Chapter 33

Safety

33-2Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Safety Culture

Safety is a functional concern of nurses from the bedside to the home and community

Excellent nursing care is safe for both the clients receiving the care, and the workers involved in the delivery of health care.

33-3Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Factors Affecting Client Safety

Age:• Fetus: maternal exposure e.g. drugs and smoking• Infants: falling, suffocation, burns. Poisoning, and

electrical shock• Toddlers: falling, sharp object injury, automobile

accident, poisoning, electrical shock• Preschooler: injuries, suffocation, poisoning, burn,

automobile accidents• Adolescent: Vehicle accident, Suicide, sport injuries,

substance abuse• Adults: accidents (occupational or vehicle), fire

burns, suicide• Elderly: falling, burns, automobile accidents

33-4Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Factors Affecting Client Safety

Lifestyle:• Work environment• Residence• Risk Talking behaviors• Income

Sensory and Perceptual Alterations: problem in senses

Mobility and health status: paralysis, patient after surgery

Emotional State: stress, or depressed

Cognitive awareness: unconscious under narcotic Ability to communicate: unable to read

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Types of Incidents

Client behavior incidents Therapeutic procedure incidents Equipment incidents

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Safety and the Environment of Care

Each nurse is responsible for following the facility’s established safety guidelines.

It is the nurse’s responsibility to report promptly and to document a mishap.

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Focus of Safety Assessments

The individual The environment Specific risk factors

• Falls• Fires• Poisoning• Suffocation and choking• Firearm injuries

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Potential Occupational Hazards

Chemical and biological exposures Physical exposures (lasers, ionizing

radiation, noise) Psychosocial stressors (shift work,

overtime, threat of workplace violence) Ergonomic stressors (lifting and moving

clients)

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Potential Occupational Hazards

Routes of Exposure• Methods by which chemical and biological

substances are assimilated into the body - Inhalation- Ingestion- Injection- Skin contact- Skin absorption

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Potential Occupational Hazards

Latex Allergy• Irritant contact dermatitis• Allergic contact dermatitis

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Potential Occupational Hazards

Hand Hygiene• Any dermatitis should be promptly reported

to Employee Health.• Barrier creams or special soaps are

available.• Strict guidelines on nail care and nail

coverings should be implemented and followed.

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Factors that Contribute to Falls

Age >65 History of falls Impaired vision or balance Altered gait or posture, impaired mobility Medication regime Postural hypotension Slowed reaction time Confusion or disorientation Unfamiliar environment

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Nursing Diagnosis

Risk for Injury• Risk for Suffocation• Risk for Poisoning• Risk for Trauma• Risk for Aspiration• Risk for Disuse Syndrome• Latex Allergy Response

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Nursing Diagnosis

Risk for Infection Related to (RT)• Inadequate primary defenses• Inadequate secondary defenses• Tissue destruction and increased

environmental exposure• Chronic diseases and malnutrition

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Nursing Diagnosis

Risk for Infection Related to• Invasive procedures• Pharmaceutical agents• Trauma• Rupture of amniotic membranes• Insufficient knowledge to avoid exposure to

pathogens

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Outcome Identification and Planning

Identification of actual or potential hazards

Reduction of the risk of injury and infection

Client/caregiver education regarding safety measures and modification of an unsafe environment

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Implementation

Raise Safety Awareness and Knowledge Bed Safety Prevent Falls

• Apply restraints• Ensure adequate lighting• Remove obstacles

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Implementation

Types of physical restraintsA. Jacket

B. Belt

C. Mitten or Hand

D. Elbow

E. Limb or Extremity

F. Mummy

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Implementation

Reduce Bathroom Hazards Prevent Fire

• Common causes of fire • Fire prevention• Protection of clients during a fire• Institutional policies and procedures for fire

containment and evacuation

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Implementation

Ensure safe operation of electrical equipment.• Three-pronged electrical plug that is

grounded• Warning labels on all equipment• Electrical shock

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Implementation

Reduce exposure to radiation.• Both the client and the nurse are at risk for

injury.• Radiation injury can occur from

overexposure or exposure to untargeted tissues.

• General principles of radiation exposure and protection are based on time, distance, and shielding.

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Implementation

Prevent poisoning.• A poison is any substance that causes an

alteration in the client’s health when inhaled, injected, ingested, or absorbed by the body.

• Antidotes and treatments are available for some but not all types of poisonings.

• Poison control center • Client education

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Implementation

Reduce Noise Pollution.• Sensory overload can alter a client’s

recovery by increasing anxiety, paranoia, hallucinations, and depression.

• Safety measures include maintaining a quiet environment, traffic control, and providing earplugs.

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Four E’s of Preventing injury

Engineering: environmental modification Enforcement: laws and regulations Education: behaviour modification Economics: financial incentives