NEO111M. Jorgenson, RN BSN

Patient Safety, Comfort, & Mobility

Patient Safety

FALLS are the fifth leading causes of death among

Americans aged 75 years and older the second leading cause of mortality from related

injuries in adults >65 years

Elderly person who sustains a fall are more likely to die within a year’s time of the fall.

Considine J, Botti M. Who, when and where? Identification of patients at risk of an in-hospital adverse event: implications for nursing practice. Int J Nurs Pract.

2004;10(1):21–31.

Fall Prevention: Everyone’s Responsibility

Physical restraints considered as a last resort after other care alternatives have

been unsuccessful

The least restrictive restraint should be used and it should be removed at the earliest possible time

Must be ordered by a MD or other licensed independent practitioner

Special monitoring/ assessment

Must be reassessed by ordering MD in 24 hours and new order obtained

Restraints

Ask family to stay with patient

Rule out physical causes for agitation

Reduce stimulation

Use electronic alarm system

Check for environmental hazards

Offer diversion activities

Consider relocation closer to nurse’s station

Conceal tubes and tubing necessary for care

Alternatives to Restraints

Extremity restraints

Jacket or vest restraint

Hand Mitt

Elbow restraints

Leather restraints

Mummy restraints

Bed alarms

Types of Restraints

Must be able to insert 2 fingers between restraint and pt’s ankle or wristRestraint must be fastened on moveable part of bed frame, NEVER side railUse a quick-release knot to tie Must be able to insert a fist between vest restraint and patientWhen assessing a restraint, must assess CMS

Circulation Motor Sensation

Call bell must be within reach

Restraints cont.

Mobility

Cardiovascular system Increased cardiac workload, orthostatic hypotension and venous

thrombosis

Respiratory system Decreased ventilatory effort and increased secretions

Gastrointestinal system Poor digestion and utilization of food Constipation

Urinary system UTI and renal calculi

Effects of Immobility

Musculoskeletal system Atrophy, osteoporosis

Metabolic system Decrease in metabolism

Integument system Skin breakdown

Psychological well-being Diminished self-esteem, social disturbances

Effects of Immobility cont.

Be organized and plan ahead

Anticipate changes/complications

Prevention versus treatment

Develop good habits Proper alignment

Preparing for Activity.

Check MD orders, Nursing plan of care, PT notes, and history for any limitations on mobility

Conduct a pain assessment and provide appropriate interventions

Talk with the patient

Talk with other members of the team

Gather equipment

Develop a plan

Planning

Know policies and procedures for facility

Ensure adequate assistance for nurse and patient safety

Prepare for smooth, coordinated transfer-only one leader

Engage brakes on equipment

Planning cont.

Comfortable working height

Good posture

Feet shoulder width apart (wide base of support)

Use large leg/arm muscles (not back)

Gluteal and abdominal muscles engaged (internal girdle)

Low center of gravity

Body Mechanics

Flex knees (and hips)

Head up

Back straight –no twisting

Smooth, coordinated movements

Position self close to object

Rocking motion (forward-push/back-pull)

Body Mechanics cont.

Bed position Arms across chest Knees flexed and feet flat

Ensure proper body alignment

Trapeze bar

Avoid friction/shearing

Patient Positioning

Change patients positions frequently

Smoothe clothes and linens

Encourage deep breathing and coughing

Apply antiembolism stockings

Pad bony prominences

Bed in lowest position

Special Considerations

Pillows

Mattresses

Side rails

Adjustable beds

Trapeze bar

Hand splints

Trochanter rolls

Heel boot

Foam pads

Hand rolls

Footboard

Positioning & Protective Equipment

Range of Motion

Promotes circulation, prevents contractures, and provides joint mobility.

Move each joint until there is resistance but not pain

Incorporate into ADLs

Teach patient and family

Encourage pt to do as much as possible

Anti-embolism Stockings

Used to enhance blood flow and venous return

Patient should be measured for the correct size.

Assess extremity for pulses, edema, movement, sensation (CMS)

Remove and check skin q 8 hours