chapter 13 Patient Safety and Restraint alternatives Flashcards
accident
An unexpected unintended event
that has the potential to cause bodily injury
Chemical restraint
any medication that alters a person’s mood or behavior such as a sedative or tranquilizer
comatose
the state of being in a coma
a state of unconsciousness from which a person cannot be aroused
entrapment
when a person becomes
trapped in the side rail or
between the side rail and the mattress
hemiplegia
Paralysis on one side of the body
incident
an occurence which is considered unusual
undesired
out-of-the-ordinary
disrupts routine for pt or res
the worker
or the facility
Incident (occurrence) report
a pre printed document that is completed following an accident or incidents involving a patient residence
paraplegia
paralysis from the waist down
Physical restraint
any device that is attached to or near person’s body
to limit a person’s freedom of movement
or access to his or her body
Restraint alternative
measures taken to avoid the use of chemical or physical restraints
Tetraplegia (quadriplegia)
paralysis from the neck down
who defines accident or incident
OBRA
accident
all accidents are considered incidents
incident
occurrence that is considered unusual undesired or out of the ordinary disrupts the normal routine for the patient or the residents of health facility or both
example resident wanders away from long-term Health Care Facility
accidents and incidents can involve patients residents staff and visitors not all incidents are accidents
Example resident hits another Resident because angry
risk factors
Age
Infants and young children high risk
- Helpless
- prone to Suffocation
- and falls
- lack knowledge of things that are dangerous
- risk for injury such as Falls
- Burns
- poisoning and drowning
Elderly recognize danger but may not have the physical or mental ability to move out of the way
risk factors
medication
medication
effects of medications like pain meds, sedatives
can affect the ability of a person to be safe regardless of age or other factors
risk factors
paralysis
Paralysis
may not be able to sense pain heat or cold in areas inability to move properly increases risk for falling
lack of sensation increases risk for injuries like burn
risk factors
poor mobility
Poor Mobility
inability to move easily risk for falling pain and
stiffness makes it difficult for a person to get around easily
affects the old but also other people
for example knee surgery
risk factors
sensory impairment
poor vision
increases the risk of Falls
especially stairs or over objects on the floor
bifocals misjudged distance and stepping off curves
increase chances of accidental poisoning for medications
if you can’t clearly read hearing may not be able to hear danger approaching- cars, carbon monoxide Touch and smell (diabetes)
Bathwater too hot
Unaware shoes causing blisters
Smell, may eat spoiled food
risk factors
limited awareness of surroundings
Limited awareness of surroundings
Confusion,
disorientation from meds,
head injury, dementia etc
Change in evnvironment,
forgetting to put on glasses
Forget to call for help
obra concerns for safety
facility maintains environment that lowers the risk of accidents and incidents to the greatest extent possible
all residents receive supervision and assistance needed to prevent accidents and incidents from occurring
physical changes of Aging
neurological changes
neurological changes
takes longer to regain balance
change course to avoid running into another person or tripping on an object
aging
sensory changes
sensory changes
Vision
hearing
taste and
smell decrease make it more difficult for an older person to detect and respond to dangerous situations
aging
urinary changes
urinary changes
amount of urine the bladder one is able to hold before the person feels the urge to urinate decreases with age leading to urinary frequency,
Rushing to the bathroom or failing to take safety measures such as a walker increases risk
aging
muscoskeletal
musculoskeletal changes
loss of muscle tissue equals weaker more fatigued during physical activity
increase risk of accidents such as falling
aging
respiratory changes
respiratory changes
lung capacity decreases
feel short of breath risk of Falls
aging
skin changes
skin changes
bruises and tears
effects of medical conditions on treatments
most of chronic health conditions treatment increase risk for accidents or incidents
example arthritis affects mobility for the person
at risk for falling
neurologic disorders stroke Parkinson’s leads people to shuffle increase risk for tripping
irregular heartbeat can suddenly lose Consciousness and fall
incontinence slip and fall on the floor
blood pressure meds can make you dizzy
environmental conditions
Change in living environment can cause new Resident become confused or disoriented
many residents in same roof will need different levels of supervision in very busy places environment where accidents environmental hazards like clutter slippery services for lighting and sun glare effect resident safety
avoiding accidents and incidents
take the extra step to help ensure the safety of those you care for
treat people like you would want your own family members treated
preventing Fall
leading cause of non-fatal and fatal injuries in the US
leading cause of accidental death among the elderly
Falls are the most common cause of
- functional decline
- hospital admission
- emotional trauma and
- placement in nursing facility
most common type of accident that occurs in the healthcare setting
Joint Commission requires
hospitals to evaluate each new patient or resident for risk factors that increase person’s risk for Falls
centers for Medicare and Medicaid services
says Falls are never events
as in they should never occur
measures that can be taken to prevent Falls are included in person’s nursing care plan
preventing Burns
tub or shower check water temperature first (105 degrees Fahrenheit)
bath measure the temperature of the water in the basin can’t be hotter than bathtub or shower (110f)
teach patient to bathe themselves to check water temperature with a thermometer, hand, or wrist
for getting in the bathtub or shower use extra care with heat applications
warn people that food or beverages hot
some people may need a cup with a lid for their coffee or tea
guidelines for electrical appliances
Entrapment
Entrapment occurs when a person becomes trapped in the side rail or between the side rail in the mattress severe injury or death can occur especially if head, neck or chest become trapped
risks of entrapment
anytime side rails are used
confused ie meds for dementia
lack of muscle control someone who is small has uncontrolled body movement
mattresses that don’t fit the bed frame
lower the risk of entrapment
check frequently use devices designed to reduce the risk of entrapment if ordered
preventing accidental poisonings
elderly at risk due to poor eyesight
confusion
sense of smell and taste
take too much or wrong medication
might forget he took medication already that day
minimize accidental poisonings
don’t store cleaners or chemicals in containers meant for food or beverages
keep chemicals and cleaners locked
make sure contents of containers are clearly marked on the other side
provide help when reading labels as necessary
how to report accidents and incidents
Immediately report to nurse
written iincident report sometimes called Safety event report
straightforward factual Manor
no opinion no blame
used by quality assurance Department for follow up
Why do healthcare workers hesitate to report
feel responsible
don’t want to be blamed
don’t want co-worker to be blamed
restraints
refer to as reminder devices
and some facilities use to keep people safe
use to restrict a person’s freedom of movement
or to prevent a person from reaching parts of his body
maybe used for agitated disoriented patient who continually tries to remove an IV from arm
when is the device is not considered a restraint
when person has the ability to undo
it seat belt in a wheelchair is not a restraint if the person can unfasten it
physical restraint
device attached to or near a person’s body to limit a person’s freedom of movement her access to her body can be applied two parts of the body such as wrist ankles
not permitting a person free access to other rooms are parts of the facility is considered a form of physical restraint
chemical restraint
chemical restraint
any medication that alters a person’s mood or behavior such as a sedative or tranquilizer
fine line between medications to help calm and for convenience medications assist in the control of anxiety not to make person sleepy or unable to function
use of restraints
never as punishment
never for staff convenience
are used to provide postural support
to protect patient from harm
to protect staff from harm
only used when other methods have failed
and person is considered to be a danger to herself and others if restraints are not applied
examples of situations where restraints might be appropriate
person attempts to remove or pull tubing necessary for medical treatment
demonstrating combative behavior that poses a serious threat welfare and safety of themselves other patients residents
person who is overdose on alcohol or medication and is demonstrating combative Behavior
or is on suicide precautions
obra/ Joint Commission FDA
address a person’s right to be free from physical and chemical restraints
false imprisonment
OBRA - improper use of restraints can be considered holding a person against his or her will or false imprisonment
assessment for needed restraints
prove less restrictive measures have been tried and unsuccessful
and meeting person’s needs consider risks and benefits benefits must outweigh the risks
restraint policies
every facility has policies and procedures you must follow them
complications associated with restraint use
a person who is restrained eight times more likely to die than a person who is not restrained
Strangulation
bruises
nerve damage
skin abrasions
permanent tissue damage
broken bones
other serious injuries
physical restraints do not prevent Falls
restrain too long incontinence
if not brought to the bathroom regularly loss of independence with decreased Mobility leads to decrease in bone and muscle strength
Mental effects associated with use can be serious and include agitation and confusion humiliation and embarrassment and depression
restraint alternatives
provide an environment which person feel safe and secure
confused person close to nurses station
take time to talk to the person
soft music television or other entertainment can be calming
frequent attention to person’s physical needs
take the person to the bathroom
offer drinks and snacks
assist person with walking or change her position frequently
call lights explain procedures and reassure the person get help from family members volunteers or other residents
use restraint measures that are less restrictive pressure sensitive alarm systems
postural support
bed control bolsters instead of side rails
motion and pressure detection
only work as restraint Alternatives if caregivers respond to the alarms in a timely manner
applying restraints
only doctors can order restraint for patient
always follow facilities policies regarding the application use of restraints in order to protect yourself your facility and your patient usually RN or LPN
check on person every 15 minutes help with repositioning meeting needs toileting need
restraints must come off every 2 hours
remember to meet emotional as well as physical needs
observe the person’s response to the restraint and Report any signs of trouble for the nurse immediately all knots are quick release knots
applying a vest restraint
going to a person’s chest to protect the person from falling out of bed or a chair arms are placed armholes straps of the vests are crossed over each other across the chest never put on backward with the back of the vest on the person’s chest in the flats across her back this can cause person to strangle is slides down against him properly Place restraint because the back of the s restraint higher than the front jacket restraint is like a vest restraint but has sleeves and closes in the back
wrist and Ankle restraints
doctor May specify the number of extremities that are to be restrained
made person in bed maybe to prevent a person from removing tubes and catheters
mitt restraint
Mitten like variation of a wrist restraint restricts finger movement
prevents the person from grasping tubes are catheters that allows for more freedom of our movement
lap or waist belt restraints
lap or waist belt restraints
used to prevent a person from sliding out of a chair waist restraint secures person to a chair bed
when to tell the nurse
immediately
if restrained person complains or shows any signs of shortness of breath
or difficulty breathing and her foot beyond the restraint is pale blue or cold skin beneath the restraint devices red blistered broken or bruised restrained person has become more confused disoriented for agitated
