SAFETY

RATIONALE FOR THE USE OF THIS

INFORMATION
Because of its complexity, the healthcare setting is potentially dangerous.
Patients room are not spacious.
The variety of equipment used within the modern healthcare environment adds to
the difficulty of maintaining safety.
The unfamiliarity of the healthcare facility for most individuals adds to the
potential for accident or injury.
Fire and natural disasters pose an especially serious threat in any facility
containing a large number of ill people.
Providing a safe environment is important for the nurse practicing in a long-term
care facility because of the advanced age and fragility of most of the residents.
SAFE STAFF BEHAVIOR
Use Good Mechanics
Standing and walking in an erect posture in good
body alignment protect you from strain.
Stretching, reaching, and carrying or moving heavy
objects can take their toll on poorly aligned
muscles.
 Walk. Avoid Running
Running is risky and can lead to falls.
Brisk walking is much safer.
Use well fitted shoes for safe movement.
Avoid shoes with open toes or heels.
Keep to the Right in Hallways
It is easy to run into someone else whose attention is diverted. Therefore as a
rule, always walk to the right. This provides a smoother flow of traffic.
Turn Corners Carefully
Most collisions take place when two people are rounding a corner. Always keep
to the right, slow your pace, and turn corners carefully.
 Open Doors Slowly
Opening a door may easily strike someone on the other side. If it is opened
slowly, it is less likely to cause injury.
Use stretchers properly
When pushing a patient on a stretcher, keep the patients head toward your
body. This is done so that the head which is highly vulnerable to impact injury, is
protected, and the feet, which are less vulnerable, are outward.
Use Brakes on Beds, Wheelchairs, and Stretchers
When beds, wheelchairs, and stretchers are stationary, apply the brake or
brakes.
Place Elevators on Hold When Loading or Unloading
When you are pushing a patient in a wheelchair or stretcher, place elevator
operating buttons on hold. This will keep the doors open until you and the
patient are safely in or out of the elevator.
SAFETY IN WORKING SPACES, HALLS
AND CORRIDORS
Lighting
Ensure that working spaces are lighted well enough to allow objects and people
to be seen clearly.
Floor Surfaces
Whether the flooring is of tile, linoleum, or carpeting, surfaces should be
smooth. Cracked tiles, raised linoleum, or torn carpeting can easily lead to falls.
Highly polished floors also can cause skidding, falls, and injury.
Dropped materials, such as tissues or food substances, should be retrieved
immediately.
Danger, Wet Floor should be posted in case unsafe floor surfaces are still in
progress of managing.
 Electrical Appliances
A frayed or damaged cord or plug, should never be used because it may cause
sparks or fire.
Unused electrical outlets in settings where young children are present should
have a safety cover in place to protect children from electrical shocks.
Needles and Other Sharps Objects
You should develop the habit of never recapping any used needle.
Do not carry an uncapped needle down the hallway.
Dangerous or Caustic Substances or Materials
All products, regardless of where they are used, should be clearly labeled to
warn of any risks or dangers.
They should never be left within easy reach of others in hallways or work spaces
including nurses stations.
 Uncluttered Hallways
In a fire or emergency, such equipment could block the access of emergency
personnel and equipment and interfere with the evacuation of patients and staff.
SAFETY IN THE PATIENTS ROOM
Lighting
Be sure that patient rooms have enough light to allow the ambulatory patient to
see objects easily that may be in the way and to allow staff to work without
difficulty.
Use wall nightlight to help orient both the bedridden patient and the patient who
is able to get out of bed to use the bathroom.
Floor Surfaces
Ensure that floors are smooth and in good repair. An unsteady patient is more
likely to slip than and able-bodied visitors or staff member.
Provide nonslip mats or bath towel for use on the floor of a shower or on the
buttom of a bathrub to prevent slipping.
 Oxygen
Oxygen, as a gas, does not itself explode, but it supports rapid combustion, and
materials will burn at an explosive rate in its presence.
Post a No Smoking sign on the door
Furniture
Be sure that all furniture in the patients room is arranged to allow access to the
wash basin, bathroom, closet area, and door.
Medications and Dangerous Substances
Remove the medications and dangerous substances from the bedside to prevent
a visitor or someone for whom they were not intended from ingesting them.
Doors
Fully pen or fully close entrance doors and bathroom, closet and cabinet doors
at all times to eliminate the possibility of people colliding with them.
PROTECTING THE DEPENDENT
PATIENT
The Dependent Adult
Position of the bed
Ensure that all occupied beds remain in the low position unless bed height is needed
for care procedures. In this way, if the patient should fall, the distance is lessened.
Side Rails
Side rails are reminders to the patient of the narrow boundaries of the bed and may
prevent falls and injury.
Positioning
Position the unconscious or immobile patient in good body alignment, making sure
that extremities are not caught beneath the heavier portions of the body or on the
side rails. The patients position should be changed every 2 hours to prevent pressure
ulcers and maintain comfort.
 Protection from sharp objects
Dropped instruments, utensils, pieces of debris, fingernail clippings, and even minute
loose hairs between the patients body and the bed can cause irritation and eventual
skin breakdown.
Eyes
Routinely examine the eyes of the comatose patient not only for irritation, but for the
presence of foreign bodies that may cause harm.
Air Passages
Protect the patients airway at all costs.
When patients are unable to swallow saliva, they should be positioned on their side so
that the saliva will drain from the mouth rather than occlude the airway and be
aspirated.
 The Dependent Child
Because children are in the early stages of development, they may be at a
higher risk for injury than adults.
To prevent falls, never leave infants and small children unattended when they
are lying on a high surface, such as an examination table
Never leave then unattended in tubs, where they might slip and drown.
Lock up or make inaccessible all medications and products used on the unit so
that nothing can be taken unintentionally.
Protect the airway at all cost to maintain adequate ventilation. Ensure that foods
are of consistency that allows them to be chewed and swallowed without
choking.
SAFETY DEVICES AND RESTRAINS
Safety devices include a wide variety of devices that can keep individuals
with specific problems safer. These devices include both physical and
chemical restraints and non restraint devices.

Nursing Diagnosis
A NURSING DIAGNOSIS TO KEEP IN MIND WHEN CONSIDERING THE USE OF ANY
SAFETY DEVICE IS RISK FOR INJURY PATIENTS CAN BE INJURED BY FALLS,
MANIPULATING OR REMOVING EQUIPMENT NECESSARY TO THERAPY, OR SCRATCHING
IRRITATED AREAS.
ANOTHER NURSING DIAGNOSIS THAT CAN BE RELATED TO THE USE OF PHYSICAL
RESTRAINTS IS RISK FOR VIOLENCE: SELF DIRECTED OR DIRECTED AT OTHERS.
HAZARDS OF USING SAFETY DEVICES
The restrained patient may feel punished rather than safe and may react by
becoming more distressed and angry, at least for a while.
This increased agitation can lead to falls or other injuries (bruises,
lacerations) that occurs when the patient attempts to escape.
RESTRAINTS
Restraint is defined as the intentional
restriction of a persons voluntary movement or
behaviour. (Counsel and Care UK, 2002),
 Restraints are physical, chemical or
environmental measures used to
control the physical or behavioural
activity of a person or a portion of
his/her body.
GEN ERAL PRINCIPLES FOR U SE OF REST RAINT S

should be selected to reduce clients

movement only as much as necessary
Nurse should carefully explain type of
restraint and reason for its use
Should not interfere with treatment

Bony prominences should be padded

before applying it
Should be changed when they become soiled
or damp
Should be secured away from a clients reach

Should be able to quickly release the device

Should be attached to bed frame not to side

rails
Should be removed a minimum of every 2
hrs
Frequent circulations checks should be
performed when extremity are used
INDICATIONS
Displaying behaviour that is putting themselves
at risk of harm
Displaying behaviour that is putting others at risk
of harm
Requiring treatment by a legal order, for
example,under the Mental Health Act 2007
Requiring urgent life-saving treatment
Needing to be maintained in secure settings.
A L L ALTERNATIVES MUST BE TRIED BEFORE
RESTRAINTING
Offer bedpan or bathroom every 2 hours

Offer fluids and nourishment frequently,

keep water within reach

Provide divertional activity

Decrease stimuli and noise

Provide change of position, up to chair,

ambulation

Have patient wear glasses and/or hearing

aides
ALTERNATIVES ..
Increase observation

Ask family to sit with patient

Alert other staff to be observant

Move patient to a room near the nurses

station

If the patient is interfering with his medical

equipment

Educate frequently not to touch the

treatment device

Place the device out of site if possible

 TYPES
OF
RESTRAINT
S
PHYSICAL RESTRAINTS
Physical restraints limit a clients
movement.
Eg: table fixed to a chair or a bed rail
that cannot be opened by the client.
ENVIRONMENTAL RESTRAINTS
Environmental restraints control a
clients mobility.
Eg:a secure unit or garden,
seclusion
CHEMICAL RESTRAINTS
Chemical restraints are any
form of psychoactive
medication used not to treat
illness, but to intentionally
inhibit a particular behaviour
or movement.
TYPES OF PHYSICAL RESTRAINTS
1. Mummy restraint

2. Elbow restraint

3. Extremity restraint

4. Abdominal restraint

5. Jacket restraint

6. Mitten or finger restraint

 MUMMY RESTRAINT
It is a short-term type of restraint used on
infants and small children during examinations
and treatment of head and neck. It is used to
immobilize the arms and legs of the child for a
brief period of time.
ELBOW RESTRAINT
This restraint is used to prevent flexion of the
elbow and to hold the elbow in an extended
position so that the infant cannot reach the
face.

plastic elbow restraint ,elbow cuff and well

padded wooden splint can also be used
 E XTREM IT Y R E STR AINT
It is used to immobilize one or more extremities. One
type of extremity restraint is clove-hitch restraint
which is done with gauze bandage strip (2 inches wide)
making figure-of-eight.

The end of the gauze to be tied to the frame of the

crib/bed.

This restraint should be used with padding of wrist or

ankle.

Precautions to be taken to prevent tightening of the

bandage
ABDOMINAL RESTRAINT
This restraint helps to hold the infant in a supine
position on the bed
MITTEN OR FINGER RESTRAINT
Mitts are used for infants to prevent self-
injury by hands in case of burns, facial injury
or operations, eczema of the face or body.

Mitten can be made wrapping the child's

hands in gauze or with a little bag putting
over the baby's hand and tie it on at the
wrist.
P O T E N T I A L R IS KS AND S ID E E FF E CT S OF R ES TRAINT U S E:

Psychological/Emotional:
Increased agitation &hostility

Feelings of humiliation, loss of dignity

Increased confusion

Fear
Physical:
Pressure ulcers, skin trauma

Decreased muscle mass, tone, strength, endurance

contractures, loss of balance, increased risk of falls

Reduced heart and lung capacity

Physical discomfort, increased pain

Increased constipation, increased risk of fecal impaction

Increased incontinence and urinary stasis

Obstructed and restricted circulation

Reduced appetite, Dehydration

Death
RESTRAINT GUIDELINES:

Doctors order
Informed consent
Follow proper technique
Least restrictive
Pad boney prominence
Maintain Good body alignment
 RESTRAINT ORDERS
Situational Medical Behavioral
-May apply in emergency,
* Initiation of -Obtain written or
but get doctor order with in
verbal order within 12
Restraints hours of initiation,
1 hour. Dr must do face-to-
face assessment within 1
(ALWAYS after physician exam within hour of restraint initiation.
24 hours.
alternatives tried) - In accordance with
following limits up to a total
of 24 hours:
* Renewing - Every 24 hours
Order - 4 hrs for adults 18 and up.

-2 hrs for children

9-17 yrs of age.

-1 hr for children
nine and under.
NURSES
ROLE
 MONITOR A PATIENT IN RESTRAINT EVERY 15 MINUTES FOR:

Signs of injury

Circulation and range of motion

Comfort

Readiness for discontinuation of restraint

DOCUMENTATION IN EVERY 2 HOURS FOR:

Release the patient, turn and position

Institute a trial of restraint release

Hydration and nutrition needs

Elimination needs

Comfort and repositioning needs

RESPONSIBILITIES OF THE NURSE
Assess the clients behaviour and the need for

restraint & applies as a last resort.

Get written order and obtain consent as per

hospital policy

Must communicates with the client and family

members

complies with institutional policies and

guidelines for restraint

Explain the client the reason for the restraint

Arrange the client under restraint in a

place for easy,close and regular observation

particular attention to his/her safety,

comfort, dignity, privacy and physical and

mental conditions.

attend the clients biological and

psychosocial needs during restraint at

regular intervals.

reviews the restraint regularly, or

document the use of restraint for record and

inspection purposes.

Explore interventions, practices and alternatives to

minimize the use of restraint.

Nurse must maintain his/her competence in the

appropriate and effective use of restraint through

continuous education.
 FACTS

Restraints may be used to

protect a patient from a greater
risk of harm, although evidence
is lacking to support the
effectiveness of using physical
restraints to prevent treatment
interference.
44
 FACTS

Studies have repeatedly demonstrated that there is no increase in serious

injuries when physical restraints are replaced with other less restrictive
safety measures based on the individuals specific needs.
Studies have also demonstrated a dramatic decrease in behavior problems
when restraints are removed.

45
BASIC BODY MECHANICS
A nurse engaged in clinical practice daily performs a variety of physical
tasks, including reaching, stooping, lifting, carrying, pushing, and pulling.
Practiced incorrectly all of these and has the potential to cause strain,
fatigue, or injury to the nurse or patient.
With practice, using the principles of body mechanics, the nurse will move
smoothly and surely, minimizing personal strain, conserving energy, and
enhancing the safety, comfort and confidence of patients.
PRINCIPLES OF BASIC BODY
MECHANICS
Weight is balanced best when the center of gravity is directly above the
base provided by the feet. In this position, an individual can maintain
balance and stability with the least amount of effort.
 Enlarging the base of the support increases the stability of the body.
Changes in position should not cause the center of gravity to fall beyond the
edge of the base. Therefore, when you assist a patient to move or the patient
moves in a standing position, each will be more stable if there feet are apart
than if they are close together.
A person or an object is more stable if the center of gravity is close to the
base of support.
Apply this principle when an object is picked up from the floor by bending the
knees and keeping the back straight rather than by bending forward at the waist
Enlarging the base of support in the direction of the force to be applied
increases the amount of force that can be applied.
Place one foot forward when you push a heavy object ( such as a bed with a
patient in it), or place one foot back when you move a patient toward the side of
the bed.
 Tighten or contract your supporting muscles before beginning a lifting task
to prevent injury.
Supporting muscles are the muscles of the abdomen and lower back that
provide stability and support to the lower spine.
Facing in the direction of the task to be performed and turning the entire
body in one plane (rather than twisting) lessens the susceptibility of the
back injury.
When the back is twisted, one group of muscles is stretched while the other is
contracted. Muscles that are stretched are weaker and more susceptible to
injury.
Lifting should be undertaken by bending the legs and using the leg muscles
rather than by using the back muscles.
Because large muscles tire less quickly than small muscles, you should use the
large gluteal and femoral muscles rather than the smaller muscles of the back.
 It takes less energy to move an object on a level surface than to move it up
a slanted surface against the force of gravity.
Therefore, you will need less effort to move a patient up toward the head of the
bed if you first lower the head of the bed. Make sure the patient can tolerate the
flat bed.
Less energy is required to move an object when friction between the object
and the surface on which it rests is minimized. Because friction opposes
motion.
You can make the task of moving a patient in bed easier by working on a
smooth surface such as a taut sheet.
It takes less energy to hold an object close to the body than at a distance
from the body. It is also easier to move an object that is close. Muscles are
strongest when contracted and weakest when stretched.
Therefore, hold heavy objects close to your body, and move the patient near to
your side of the bed (for bathing) to conserve energy.
 The weight of the body can be used as a force to assist in lifting or moving.
When you help a patient stand, you can use the weight of your body by rocking
back, counterbalancing the patients weight.
Smooth, rhythmic movement at moderate speed require less energy than
rapid, jerky ones. Smooth continuous motions also are more accurate,
safer, and better controlled than sudden, jerky movements
When an object is pushed, it absorbs part of the force being exerted,
leaving less force available to move the object. When an object is pulled ,
all of the force exerted is available for the task of moving.
When moving patients, pull rather than push, which is much less effective.
It takes less energy to work on a surface at an appropriate height (usually
waist level) than it does to stoop or stretch to reach the surface.
The back is susceptible to injury and fatigue from excessive bending.
DOCUMENTATION
Rationale for the use of this skill
The patients official record is used by all members of the healthcare team to
communicate the patients progress and the current treatment.
Entries in the record must be clear, accurate, legible and complete.
TYPES

OF RECORDS
Temporary Records
Vital signs record
Input and Output Record
Kardex
Temporary bedside records
The Permanent Record
The Chart
It is the legal record of care. It is the proof of the patients condition and care in legal
proceedings.
The Computerized Record
Information may be printed in a permanent paper record.
Facilitates immediate entry and retrieval of data.
RECORD CONTENT
Personal data of the patient
The admitting diagnosis and the date of admission
Medical history, physical examinations and medical progress
Medical orders
Laboratory results
Nursing care plan
Type of care given to the patient
SYSTEMS FOR ORGANIZING CONTENT
Source Oriented Record
Majority of the information is organized according to the source of that
information.
Different medical records such as doctors notes, nurses notes and other
disciplines have their own record forms
Problem Oriented Record
All members of the healthcare team write progress notes about the same
problem on the same form in the chart.
CONTENT OF THE NURSING RECORDS
Assessment Data
Objective and subjective Data
Analysis and New Problems Identified.
Intervention Data
Nursing actions in response to an existing nursing diagnosis and measures taken
to prevent problems.
Evaluation Data
Document the effectiveness of nursing and all other actions and therapies.
MECHANICS OF CHARTING
As legal record, a chart must conform to a legal standards of legibility,
clarity, and accuracy.
All entries in a paper chart should be in ink so that changes are noticeable
and the record is permanent.
Legibility is critical; obviously statement that are not legible are not usable
either for care or in court.
ERRORS IN CHARTING
If you make an error , draw a single line through the incorrect entry so that
it remains legible.
Documentation errors should never be corrected by erasing, using
correction fluid, or obliterating the first entry.
Do not delay an entry. It may arouse suspicion as to whether the entry is
correct.
Put your initials after the single line in the incorrect entry.
SPACES
If you are using the narrative form of charting, chart on consecutive lines
and do not leave any blank spaces. Draw a single line through any empty
spaces to prevent subsequent entries from being made above your
signature.
SIGNATURE
When you sign a notation on a patients record, use your first initial and full
last name followed by the abbreviation of your position
Ex. J. Smith NS or SN
TIME
Notations of time and date are important for health care reasons and legal
reasons. Time sequence can be crucial in certain problems
You can note time in the 24- hour or military format.
RIGHT TO PRIVACY
Access to the chart is prohibited to all except for the healthcare team in
concern for the patient.
The medical record is the property of the hospital but the patient has the
right to the information contained in that record.
USING SPECIAL TERMINOLOGY AND ABBREVIATIONS

As you progress in your nursing and related studies, you will pick up a large
medical vocabulary. You must use this vocabulary and use this effectively
and correctly.