1. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 19 Safety

2. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins National Patient Safety Goals Description Purpose Potential methods for implementation

3. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Safety Major nursing responsibility Death from hospital errors: ranked between 5 th – 8 th leading cause of death by National Center for Health Statistics

4. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Age-Related Safety Factors Infants –Falling off changing tables –Unrestrained in automobiles Toddlers –Climbing; accidental poisoning; falling downstairs or from high chairs; burns; electrocution; drowning

5. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Age Related Safety Factors (cont’d) 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

6. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Environmental Hazards Latex sensitization Thermal burns Asphyxiation Electrical shock Poisoning Falls

7. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Poisoning is a common hazard found only in homes.

8. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. Poisoning is a common hazard found in the home and health care environment.

9. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Environmental Hazards (cont’d) Latex sensitization: allergic response to the latex proteins –Latex is natural rubber sap –Component of many household items –Predisposition to latex sensitivity

10. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Environmental Hazards (cont’d) Types of latex reactions –Contact dermatitis –Immediate hypersensitivity –Possible cross-reaction to fruits or vegetables

11. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Environmental Hazards (cont’d) 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? People with latex allergy may develop a cross-reaction to certain foods.

13. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True. People with latex allergy may develop a cross- reaction to certain fruits and vegetables.

14. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Environmental Hazards (cont’d) Safeguarding clients and personnel –Prevent latex sensitization –If using latex gloves, avoid oil-based hand creams –Wash hands thoroughly after removing gloves

15. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? When using latex gloves, a nurse should use oil-based hand creams.

16. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False. When using latex gloves a nurse should avoid the use of oil-based creams.

17. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Environmental Hazards (cont’d) Burns –Thermal burns or chemical burns –Burn prevention: exits identified, lighted, unlocked; ensure functioning sprinkler system –Fire plans

18. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Environmental Hazards (cont’d) Burns (cont’d) –Fire management: RACE o Rescue o Alarm o Contain o Extinguish

19. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Environmental Hazards (cont’d) Burns (cont’d) –Roles and responsibilities at and away from fire’s origin –Use of fire alarm system –Agency fire plan concepts

20. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Environmental Hazards (cont’d) Burns (cont’d) –Rescue and evacuation; proper use of equipment –Building compartmentalization for containing smoke and fire –Fire extinguishers

21. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Environmental Hazards (cont’d) Burns (cont’d) –Fire extinguishers Class A: wood, paper Class B: liquids, grease Class C: electrical Class ABC: combination

22. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Evacuation of Clients

23. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Environmental Hazards (cont’d) Asphyxiation –Airway obstruction –Carbon monoxide (CO) oCO binds with hemoglobin oCO poisoning: symptoms similar to flu, except for cherry-red skin color

24. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Environmental Hazards (cont’d) Drowning –Fluid occupies airway, interferes with ventilation –Accidental drownings –Resuscitation –Immediate CPR –CPR certification in nurses

25. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Environmental Hazards (cont’d) Electrical shock –Body prone to electric shock –Macroshock; microshock –Grounded equipment reduces electrical shock potential –Measures to prevent electrical shock

26. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Environmental Hazards (cont’d) Poisoning –Caused by ingestion, inhalation, or absorption of toxic substance –More common in homes than in health care institutions –Accidental poisonings; medication errors

27. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Environmental Hazards (cont’d) Poisoning prevention –Educate children; teach parents –Cognitive-impaired adults: use prefilled medication containers –American Association of Poison Control Centers

28. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Environmental Hazards (cont’d) 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

29. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Environmental Hazards (cont’d) Falls (cont’d) –Contributing factors (cont’d) oUrinary urgency oSocial, environmental factors oAccumulation of clutter oHospitalization oConfusion, impaired judgment

30. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Environmental Hazards (cont’d) Assessment –Determine risk factors –Fall prevention measures –Keep emergency numbers near phone –Daily phone tree –Personal response services

31. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Restraints Physical restraints Chemical restraints 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

32. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Restraints (cont’d) 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

33. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Restraints (cont’d) Legislation –Law incorporated; compliance mandatory since 1990 Accreditation standards –Restraint protocol; medical orders; monitoring and documentation

34. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Restraints (cont’d) Restraint alternatives: protective or adaptive devices that promote client safety and postural support which the client can release independently

35. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Implications Recognize safety hazards Identify clients at greatest risk for injury Identify several nursing diagnoses Client safety; allegations of malpractice

36. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins General Gerontologic Considerations Number of falls and severity of injury Falls rob client of independence Well-fitting enclosed shoes, nonskid soles Most falls occur in clients 65 years or older, at home

37. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins General Gerontologic Considerations (cont’d) Factors contributing to falls in older adults: health conditions; situations such as environmental hazards, inadequate lighting, general clutter, assistive devices Osteoporosis Fear of falling; history of falling Cognitive impairment