock Poisoning
Ra'ed Ali Jaradat

Common Potential Hazards: Toddlers

Physical trauma from falling, banging into objects, or getting cut by sharp objects Motor vehicle crashes Burns Poisoning Drowning Electric shock
Ra'ed Ali Jaradat

Lead Poisoning Animation

Click here to view an animation on lead poisoning.

Back to Directory
Ra'ed Ali Jaradat

Common Potential Hazards: Preschoolers

Injury from traffic, playground equipment, and other objects Choking, suffocation, and obstruction of airway or ear canal by foreign objects; poisoning Drowning Fire and burns Harm from other people or animals
Ra'ed Ali Jaradat

Common Potential Hazards: Adolescents

Motor vehicle or bicycle crashes Recreational injuries Firearms Substance abuse

Ra'ed Ali Jaradat

Common Potential Hazards: Older Adults

Falling Burns Motor vehicle crashes and pedestrian injuries

Ra'ed Ali Jaradat

Nursing Diagnoses for Clients at Risk for Injury

Risk for Injury
Risk for Poisoning Risk for Suffocation Risk for Trauma Latex Allergy Response Risk for Aspiration Risk for Disuse Syndrome

Deficient Knowledge (Injury Prevention)

Ra'ed Ali Jaradat

Desired Outcomes for Clients with Safety Risks

Prevent injury Often need to change health behavior Modify their environment Desired outcomes depend on individual client

Ra'ed Ali Jaradat

Nursing Interventions for Clients at Risk for Injury

Helping the client and family accomplish the following:
Identify environmental hazards in home and community Demonstrate safety practices appropriate to the home health care agency, community, and workplace Experience a decrease in the frequency or severity of injury Demonstrate safe childrearing practices or lifestyle practices
Ra'ed Ali Jaradat

Preventing Thermal Injuries

Pot handles should not protrude over edge of stove Electrical appliances should be out of reach of crawling infants and young children Bath water should not be excessively hot Monitor clients with impaired skin sensitivity Use care when using therapeutic applications of heat

Ra'ed Ali Jaradat

Preventing Agency Fires

Be aware of fire safety regulations and fire prevention practices of the agency If fire occurs:
Protect and evacuate clients who are in immediate danger Report the fire Contain the fire Extinguish the fire
Ra'ed Ali Jaradat

Preventing Home Fires

Teach fire safety Keep emergency numbers near the telephone, or stored for speed dialing Be sure smoke alarms are operable and appropriately located Teach to change batteries in smoke alarms annually on a special day Have a family fire drill Keep fire extinguishers available and in working order
Ra'ed Ali Jaradat

Preventing Home Fires

If fire occurs:
Close windows and doors, if possible Cover mouth and nose with damp cloth Avoid heavy smoke by assuming bent position with head close to floor as possible

Ra'ed Ali Jaradat

Preventing Poisoning
Teaching parents to childproof the environment Providing information and counseling about insect, snake bites and drugs used for recreational purposes Safeguarding the environment and monitoring the underlying problems to prevent accidental ingestion of toxic substances Teaching the telephone number of poison control centers Educating the public about what to do in the event of poisoning
Ra'ed Ali Jaradat

Preventing Choking and Suffocation

Teach universal distress signal Teach Heimlich maneuver

Ra'ed Ali Jaradat

Minimizing Excessive Noise

Minimize noise in the hospital setting Encourage clients to protect hearing as much as possible Noise can be minimized in several ways:
Acoustic tile on ceilings, walls, and floors Drapes and carpeting absorb

Background music

Ra'ed Ali Jaradat

Reducing Electrical Hazards

Properly grounded electrical equipment Using machines in good repair Wearing shoes with rubber shoes Standing on a nonconductive floor

Using nonconductive gloves

Ra'ed Ali Jaradat

Firearm Safety
Store all guns in sturdy locked cabinets without glass Make sure the keys are inaccessible to children Store the bullets in a different location Tell children never to touch a gun or stay in a friends house where a gun is accessible Teach children never to point the barrel of a gun at anyone Ensure the firearm in unloaded and the action open when handing to someone else
Ra'ed Ali Jaradat

Firearm Safety
Dont handle firearms while affected by alcohol or drugs of any kind, including pharmaceuticals When cleaning or dry firing a firearm, remove all ammunition to another room Double-check the firearm when entering the room used to clean the firearm Have firearms that are regularly used inspected by a qualified gunsmith at least every 2 years

Ra'ed Ali Jaradat

Protecting Against Radiation

Limit time near source Provide as much distance as possible from source Use shielding devices Be familiar with agency protocols

Ra'ed Ali Jaradat

Planning for Bioterrorism

Important health care personnel and facilities plan and prepare for the unknown Healthcare organizations expected to address four specific phases of disaster planning
Mitigation Preparedness Response Recovery

Should participate annually in at least one community-wide practice drill

Ra'ed Ali Jaradat

Measures to Prevent Falls

Orient clients to surroundings and explain the call system Carefully assess the clients ability to ambulate and transfer Provide walking aids and assistance as required Closely supervise the clients at risk for falls, especially at night
Ra'ed Ali Jaradat

Measures to Prevent Falls

Encourage the client to use the call bell to request assistance and ensure that the bell is within easy reach Place bedside tables and overbed tables near the bed or chair so that clients do not overreach Always keep hospital beds in the low position and wheels locked when not providing care so that clients can move in or out of bed easily

Ra'ed Ali Jaradat

Measures to Prevent Falls

Encourage clients to use grab bars mounted in toilet and bathing areas and railings along corridors Make sure nonskid bath mats are available in tubs and showers Encourage the clients to wear nonskid footwear

Ra'ed Ali Jaradat

Measures to Prevent Falls

Keep the environment tidy, especially keeping light cords from underfoot and furniture out of the way Use individualized interventions, e.g. electronic devices, rather than side rails for confused client

Ra'ed Ali Jaradat

Potential Environmental Causes of Falls

Inadequate lighting Presence of electrical cords, loose rugs, clutter and slippery floors Absent or unsteady railings Uneven step height or surfaces Unsteady base on furniture Lack of armrests on chairs Cabinets that are too high or too low Inappropriate toilet height Slippery floors in the bathroom Absence of grab bars

Ra'ed Ali Jaradat

Seizure Precautions
Pad the bed by securing blankets, linens around the head, foot, and side rails of the bed Put oral suction equipment in place and test to ensure that it is functional Children who have frequent seizures should wear helmets for protection.

Ra'ed Ali Jaradat

Seizure Precautions
In the home, safety precautions if seizures are not well-controlled include restriction or direct supervision by others for certain activities:
Tub bathing Swimming Cooking Using electrical equipment or machinery Driving
Ra'ed Ali Jaradat

Alternatives to Restraints
Assign nurses in pairs Place unstable clients in an area that is constantly or closely supervised Prepare clients before a move to limit relocation shock Stay with a client using a bedside commode or bathroom if confused, sedated or has a gait disturbance or a high risk score for falling
Ra'ed Ali Jaradat

Alternatives to Restraints
Monitor all the clients medication and if possible lower or eliminate dosages of sedatives or psychotropics Position beds in lowest position Replace full-length side rails with half- or three-quarter length rails

Ra'ed Ali Jaradat

Alternatives to Restraints
Use rocking chairs to help confused clients expend some energy Wedge pillows or pads against the sides of wheelchairs Place a removable lap tray on a wheelchair

Ra'ed Ali Jaradat

Alternatives to Restraints
Try a warm beverage, soft lights, a back rub or a walk Use environmental restraints Place a picture or other personal item on the door to the clients room Try to determine the causes of the clients sundowner syndrome Establish ongoing assessment

Ra'ed Ali Jaradat

Use and Legal Implications of Restraints

Restraints restrict the individuals freedom U.S. Centers for Medicare and Medicaid Services standards
Behavior management standard Acute medical and surgical care standard

Ra'ed Ali Jaradat

Behavior Management Standard

Nurse may apply restraints but the physician or other licensed independent practitioner must see the client within 1 hour for evaluation Written restraint order for an adult, following evaluation, valid for only 4 hours. Must be continual visual and audio monitoring if client restrained and secluded
Ra'ed Ali Jaradat

Medical Surgical Care Standard

Up to 12 hours for obtaining the physicians written order Orders renewed daily Order must state the reason and time period PRN order prohibited In all cases, restraints used only after every possible means of ensuring safety unsuccessful and documented Nurses must document need for the restraint made clear both to client and family
Ra'ed Ali Jaradat

Use and Legal Implications of Restraints

Ra'ed Ali Jaradat

Use and Legal Implications of Restraints

Ra'ed Ali Jaradat

Desired Outcomes for Injury Prevention

Nurses role largely educative Desired outcomes reflect:
Acquisition of knowledge of hazards Behaviors that incorporate safety practices Skills to perform in the event of certain emergencies

Ra'ed Ali Jaradat

Examples of Desired Outcomes

Describe methods to prevent specific hazards Report use of home safety measures Alter home physical environment to reduce risk of injury

Ra'ed Ali Jaradat

Examples of Desired Outcomes

Describe emergency procedures for poisoning and fire Describe age-specific risks or work safety risks or community safety risks Demonstrate correct use of child safety seats Demonstrate correct administration of cardiopulmonary resuscitation
Ra'ed Ali Jaradat