Chapter 37

Client Safety

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Objectives for Safety
 State safety measures to be implemented in the
laboratory setting
 Describe safety issues to note in the client’s room;
include lighting, temperature, obstacles, hazards,
bathroom hazards.
 Describe safety issues involved with the use of
restraints
 Discuss the influence JCAHO and the state have on
the use of restraints and patient safety
 Describe the restraint free environment and the
alternatives to traditional restraints
 List measures to prevent falls; specific measures to
use for older adults and the physiological conditions
associated with aging that put these clients at risk

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Objectives (con’t)
 State measures employed to reduce risk of
injury in the patient with seizures; with
procedure, accidents, and the use of
equipment
 Discuss the threats to patient safety
resulting for fatigued nurses (article)
 Describe fatigue
 State what nursing can do to improve
patient safety
 National patient safety goals

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Safety Management Plan
 Life safety
 Fire safety
 Utilities
 EMP (Emergency Management Plan)
 Hazardous Waste
 Security
 Medical Equipment

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Patient Safety
 Evaluation of Sentinel events
• An occurrence that caused or had the
potential to cause permanent loss of
function of death.
 Evaluation of system issues relating
to the sentinel event (root cause
analysis)
 Review of policies and procedures
relating to patient safety

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Environmental Safety
 Basic needs
 Oxygen

 Optimum temperature and

humidity
 Call light

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Environmental Safety (cont'd)
 Physical hazards
 Accidents
 Lighting
 Obstacles
 Bathroom hazards
 Security: fires, lead, carbon monoxide,
break-ins

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Environmental Safety (cont'd)
 Transmission of pathogens
 Exposures

 Immunizations

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Life Safety
 Injuries
 Building issues

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EMP (Disaster Plan) Bioterrorism
 Anthrax—not contagious
 Botulism—not contagious
 Small pox—very contagious
 Plague--contagious
 Neurotoxic gases

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EMP (Emergency Prepardness)
 Practiced twice a year
 Influx of patients 1 time a year
 Must be community wide
 Must participate with the federal
government

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Anthrax
 Inhalational anthrax
 Flu like symptoms

BUT: rhinorrhea and sore throat with

flu, unlikely with anthrax

Treated with Cipro and doxycycline

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Botulism
 “I am going numb from my face to
my toes and I know it”
 Interferes with nerve conduction
 Treatment with respirator/ventilator
likely—ties up healthcare resources

May treat early with antitoxin, but

mostly supportive treatment for
weeks.
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Plague (pneumonic/bubonic)
 Black death (Yersinia pestis—
bacterium)
 Coughing up of blood
 Transmitted by fleas and contact with
body fluids
 Treatment: ANTIBIOTICS
 Pneumonic for bioterrorism
 Bubonic– host- rat, vector-- flea
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Small Pox
 Deep seated pustules
 All lesions are in same stage

 Centrifugal: face and arms

 Very sick- very contagious

 Supportive measures and airborne

precautions
Therer is an immunization for small
pox- only supportive treatment
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Sarin is a human-made chemical warfare agent classified
as a nerve agent. Nerve agents are the most toxic and
rapidly acting of the known chemical warfare agents.

All nerve agents cause their toxic effects by preventing the

proper operation of the chemical that acts as the body’s “off
switch” for glands and muscles. Without an “off switch,” the
glands and muscles are constantly being stimulated. They
may tire and no longer be able to sustain breathing function.

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Sarin/other gases
If p eop le thi nk t hey ma y ha ve b een ex posed , t hey sho uld remo ve
thei r c lo thin g, r ap id ly was h t heir entir e b od y wi th soap an d
wat er , a nd get m edi cal c ar e as q uic kl y a s p ossi ble.
Remov in g an d disp osi ng o f c lo thin g:
 Quic kl y t ake o ff c lot hin g th at has li quid sar in on i t. Any
clot hin g t hat has to be pull ed ov er t he head shou ld b e c ut off
the bo dy in st ead o f pull ed ov er t he hea d. If p ossi ble, se al the
clot hin g i n a plast ic ba g. T hen se al the f ir st pla st ic bag in a
sec ond p last ic b ag. Remov in g a nd seali ng t he clo thi ng in t his
way wil l h elp p rot ec t peop le fr om an y c hemi cal s t ha t m igh t
be on t heir clot hes.
 If c lot hes wer e p lac ed i n p la st ic bags, i nfor m eit her t he lo cal
or st ate heal th dep artmen t o r em ergen cy p er son nel upon
thei r a rriva l. D o n ot ha ndle the p last ic b ag s.
 If hel pin g o ther peop le remo ve t heir clo thi ng, t ry t o av oi d
tou chin g an y contami nat ed a rea s, a nd remov e t he clo thi ng as
quic kly as possib le.

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 Decontamination Procedure:

Washing the body:

As quickly as possible, wash any liquid sarin from the
skin with large amounts of soap and water. Washing
with soap and water will help protect people from any
chemicals on their bodies.
Rinse the eyes with plain water for 10 to 15 minutes if
they are burning or if vision is blurred.
If sarin has been swallowed, do not induce vomiting or
give fluids to drink.

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General Safety Risks at Developmental
Stages
 Infant, toddler, preschooler—little
common sense
 Exploration of the environment
 Accidents and injuries
 School-age child—industry vs. inferiority
– Activities: sports, bicycles

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General Safety Risks at Developmental
Stages
 Adolescent
 Greater independence

 Risk-taking behaviors

(feeling invincible!!)
STD’s, Drugs, Driving

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General Safety Risks at Developmental
Stages
 Adult
 Lifestyle habits
 Stress

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Risks at Developmental Stages (cont'd)
 Older adult
 Physiological changes; such as??
 P. 979 Box 37—6 (Focus on Older-Adults)

Hip Fractures major cause of disability,

functional impairment, and death.
P. 982: Research Highlight

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Individual Risk Factors
 Lifestyle
 Impaired mobility
 Sensory or communication impairment
 Lack of safety awareness

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Risks in the Health Care Environment
 Medical errors (IOM) 1999
 Falls (90% of reported incidents)
 Procedure-related occurrences
 Equipment-related occurrences
 Medication-related occurrences
 Failure in communication
 Failure in patient identity

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Patient Assessment for Safety

 Nursing history
 Client’s home environment
 Health care environment
 Risk for falls
 Risk for medication errors
 Client expectations

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Nursing Diagnoses
 Risk for injury
 Deficient knowledge
 Risk for poisoning
 Disturbed sensory perception
 Risk for trauma

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Planning
 Goals and outcomes
 Examples
 Client does not suffer a fall or injury
 Client identifies risks associated with visual
impairment
 Setting priorities
 Continuity of care

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Implementation
 Developmental interventions for injury
prevention:
 Infants- mainly preventable
 School-age– instruction
 Adolescents- instruction
 Adults– instruction on risk factors
 Older Adult– decreasing environmental
factors
 Page 963-965

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SAFETY CONCERNS ACROSS THE LIFE SPAN

Age Group Specific Safety Preventive

Concern Measures/Teach
ing
Infant

Toddler/Preschool
Child

School-age Child

Adolescent

Adult

Older Adult

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Implementation:
Acute Care

 Fall prevention-- protocols

 Restraints
 Legal guidelines (specific state to state).
 Restraint-free environment
 Side rails
 Fire safety (RACE)
 National Patient Safety Goals

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National Patient Safety Goals 2006

 Have 2 Patient Identifiers

 Care Giver Communication
 Read back all verbal orders
 Standardize “Do Not Use” Abbreviations
 Critical result timeliness
 Standardize “hand-off” communication-
verbal reports, standardized medication-
reconciliation forms

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NPSG 2006 (con’t)
 Medication Safety
 Limit available drug concentrations
 Review annually look-alike/sound-alike drugs
 Label medications/medication
containers/solutions in perioperative and
procedural settings
 Prevent Risk of Hospital Infections
 Follow CDC guidelines for handwashing and
hand hygiene guidelines
 Review nosocomial deaths as sentinel events

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NPSG’s 2006 (con’t)
 Reconcile Patient Medications
 Get complete list of home medications
on admission
 Send a complete list of medications for
next provider
 Reduce Patient Falls
 Institute and implement falls reduction
program and evaluate effectiveness.

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You can delegate application of restraints to UAP’s. Which
CNA demonstrates correct understanding of restraints?

A. The one who fastens the restraints to

the side rail
B. The one who applies a vest restraint
to a confused client who tries to pull
out the iv
C. The one who ties the restraint to the
bed frame with a quick release tie

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 Your client is very confused and increasingly
aggressive. Your correct first and second action after
exhausting all other options is

A. 1.Restrain him and 2.notify the

physician for a face to face physician
assessment
B. 1.Notify the physician and 2.wait to
restrain him until the physician has
seen him
C. 1.Restrain him and 2.notify the
physician within 24 hours

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Implementation:
Home Environment

 Temperature and humidity

 Lighting
 Safety features
 Security measures
 Nutrition: food preparation
 Asepsis: cleanliness

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 Evaluation

 Prevention of injury
 Client expectations
 Outcome management
 Hazard Analysis
 FMECA

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