Safety


Chapter 13

Safety





Key Abbreviations























































AED Automated external defibrillator
C Centigrade
CDC Centers for Disease Control and Prevention
CMS Centers for Medicare & Medicaid Services
CO Carbon monoxide
CPR Cardiopulmonary resuscitation
EMS Emergency Medical Services
F Fahrenheit
FBAO Foreign-body airway obstruction
HCS Hazard Communication Standard
ID Identification
MET Medical Emergency Team
OSHA Occupational Safety and Health Administration
PASS Pull the safety pin, aim low, squeeze the lever, sweep back and forth
RACE Rescue, alarm, confine, extinguish
RRT Rapid Response Team
SDS Safety data sheet

Safety is a basic need. Patients and residents are at great risk for accidents and falls. (See Chapter 14 for falls.) Some accidents and injuries cause death.


The health team must provide for safety. This includes you. Common sense and simple safety measures can prevent most accidents. Sometimes extraordinary measures are needed. You must protect patients, residents, visitors, co-workers, and yourself. The safety measures in this chapter apply to all health care settings and everyday life.


The goal is to decrease the person’s risk of accidents and injuries without limiting mobility and independence. The care plan lists other safety measures for the person. Measures to promote safety must not interfere with the person’s rights (Chapter 2).


See Focus on Surveys: Safety.




A Safe Setting


In a safe setting, a person has little risk of illness or injury. The person’s setting is free of hazards to the extent possible. The person feels safe and secure physically and mentally. The risk for infection, falls, burns, poisoning, and other injuries is low. Temperature and noise levels are comfortable. Smells are pleasant. There is enough room and light to move about safely. The person and the person’s property are safe from fire and intruders. The person is not afraid and has few worries and concerns.


The person must receive the right care and treatment. To protect the person from harm, follow the person’s care plan. Also practice the safety measures in this chapter.


See Teamwork and Time Management: A Safe Setting.




Accident Risk Factors


Some people cannot protect themselves. They present dangers to themselves and others. They rely on others for safety. Certain factors increase the risk of accidents and injuries. Follow the person’s care plan.



Age. Children and older persons are at risk for injuries. See Focus on Children and Older Persons: Accident Risk Factors (Age).


Awareness of surroundings. People need to know their surroundings to protect themselves from injury. Confused and disoriented persons may not understand what is happening to and around them. A coma can occur from illness or injury. Coma is a state of being unaware of one’s setting and being unable to react or respond to people, places, or things.


Agitated and aggressive behaviors. Pain can cause these behaviors. So can confusion, decreased awareness of surroundings, and fear of what may happen.


Vision loss. Persons with poor vision can fall or trip over toys, rugs, equipment, furniture, and cords. Some cannot read container labels. Poisoning can result. Harm can result from taking the wrong drug or the wrong dose.


Hearing loss. Persons with hearing loss have problems hearing the spoken word. They may not hear warning signals or fire alarms. Some cannot hear approaching meal carts, drug carts, stretchers, or wheelchairs. They do not know to move to safety.


Impaired smell and touch. Illness and aging affect smell and touch. The person may not detect smoke or gas odors. Burns are a risk from impaired touch. The person has problems sensing heat and cold. Some people have a decreased sense of pain. They may be unaware of injury. For example, Mrs. Parks does not feel a blister from her shoes. She has poor circulation in her legs and feet. The blister can become a serious wound.


Impaired mobility. Some diseases and injuries affect mobility. A person may know there is danger but cannot move to safety. Some persons cannot walk or propel wheelchairs. Some persons are paralyzed.


Paralysis means loss of muscle function, sensation, or both.


Paraplegia is paralysis in the legs and lower trunk. (Para means beyond. Plegia means paralysis.)


Quadriplegia (tetraplegia) is paralysis in the arms, legs, and trunk. (Quad and tetra mean 4. Plegia means paralysis.)


Hemiplegia is paralysis (plegia) on 1 side (hemi) of the body.


Drugs. Drug side effects may include loss of balance, drowsiness, and lack of coordination. Reduced awareness, confusion, and disorientation may occur. The person may be fearful and uncooperative. Report behavior changes and the person’s complaints to the nurse.



Focus on Children and Older Persons


Accident Risk Factors (Age)







Older Persons


Changes from aging increase the risk for falls and other injuries. Many older persons have decreased strength and move slowly. Some are unsteady. Often balance is affected. These changes prevent quick and sudden movements to avoid dangers and falls. Older persons also are less sensitive to heat and cold. They have poor vision, hearing problems, and a dulled sense of smell. Confusion, poor judgment, memory problems, and disorientation may occur (Chapter 49).


Some persons have dementia. Dementia is the loss of cognitive and social function caused by changes in the brain (Chapter 49). (Cognitive relates to knowledge.) Memory and the ability to think and reason are lost.


Persons with dementia are confused and disoriented. Their awareness of surroundings is reduced. They may not understand what is happening to and around them. Judgment is poor. They no longer know what is safe and what are dangers. They may access closets, cupboards, or other unsafe and unlocked areas. They may eat or drink cleaning products, drugs, or poisons. Accidents and injuries are great risks.



Identifying the Person


Each person has different treatments, therapies, and activity limits. Life and health are threatened from the wrong care.


The person may receive an identification (ID) bracelet when admitted to the agency (Fig. 13-1). The bracelet has the person’s name, room and bed number, birth date, age, doctor, and other identifying information.


image

FIGURE 13-1 ID bracelet.

You use the bracelet to identify the person before giving care. Your assignment sheet states what care to give. To identify the person:



See Focus on Communication: Identifying the Person.


See Focus on Long-Term Care and Home Care: Identifying the Person.


See Promoting Safety and Comfort: Identifying the Person.



Focus on Communication


Identifying the Person



To identify the person, call the person by name. Ask to see the ID bracelet. For example: “Hello, Mr. Hall. May I see your ID bracelet?” Then ask for 2 identifiers. You can say: “Please tell me your full name and birth date.” Compare the identifiers with the information on the ID bracelet and your assignment sheet.


For some persons, identifying themselves is annoying. The person may say: “Do I have to say it again? You know who I am.” Be polite. Explain why you check the person’s identity. You can say: “It is important to check so I give care to the right person. It is for your safety.” Thank the person. Use his or her title and name. For example: “Thank you, Mr. Green.”



Focus on Long-Term Care and Home Care


Identifying the Person






Long-Term Care


Alert and oriented residents may choose not to wear ID bracelets. This is noted on the person’s care plan. Follow center policy and the care plan to identify the person.


Some nursing centers have photo ID systems (Fig. 13-3). The person’s photo is taken on admission. Then it is placed in the person’s medical record. If your center uses such a system, learn to use it safely.




Promoting Safety and Comfort


Identifying the Person






Safety


Always identify the person before starting a task or procedure. Do not identify the person and then leave the room for supplies and equipment. You could go to the wrong room and give care to the wrong person. And the person for whom the care was intended would not receive it. This too could cause harm.


Sometimes ID bracelets are damaged from water, spilled food and fluids, and everyday wear and tear. If you cannot read the information on the ID bracelet, tell the nurse. The nurse can have a new bracelet made.



Comfort


Make sure ID bracelets are not too loose or too tight. You should be able to slide 1 or 2 fingers under a bracelet. If it is too loose or too tight, tell the nurse.



Preventing Burns


Burns are a leading cause of death among children and older persons. Smoking, spilled hot liquids, children playing with matches, barbecue grills, fireplaces, and stoves are common causes. So are electrical items and very hot water (sinks, tubs, showers). The safety measures in Box 13-1 can prevent burns.



Box 13-1


Preventing Burns










Burn severity (Chapter 54) depends on water temperature and length of exposure (Table 13-1). The person’s condition is also a factor.




See Focus on Children and Older Persons: Preventing Burns.



Focus on Children and Older Persons


Preventing Burns






Older Persons


Older persons are at risk for burns. Risk factors include decreased skin thickness, decreased sensitivity to heat, reduced reaction time, decreased mobility, communication problems, confusion, and dementia. Many of the measures in Box 13-1 for children apply to persons who are confused or have dementia.



Preventing Poisoning


A poison is any substance harmful to the body when ingested, inhaled, injected, or absorbed through the skin. If too much is taken, any substance can be poisonous. Poisonings are intentional or unintentional.



Poisoning can cause illness, brain damage, coma, and death. Children and older persons are at risk. Drugs and household products are common poisons. Poisoning in adults may be from carelessness, confusion, or poor vision when reading labels. As a result, a person may take too much of a drug.


Common poisons include:



The measures in Box 13-2 (p. 160) can prevent poisoning.



Box 13-2


Preventing Poisoning



All Ages



Keep harmful products in high, locked areas (Fig. 13-4). Children and confused persons cannot see or reach them.



Use prescription drugs correctly.


Only take prescription drugs prescribed by a licensed health care professional.


Take drugs as prescribed. Do not take larger or more frequent doses. This is especially important for pain-relief drugs.


Do not share or sell prescription drugs.


Keep all drugs in a safe place. Keep them where children cannot reach them.


Read all directions and warning labels. Have good lighting.


Follow all directions.


Keep drugs in their original bottles or containers.


Dispose of unused, no longer needed, and out-dated drugs.


Buy products with child-resistant packaging.


Keep child-resistant caps on all harmful products.


Keep harmful products in their original containers. Do not store them in food containers.


Leave the original label on harmful products (p. 171).


Store personal care items according to agency policy. Soap, mouthwash, lotion, deodorant, and shampoo are examples. These items could cause harm when swallowed.


Use and store harmful products according to the manufacturer’s instructions (p. 171).


Do not sniff chemical containers.


Read all labels carefully before using the product. Have good lighting.


Do not leave harmful products unattended when in use.


Do not mix cleaners or other household products together.


Turn on fans and open windows when using cleaners and other household products.


Point spray nozzles away from your face and other people.


Do not store harmful products near food.


Discard harmful products that are out-dated.


Use safety latches on kitchen, bathroom, utility, garage, basement, and workshop cabinets and drawers.


Discard poisonous household plants. Or place them where persons at risk cannot reach them.


Keep emergency numbers by the phone: Poison Control Center (1-800-222-1222), police, ambulance, hospital, and doctor.


Prevent carbon monoxide poisoning.



See Focus on Long-Term Care and Home Care: Preventing Poisoning.


See Promoting Safety and Comfort: Preventing Poisoning, p. 161.



Focus on Long-Term Care and Home Care


Preventing Poisoning






Home Care


Provide good lighting when patients are taking their drugs. Make sure they read prescription labels correctly and are taking the correct drug and dosage (Chapter 53).


Bathroom medicine cabinets, drawers, and counters are checked for out-dated products and drugs. Also check for such items in kitchens and bedrooms. To safely dispose of out-dated items:






Lead Poisoning


Lead is a metal. When in the body, it affects normal body functions. A very strong poison, it can injure the brain, nervous system, red blood cells, kidneys, liver, teeth, and bones. It can lower intelligence and cause learning and behavior problems. See Box 13-3, p. 162, for the sources of lead poisoning.



Box 13-3


Lead Poisoning





Safety Measures to Prevent Lead Poisoning



Prevent or discourage children from eating, chewing, or sucking on non-food items. They include:


Toys and furniture painted before 1976


Painted toys and decorations made outside the United States


Paint chips


Dirt


Keys


Pewter and lead-based figurines


Fishing sinkers


Other sources of lead as listed in this box


Do not let children play in dirt. Have them play in grassy or sandy areas.


Assist the child with hand-washing before eating, after playing outside, and before going to bed.


Wash toys often.


Rinse pacifiers, baby bottles, and other items that fall to the floor.


Prevent exposure to lead-based plumbing.


Do not use hot tap water for cooking or drinking. Let cold water run for 1 to 2 minutes before drinking water or using it for coffee or cooking. This helps flush the lead out of the plumbing.


Do not use hot tap water to make baby formula.


Prevent exposure to lead-based paint.


Keep children away from paint chips.


Keep children away from dust contaminated with lead paint.


Do not sweep or vacuum lead-based paint dust or paint chips.


Use a wet mop and wet cloths to clean up dust and paint chips.


Use a wet mop and wet cloths to clean furniture, window sills, and dusty surfaces.


Use duct tape to cover peeling or chipping paint. This is only a temporary measure. Peeling and chipping paint must be removed.


Do not bump into walls or furniture that may contain lead-based paint. This prevents dust and paint chips.


Do not open and close windows that have lead-based paint. This prevents dust and paint chips.


Keep the home as dust-free as possible.


Prevent exposure to food contaminated with lead.


Do not use glazed pottery to cook food.


Do not eat foods that are stored or served in glazed pottery.


Do not eat foods that are canned outside the United States.


Do not store wine, alcohol, or vinegar-based salad dressings in lead crystal decanters for long periods. Lead can get into the liquid.


Prevent children from having contact with work or hobby materials that may contain lead. Welding, pottery, home building and repair, and automotive repair products and supplies are examples. So are children’s paint sets and art supplies.


Store lead-based products where children cannot see or reach them.


Take shoes off before entering the home.


Shower and change clothes before contact with children.


Wash and store clothes contaminated with lead separately from others.


Do not let children handle or play with old newspapers, magazines, or comic books. The ink may contain lead.


Lead enters the body through:



Children between the ages of 6 months and 6 years are at risk for lead poisoning. Lead can affect almost every body system. Signs and symptoms are usually gradual in onset. They are not always obvious. See Box 13-3 for signs, symptoms, and safety measures.


See Focus on Long-Term Care and Home Care: Lead Poisoning.



Focus on Long-Term Care and Home Care


Lead Poisoning






Home Care


Household dust is a major source of lead. Window sills and window wells may contain high levels of leaded dust. The Centers for Disease Control and Prevention (CDC) recommends cleaning floors, window sills, window wells, and other surfaces every 2 to 3 weeks. The CDC recommends using a wet mop for floors and wet-wiping other surfaces.


The CDC also recommends keeping windows shut to avoid chipping painted surfaces. To open windows, the CDC suggests opening them from the top.



Carbon Monoxide Poisoning


Carbon monoxide (CO) is a deadly colorless, odorless, and tasteless gas. It is produced by the burning of fuel—gas, oil, kerosene, wood, charcoal (Box 13-4, p. 163). Fuel-burning devices must work properly and must be used correctly. Otherwise, dangerous levels of CO can build up in closed or semi-closed areas. Instead of breathing in oxygen, the person breathes in air filled with CO. Red blood cells pick up CO faster than oxygen. Oxygen does not get into the body. CO can quickly or slowly kill. If not fatal, brain and nervous system damage can result.



Box 13-4


Carbon Monoxide Poisoning





Safety Measures to Prevent Carbon Monoxide Poisoning



Have CO alarms installed in each sleeping area and in rooms with fireplaces. Also install them near furnaces and gas appliances (outside of kitchens, laundry rooms, and so on).


Have vehicle exhaust systems checked regularly.


Have the furnace inspected and repaired before every heating season.


Have chimneys and flues inspected and repaired.


Have fuel-burning appliances checked regularly. See “Sources of Carbon Monoxide: Examples” in this box.


Follow the manufacturer’s instructions when using fuel-burning devices.


Use the correct fuel for fuel-burning devices.


Do not idle a vehicle, lawn mower, snow blower, weed trimmer, or other device in an open or closed area or garage. Fumes can leak into the house.


Have fuel-burning devices, chimneys, and flues checked when people in the same building show signs and symptoms.


Ventilate the room when using a space heater.


If you or others have signs and symptoms:


Open doors and windows.


Turn off appliances.


Leave the home.


Go to an emergency room.


Open doors and windows if you notice gas odors. Turn off appliances and leave the home.


Have gas odors checked by trained professionals.


Do not use a gas stove or oven to heat a home or room. Do not use a gas stove or oven to dry clothing or other items.


Do not use charcoal grills, barbecue grills, and gas camp stoves indoors or in a garage.


Never burn charcoal indoors.


Do not use a generator indoors, in a basement, in a garage, or by a window, door, or vent.

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Apr 13, 2017 | Posted by in NURSING | Comments Off on Safety

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