chapter 13 Patient Safety and Restraint alternatives Flashcards by Traci Anderson

accident

An unexpected unintended event

that has the potential to cause bodily injury

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Chemical restraint

any medication that alters a person’s mood or behavior such as a sedative or tranquilizer

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comatose

the state of being in a coma

a state of unconsciousness from which a person cannot be aroused

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entrapment

when a person becomes

trapped in the side rail or

between the side rail and the mattress

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hemiplegia

Paralysis on one side of the body

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incident

an occurence which is considered unusual

undesired

out-of-the-ordinary

disrupts routine for pt or res

the worker

or the facility

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Incident (occurrence) report

a pre printed document that is completed following an accident or incidents involving a patient residence

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paraplegia

paralysis from the waist down

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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

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Restraint alternative

measures taken to avoid the use of chemical or physical restraints

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Tetraplegia (quadriplegia)

paralysis from the neck down

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who defines accident or incident

OBRA

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accident

all accidents are considered incidents

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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

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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

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risk factors

medication

effects of medications like pain meds, sedatives

can affect the ability of a person to be safe regardless of age or other factors

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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

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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

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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

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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

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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

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physical changes of Aging

neurological changes

takes longer to regain balance

change course to avoid running into another person or tripping on an object

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aging

sensory changes

Vision

hearing

taste and

smell decrease make it more difficult for an older person to detect and respond to dangerous situations

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aging

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

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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

lung capacity decreases

feel short of breath risk of Falls

aging

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

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

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

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chapter 13 Patient Safety and Restraint alternatives Flashcards

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