NSE 111Safety in the

Health Care Setting

 Week 11 Objectives:
Safety in the Health Care Setting:

1. Discuss how organizations can build a “culture of safety”

2. Understand the role of the nurse in reporting patient safety incidence.
3. Identify the three categories of risks to patient safety within the health care environment.
4. Discuss the specific risks to safety related to individuals (late teens, adults, older adults).
5. Identify methods used to assess and maintain a safe environment for clients.
6. Define the acronym WHMIS, discuss the purpose, describe the three main elements and recognize the
symbols of WHMIS.
Restraints:
7. Discuss the legal, ethical, nursing and medical issues involved in the use of restraints:
8. Describe the least-restraint approach.
9. Identify alternatives to restraints.
10. Describe and give examples of physical, environmental and chemical restraints.

11. Identify four objectives for the use of restraints.

12. Identify potential complications of physical restraints.

13. Identify nursing responsibilities regarding the use of restraints, including assessment, documentation
and support for client and family.
Building a Culture of Safety

A critical component of health care delivery

is to build a culture of safety.

Patient safety is the reduction and

mitigation of unsafe acts within the health
care system, as well as through the use of
best practices shown to lead to optimal
patient safety (P&P 2019, p.168)
 The role of the nurse in reporting patient safety
incidence
When an actual adverse event occurs, the following must occur:
The RN or health care provider involved must complete an incident
report.

Incident Report:
Is confidential document
Describes any patient incident that has occurred on the premise of
the health care facility
Allows organization to identify trends or patterns of incidents taking
place
Allows for the organization to examine areas to improve.

Focusing on the event and not the individuals involved promotes a

“culture of safety”
 Risks to healthcare provider and patient safety
In the health care environment…..

Workplace Risks
workplace hazardous materials information system (WHMIS)
WHMIS: education, product labels and Material Safety Data Sheets

Spread of infection (i.e importance the use of hand hygiene/PPE)

Violence against RNs
 Risks to healthcare provider and patient safety
In the health care environment…..

Risks to Patient Safety

Falls
Falls Risk Assessment Tools
Related to age, history of previous falls, gait, balance/mobility issues,
postural hypotension, sensory impairment, use of medications etc.)
Procedure-related accidents
Medication errors
Equipment-related accidents
Results from malfunction of equipment (i.e. mechanical lift)
 Individual Risks at Developmental Stages

Adolescents
Risk taking behaviours
Smoking/substance use
Adults
Lifestyle habits (stress
Stress levels, non-active lifestyle
Older adults
Changes in sensory
Most common injury is falls
Activity: Identifying Risk Factors
Good morning! It is early morning and the overnight
quiet of the hospital is changing to hustle and bustle.
The night staff are checking their patients for the last
time and preparing to give their report to the day shift.
Day shift staff are entering the building and making
their way to their units.

Consider the following scenarios……..

 Identifying Risk Factors
80 year old Mrs. Brown is just waking up. She has Parkinson’s
disease, and has been rather unsteady on her feet lately. Thus,
the nurses have told her to call for help when getting up, and
have placed her call bell within easy reach. This morning, when
she realizes how badly she needs to go to the toilet, she decides
to get up to the washroom on her own, using her cane. “The
nurses are so busy at this time of day, I hate to be a bother,” she
thinks to herself. “As long as I’m careful, I’ll be OK on my own”.
 Identifying Risk Factors

Jill Rule, RN has decided to move Mr. Davis up in bed by herself. He

is a large man, but he looks so uncomfortable, and with everyone in
report it will be some time before Jill can get anyone to help her.
“It’s not fair to make Mr. Davis wait that long” she says to herself.
“I’ll just do it myself”.
 Identifying Risk Factors

On the pediatric unit, Dawn

Pender, RN is caring for 4yr old
Olivia, who is still sound asleep.
Dawn moves the IV pump away
from Olivia’s bedside, out of her
reach – Olivia loves pressing
buttons and hearing beeps!
How does one define the term “restraint”?
A restraint is a measure “used to control the physical or
behavioural activity of a person or a portion of his/her
body”
What are the different forms of restraints?
Physical
Environmental
Chemical
What is considered restraint in one setting may
not be considered a restraint in another setting.
 Physical Restraints
items which restrict or control movement
may be attached to a person or create a physical
barrier
Examples:
bed rail
wrist restraints
table fixed to a chair
 Chemical Restraints
any form of psychoactive medication used to
intentionally inhibit a particular behaviour and
not to treat illness
Examples:
tranquilizers
sedatives
 Environmental Restraint
modification of an individual’s surroundings
used to control a client’s mobility
confine the client to a specific geographic area or
location
Examples:

locked unit
 Least Restraint Policy
Use of restraints is an intervention of last
resort & is based on meeting the needs of
the client, not the needs of the staff.
 Potential Complications of Physical Restraints
Respiratory - Pneumonia
Skin Integrity -  skin breakdown
ROM - Contractures
Genitourinary - Incontinence
Psychological - Emotional distress
Circulation - Impaired circulation
 Potential Complications of Physical Restraints
restraint use increases severity of falls
removing restraints will decrease injurious falls
clients are 14 times more likely to fall if restrained
versus those who are not
many deaths have been related to bedrail entrapment
https://toronto.citynews.ca/2017/08/09/senior-dies-after-getting-wed
ged-between-bed-rail-and-mattress/
 Before considering use of a restraint
Assessment
Client involvement
Collaboration
Alternatives
Documentation
 Alternatives to Restraints
Provide companionship and supervision
Provide diversionary activities
Promote relaxation techniques and normal sleep
patterns
Attend to needs for toileting, food, and liquid.
 Reasons for using restraints
Protect from injury
Protect others from injury
Maintain treatment
 When restraints are needed…
Know agency policy
Review regularly
Document:
discussion with client, family, substitute decision-
maker, healthcare team
attempts at alternatives
the restraint decision
ongoing assessments
patient response
 Case Study
You are a nurse in a long-term care facility that has a
very successful no-restraint policy. There has been no
increase in the number of falls since this policy was
implemented, and when falls have happened the
associated injuries have been less serious. Also, your
agency has identified a 50% decrease in incidents of skin
breakdown since this policy took effect.
You are admitting a new resident whose family insists
that she be restrained to protect her from falling. They
tell you that if their mother is not restrained and she falls,
they will take legal action.