Safety- Unit 5a Nursing Fundamentals F18


Hello and welcome to the unit 5 lecture on safety for nursing fundamentals. Our course competency is to maintain a safe and effective care environment for patients of all ages. These are your learning objectives on this slide and the next slide. I encourage you to look through them and understand them to prepare yourself for the exam. National patient safety goals are established by the Joint Commission for all hospitals and long-term care facilities and this is nationwide. They’re updated periodically and what they do is they are a means to decrease harm that may come to patients when they are admitted or seen in health care facilities the primary focus of the national patient safety goals is to prevent patient injury and promote patient safety in health care organizations. Each organization is expected to implement facility wide interventions to better meet the patient safety goals. So for example, the first goal which is improve accuracy of patient identification, the organization might require a photo ID in each patient’s chart in addition to armband identification. There’s more information in your Cravent text, so be sure to view this as well as a handout in a 360 that talks about national patient safety goals. Correct patient identification is crucial for any patient interaction. Even if you have asked for this information a million times on your shift, you must verify what the patient tells you against what is in the chart and armband for each patient encounter each time to make sure that it’s the right patient. Don’t rely on your memory alone- ask the patient’s name and birthday and compare it to the order in the medical record or check the chart or check the armband for the name and medical record number and compare that to the order of the medical record. Your clinical instructor will be watching closely for this identification step so make sure you don’t skip it. So what if your patient isn’t wearing an armband? Well many times this is the case in skilled nursing facilities. In this case we’d ask the patient for their name and date of birth and compare that with the medical record. Many dementia or Alzheimer’s units have a photograph of the patient in their chart as a means of identification just in case the patient can’t tell you their name or their date of birth, so this would be another option. Never assume the patient’s identity based on what room they’re in. Remember confused patients can wander and they might have wandered into the wrong room. Another part of patient safety is the practice of always always double-checking and order in the chart before we complete the procedure or give them medication. Sometimes orders get changed or deleted by the provider but the provider hasn’t communicated it directly with us, so we might not know unless we look in the chart. The patient goal of “the patient will remain free of Falls” can be used for almost all patients anywhere anytime. Also a fall risk assessment should be completed on all patients because they might be predisposed to falling based on their disease process or medications they take or any other number of factors. By completing a fall risk assessment, we as nurses, can plan our interventions to prevent Falls and make them more patient specific. So for example some patients might simply need reminders to call for help while others might need bed alarms or visual monitoring to prevent Falls. By doing a fall risk assessment we can put the right intervention with the right patient. There’s many factors including age, developmental stage, Mental Status, lifestyle such as impairments from drug use that put patients at risk for Falls and we need to be diligent in identifying all risks for Falls and implementing fall prevention strategies. Accurate identification of risk factors helps us to provide competent and non negligent care. So common fall risk tools are the Morse fall scale and the get-up-and-go test as well as the Hendrich II- the Morse fall scale assesses various fall risk variables including history of falling, any secondary diagnoses that were predisposed to Falls, any ambulatory aids, crutches or canes, if they have an IV in place how, they transfer or ambulate and their mental status. Patients are scored in each category and their fall risk is determined based on their score. Generally speaking 0 to 24 is a no-risk 25 to 50 is a low or medium risk for Falls and above 55 is a high risk. These numbers and labels might vary slightly by organization and which tool is used but as a general rule fall risk precautions of some sort should be implemented for the low or high fall risk categories. The get-up-and-go test is an observational tool for nurses to use to evaluate fall risk as well. Clients are observed for their ability to move from a sitting to standing position without using their arms to help them. They walk about ten feet they turn and then they return to the chair and sit back down again without using their arms for support. Inability to do this or if the patient’s unsteady just is an indicator that we need to do another more comprehensive or in-depth fall risk scale. The hendrich II fall risk model is another common fall risk scale and that also just evaluates different ways that a patient can how they can get up and how many medications they might have or a variety of things but there’s a video that I posted on a 360 that walks you through the different components as well as how to complete it for the Henrich II so this is something I would recommend watching and this fall scale is the one I’m most familiar with in my practice. And what I’ve noticed is it’s generally pretty accurate I mean. I haven’t actually used the Morse fall scale before. Alright so take a few minutes now that we’ve talked about fall risks and think about fall prevention. So take a minute, stop here and list some priority nursing interventions that you might use in your practice to prevent Falls. Now these next couple slides are just some possible nursing interventions for fall prevention. I’m not going to read them all you can stop and read them as you need to. Just know that failure to implement certain interventions such as keeping the bed in a low position- if you don’t do that this can be seen as negligence and make you as the nurse open to litigation if the patient falls and hurts themselves. Some of these interventions also can be recommended for patients going home to keep them safe in their home environment. So for example, walking in a dark room or in an area with throw rugs puts patients at significant risk for Falls so we would want to modify this. Some other things or encourage them to modify it as best we can. Some other things to keep in mind you know if a patient feels faint when they’re doing an activity you want to immediately stop that activity and help them to a safe position whether that’s sitting down or lying down so they don’t fall. Also patients who have been in bed for a while all are at actually a much greater risk of falling when they finally do stand up because they might have shifts in their blood volume and blood pressure that might lead to dizziness so you want to plan accordingly and go slow, maybe by sitting them on the edge of the bed for a while and see if they’re dizzy and then move to standing and then move to walking. So on to restraints- sometimes we have to restrain patients to keep them safe. Now this doesn’t mean we put them in restraints because that would make our life easier. That is never an appropriate use for restraints, but sometimes they need it to keep them safe. So restraint examples include physical restraints like soft restraints that go on your wrist, side rails, leathers, Posey vests, mitt restraints, and lap belts. There’s probably others that aren’t listed here. Also sometimes side rails are considered positioning devices rather than restraint so this really just depends on agency policy and why the side rails are being used. Chemical restraints are certain mind-altering medications used to sedate a patient. They’re not considered a restraint if they’re used to treat a medical condition, however. So an example would be benzodiazepine use for anxiety as a treatment for a medical condition versus benzodiazepine use for combativeness as a chemical restraint, and this distinction is pretty important when you’re actually giving these kinds of medications. Seclusion is a room free of stimulation with no movable objects and continuous visual monitoring by trained staff. The patient may or may not be in four-point restraints as well, and what that means is that both their arms and legs are restrained. So why do we use restraints? Restraints are used to prevent injury to the patients or other people but keep in mind they can also create a safety hazard, especially if they’re applied incorrectly. So for example restraints can be a strangulation hazard if we’re using a roll belt or a lap belt or a vest that’s not on correctly or an entrapment hazard if we’re using side rails incorrectly and the patient’s able to slip through the side rails- they might get stuck in there. And they should only be used after every other possible alternative has been tried and documented, and this is because the risks of serious complications when we use restraints. Renewal and initial ordering might vary depending on whether it’s a behavioral restraint or for a combative patient or just a general restraint to prevent Falls or to prevent the patient from removing life-sustaining lines. Generally speaking though the provider must order the restraint within 12 hours of application for a medical restraint and they must renew the order every 24 hours. There’s a lot of alternatives to restraints that we could try and several of these should be tried before putting the patients in restraints. They also must be documented so that there’s proof that we tried things before just jumping to restraints. Also in addition to these alternatives here that are listed you want to think about what’s causing the behavior are the medical medications making it worse? could meds make it better? Maybe the patient’s having uncontrolled anxiety or pain. You want to fix what you can before putting on the restraints. Sometimes restraints can make the behavior worse or could cause trauma to the patient. So for example I was caring for a woman one time that was having hallucinations that she was being raped every time we touched her and so think about what putting her in restraints would have done to her emotional state! We had to find a different way to work with this lady. And this slide walks you through the nursing process when a patient needs to be in restraints. So take a look through that from the assessment phase on through the evaluation phase and just be familiar with some of those things to think about when we’re gonna use restraints. So we talked a little bit about side rails before and just know that side rails are commonly used in healthcare organizations and if they’re used properly side rails really can increase a patient’s mobility and stability but if they’re used improperly they can cause more injury so it’s important to check agency policy and just know that side rails can be considered a restraint if they’re used to prevent the patient from getting out of bed, but they’re not typically considered a restraint if it’s to improve patient mobility or / the patient requests. And also we need to consider if there’s two or four side rails. So four side rails are seen as more restrictive while two side rails are seen as less restrictive and more for repositioning. OSHA regulates workplace safety. Failure to comply with OSHA guidelines can result in big financial penalties for organizations. Please review the handouts an e360 that talk a little bit more about OSHA, blood-borne pathogens and body mechanics. This kind of stuff is really important to understand to keep you safe in the work environment. You know a lot of times our focus is on the patient and keeping the patient safe but we really need to think about keeping ourselves safe as well. One way we can keep ourselves safe is by preventing blood-borne pathogen transmission. Healthcare workers suffer up to a million injuries from needles and sharps a year and these exposures can lead to hepatitis B C, and HIV. At least a thousand health care workers are estimated to contract serious infections annually from needle stick and sharp injury and nurses working at the bedside are at high risk, so we want to make sure we’re doing everything possible to prevent this exposure. So how can we prevent needle stick injuries? Well the main way is by not recapping needles and by putting them in the sharps container right away. Don’t leave them lying around- keep track of where they are. So if you’re starting an IV you need to know where that needle is while you’re trying to dress the IV and you need to get it put away as soon as you can. Dispose of blood-soaked items like blood-soaked bandages or bloody incontinence pads in red biohazard bags. This helps prevent accidental exposure to biohazardous materials.Flammable materials or chemotherapy contaminated items also have to be disposed in specific places and not the regular trash and this is just to protect everyone involved from the nurse on to the housekeeper. Using correct body mechanics protects you from injury. Healthcare workers are at an increased risk of back injury and this is because we do a lot of lifting and pulling and twisting and bending. This can be debilitating and really drain resources, both putting you out of work and a cost to the organization as well. Many organizations are recognizing this and they’re making mechanical lift equipment a priority in injury prevention. So look at your Craven text for more detailed body mechanics information and be familiar with that kind of stuff as well. So an incident report or variance report should be completed anytime there’s a breach in safety and we talked a little bit about incident reports with medication errors, and it’s kind of the same thing. So examples of times you would use an incident or variance reporting would be a med error and a patient fall among other things. Remember these reports don’t go in the patient chart but they’re for the organization to use. The Joint Commission defines Sentinel events as patient safety events that reach the patient and results in death, permanent harm, or an intervention is needed to sustain life. Health care organizations then look at these events to prevent future occurrences and they’re encouraged to report them to the Joint Commission. However they’re not required to report them. Employee injuries also should be reported so that employers can track problems and it’s a requirement for workers compensation. So even if it’s just a little injury reported you never know when that little cut could turn into a big infection so that document protects you as well. And finally we’ll talk a little bit about fire safety. So race stands for rescue, alarm, contain, and evacuate or extinguish. This is important to understand and you need to know what to do if you come upon a fire in a health care organization or anywhere for that matter. Rescue anyone in immediate danger first. This includes you- it’s not expected that you sacrifice yourself for your patient. Then pull the alarm. Next contain the fire by closing the doors and windows. We want to evacuate the patients behind fire doors. Don’t use the elevators- you could get trapped-and you can also extinguish the fire if it’s small such as in a garbage can. Now this concludes the unit 5 presentation on safety. Thanks for watching and be sure to watch the other videos on wounds and infection. Thanks have a great day!

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