Safety and Comfort

Patient Safety

• Safety is the prevention of errors and adverse effects to patients associated with health care

Factors affecting safety

Age and DevelopmentSelected safety hazards throughout the lifespan

Developing fetus: Exposure to maternal x-rays(1st trimester), certain pesticides, maternal smoking or alcohol consumption, addictive drugsNewborns & Infants: Falling, suffocation in crib, choking(aspirated milk/ingested objects), burns from hot liquids, automobile accidents, play pen injuries, electric shock, poisoningToddlers: Falling, banging into objects, getting cut by sharp objects, automobile accidents, electric shock, poisoning, drowningPreschoolers: Falling, playground equipment, choking, suffocation, obstruction of airway or ear canal by foreign objects, fire and burns, harm from other people or animal, poisoning, drowning

Adolescents: automobile accidents, recreational accidents, fire, substance abuseOlder adults: Falling, burns, automobile accidents

Lifestyle

• Unsafe work environments• Residence neighborhoods with high crime

rate• Access to guns and ammunition• Insufficient income to buy safety

equipment or make necessary repairs• Access to illicit drugs• Accidents at home

Mobility and health status

• Impaired mobility due to paralysis, muscle weakness, poor balance/coordination – Prone to injury

• Spinal cord injury and paralysis of both legs

• Hemiplegic clients or with leg casts – Falls• Weakened by illness/surgery

Sensory – perceptual alterations

• Impaired touch perception, hearing, taste, smell, and vision – highly susceptible to injury

Cognitive awareness

• Impaired awareness – People with lack of sleep, unconscious/semiconscious

• Disoriented people• People with altered judgment by

disease/medications

Emotional state

• Extreme emotional state – alter ability to perceive environmental hazards

• Stressful situations – reduce a person’s level of concentration, cause errors of judgment, decrease awareness of external stimuli

Ability to communicate

• Individuals with diminished ability to receive and convey information – aphasic clients, people with language barriers, unable to read

Safety Awareness

• Clients in unfamiliar environments

Environmental factors

• At home: flooring and carpets, bathrooms, swimming pools, light.

• At workplace: Machinery, chemicals, worker fatigue, noise, air pollution, working at height.

• Community: Street lights, sewage treatment, Handling foods at eateries, noise, crime, roads

Health care setting

• Limited short term memory – Systems rely on human memory are prone to failure.

• Being late or in a hurry – contributes to miss the important detail of information cause harm

• Limited ability to multitask – people perform better at single task. E,g: using cell phone while driving

• Interruptions: Occurs in complex environments (e.g; alarms, call lights, telephone calls)

• Stress: Stress causes anxiety, anxiety affects performance

• Fatigue and other physiological factors: affects a person’s ability to process complex environment

• Environmental factors: Heat, noise, distractions, visual stimuli, lighting, work place design

Nurses’ work environment and client safety

• Inconsistent staffing levels• Long work hours• Some nursing work processes eg:

medication administration, hand washing• Inefficient nurse work processes -

Consume large work hours for documentation and paper work

• Physical design of the workplace

Safety measures throughout the life span

Newborns and InfantsUse an approved car seat at all times in travelling.

Crib/cot should be in appropriate height, lead free paint, height if sides, tight of mattress to crib and no pillow should be used.Never leave an infant unattended on a raised surface.

Check the temperature of the infant’s bath water and formula prior to using.

Hold the infant upright during feeding. Do not prop the bottle. Cut food in small pieces, and do not feed the infant peanuts or popcorn.Provide large soft toys

Use guard gates on stairs and screens on windows. Supervise the infant in swings and highchairs.Cover electric outlets.

Place plants, house hold cleaners, and waste baskets out of reach. Lock away potential poisons, such as medicines, paints and gasoline.

ToddlersContinue to use car seats all the time in travelling. Place children in back seats when traveling in car.Teach children not to put objects in the mouth, including pills(unless given by parent)Keep objects with sharp edges out of children's reach and sight.(knives)

Place hot pots on back burners with handles turned inward.

Keep cleaning solutions, insecticides, and medicines in locked cupboards.

Keep windows and balconies screened.

Supervise toddlers in the tub.

Fence the pools. Supervise when in/near the pool.

Teach children not to run/ride a tricycle into the street.

Obtain a low bed when the child begins to climb.

Cover outlets with safety covers/plugs.

PreschoolersDo not allow children to run with candy/any objects in the mouth.

Teach children not to put small objects in to mouth, ears and nose.

Always supervise them on road rules, especially in crossing roads.

Teach children to play in safe areas.

Teach preschoolers the dangers of playing with matches, fire and heating appliances.Teach children to avoid strangers and keep parents informed of their whereabouts.Teach preschoolers not to walk in front of swings and not to push others off playground equipment.

School-aged childrenTeach children safety rules for recreational and sport activities; never swim alone and wear protective helmet and knee and elbow pads when needed.Teach children to obey traffic rules.

Teach children to use stove, tools, and electric appliances in safe ways.

Teach children the health hazards of smoking, the effects of drugs and alcohol.

AdolescentsHave adolescents a complete driver’s course and allow them to drive.

Have them free of alcohol and drugs consumption before driving.

Encourage them to use proper equipment when participating sports and with groups.Teach safety measures to use power tools.

Be alert to changes in adolescent's mood and behavior.

Young adultsReinforce them to use traffic rules, using seat belts while driving, and to test visual acuity periodically.Reinforce water safety; while driving near lake or rivers.

Discuss evaluating the potential for workplace injuries/death when making decisions about a career/occupation.Encourage young adults who are unable to cope with the pressures, responsibilities and expectations of adulthood to seek counseling.

Middle-aged adultsReinforce to obey traffic rules and test visual acuity periodically.

Make certain stairways are well lighted and uncluttered.

Equip bathrooms with hand grasps and nonskid bath mats.

Keep all machines and tools in good working condition at work and at home. Follow safety precautions when using machinery.

EldersEncourage the client to have regular vision and hearing tests.

Assist the client to have a home hazard assessment.

Encourage the client to keep active as possible.

Preventive Measures for eldersEnsure eyeglasses are functional.

Ensure appropriate lighting.

Mark doorways and edges of steps as needed.

Set safe limits to activities.

Keep environment tidy.

Set safe limits to activities.

Remove unsafe objects.

Wear shoes/well-fitted slippers with nonskid soles.

Use ambulatory devices as necessary (cane, crutches, walker, braces, wheelchair)Provide assistance with ambulation as needed.

Monitor gait and balance.

Adapt living arrangements to one floor if necessary.

Encourage client to request assistance.

Keep bed in the low position.

Install grab bars in bathroom.

Provide raised toilet seats in bathroom.

Preventive Measures for elders Cont.…Instruct client to rise slowly from a lying to sitting to standing position, and to stand in a place for several seconds before walkingProvide a bedside commode as needed.

Assist with voiding on a frequent and scheduled basis.

Monitor activity tolerance.

Attach side rails to the bed.

Monitor orientation and alertness.

Encourage annual/more frequent review of all medications prescribed.

• The incidence of suicide in elders is increasing due to hidden self-destructive behaviors, such as starvation, overdosing with medications, and noncompliance with medical care, treatments, and medications.

• Important factors regarding suicide of the older adult due to, uncontrollable pain, loss of a loved one, major depression social isolation.

• Domestic violence is an increasing rate and involving all the ages of individuals. (Includes child abuse, intimate partner abuse and elder abuse)

Promoting safety in health care setting• Establishing a National center for patient safety

for improvements of safety and knowledge for preventing errors in health care.

• Establishing a reporting system to help design systems for the patient safety.

• Promoting effective teamwork and communication.

• Creating a culture of trust.• Involving health care workers in the design of

work processes and work spaces to promote efficiency and safety.

Preventing specific hazardsSpecific hazards /injuries• Burns – Results from excessive exposure to

thermal/chemical/electric/radio active agents.

• Scalds – A burn from a hot liquid/vapor/steam.

• Fires – Result from malfunctioning electric equipment/combustion of anesthetic gas. Home fires result from malfunctioning electric equipment, careless disposal of burning cigarettes/matches, grease/from faulty wiring.

Nursing interventions for fire safety. (Preventive measures)

• Keep emergency numbers near the telephone/stored for speed dialing.

• Keep fire extinguishers available and working in order.

• Close windows and doors if possible; cover the mouth and nose with a damp cloth when exiting through a smoke filled area. Avoid heavy smoke by assuming a bent position with the head as close to the floor as possible.

• When fire occurs, 1. Protect and evacuate clients who are in

immediate danger. 2. Report the fire. 3. Contain the fire. 4. Extinguish the fire.

Electrical Safety in Health Care Facilities• Regular safety inspections ensure electrical equipment is safe to operate.• Performing tests and visually observing the equipment alerts personnel as

to whether safety hazards loom. • Inspectors to look for worn wires, frayed cords or cracks in machinery, as

these lead to faulty electric functioning and require immediate repair.• Knowing how to properly handle electrical equipment reduces the risk of

shock and electrocution. • Employees should never operate electrical equipment with wet hands.• Often charge electrical medical equipment overnight so the equipment is

ready for use in emergencies.• Leaving electrical equipment plugged into the receptacle continues

electricity generation, which leads the equipment can still burn, shock and electrocute the people who use it.

Chemical safety in health care facilities• Set safety policies for the handling and storing hazardous

chemicals. • All hazardous chemical containers must be labelled

“hazardous”.• Chemicals must be locked in an area that is inaccessible

to patients. • It is important that patients are not accidentally exposed

to hazardous substances, or this will become a risk-management issue.

• Clean spills immediately.• Never mix solutions.• Read labels of solutions three times before using: 1. when removing from shelf 2. when pouring 3. when replacing

Radiation Hazards and safety• All presence of radioactive material must be identified

with warning signs featuring a radiation symbols.• Containers that store radioactive material must be

labelled with warning signs.• Limiting the time in areas around radiation.• Keeping a distance of at least six feet from materials. • Maintain a shielding door between a person and the area.• Cover the body while undergoing a radiation

therapy/procedures.

Falls

• Infants and elders are prone to falling and causing serious injury.

• Falls can break bones and self-confidence, leading to fear of falling causing a decreased activity level and decreased muscle strength.

Risk factors and Preventive measures for FallsRisk factor Preventive measuresPoor vision Ensure eyeglass are functional.

Ensure appropriate lighting.Mark doorways and edges of steps as needed.Keep the environment tidy.

Cognitive dysfunction(Confusion, disorientation, impaired memory, or judgment)

Set safe limits to activities.Remove unsafe objects.

Impaired gait/balance and difficulty walking because of lower extremity dysfunction (e.g.; arthritis)

Wear shoes/well-fitted slippers with nonskid soles.Use ambulatory devices as necessary (cane, crutches, walker, braces, wheelchair)Provide assistance with ambulation as needed.Monitor gait and balance.Adapt living arrangements to one floor if necessary.

Risk factor Preventive measuresEncourage exercise and activity as tolerated to maintain muscle strength, joint flexibility, and balance.Ensure uncluttered environment with securely fastened rugs.

Difficulty getting in and out of chair/in and out of bed

Encourage client to request assistance.Keep bed in the low position.Install grab bars in bathroom.Provide raised toilet seats in bathroom.

Orthostatic hypotension Instruct client to rise slowly from a lying to sitting to standing position, and to stand in a place for several seconds before walking.

Urinary frequency/receiving diuretics Provide a bedside commode as needed.Assist with voiding on a frequent and scheduled basis.

Weakness from disease process/therapy

Encourage client to summon help.Monitor activity tolerance.

Risk factors Preventive measuresCurrent medication regimen that includes sedatives, hypnotics, tranquilizers, narcotic analgesics, diuretics

Attach side rails to the bed if appropriate.Keep the rails in place when the bed is in the lowest position.Monitor orientation and alertness status.Discuss how alcohol contributes to fall-related injuries.Encourage client not to mix alcohol.Encourage frequent review of all medications prescribed.

When a client falls, the nurse’s first duty is to the client. First, assess for injuries. Then, notify the physician

Thank You…