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Chapter 38: Client Safety Bonnie M. Wivell, MS, RN, CNS.

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Presentation on theme: "Chapter 38: Client Safety Bonnie M. Wivell, MS, RN, CNS."— Presentation transcript:

1 Chapter 38: Client Safety Bonnie M. Wivell, MS, RN, CNS

2 JCAHO 2010 National Patient Safety Goals  Identify patients correctly – 2 identifiers  Improve staff communication – read back, not using certain abbreviations, SBAR  Uses medicines safely – label, look alike/sound alike, blood thinners  Prevent infection – hand hygiene, NO HAIs  Reconcile medications across the continuum of care  ID patient safety risks – suicide  Prevent falls  Help patients to be involved in their care  Watch patients closely for changes in their health and respond quickly if they need help – Rapid response teams  Prevent errors in surgery

3 Environmental Safety  A safe environment includes meeting basic needs, reducing physical hazards, reducing the transmission of pathogens, maintaining sanitation, and controlling pollution.  A safe environment also includes one where the threat of attack from biological, chemical, or nuclear weapons is prevented or minimized.

4 Environmental Safety  Basic Needs  Oxygen  CO2 poisoning  Nutrition  Keeping perishable foods fresh  Temperature and Humidity  Extreme cold and heat

5 Physical Hazards  Fractures are the most serious health consequence of falls  Almost 90% of all fractures among older adults are due to falls  Lighting  Obstacles  Bathroom Hazards – burns, poisoning, falls  Security – fire safety, lead poisoning, contaminated soil and water

6 Transmission of Pathogens  Pathogen = any microorganism capable of producing an illness  Hand hygiene most effective method of limiting transmission  Immunization = resistance to an infectious disease is produced or augmented

7 Environment Safety Cont’d.  Pollution  Air  Land  Water  Noise  Terrorism  Bioterrorism

8 Risks at Developmental Stages  Infant, Toddler, Preschool: Injuries are the leading cause of death in children over age 1  School aged child: Sports injuries  Adolescent: Risk taking behaviors  Adult: Lifestyle habits  Older Adult: Physiological changes result in increased risk for falls, burns, MVAs

9 Individual Risk Factors  Lifestyle  Impaired Mobility  Sensory or communication Impairment  Lack of Safety Awareness 9

10 Risks in the Health Care Agency  3 Types of medical errors accounted for almost 60% of the client safety incidents  Post-op infections  Bed sores  Failure to diagnose and treat in time  Medication errors  Falls  Patient-Inherent Accidents: self-inflicted  Procedure-related Accidents: occur during therapy  Equipment-related Accidents: malfunction, disrepair, or misuse

11 Safety and the Nursing Process  Assess  Activity and exercise  Medications  History of falls  Home maintenance and safety

12 Nursing Diagnosis  Risk for injury  Related to:  General weakness  Right or Left sided weakness  Side effects of medication  Poor eyesight  As evidenced by:  Recent falls  New CVA  Confusion  Macular degeneration

13 Implementation  Nursing Diagnosis  Risk for injury related to (r/t) generalized weakness as evidenced by recent falls  Goal  Pt. will ask for help to the bathroom  Pt. will remain free from injury during hospitalization  Interventions  Nurse will ensure call light is in reach  Nurse will work with other care providers to make sure patient is seen every hour  Nurse will work with other care providers to ensure pt. receives required assistance with ADLs/activities

14 Use of Restraints in the Health Care Setting  Physical or chemical means of stopping a patient from being free to move.  4 bedrails up is considered a restraint  Used only in emergency situations to ensure the patient’s safety.  Restraint orders must be specific and time-limited.

15 Other Mechanisms to Prevent Falls  Tab Alarms  Arm Bands  ID outside of Patient room  Notice Inside the Patient room  Colors of gowns, slippers, blankets  Bed Alarms  Chair Alarms

16 Restraint Use  Must have a physician order  Order must be rewritten every 24h.  Restraint policies are specific to health care setting  Nursing documentation must occur at least every two hours

17 Complications from Restraints  Skin breakdown  Constipation  Pneumonia  Incontinence  Urinary retention  Nerve damage  Circulatory damage

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24 Other Safety Issues  Fires  Poisoning  Electrical Hazards  Seizure precautions  Radiation safety  Bioterrorist attack  Bomb threats

25 Chapter 39: Hygiene

26 Patient Hygiene  Oral Care  Bathing  Shaving  Hair care  Perineal care  Foot care  Bed making  Occupied/unoccupied

27 Goal  What is the goal of hygiene in the health care setting? a)Moving the patient to a higher level of health b)Check the box on the nursing documentation sheet c)Prevent Infection d)All of the above

28 Self-Assessment  Have you ever bathed another adult person?  Someone not in your family?

29 Why is Hygiene Important?  Personal hygiene affects a patient’s comfort, safety, and sense of well-being.  A variety of personal, social, and cultural factors influence hygiene practices.

30 Factors Influencing Hygiene  Physical Condition  Ability to care for self  Energy level  Sensory deficits  Incontinence of urine and/or stool  Dexterity and ROM  Sedation, Pain level  Chronic illnesses  Psychiatric conditions

31 Factors Cont’d.  Social practices  Personal preferences  Body image  Socioeconomic status  Health beliefs and motivation  Cultural variables

32 Assessment  Skin: wounds, infection  Feet and Nails: PVD, diabetic patient with foot issues, foot fungus around toe nails  Patients with poor circulation to the feet and lower legs needs close assessment of those areas  Oral Cavity: condition of the mouth and teeth  Hair: tangles, lice  Eyes, Ears, and Nose: Does the patient have any sensory deficits?

33 Critical Evaluation  What is the ability of the person to care for themselves?  Physical disabilities  Mental disabilities 33

34 Specific Issues Needing to be Addressed at Bath Time  Foot care  Normal vs Diabetic  Do not soak feet of patients with DM and/or vascular insufficiency  Sensitive skin  Infestations  Infections  Incontinence

35 Types of Baths  Complete bed bath  Partial bed bath  Sponge at the sink  Tub bath  Shower  Bath in a bag

36 Critical Evaluation  Are there any cultural issues that need to be addressed prior to bathing?  What is your patient’s developmental status?  Teen, Young adult, Adult, Older Adult, Elderly  How does that affect their hygiene needs and attitudes?  What do you do with this information about the patient?  Care Plan

37 Critical Evaluation  Involve patient as much as possible in bathing decisions  When  Where  Type  Tub  Shower  Bed bath

38 Nursing Diagnosis  BATHING/HYGIENE SELF-CARE DEFICIT: R/T CONFUSION: AEB POOR PERSONAL HYGIENE  BATHING/HYGIENE SELF-CARE DEFICIT: R/T DECREASED CEREBRAL CIRCULATION (RECENT CVA) AEB RIGHT SIDED WEAKNESS

39 Oral Care  Oral care is an essential nursing intervention  Assess for decreased saliva, infection, coated tongue, cracked lips  Brush all tooth surfaces using a soft bristle brush  Observe for complications such as bleeding gums  Oral care for the patient who is not conscious  Oral care for the patient with partial paralysis of the mouth  Oral care for the patient who has had mouth surgery or injury

40 Other  Hair Care: Gather supplies (plastic trough, towels, shampoo, drainage wash basin)  Shaving: Check doctor’s orders  Anticoagulants  Perineal Care (see page 877)  Independent  Needs assist  Dependent  Foot Care (see page 880)  Do not soak feet of patients with DM and/or vascular insufficiency

41 Care of Patient with Sensory Aids  Glasses/Contacts (pg. 894)  Dentures (pg. 891)  Hearing Aids (pg. 895)  Prosthetic Eyes

42 Basic Principles  Remember body mechanics  Raise the bed to a comfortable height  Follow medical asepsis when making a bed  Wear gloves if linen is soiled  Keep linen away from uniform  Do not place soiled linen on the floor

43 Bed Making – Occupied/Unoccupied  Linen  Use appropriate linen for the patient  Chucks and linen savers  Draw sheets  Therapy beds  Learn to place a bottom flat sheet when there are no fitted sheets


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