1. Unit 2 Chapter 10: Patient Safety and Restraint Alternatives
Nursing assistant III
Unit 2 Chapter 10: Patient Safety and Restraint Alternatives

2. Accidents and incidents
OBRA defines as an unexpected, unintended event that has the potential to cause bodily injury
Incident
An occurrence that is considered unusual, undesired, or out of the ordinary and disrupts the normal routine for the patient, the facility, or both
Accidents and incidents can involve patients, visitors, or staff
All accidents are considered incidents
Accidents and incidents

3. Accidents and incidents
OBRA requires that nursing facilities maintain an environment that lowers the risk of accidents and incidents to the GREATEST EXTENT POSSIBLE
OBRA requires that residents receive the supervision and assistance neded to prevent accidents and incidents from occurring
ALL staff are expected to take appropriate measures to protect all people in the facility
Accidents and incidents

4. Accidents and incidents
Risk Factors
Certain groups of people are more at risk than others to have an accident
Accidents and incidents

5. Accidents and incidents
Risk Factors
Age
Infants and young children
The elderly
Medication
Pain medication
Antianxilytics
Antidepressants
Blood pressure
Accidents and incidents

6. Accidents and incidents
Risk Factors
Paralysis
Paraplegia
Tetraplegia (quadriplegia)
Hemiplegia
Sensory Impairment
Vision
Hearing
Touch
Smell
Taste
Accidents and incidents

7. Accidents and incidents
Risk Factors
Limited Awareness of Surroundings
Confusion
Disorientation
comatose
Accidents and incidents

8. Accidents and incidents
Avoiding Accidents and Incidents
Preventing Falls
Most common type of accident in health care
Each new patient is evaluated
Accidents and incidents

9. Accidents and incidents
Avoiding Accidents and Incidents
Preventing Falls
Check Clothing
Use had rails
Walking aids
Glasses
No clutter
Beds low
Side rails
Call lights
Clean spills
Offer assistance
Accidents and incidents

10. Accidents and incidents
Avoiding Accidents and Incidents
Preventing Burns
Always check the water temperature of the bath with a thermometer
Temp should be between 105 degrees F (40.5C) and 115 F (46C)
Best to keep on low end of range
Teach patients who will be bathing themselves to check temperature
Use extreme care with heat applications
Warn people that food or beverage is hot
Follow guidelines for use of electrical appliances
Accidents and incidents

11. Accidents and incidents
Avoiding Accidents and Incidents
Entrapment
When a person becomes trapped in the side rail or between the side rail and the mattress
Can cause severe injury or even death
Cover open spaces for certain patients
Use pillows for support
Accidents and incidents

12. Accidents and incidents

13. Accidents and incidents
Avoiding Accidents and Incidents
Preventing accidental poisonings
Never store household clearers or other chemicals in containers meant for food or beverages
Keep household cleaners and chemicals in a locked cabinet
Make sure the contents of all containers are clearly marked on the outside
Provide help with reading labels as necessary
Accidents and incidents

14. Accidents and incidents
Reporting Accidents and Incidents
Should be reported to nurse immediately
Follow policy for written reporting
Does not make you “guilty”
Accidents and incidents

15. restraints Restraints can also be called “Reminder Devices”
Used to restrict a person’s freedom of movement
Prevent a person from reaching a part of their body
Might be used for an agitated or disoriented patient
A device is not considered a restraint if a person has the physical and mental ability to release the fastener
Lap safety strap in a wheelchair
restraints

16. restraints Physical Restraint Chemical Restraint
A device attached to or near a person’s body to limit freedom of movement, or access to his or her body
Can be applied to many different parts of the body
Chemical Restraint
Any medication that alters a person’s modd or behavior
Sedatives
tranquilizers
restraints

17. restraints Chemical Restraint
Any medication that alters a person’s modd or behavior
Sedatives
Tranquilizers
Fine line between using a medication to help calm and anxious or agitated person and using for staff convenience
Should not be used in such a high dose to make person sleepy or unable to function
restraints

18. restraints Use of Restraints
Never used for punishment or staff convenience
Used to provide postural support
Protect patient
Protect staff
Only use if ALL other alternatives have failed
restraints

19. restraints Use of Restraints When restraints may be needed:
A person who is at risk for falling but cannot remember to call for help
A person who is at risk for wandering away
A person who attempts to remove to pull out tubing necessary for treatment
A person who has overdosed on alcohol or medications, and is demonstrating combative behavior
restraints

20. restraints Use of Restraints
Clearly defined guidelines for restraint use
Do not use restraints without a written doctor’s order that states the reason for the restraint
Never use a restraint to “punish” a patient or resident, or for your own convenience
Use the least restrictive restraint for the least amount of time
Follow the manufacturer’s instructions, nurse’s direction, and facility policy for applying the restraints
restraints

21. restraints Use of Restraints
Clearly defined guidelines for restraint use
Use a restraint that is the correct size and in good condition
Use commercial restraints. Do not use makeshift restraints, such as bed sheets or locks
Restraints are always applied over clothing, pajamas, or gown
Restraints are always tied in simple, quick release knots placed out of reach of the patient
Ensure that you have enough help when applying restraints
restraints

22. restraints Use of Restraints
Clearly defined guidelines for restraint use
Check on the restrained person every 15 minutes to make sure feeling a blood flow are normal in any restrained extremity
Make sure wheelchair wheels are locked and the front swivel wheels are facing forward
Side rails should always be raised
Completely remove restraint every 2 hours, for a total of 10 minutes
Record and care given to a restrained person
Used restraints only if you have been properly trained
restraints

23. restraints Complications Associated with Restraint Use
Strangulation can occur if a vest restraint is improperly applied
Bruises, nerve damage, skin abrasions if restraint is too tight or too loose
Permanent tissue damage as a result of impaired blood flow
Broken bones
Pneumonia, pressure ulcers, blood clots
Incontinence
Mental effects
restraints

24. restraints Restraint Alternatives
Measures taken to avoid the use of restraints
Provide an environment in which the person feels safe and secure
Provide frequent attention to the person’s physical needs
Explain procedures and reassure the person
Get help from family members, volunteers, or other residents
Use methods that are less restrictive
Bed alarms
Wanderer system
Postural supports
pillows
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25. restraints Applying a Vest Restraint Applied to chest Opening in back
Never put on backwards
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26. restraints

27. restraints Applying Wrist or Ankle Restraints
Doctor may specify the number of extremities to be restrained
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28. restraints

29. restraints

30. restraints