Exam 2; Environmental safety Flashcards
safety
freedom from psychological and physical injury—is a paramount concern that underlies all nursing care.
Reducing the risk of harm associated with the delivery of healthcare is a national health care policy priority.
WHO (2021) says safety is the prevention of errors and adverse effects to patients associated with healthcare.
The Joint Commission (TJC) 2021 National Patient Safety Goals include standards to prevent infection, identify patients correctly, and reduce the risk of medical errors.
Environmental Health and Safety
Environmental health and protection refers to protection against environmental factors that may adversely impact human health.
A safe environment meets basic needs, reduces physical hazards, as well as the transmission of pathogens, and controls pollution.
Common Environmental Hazard
Environmental hazards in the home and at work threaten a person’s safety and often results in physical or psychological injury or death.
2016 – Unintentional injuries became the third leading cause of death in the US.
Motor Vehicle Accidents
Poison
Falls
Fire
Disasters
Transmission of Pathogens
Pathogens and parasites are an ongoing threat to an individuals safety
Patients and healthcare providers are at risk for exposure to pathogens
Hospital acquired infection (HAI) – CAUTI, surgical site, CLABSI
Most effective prevention of infection is HANDWASHING (hand hygiene)!
Immunizations – control and prevent disease
Factors Affecting Safety
Developmental considerations
Workplace culture
Lifestyle
Mobility
Sensory perception
Ability to communicate
Economic Resources
Knowledge
Factors Affecting Safety
Developmental considerations
Workplace culture
Lifestyle
Mobility
Sensory perception
Ability to communicate
Economic Resources
Knowledge
Safety Considerations for Neonates
Avoid behaviors that might harm the baby in utero.
Be attentive to the infant; don’t leave alone.
Use crib rails.
Don’t leave pillows, blankets, or bumper pads in the crib as they are a suffocation risk.
Monitor setting for objects that are choking hazards.
Use car seats properly.
Introduce 1 new food per week to easily identify potential food allergies.
Safety Considerations for Infants
Choking
Chocking hazards for children include food, toys and household items.
The danger signs of choking are:
Bluish skin color
Difficulty breathing – ribs and chest pull inward
Loss of consciousness if blockage is not cleared
Inability to cry or make much sound
Weak, ineffective coughing
Soft or high pitched sounds while inhaling.
Prevention:
Parents should always supervise feeding times
Offer foods that are easy to chew and swallow, cut into small pieces and cook till soft
Meal times at a table to prevent running and walking while eating
Offer small amount of food at a time
Encourage children to chew their food thoroughly and to swallow it before talking or laughing
Assess living environment regularly throughout the day for small items or materials the infant might try to place in their mouth
Safety Considerations for Infants:
Anaphylaxis
Prevention:
Avoid the responsible allergen (e.i. food, drug, latex, etc.)
Introduce 1 new food per week.
Only give a small amount of the food and wait for 30 min. to see if signs of allergy arise before giving more.
Treatment:
Keep an adrenaline kit ( e.i. Epipen) and Benadryl on hand at all times.
Medic Alert bracelet should be worn.
Call 911 for ambulance
Stay with the child and assist with breathing difficulty
Encourage parents to take a CPR class
Safety Considerations for Toddlers/Preschoolers
Childproof home environment.
Prevent poisoning.
Be alert to manifestations of child maltreatment or abuse.
Use car seats properly.
Safety Considerations for Toddlers/Preschoolers:
Poisoning
Ingestion of injurious agents:
Cosmetics and personal care products
Cleaning products
Plants
Foreign bodies, toys, and miscellaneous substances
Hydrocarbons (gasoline)
Heavy metal poisoning
Most common is lead ingestion
Mercury toxicity (less frequently)
Act by changing cellular metabolism, causing damage to structures, or disturbing function.
Tend to alter person’s mental status = difficulty obtaining accurate health history.
Need to recognize the toxin and interrupt effects.
Safety Considerations for School-Aged Children
Help to avoid activities that are potentially dangerous.
Provide interventions for safety at home, school, and neighborhood.
Swimming and water safety
Teach bicycle safety: wear a helmet
Teach about child abduction.
Teach about sexual predators
Wear seatbelts.
Safety Considerations for School-Aged Children:
A concussion is an injury to the brain that causes the brain to actually stop working normally for a temporary or permanent time.
Concussions are especially dangerous in young children because they may not be able to tell you how they’re feeling. You’ll need to watch them carefully for any signs and symptoms.
Symptoms:
Headache, vomiting, problems with balance
Fatigue and Sleep disturbances: drowsiness, difficulty falling asleep, sleeping more or less than usual
dazed or stunned appearance
mentally foggy, difficulty concentrating and remembering, confusion, forgets recent activities
irritability, nervousness, very emotional behavior
Safety Considerations for School-Aged Children:
Near-Drowning
Used to describe submersion with at least temporary survival of the victim of asphyxiation.
Asphyxia – insufficient oxygen intake; can cause death.
Symptoms: mild dyspnea, death-like appearance with blue or gray skin color, apnea or tachycardia, hypotension, slow heart rate, cold skin temperatures, dilated pupils, hypothermia, and vomiting.
Safety Considerations for School-Aged Children:Neglect and Abuse
Physical neglect
Deprivation of food, clothing, shelter, supervision, medical care, and education
Emotional neglect
Lack of affection, attention, and emotional nurturance
Emotional abuse—destroy or impair child’s self-esteem
Physical abuse—deliberate infliction of physical injury on a child
Sexual abuse of children - defined as
“the use, persuasion, or coercion of any child to engage in sexually explicit conduct (or any simulation of such conduct) or producing visual depiction of such conduct, or rape, molestation, prostitution, or incest with children”
Safety Considerations for School-Aged Children:Neglect and Abuse
Prevention
Strengthen economic support of families to meet basic needs
Encouraging family friendly work policies
Changing social norms to encourage positive parenting
Provide quality care and education early in life
Enhance parenting skills through education, community support, home visits to promote healthy child development
Intervene to lessen harm and prevent future risk
Safety Considerations for Adolescents
Teach safe driving skills and avoiding distracted driving.
Teach avoidance of tobacco and alcohol.
Teach risk of infection with body piercing and tattoos
Teach about guns and violence.
Discuss dangers associated with the Internet; including human trafficking.
Assess for risk of suicidal thinking.
Safety Considerations for Adolescents:Distracted Driving
Prevention:
Fully focus on driving:
Stow all electronics: no cell phones
Store loose gear and possessions so you don’t feel tempted to reach for them
Finish dressing and grooming at home: no putting on make up and changing clothes while behind the wheel.
Try to avoid eating and driving
If you have passengers, enlist their help so you can focus on driving
Pull off the road to answer a phone call or adjust the radio
If you are drowsy, pull off the road.
Limit the amount of activity happening inside the car
Program navigation/direction before leaving
Safety Considerations for Adolescents:Rape and Sexual Violence
Talk to your teen about sex early. Talk often. Give your child the facts about sex, sexual coercion and assault before they obtain misinformation from peers. Start talking long before your teen begins dating.
It’s never too late to start the conversation. Young women are at the most risk for sexual assault between ages 16-24.
Remember that teens are craving factual information about sex from someone they trust – even if they act like they don’t want to talk to you.
Talk to them when you can both be as attentive as possible. The car may be a great place.
Don’t make it a joke. Rape is not funny – ever. Don’t skirt the issue by sandwiching this message between playful topics. Sexual violence is a serious issue and should be handled that way. If you approach it as a joke, your teen will too.
Use media stories to start the conversation. “What do you think about the case in the news? What are you hearing at school about this? What do you think about it?” It is easier for them to open up about what other people think first. Then you can share your message: “If anyone has ever or anyone ever does hurt you, you can talk to me.”
safety Considerations for Adolescents:Substance Abuse
Individuals who begin using drugs as juveniles are at greater risk of becoming addicted compared to those who begin drug use as an adult due to the immaturity of the teenage brain, particularly of that part of the brain that controls impulses.
The symptoms of drug abuse include tolerance to a substance, withdrawal episodes, using more drugs for longer periods of time, and problems managing life issues due to the use of a drug.
Substances: Tobacco, Alcohol, Marijuana, Cocaine, Narcotics, Mind-altering drugs
Safety Considerations for Adolescents:Substance Abuse
Effects:
Drugs of any kind decreases teens’ ability to pay attention.
Juveniles who use drugs are more likely to have unprotected sex, sex with a stranger, as well as to engage in sexual activity at all.
Substance use can cause or mask other emotional problems, like anxiety, depression, mood swings, or hallucinations. Those illnesses can result in death by suicide or homicide.
Long term damage to multiple body systems can occur.
Prevention:
Clear communication by parents and adults about the negative effects of drugs
Adequate parental supervision
Closely monitor the alcohol and medications kept in the home
Participation in extracurricular activities provides mental distraction and accountability
Safety Considerations for Adolescents:Suicide
Many teens who attempt or die by suicide have a mental health condition.
As a result, they have trouble coping with the stress of being a teen, such as dealing with rejection, failure, breakups and family turmoil. They might also be unable to see that they can turn their lives around — and that suicide is a permanent response, not a solution, to a temporary problem.
Methods
–Firearms
–Hanging
–Overdose
Safety Considerations for Adolescents:Suicide
Ways to Protect your Teen from Suicide:
Address depression or anxiety. Don’t wait for your teen to come to you. If your teen is sad, anxious or appears to be struggling — ask what’s wrong and offer your help.
Pay attention. If your teen is thinking about suicide, he or she is likely displaying warning signs. Listen to what your child is saying and watch how he or she is acting. Never shrug off threats of suicide as teen melodrama.
Discourage isolation. Encourage your teen to spend time with supportive friends and family.
Encourage a healthy lifestyle. Help your teen eat well, exercise and get regular sleep.
Support the treatment plan. If your teen is undergoing treatment for suicidal behavior, remind him or her that it might take time to feel better.
Help your teen follow his or her doctor’s recommendations. Also, encourage your teen to participate in activities that will help him or her rebuild confidence.
Safely store firearms, alcohol and medications. Access to means can play a role if a teen is already suicidal.
Safety Consideration for Adults: Domestic Abuse
Studies indicate that each year, more than 10 million adult men and women in the United States are victims of intimate partner violence (IPV), which involves “physical violence, sexual violence, stalking and psychological aggression (including coercive tactics) by a current or former intimate partner (i.e., spouse, boyfriend/girlfriend, dating partner, or ongoing sexual partner)” .
Safety Consideration for Adults:Domestic Abuse
Safety while living with an abusive partner: remove weapons, keep phone accessible, develop a signal to notify trusted friends and family, teach your children how to get help and how to get out safely, keep the car keys accessible and the car full of gas, do not wear jewelry or scarves that could pose a threat to your safety, keep copies of important documents
Safety planning with children: teach them how to call 911, teach them not to intervene, involve them in the plans for physical safety, teach them IPV is not their fault
Safety planning for pets: stock extra supplies, copy their medical records
Safety planning during pregnancy: recognize the heightened risk, utilize time with your provider to discuss IPV issues, take a women-only prenatal class
Leaving a relationship: keep evidence of abuse, plan with your children, contact a local shelter or other community resource, pack and take essential items, communicate your history and needs to new support systems, protect yourself and avoid the perpetrator after leaving, consider your legal options
Safety Considerations for the Adult:Trauma Injuries
Accidents or unintentional injury were the leading cause of death in the US in 2018 for people age 20-44 (214,000 people/yr in the US) mainly affecting the young and older populations.
Mechanism of injury:
Penetrating, or open injuries, can be caused by any sharp object or by projectiles traveling at high speed.
Blunt, or closed injuries, the skin surface in intact; injury affects surrounding tissues.
Prevention:
Safe driving
Safety in recreational sports: ATV, jet skis, sky diving
Tool safety: lawn mowers, power saws, drills
Avoid violent encounters and situation
Safety Considerations for Older Adults
Prevent falls and accidents.
Orient person to surroundings (avoid falls).
Maintain vehicle in working order, schedule eye exams, and keep noise at a minimum.
Promote safe environment at home (avoid fires).
Use medication trays (avoid poisoning).
Safety Considerations for Older Adults:Falls
Falls are the second leading cause of accidental or unintentional injury deaths worldwide.
Each year an estimated 646 000 individuals die from falls globally of which over 80% are in low- and middle-income countries.
Adults older than 65 years of age suffer the greatest number of fatal falls.
37.3 million falls that are severe enough to require medical attention occur each year.
Prevention strategies should emphasize education, training, creating safer environments, prioritizing fall-related research and establishing effective policies to reduce risk.
Safety Considerations for Older Adults:Falls
Prevention
screening within living environments for risks for falls;
clinical interventions to identify risk factors, such as medication review and modification, treatment of low blood pressure, vitamin D and calcium supplementation, treatment of correctable visual impairment;
home assessment and environmental modification for those with known risk factors or a history of falling;
prescription of appropriate assistive devices to address physical and sensory impairments;
muscle strengthening and balance retraining prescribed by a trained health professional;
community-based group programs which may incorporate fall prevention education and Tai Chi-type exercises or dynamic balance and strength training;
use of hip protectors for those at risk of a hip fracture due to a fall.
Safety Considerations for Older Adults:Cold Injury
Prevention:
Assess home environment for working electrical or gas heat
Encourage them to wear layers of clothes
Ensure they have access to cold weather gear like coats, hats, gloves, scarves, and proper foot attire to keep out the wet and cold.
Check for adequate bedding material
Keep thermostat at 68*F or greater
Consider supplemental or alternative sources of heat
Schedule outdoor activities at the warmest part of the day
Avoid getting wet
Avoid alcohol and sedatives
Safety Considerations for Older Adults:Heat Injury
Hyperthermia results when thermoregulation breaks down because of excessive heat generation, an inability to dissipate heat, overwhelming environmental heat, or a combination of these factors.
Three forms of hyperthermia:
Heat cramps – mildest form, involve painful muscle spasms in the legs or abdomen that occur after strenuous exercise; treat with rest and fluid replacement.
Heat exhaustion – the body loses so much water and electrolytes through heavy sweating that hypovolemia occurs; strain to cardiovascular system; patient is irritable and shows poor judgement; skin cool and clammy; face gray in color; body temperature is from 100.4 to 102.2; vomiting and diarrhea may be present; patient is dizzy and weak; ability to sweat remains.
Heat stroke – altered mental status (confusion or psychosis); inability to sweat; hot, dry, flushed skin; body temperature rises to 106 or higher; can result in death; late complications are seizures, cerebral ischemia, renal failure, late cardiac decompensation, and GI bleeding.
Safety Considerations for Older Adults:Heat Injury
Prevention
Assess home environment for access to cooling measures like air conditioning, fans, open windows, etc.
If home isn’t well air-conditioned, consider spending time in an air-conditioned mall, library, or other cool public place during hot spells
Encourage elderly to avoid exertion or exercise during the hottest part of the day
When outside, wear a hat and loose clothing.
When indoors, remove as much clothing as needed to be comfortable
Take a tepid bath or shower
Use cold wet towels with the heat is extreme
Avoid hot and heavy meals
Avoid alcohol
Educate on warning signs that they are overheating and when to call for emergency help
Safety Considerations Among All Age Groups: Insect Stings or Bites
Culprits: bees, wasps, yellow jackets, hornets, certain ants, scorpions, spiders
Treatment: ice to the site, elevate the affected part, remove stinger by gently scraping it off the skin (don’t use tweezers or forceps because the squeezing the stinger will release more venom into the patient), antivenin for black widow and brown recluse spider bites.
Prevention:
Insect repellant
Remaining aware of environment
Having home treated for any infestation
Safety Considerations Among All Age Groups:Fires
Thanks in part to successful fire injury prevention activities, such as smoke alarm installation and fire safety education, deaths and injuries caused by residential fires have declined over the past several decades. However, many residential fire-related deaths remain preventable and continue to pose a significant public health problem.
Prevention is key
Everyone should have a fire escape plan
Store fire extinguishers, second story rope ladders, and fire blankets in case of emergency
R—Rescue anyone in immediate danger.
A—Activate the fire code and notify appropriate person.
C—Confine the fire by closing doors and windows.
E—Evacuate patients and other people to safe area.
Risks in Healthcare Agencies
Prevention of medical errors and patient safety
Procedure related accidents
Equipment related accidents
Chemical Exposure
Falls
Workplace Safety (Violence)
Sentinel Health Event
Per The Joint Commission, a sentinel event is a patient safety event that reaches a patient and results in any of the following:
Death
Permanent harm
Severe temporary harm
An event is also considered sentinel if it is one of the following:
Suicide of any patient receiving care, treatment, or services in a staffed around the clock care setting or within 72 hours of discharge, including from the organization’s emergency department (ED)
Unanticipated death of a full-term infant
Discharge of an infant to the wrong family
Abduction of any patient receiving care, treatment, or services
Major Regulating Agencies responsible for Environmental and Occupational Health and Safety:
World Health Organization (WHO)
United States Department of Labor: Occupational Safety and Health Administration (OSHA)
The United States Department of Health and Human Sciences
Healthy People 2020
Center for Disease Control: National Center for Environmental Health
The Joint Commission
The Oklahoma State Department of Health (or other state and county health departments)
World Health Organization
WHO is implementing a Global Plan of Action on Workers’ health 2008-2017 endorsed by the World Health Assembly in 2007 with the following objectives:
devising and implementing policy instruments on workers’ health;
protecting and promoting health at the workplace;
improving the performance of and access to occupational health services;
providing and communicating evidence for action and practice; and
incorporating workers’ health into other policies.
United States Department of Labor:Occupational Safety and Health Administration
In 1970, Congress created the Occupational Safety and Health Administration (OSHA)to ensure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance.
Employers shall provide employees with effective information and training on hazardous chemicals in their work area.
Injury and illness prevention programs are systems that can substantially reduce the number and severity of workplace injuries and illnesses while reducing costs to employers.
OSHA insists that employers have emergency plans and provide personal protective equipment for employees.
Department of Health and Human Services:Healthy People 2020 Environmental Health Objectives:
Reduce deaths from work-related injuries
Reduce nonfatal work-related injuries
Reduce sleepiness at work and sleep disturbances caused by shift work
Reduce occupational skin diseases or disorders among full-time workers
Reduce work-related assaults
Increase the proportion of employees who have access to workplace programs that prevent or reduce employee stress
Reduce new cases of work-related, noise-induced hearing loss
Reduce the proportion of persons who have elevated blood lead concentrations from work exposures
Center for Disease Control:National Center for Environmental Health
NCEH protects people’s health from environmental hazards that can be present in the air we breathe, the water we drink, and the world that sustains us. They do this by investigating the relationship between environmental factors and health, developing guidance, and building partnerships to support healthy decision making.
NCEH Goals
Implement environmental health programs and interventions to protect and promote health.
Prepare for and respond to public health emergencies, including chemical, biological, radiological, and nuclear incidents; natural disasters; and extreme weather events.
Identify, characterize, and monitor health outcomes and environmental exposures to guide actions that protect and promote health.
The Joint Commission
The Joint Commission seeks to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. The Joint Commission evaluates and accredits more than 22,000 health care organizations and programs in the United States.
Oklahoma State Department of Health
Work@Health
Employers participating in the Work@Health® Program receive a variety of benefits, including:
A complete health and safety assessment of their organization to define existing needs, interests and the capacity of their worksite for specific health and safety interventions to address those needs
Professional training via a blended delivery model to learn how to develop a worksite health intervention plan to meet individual employer needs
Technical assistance and community support resources aimed at giving employers what they need to sustain the worksite health promotion interventions
The careful monitoring of participants’ progress in implementing their worksite health interventions by professional worksite health trainers and on-going availability of technical assistance
An on-going opportunity to expand their network by linking to and partnering with other employers and organizations with a focus on health in their community
A safer and healthier work environment at the end of the program
Certification and recognition of employer participants as healthy worksites
Healthcare Related Safety Concerns
Use electronic equipment in the health care setting properly and recognize signs of malfunctioning and clearly mark and set away from patient area.
Medication administration errors
Patient’s with same/similar names being treated on the same unit.
Transferring patients: esp. frail, weak, obese, and unconscious patients are high risk.
Changing dressings/lines: increases risk of hospital acquired infections
Prevention of pressure wounds
Applying heat or cold therapy to a patient for prolonged periods of time.
Working in understaffed conditions
Safety Event Reports
Must be completed after any accident or incident in a health care facility that compromises safety
Describes the circumstances of the accident or incident
Details the patient’s response to the examination and treatment of the patient after the incident
Completed by the nurse immediately after the incident
Is not part of the medical record and should not be mentioned in documentation
Disaster Response
A disaster is defined as any event that overwhelms existing personnel, facilities, equipment, and capabilities of a responding agency, institution, or community.
Sources: fire, explosions, floods, storms, earthquakes, tornados, hurricanes, tsunamis, motor vehicle accidents, plane crashes, and acts of terrorism.
Victims of a disaster are called casualties when they are injured.
Triage is sorting casualties for the purpose of assigning priority for care.
Ergonomics
The design of work tasks to best suit the capabilities of workers… the use of mechanical equipment & safety procedures
