SAFETY, SECURITY AND PRIVACY iv.

Inefficient nurse work processes – eg: documentation

Factors Affecting Safety: (explain how each factor affects safety
/ how patient may be prone to injury or accidents or give Ex.)
1. Age and Developmental considerations
2. Lifestyle
and paperwork consume large amounts of time.
v. Physical design of the workplace – eg: poor design of
communication technologies
*Bioterrorism – intentional attack using weapons of viruses,
bacteria and other germs.

3. Mobility A. ASSESSMENT
– nurse focuses on three categories:
4. Sensory Perception  The individual (nursing history and physical
- Visual impairment examination)
- Hearing deficit  The environment
- Reduced odor  Specific risk factors
- Loss of taste
1. Assessing the Individual
- Impaired tactile sense a. Nursing history
- Accident and injury history
5. Cognitive Awareness/ Knowledge
- Safety history: awareness of hazards, knowledge of
- Awareness safety precautions, perceived threats to safety
b. Physical examination
6. Emotional state and Psychosocial Health State
- Age and developmental level
- General health status
7. Ability to Communicate
- Mobility status
- Factors that can affect personal communication:
o Fatigue - Presence or absence of physiologic or perceptual
o Stress deficits such as olfactory, tactile, taste, visual, or
o Medication other sensory impairment.
o Aphasia - Altered thought processes or impaired cognitive
o Language barriers and emotional capabilities
- Substance abuse
8. Physical Health State - Any indications of abuse or neglect
2. Assessing the Environment – environmental safety hazards
9. Safety Awareness can result in falls, fires, poisoning, suffocation, and accidents
involving motor vehicles, equipment and procedures.
10. Environmental Factors
a. Home 3. Performing a Specific Risk Factor Assessment
b. Workplace a. Falls
c. Community - Age older than 65 years old
d. Health care setting - Documented history of falls
- Impaired vision or sense of balance
Factors that increase the risk of human errors; - Altered gait or posture
i. Limited short-term memory - A medication regimen that includes diuretics,
ii. Being late or in a hurry tranquilizers, sedatives, hypnotics, or analgesics
iii. Limited ability to multitask - Postural hypotension
iv. Interruptions
- Slowed reaction time
v. Stress
vi. Fatigue and other physiological factors - Confusion or disorientation
vii. Environmental factors - Impaired mobility
- Weakness and physical frailty
Nurses’ usual work environment that affect a client’s safety: - Unfamiliar environment
i. Inconsistent staffing levels
ii. Long work hours
iii. Some nursing work processes
 Nursing Responsibilities:
- Identify patients at risk for falls
- Document pertinent assessment on the chart
- Plan appropriate interventions to ensure safety
b. Fires – often occurs when people are asleep
- Other causes: faulty wiring, unsafe electrical equipment
Nursing Responsibilities:
- Assess knowledge of the family members
- Awareness on agency’s policies
- Review equipment and its proper functioning
- Assess when and how often fire drills are performed
c. Poisoning – consider developmental levels
“Poison control centers” – provide checklists for
“poison-proofing” a home and provide lists of toxic
household items.
- Helpful when assessing and teaching a family about
poisonous materials.
d. Suffocation and Choking
Suffocation – also known as asphyxiation
- Air does not reach the lungs and breathing stops.
Causes: drowning, choking on a foreign substance
inhaled into the trachea, gas or smoke poisoning
Drowning – is a form of suffocation
Nursing/ Public Responsibilities:
- Education on the causes of suffocation
- Assessing knowledge of individuals and families.
- Review of Home Security Checklist
e. Firearm Injuries – unintentional gunshot wounds – leading
cause of M&M in children.
Nursing Responsibility:
- Approach sensitive issues in gun ownership in a
nonjudgmental manner with focus on injury prevention.
- Inform families about the risks of firearm injury.
- Discuss appropriate safety measures.
B. DIAGNOSES
1. Risk for Injury.
2. Risk for Poisoning
3. Risk for Suffocation
4. Latex Allergy Response
5. Risk for Latex Allergy Response
6. Contamination: Exposure to environmental
contaminants in doses sufficient to cause adverse health
effects.
7. Risk for Contamination
8. Risk for Aspiration
9. Risk for Disuse Syndrome
10. Risk for Trauma
11. Impaired Home Maintenance
12. Deficient Knowledge (Accident Prevention)
C. PLANNING
Expected Outcomes to Prevent Injury:
 Identify unsafe situations in his or her environment.
 Identify potential hazards in his or her environment.
 Demonstrate safe measures to prevent falls and other
accidents.
 Establish safety priorities with family members or
significant others.
 Demonstrate familiarity with his or her environment.
 Identify resources for safety information.
 Remain free of injury during hospitalization
D. IMPLEMENTION
1. Acquiring safety knowledge
 First aid – is the immediate care given to an acutely
injured or ill person.
- Temporary assistance that is rendered until
competent professional care, if required, arrives
and takes over.
 Emergency Action Steps:
Assess-Alert-Attend
a. Assess the Scene for Safety
- Is it safe to approach the victims?
- Use of all senses and look for danger
- If scene is safe, approach victims and Assess
victim for responsiveness.
Assess the Victim
- Look for additional bystanders for help as
you approach.
- Gently tap victim and ask “Are you alright?”
b. Alert – if victim is unresponsive or has an
altered level of consciousness, EMS must be
notified
- Alone – look for a phone, notify EMS and
attend to the victim
- With bystander – ask bystander to notify
EMS while you attend to the victim
- Victim is child – provide one minute care
first, then call EMS.
c. Attend – attend to victim and provide
necessary care until EMS arrives and take over
care.
 Common Agents in Childhood Poisoning
Poisonous Source Common Clinical Manifestations Treatment
Agent
Salicylates Products Nausea, hyperpnea, dehydration, If clear history of intake is available and
containing aspirin vomiting, confusion, fever, tinnitus, intake is 150-300mg/kg, use activated
metabolic acidosis, respiratory alkalosis, charcoal. Intake >300mg/kg, take child
seizures, coma to the ER.

Hydrocarbons Gasoline Gagging, coughing, choking, dyspnea, Never induce vomiting.

Kerosene grunting, nausea, chills, fever, lethargy Contact physician.
Furniture polish
Lamp oil

Caustics Oven cleaner Burning pain in mouth and throat, Never induce vomiting!
Drain openers drooling, edema of lips; oral, esophageal, Never attempt to neutralize the caustic.
Toilet bowl gastric burns; vomiting, hemoptysis Dilute with milk or water.
cleaners Contact physician.
Battery contents
Rust removers
Hair perms

Iron Vitamin
preparation Nausea, vomiting, diarrhea, abdominal If clear history of intake is available and
pain, melena, hematemesis, lethargy, exposure is 20-40mg/kg use activated
coma charcoal. Intake >40mg/kg, take child to
the ER.
Lead Paint chips May be asymptomatic, anorexia,
Paint dust abdominal pain, anemia, encephalopathy, Chelation therapy and monitor lead levels.
neuro-behavioral deficits
ii. Instruct the patient to stand.
Can he stand in one fluid
2. Teaching to Prevent Accidents motion, or does he need the use
3. Orienting the Person to Surroundings of his hands to push up into a
- A person who is familiar to his surroundings is less standing position? Does he
likely to suffer an accidental injury. require multiple attempts to
- Orientation of patient to the safety features and stand?
equipment in the room – part of hospital admission iii. Once the patient is standing, as
routine. him to keep his eyes open and
stand as still as possible. The ask
him to close eyes. Observe for
4. Preventing Falls
stability.
a. In the Home iv. Ask him to open his eyes and
- Measures: installing hand
walk 10 feet (3meters). Once at
rails in the bathroom and that point, patient should turn
stairs, ensuring good lighting,
around and walk back to the
discarding or repairing broken
chair.
equipment around the home.
b. In the Healthcare Facility
Tests to check patient’s risk for falling:
i. Have the patient sit in a straight- Nursing Interventions to Prevent fall in a
backed chair. Observe posture Healthcare Facility:
while seated. i. Complete a risk assessment.
 ii. Indicate risk of falling on
patient’s door and chart.
iii. Keep bed in low position.
iv. Keep wheels on bed and
wheelchairs locked.
v. Leave call bell within patient’s
reach
vi. Instruct patient regarding the use
of call bell
vii. Answer call bells promptly
viii. Leave a night light on
ix. Eliminate all physical hazards in
the room
x. Provide nonskid footwear
xi. Leave water, tissues, bedpan,
urinal within patient’s reach
xii. Document and report any
changes in patient’s cognitive
status to help physician and other
nurses at the change of shift.
xiii. Use alternative strategies when
necessary instead of restraints.
xiv. As a last report, use the least
restrictive restraint according to
agency policy.
xv. If restraint is applied, assess
patient at the required intervals.
5. Using Restraints in Healthcare Facilities
*Restraints – are physical devices used to limit
a patient’s movement.
Physiological hazards associated with the use
of restraint include the following:
- Danger of suffocation from
entrapment in side rails or an
improperly applied vest.
- Impaired circulation
- Altered skin integrity
- Pressure ulcers and contractions
- Diminished muscle and bone mass
- Fractures
- Altered nutrition and hydration
- Aspiration and breathing difficulties
- Incontinence
- Changes in mental status
a. Using Side Rails as Restraints
Nurse’s Responsibility: Review benefits and
risks associated with their use and
periodically evaluate the reason for their use.
b. Using Alternatives to Restraints
- Careful nursing assessment is the key
to identifying appropriate alternatives
to restraint use and finding individual
solution.
c. Using Restraint as last Resort
The following protocols are recommended
when restraints are applied as last resort: (by
DiBartolo and Napierkowski)
i. The patient’s current condition, not
his past history, must determine the
need for the restraints. The must
never be applied for the convenience
of the staff.
ii. Evaluate the potential for injury.
Determine whether the patient is at
increased risk for harming self or
others.
iii. The patient’s family must be
consulted and involved in the plan of
care before applying restraints.
iv. Try using alternative measures first,
and determine whether the
alternatives are successful.
v. Alert the physician if restraints are
needed. Order of restraint should
include the type, justification and
criteria for removal. It must not be
order for p.r.n use
vi. In an emergency, the physical restraint
can be applied, but a physician’s order
must be obtained within 1 hour.
Order states intended duration of use.
vii. The patient must be monitored and
assessed on a regular basis.
viii. Documentation must reflect the date
and time restraint is applied, type of
restraint, alternatives that were
attempted with their results, and
notification of the patient’s family
and physician.
6. Preventing Fires and Maintaining Fire Safety
Most common sources of hospital fires:
- Careless smoking
- Faulty electrical equipment
- Combustion of anesthetic agents
RACE as Guide:
R – Rescue anyone in immediate danger
A – Activate the fire code and notify the
appropriate person
C – Confine the fire by closing doors and
windows
E – Evacuate patients and other people to a
safe area.
 7. Preventing Poisoing
Nursing Interventions:
- Health education aimed at preventing
accidental poisoning in the home.
- Activated charcoal – considered as the
most effective agent for preventing
absorption of the ingested toxin.
- Healthcare providers should recommend
that a carbon monoxide detector be
installed to alert family members to toxic
levels of gas.
- Correctly identify real and potential
unsafe environmental situations
- Implement safety measures in the
environment
- Use available resources to obtain safety
information
- Incorporate accident prevention practices
into activities of daily living
- Remain free from injury

8. Preventing Suffocation
- Begins with the removal of any
obstruction and administration of
cardiopulmonary resuscitation
- Emphasize careful supervision of children
and should outline specific situations that
place children at risk for suffocation.

9. Preventing Injury from Firearms

- Nurses – raise awareness and to help
reduce high-risk behaviors that may lead
to firearm injuries and death.
- School, home, and other healthcare
facilities

10. Preventing Equipment-Related Accidents

- Healthcare practitioners must learn how
to use the equipment properly and must
recognize signs of malfunctioning
equipment.

11. Preventing Procedure-Related Accidents

- Errors are possible with the administration
of medications or IV solutions,
transferring a patient, changing a dressing,
applying external heat to a patient’s
extremity, etc.

12. Filling an Incident Report

- An accident in a healthcare agency requires
filling out of an incident report.
- Incident report – confidential document
that objectively describes the
circumstances of the accident. It reports
details on patient’s response and the
examination and treatment of the patient
after the incident.

E. EVALUATION
The patient should be able to accomplish the
following;