Module 05: Safety Guidelines

Question 1

This is the fundamental concern of nurses which extends from the bedside to the home to the community. This concerns the act of preventing injuries and assisting the injured.

Answer 1

Safety

Question 2

Why should nurses be aware of safety?

Answer 2

Nurses need to be aware of what constitutes a safe environment for a particular individual or for a group of individuals in home and community settings.

Question 3

What are the different factors affecting safety?

Answer 3

(1) Age and Development
(2) Lifestyle
(3) Mobility and Health Status
(4) Sensory and Perceptual
alterations
(5) Emotional State
(6) Cognitive Awareness
(7) Ability to communicate
(8) Safety awareness
(9) Environmental factors

Question 4

Based on the Joint Commission’s 2019 National Patient Safety Guidelines for Hospitals and Nursing Care Centers, what are the different goals?

Answer 4

(1) Goal: Improve the accuracy of patient identification
(2) Goal: Improve the effectiveness of communication among caregivers
(3) Goal: Improve the safety using medications
(4) Goal: Reduce the harm associated with clinical alarm systems
(5) Goal: Reduce the risk of healthcare-associated infections
(6) Goal: Reduce the risk of patient and resident harm resulting from falls
(7) Goal: Prevent healthcare-associated pressure ulcers (Decubitus Ulcers)
(8) Goal: The hospital identifies safety risk inherent in its patient population

Question 5

What falls under the goal: improve accuracy of patient identification?

Answer 5

(1) Use at least two patient identifiers when providing care, treatment, and services. [Hospital and Nursing Care Center]
(a) Note: In the Nursing Care Center, at the first encounter, the requirement for two identifiers is appropriate; thereafter, and in any situation of continuing one-on-one care in which the clinician knows the patient or resident, one identifier can be facial recognition.

(2) Eliminate transfusion errors related to patient misidentification

Question 6

What falls under the goal: improve effectiveness of communication among caregivers?

Answer 6

Report critical results of tests and diagnostic procedures on a timely basis [hospital]

Question 7

What falls under the goal: improve the safety of using medications?

Answer 7

(1) Label all medications, medication containers, and other solutions on and off the sterile field in perioperative and other procedural settings. [Hospital]
(2) Reduce the likelihood of patient harm associated with the use of anticoagulant therapy. [Hospital and Nursing Care Center]
(3) Maintain and communicate accurate patient medication information. [Hospital and Nursing Care Center]

Question 8

What falls under the goal: reduce the harm associated with clinical alarm systems?

Answer 8

Improve the safety of clinical alarm systems

Question 9

What falls under the goal: reduce the risk healthcare-associated infections?

Answer 9

(1) Comply with either the current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines or the current World Health Organization (WHO) hand hygiene guidelines. [Hospital and Nursing Care Center]
(2) Implement evidence-based practices to prevent healthcare- associated infections due to multidrug-resistant organisms in acute care hospitals and in nursing care centers. [Hospital and Nursing Care Center]
(3) Implement evidence-based practices to prevent central line-associated bloodstream infections. [Hospital and Nursing Care Center]
(4) Implement evidence-based practices for preventing surgical site infections. [Hospital]
(5) Implement evidence-based practices to prevent indwelling catheter-associated urinary tract infections (CAUTI). [Hospital and Nursing Care Center]

Question 10

What falls under the goal: reduce risk of patient and resident harm resulting from falls?

Answer 10

Reduce the risk of falls (Nursing Care Center)

Question 11

What falls under the goal: prevent healthcare-associated pressure ulcers (decubitus ulcers)?

Answer 11

Assess and periodically reassess each patient’s and resident’s risk for developing a pressure ulcer and take action to address any identified risk (Nursing Care Center).

Question 12

What falls under goal: the hospital identifies safety risk inherent in its patient population?

Answer 12

(1) Identify patients at risk for suicide (Hospital)
(a) Note: This requirement applies to a psychiatric hospitals and patients being treated for emotional or behavioral disorders in general hospitals.

Question 13

This applies to all surgical and nonsurgical invasive procedures. Hospitals can enhance safety by correctly identifying the patient, the appropriate procedure, and the correct site of procedure.

Answer 13

Universal Protocol for preventing wrong site, wrong procedure, and wrong person surgery (hospitals)

Question 14

What falls under Universal Protocol for preventing wrong site, wrong procedure, and wrong person surgery (hospitals)?

Answer 14

(1) Conduct a preprocedural verification process
(2) Mark the procedure site
(3) A time-out is performed before the procedure

Question 15

What are the different adult safety measures?

Answer 15

(1) Reinforce motor vehicle safety: Drive defensively, use “designated drivers” if alcohol is consumed, routinely check brakes and tires, and use seat and shoulder belts or car seats for all passengers.
(2) Remind the young adult to repair potential fire hazards, such as electric wiring.
Reinforce water safety: Know the depth of a pool or lake before diving; supervise backyard pools and other water activities.
(3) Discuss evaluating the potential for workplace injuries or death when making decisions about a career or occupation. Encourage the young adult to participate actively in programs that reduce occupational hazards.
(4) Discuss avoiding excessive sun radiation by limiting exposure, using sun-blocking agents, and wearing protective clothing. Explain the skin changes that may indicate a cancerous condition.
(5) Encourage young adults who are unable to cope with the pressures, responsibilities, and expectations of adulthood to seek counseling.
(6) Discuss the dangers associated with the internet and social networking.

Question 16

What are the different older adult safety measures?

Answer 16

(1) Encourage the client to have regular vision and hearing tests.
(2) Assist the client to have a home hazard appraisal. Encourage the client to keep as active as possible. Ensure eyeglasses are functional.
(3) Ensure appropriate lighting.
(4) Mark doorways and edges of steps as needed.
(5) Keep the environment tidy and uncluttered.
(6) Set safe limits to activities.
(7) Remove unsafe objects.
(8) Wear shoes or well-fitted slippers with nonskid soles.
(9) Use ambulatory devices as necessary (cane, crutches, walker, braces, wheelchair).
(10) Provide assistance with ambulation as needed.
(11) Monitor gait and balance.
(12) Adapt living arrangements to one floor if necessary.
(13) Encourage exercise and activity as tolerated to maintain muscle strength, joint flexibility, and balance.
(14) Ensure uncluttered environment with securely fastened rugs.
(15) Encourage the client to request assistance.
(16) Keep the bed in the low position.
(17) Install grab bars in the bathroom.
(18) Provide a raised toilet seat.
(19) Instruct the client to rise slowly from a lying to sitting to standing position, and to stand in place for several seconds before walking.
(20) Provide a bedside commode as needed.
(21) Assist with voiding on a frequent and scheduled basis. Encourage the client to summon help.
(22) Monitor activity tolerance.
(23) Attach side rails to the bed.
(24) Keep rails in place when the bed is in the lowest position.
(25) Monitor orientation and alertness status

Question 17

What should be the preventative measures for the risk factor in poor vision?

Answer 17

(1) Ensure eyeglasses are functional.
(2) Ensure appropriate lighting
(3) Mark doorways and edges of steps as needed.
(4) Keep the environment tidy.

Question 18

What should be the preventative measures for the risk factor in cognitive dysfunction (confusion, disorientation, impaired memory or judgement)?

Answer 18

(1) Set safe limits to activities
(2) Remove unsafe objects

Question 19

What should be the preventative measures for the risk factor in impaired gait or balance and difficulty walking because of lower extremity dysfunction (eg arthritis)?

Answer 19

(1) Wear shoes or well-fitted slippers with nonskid soles
(2) Use ambulatory devices necessary (cane, crutches, walker, braces and wheelchair)
(3) Provide assistance with ambulation as needed
(4) Monitor gait and balance
(5) Adapt living arrangements to one floor if necessary
(6) Encourage exercise and activity as tolerates to maintain muscle strength, joint flexibility and balance
(7) Ensure uncluttered environment with securely fastened rugs.

Question 20

What should be the preventative measures for the risk factor in difficulty getting in and out of a chair or in and out of bed?

Answer 20

(1) Encourage client to request assistance
(2) Keep the bed in the low position
(3) Install grab bars in bathroom
(4) Provide a raised toilet seat

Question 21

What should be the preventative measures for the risk factor orthostatic hypotension?

Answer 21

(1) Instruct the client to rise slowly from a lying to sitting to standing position and to stand in place for several seconds before walking

Question 22

What should be the preventative measures for the risk factor urinary frequency or receiving diuretics?

Answer 22

(1) Provide a bedside commode
(2) Assist with voiding on a frequent and scheduled basis

Question 23

What should be the preventative measures for the risk factor weakness from disease process or therapy?

Answer 23

(1) Encourage the client to summon help
(2) Monitor activity tolerance

Question 24

What should be the preventative measures for the risk factor on current medication regimen that includes, sedatives, hypnotics, tranquilizers, narcotic analgesics, and diuretics?

Answer 24

(1) Attach one-quarter to one-half length side rails to the bed if appropriate
(2) Keep the rails in places when the bed is in the lowest position
(3) Monitor orientation and alertness status
(4) Discuss how alcohol contributes to fall-related injuries
(5) Encourage client not to mix alcohol and medications and to avoid alcohol when necessary
(6) Encourage annual or more frequent review of all medications prescribed.

Question 25

What are the practice guidelines in healthcare agencies?

Answer 25

(1) On admission, orient clients to their surroundings and explain the call system.
(2) Carefully assess the client’s ability to ambulate and transfer. Provide nonskid footwear, walking aids, and assistance as required.
(3) Closely supervise the clients at risk for falls, especially at night. Implement hourly rounding and toileting schedule, as needed.
(4) Encourage the client to use the call light to request assistance. Ensure that the light is within easy reach.
(5) Place bedside tables and overbed tables near the bed or chair so that clients do not overreach and consequently lose their balance.
(6) Always keep hospital beds in the low position and wheels locked when not providing care so that clients can move in or out of bed easily.
(7) Encourage clients to use grab bars mounted in toilet and bathing areas and railings along corridors.
(8) Make sure nonskid bath mats are available in tubs and showers.
(9) Keep the environment tidy; keep light cords from underfoot and furniture out of the way.
(10) Use individualized interventions (e.g., alarm sensitive to client position) rather than side rails for confused clients.
(11) Use mechanical or electronic ceiling lifts to transfer dependent clients.
(12) Assess for medication side effects (e.g., sedation, dizziness, lightheadedness, unsteadiness) and develop appropriate management plan

Question 26

This is a single temporary event that consists of uncontrolled electrical neuronal discharge of the brain that interrupts normal brain function

Answer 26

Seizure

Question 27

What are the two (2) categories of seizures?

Answer 27

(1) Partial
(2) Generalized

Question 28

This seizure involve electrical discharges from one area of the brain.

Answer 28

Partial or focal seizure

Question 29

This seizure affects the whole brain.

Answer 29

Generalized seizure

Question 30

Who are the patients at risk for seizure precautions?

Answer 30

(1) Pad the bed of any client who might have a seizure. Secure blankets or other linens around the head, foot, and side rails of the bed
(2) Put oral suction equipment in place and test to ensure that it is functional.

Question 31

What are the eleven (11) seizure precautions for patients actively seizing?

Answer 31

(1) Remain with the client and call for assistance. Do not restrain the client.
(2) If the client is not in bed, assist the client to the floor and protect the client’s head by holding it in your lap or on a pillow. Loosen any clothing around the neck and chest.
(3) Turn the client to a lateral position if possible. This may not be possible during the seizure but is required after the seizure.
(4) Move items in the environment to ensure the client does not experience an injury.
(5) Do not insert anything into the client’s mouth.
(6) Time the seizure duration.
(7) Observe the progression of the seizure, noting the sequence and type of limb involvement. Observe skin color. When the seizure allows, assess pulse, respirations, and oxygen saturation.
(8) Apply gloves and use equipment to suction the oral airway if the client vomits or has excessive oral secretions.
(9) Apply oxygen to the client via mask or nasal cannula.
(10) Administer anticonvulsant medications, as ordered.
(11) When the seizure has subsided, assist client to a comfortable position. Reorient. Explain what happened. Reassure the client. Provide hygiene as necessary. Allow the client to verbalize feelings about the seizure.

Question 32

These are devices used to reduce or prevent physical activity of a client or a part of the body when the client is unable to remove the device.

Answer 32

Restraints

Question 33

What should be considered when restraining clients?

Answer 33

(1) All patients have the right to be free from restraint or seclusion, of any form, imposed as a means of coercion, discipline, convenience, or retaliation by staff. Restraint or seclusion may only be imposed to ensure the immediate physical safety of the patient, a staff member, or others and must be discontinued at the earliest possible time
(2) Restraints should not be considered a part of routine client care and should not be included in a fall prevention program. A request from a family member to apply a restraint is not sufficient cause to apply a restraint.

Question 34

This type of restraint pertains to the use of an intervention or device that hinders the client from moving or restricts the individual from contact with his or her body.

Answer 34

Physical Restraint

Question 35

This type of restraint pertains to the use of medication to control behavior or to restrict the client’s freedom of movement and is not a standard treatment for the client’s medical or psychologic condition.

Answer 35

Chemical Restraint

Question 36

This type of restraint pertains to the involuntary confinement of a client alone in a room or area from which the client is physically prevented from leaving.

Answer 36

Seclusion Restraint

Question 37

What is the criteria for selecting restraints?

Answer 37

(1) It restricts the client’s movement as little as possible. If a client needs to have one arm restrained, do not restrain the entire body.
(2) It is safe for the client. Choose a restraint with which the client cannot self-inflict injury
(3) It does not interfere with the client’s treatment or health problem. If a client has poor blood circulation to the hands, apply a restraint that will not aggravate that circulatory problem.
(4) It is readily changeable. Restraints need to be changed frequently, especially if they become soiled. Keeping other guidelines in mind, choose a restraint that can be changed with minimal disturbance to the client.
(5) It is as discreet as possible. Both clients and visitors are often embarrassed by a restraint, even though they understand why it is being used. The less obvious the restraint, the more comfortable people feel.