Pearson's Nursing Assistant Today CHAPTER Safety 7 Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French General Safety Measures See Guidelines: Safety Measures for Young Children Children cannot be held responsible for their own actions. They are dependent on adults to protect them. Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French General Safety Measures Use handrails on stairways. Use caution when opening doors. Lock brakes and wheels. Be aware of position of patients feet during wheelchair transfer. Pick up things on floor. Follow instructions of supervisor. Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Figure 7-3 Be careful going through doorways. Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French General Safety Measures Never use contents of unlabeled container. Check meal trays for dentures. Check soiled linens for misplaced items. Place sharps in approved containers. Use disposable gloves. Keep bedside rails up and locked. Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Oxygen Safety Flowmeter: Regulating device that controls amount of oxygen delivered to a patient. Respiratory therapy or technicians responsible for administration. Oxygen by itself does not burn; element needed to cause fire. Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Oxygen Safety Oxygen therapy Oxygen masks and nasal cannula are types of oxygen-delivery devices. Place Oxygen in Use sign on door. Keep oxygen tubing free of kinks. Monitor electrical appliances or devices. Look for lighters, matches, and smoking material. Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Figure 7-6 and 7-7 Oxygen is administered by an oxygen mask. Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Fire Safety and Prevention Best plan is prevention. Observe all fire safety rules. If fire breaks out, you must: Know what to do. Remain calm. Carry out what you have learned. Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Fire Safety and Prevention Fire extinguishers A = Paper products, wood, household garbage B = Burnable liquids such as oil or grease C = Electrical fires ABC = Use on any type of fire K = Kitchen fires Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Fire Safety and Prevention Fire extinguishers Acronym PASS Pull safety pin on upper handle. Aim low. Point nozzle at base of fire. Squeeze handle to release extinguishers agent. Sweep from side to side, aiming at base of fire, until fire is extinguished. Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Fire Safety and Prevention Major causes of fire Smoking and matches/lighters Improper use of electrical appliances or faulty electrical systems Defects in heating systems Spontaneous ignition Improper waste disposal Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Fire Safety and Prevention Three elements for fire to start Heat: In form of sparks or flame Fuel: Any combustible material Oxygen: Present in air we breathe Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Fire Safety and Prevention In case of fire Acronym RACE Remove patient from immediate area of fire. Activate alarm and alert staff members fire exists. Contain or confine fire by closing all doors to area. Extinguish fire if safe to do so. See Procedure 7-1: Using a Fire Extinguisher Know and follow employers evacuation plan. Call 911. Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Figure 7-10 In case of a fire, remember the acronym R. A. C. E. Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Emergency Preparedness Natural disasters Snow and ice storms Hurricanes and tornados Floods Earthquakes Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Emergency Preparedness Disasters caused by people Transport vehicle crashes and explosions Nuclear power plant accidents Gas and chemical leaks Fires and explosions Riots and wars Acts of terrorism Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Emergency Preparedness You are responsible for knowing your communitys or facilitys disaster plan. Disaster drills help you prepare. Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Patient Safety Help prevent falls Anticipate patients needs. Place call light/personal items within reach. Correct positioning patients in beds/chairs. Practice safe patient lifts and transfers. Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Patient Safety Help prevent falls (contd) Maintain clutter-free environment. Answer call lights promptly. Clean up spills as soon as possible. Know and follow employers emergency plan. Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Patient Safety Use side rails for safety. Use restraints in preventing falls: Mitts Soft limb Leather See Table 7-1: Factors That Put Older Patients at High Risk for Injury in a Health Care Setting Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Alternatives to Restraints Find underlying clinical problem that can be corrected. Frequently reorient patient. Individualize your approach. Eliminate tubes and drains. Have patient sit in hallway. Give patient activity to do with his/her hands. Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Alternatives to Restraints Involve the family. Allow patient to have items from home. Allow patient to have snacks. Provide reality links. Reposition patient for comfort. Give verbal reminders. Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Alternatives to Restraints Restraint orders Type of restraint and clinical justification Attending physician examine Attempted alternatives Results of patient monitoring, assessment, and reassessment Significant changes in patient condition Patient and family education Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Documenting the Emergency Application of Restraint Devices Events leading up to intervention. Prior use of alternative measures. Patients response to those measures. Time restraint was initiated. Time restraint was terminated. Physician order for restraint. Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Documenting the Emergency Application of Restraint Devices Use of positive reinforcement for desired behavior. Deceleration interventions. Attempts to obtain patients voluntary submission to restraint. Appropriate alternatives. Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Management of Escalating or Agitated Behavior Cues of escalating behavior Possible causes of agitated behavior Therapeutic communication Helpful interventions Personal space Coping with fear Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Management of Escalating or Agitated Behavior Physical crisis management Team leader Team members Support staff Threatening situation: About to be or already been assaulted. Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French OBRA Regulations OBRA regulation regarding physical restraints: Any device that limits movement or restricts normal access to ones body may be used only in circumstances in which a patient may harm himself/herself or someone else or to protect a patient during a medical procedure and only with a physicians order. Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Alternative Restraint Devices Wedge or saddle cushion Self-release belt; seat belt-style lap belt Lap tray or pillow Posey grip Chair or bed alarm See Procedure 7-2: Applying Bed and Chair Alarms Diversion Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Figure 7-15 Lap pillow. Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Ambulation Safety with Assistive Devices Ambulation: Act of walking. Gait: Rhythm and movement of feet and speed of walking. Pearson's Nursing Assistant Today Francie Wolgin Kate Smith Julie French Ambulation Safety with Assistive Devices Physical therapists use gait training. Equipment: Cane Walker Crutches