SAFETY RISK FACTORS

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SAFETY RISK FACTORS
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SAFETY

• Freedom from psychological and physical injury
• Essential for a clients well-being
• Critical thinking skills and nursing process used
  by nurses for assessment of environmental hazards

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ENVIRONMENTAL SAFETY

• Includes all physical and psychosocial factors
  that influence the life and survival of a client.
• Includes home, school, clinic, hospital,
  community center , long-term care facility

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BASIC NEEDS MET IN A SAFE ENVIRONMENT

• Physical hazards reduced
• Transmission of pathogens reduced
• Sanitation is maintained
• Pollution is controlled
• Threat of attack prevented

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ENVIRONMENTAL HAZARDS

• Oxygen-essential for life
• Improperly functioning heating system may produce
  carbon monoxide
• Symptoms may include nausea, dizziness, headache,
  decreased concentration
• Fatigue

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Environmental Hazards Contd

• Nutrition-using nutrients to carry on essential
  body functions
• Food poisoning- can result from improperly
  prepared or stored food

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Environmental Hazards Contd

• Temperature Humidity comfort zone (18.3
  23.9 C or 65 75 F)
• Exposure to severe cold frostbite hypothermia
• Exposure to extreme heat-heatstroke/ exhaustion
• Humidity- amount of water vapor in air (60-70)

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Control of Physical Hazards

• Adequate lighting
• Obstacles-extrinsic (remove small rugs)
  intrinsic(illness, drug therapy)
• Bathroom hazards-grab bars
• Security system
• Smoke detectors

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Transmission of Pathogens

• Definitions
• Pathogen-any microorganism capable of producing
  an illness
• Immunization
• Active immunity
• Passive immunity
• Human Immunodeficiency Virus (HIV)
• Safe sex practices

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Pollution

• Air pollution
• Land pollution
• Water pollution
• Noise pollution
• Bio-terrorism
• Department of Homeland Security

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DEVELOPMENTAL STAGES

• Infant, toddler, preschooler- injuries are
  leading cause of death
• School-age child- safety depends on instruction
  by parents, teachers, and nurses

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DEVELOPMENTAL STAGES CONTINUED

• Adolescent- greater independence may engage in
  risk-taking behaviors
• Adults-threats related to lifestyle habits
• Older adult- risks due to physiological changes
  that occur

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DEVELOPMENTAL STAGES CONTD

• Clients in all developmental stages may be
  subject to abuse.
• Types child abuse, domestic violence, elder
  abuse
• Nurses must be aware
• Must be reported if abuse suspected

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INDIVIDUAL RISK FACTORS(THREATS SAFETY)

• Lifestyle-usage of drugs alcohol, risk takers
• Impaired mobility-from muscle weakness
• Sensory or communication impairment- visual,
  hearing , tactile

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HEALTH CARE AGENCY(FALLS/ ACCIDENTS)

• Environmental safety
• Medical errors-8th leading cause of death
• Errors due to system failures
• Material Safety Data Sheets
• Incident report

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Environmental Safety Contd

• Falls- 90 of reported incidents in hospitals
• Increase in elderly due to age, gait problems
• Bed to toilet transfers
• Drug and drug interactions
• Hip fractures-most serious

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Client Inherent Accidents

• Client primary reason for accident
  (self-inflicted cuts, injuries, ingestion or
  injection of foreign substance)
• Seizure-hyper-excitation and disorderly discharge
  of neurons in brain leading to involuntary muscle
  contractions

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PROCEDURE-RELATED ACCIDENTS

• Medication and fluid administration errors
• Preventive measures
• Follow policy procedure for meds administration
• Maintain surgical asepsis for sterile dressings

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Equipment-Related Accidents

• Result from malfunction, disrepair or misuse of
  equipment, from electrical hazards
• Preventive measures
• Read instructions before use
• Safety checklist

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PRINCIPLES OF BODY MECHANICS

• Includes the knowledge of the actions of various
  muscle groups, understanding of the factors
  involved in the coordination of body movement,
  and familiarity with the integrated functioning
  of the skeletal, muscular, and nervous systems.

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Body Mechanics Contd

• Body Alignment
• Body balance
• Coordinated body movement

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BASIC POSITIONS

• Supported Fowlers Position
• Supine Position
• Prone Position
• Side-Lying Position
• Sims Position

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Positioning Devices

• Pillows
• Footboard
• Trochanter roll
• Trapeze bar

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TRANFERS

• Positioning changes
• Moving up in bed
• Transferring from bed to chair
• Transferring from bed to stretcher
• Utilizing proper body mechanics

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Transfers Contd

• Moving clients-require various levels of
  assistance
• Transfer bed to chair with one nurse requires
  patient assistance
• Bed to stretcher-three person carry

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AMBULATION

• Independent
• Assisted-assess activity tolerance
• Assess tolerance to upright position
• Assess strength
• Assess presence of pain
• Explain procedure

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Assistive Devices

• Clients recovering from a lengthy illness may
  require assistive devices.
• Walkers
• Canes
• Crutches

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SAFETY RESTRAINTS

• A mechanical or physical device used to
  immobilize a client or extremity, restricts the
  freedom of movement or normal access to a
  persons body

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Restraints Contd

• Explain purpose to client family
• Explain expected care
• Explain precautions taken to avoid injury
• Explain restraints are temporary
• May need informed consent from family

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Objectives for Physical Restraints

• Reduce the risk of client injury
• Prevent interruption of therapy
• Prevent confused or combative client from
  removing life support
• Reduce the risk of injury to others

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Guidelines and Risk Factors for Using Physical
Restraints

• Assess need for restraint
• Assess behavior
• Review agency policies
• Inspect area where restraint is to be placed
• Approach client in a calm manner
• Provide privacy
• Apply appropriate size restraints

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Legal/ Policies Issues

• Nurse is responsible for assessment of clients
  safety needs
• Know agencys specific policy procedure
• Must be clinically justified and part of medical
  treatment and plan of care

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Legal Contd

• Physicians order is required
• Order must state type of restraint, location, and
  specific behaviors for which restraints are to be
  used and must have a limited time frame
• Ongoing assessment by nurse

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Recording /Reporting

• Proper documentation should include behaviors
  that necessitated the use of restraints
• Procedure used in restraining
• Condition of the body part restrained
• Evaluation of clients response
• Remove prn for ROM etc..

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Restraint Alternatives

• Orient client family to surrounding
• Encourage family or friends to stay
• Provide appropriate visual and auditory stimuli
• Use relaxation techniques
• Evaluate all meds
• Exercise or ambulate to a schedule

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Unexpected Outcomes

• Client has signs of impaired skin integrity
• Assess skin provide appropriate therapy
• Notify MD reassess the need for contd use of
  restraint
• Client has altered neurovascular status

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Hazards of Immobility

• Anorexia
• Constipation
• Thrombus
• Hypostatic Pneumonia
• Atelectasis
• Decubitus
• Contractures
• Urinary Retention
• Loss of Calcium from bones
• Renal Calculi

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Muscular Areas Involved in Muscle Strain

• Neck
• Elbow
• Lumbar area
• Wrist
• Knees
• Toes
• Ankles
• Hips
• Shoulders

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Contracture Development

• Flexing muscles overpower extending muscles
• Prolonged flexion
• Shortening and tightening of muscles
• Contractures in flexed position

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How Pressure Affects Various Body Systems
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CIRCULATORY

• Flattens blood vessels, skin
• Less blood transported
• Decrease O2 and nutrients
• Thrombus and embolus formation

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INTEGUMENTRY

• Strongest line of defense
• Bony areas affected
• Weight from organs etc. decrease O2 to cells
• Cells die
• (costly)

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RESPIRATORY

• O2 in and CO2 out
• AVEOLI- site of gas exchange
• Decrease circulation and increase waste in lungs
• Shallow breathing/Aveoli flattened
• Moisture in Aveoli
• HYPOSTATIC PNEUMONIA

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GASTROINTESTINAL

• Absorption
• Peristalsis
• Elimination
• Pressure and weight affects blood vessels
• Decreased peristalsis (constipation and anorexia)

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DISASTER MANAGEMENT

• Federal Emergency Management Agency
  (FEMA)-central federal agency for emergency
  planning
• Health Care Facility-follow facilitys policy
  procedure on management of large scale disasters

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Internal Disasters

• Nurse protects client from immediate injury
• Setting priorities in case of fire using RACE
  mnemonic
• R-rescue remove all clients in immediate danger
• A-activate the alarm
• C-confine the fire
• E extinguish the fire

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External Disaster

• Nurses play important roles in planning
  implementing disaster relief efforts
• Collaborate with community agencies
• ANA-along with other agencies enhance nurses
  role
• Focus on primary prevention
• Bio-terrorism

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Four Phases in Emergency Management

• Mitigation identifies the kinds of emergency
  situations that may occur
• Preparedness-steps taken to manage situations
• Response-steps taken by staff in event of
  emergency
• Recovery- steps taken to restore essential
  services

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RISK MANAGEMENT

• A system of ensuring appropriate nursing care
  that attempts to identify potential hazards and
  eliminate them before harm occurs

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Risk Management Nurse

• Identify possible risks
• Analyze the risk
• Act to reduce the risk
• Evaluate the steps taken
• Accurately document assessments and findings
• Report significant changes in clients condition

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Incident Reporting

• Incident report or occurrence report is one tool
  used in risk management
• Incident is any event that is not consistent with
  the routine operation of a health care unit or
  routine care of client
• Follow policies procedures of agency

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Types of Asepsis

• Asepsis is the absence of pathogenic
  microorganisms.
• Medical (clean) technique-includes procedures to
  reduce and prevent the spread of microorganisms
• Surgical(sterile)- eliminates all microorganisms

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Medical Aseptic Procedures

• Hand Hygiene
• Alcohol-based waterless antiseptic
• Clean dressing procedures

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Surgical Asepsis

• Used during procedures that intentionally break
  the skin (IVs)
• Surgical trauma or burns
• Procedures that involve involve insertion of
  catheters into sterile body cavities

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Principles of Surgical Asepsis

• A sterile object is sterile only when touched by
  another sterile object
• Only sterile objects placed on sterile field
• Sterile field contaminated by prolonged exposure
  to air
• 1 inch or 2.5 cm around border is considered
  contaminated

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Chain of Infection

• An infectious agent or pathogen
• Reservoir
• Portal of exit
• Mode of transmission
• Portal of entry
• Susceptible host

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The Infectious Process

• Localized-client may experience localized
  symptoms such as pain tenderness at the wound
  site
• Systemic-affects the entire body instead of just
  a single organ. Can be fatal

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Stages of Infection

• Incubation Period-interval between entrance of
  pathogen into body and appearance of first
  symptoms
• Prodromal Stage-interval from onset of
  nonspecific s/s (tired)
• Illness stage-client shows s/s (sore throat)
• Convalescence-acute symptoms disappear

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The Inflammatory Process

• A protective reaction that neutralizes pathogens
  and repairs body cells.
• Normal flora
• Body systems defenses
• Inflammation
• Vascular cellular response
• Inflammatory exudates
• Tissue repair
• General Adaptation Syndrome (GAS)

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Stages of GAS

• Alarm reaction stage-rising hormone levels result
  in increase blood volume, blood glucose levels
  etc
• Resistance stage-body stabilizes
• Exhaustion stage-body can no longer resist the
  effects of the stressor

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OSHA GUIDELINES FOR HEALTH CARE PROVIDERS

• Universal precautions shall be observed to
  prevent contact with blood or other potentially
  infectious material
• Work practice control to eliminate employee
  exposure
• Accessible hand-washing facilities
• Hand-hygiene practices
• No food kept where blood products are present

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STANDARD PRECAUTIONS

• Tier one
• Hands are washed
• Gloves are worn when touching body fluids
• Masks are worn for splash occurrences
• Gowns are worn if soiling of clothing is likely
• Equipment is cleaned properly
• Discard sharps instruments properly

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Standard Precautions Contd

• Tier two
• Airborne precautions-mask (measles)
• Droplet precautions- mask (mumps)
• Contact precautions-gloves gown (respiratory
  synctial virus (RSV), scabies)

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Personal Protective Equipment

• Gowning- prevents soiling of clothes
• Full face protection-when splashing may occur
• Gloves- prevents transmission of pathogens by
  direct or indirect contact

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Measures to Ensure a Safe Environment

• Fire- smoke fire alarms plan of action in case
  of fire
• Electrical-electrical equipment in good working
  order
• Chemicals- out of reach of children stored
  properly

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DOCUMENTATION PROCESSES

• Documentation should be accurate, factual,
  complete, current, organized
• Material Safety Data Sheet (MSDS)-provide workers
  ER personnel with the proper procedures for
  handling or working with a particular substance
• Policies procedures-conform to state federal
  laws

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Process for Reporting

• Breaches in safety security
• Ethics committee
• Chain of command
• Incident reports-risk management tool
• Health Insurance Portability and Accountability
  Act (HIPPA)