Safety and Infection Control Flashcards
Nursing Responsibilities: a safe and secure environment
- Ensure that staff members are knowlegeable about safety procedures and implement safety actions
- Identify ct at risk for injury and implement measures to protect ct
- Evaluate the client care environment for hazards and remove them
- Verify prescriptions for treatments that could contribute to an accident or injury (e.g., cane, walker, crutches, and equipment such as IV controller devices or feeding pumps).
- Inspect equipment in the client care environment for hazards.
- Remove malfunctioning equipment from the client care area and report the malfunction to the appropriate personnel in accordance with agency procedures.
- Conduct a home safety assessment with the client and family and teach them about hazards in the home.
- Take measures to prevent falls.
Factors that influence client safety
○ Age
○ Developmental level
○ Lifestyle
○ Mental status
○ Health conditions
○ High risk behaviours on the part of the client
Nursing Responsibilities: Preventing Errors
- Follow agency policies and procedures for administering medications and intravenous therapy, for providing other treatments, and for any other interventions related to client care.
- Verify the identity of the client before providing care by using 2 client identifiers.
- Ask the client about allergies or sensitivities (e.g., medications, food, environmental, latex); ensure appropriate intervention and documentation of allergies in accordance with agency policy and procedure.
- Check primary health care providers’ prescriptions for accuracy and appropriateness for the client.
- Always clarify or question a primary health care provider’s prescription with the primary health care provider who wrote it if the prescription is unclear or inaccurate
- If the client questions a primary health care provider’s prescription (e.g., a medication dosage or treatment), clarify the prescription with the primary health care provider.
- When an error is made, the nurse must acknowledge and document it, with the use of the appropriate forms, in accordance with agency policies and procedures.
A hospital nurse transcribing a primary health care provider’s prescriptions for a client is unable to read a prescribed dosage because the primary health care provider’s handwriting is unclear. Which action should the nurse take?
► Call the primary health care provider
► Ask the client about the usual dosage of the medication
► Call the pharmacy to ask about the usual dosage of the prescribed medication
► Contact the nursing supervisor for clarification of the primary health care provider’s prescriptions
► Call the primary health care provider
R- It is the nurse’s responsibility to follow the primary health care provider’s prescriptions unless the nurse believes that a prescription is in error or would cause harm to the client. If the nurse implements a prescription that is inaccurate and causes harm to the client, the nurse is responsible. If a primary health care provider’s prescription is illegible, it is the nurse’s responsibility to clarify the prescription with the primary health care provider. The nurse would contact the nursing supervisor if he or she were unable to make contact with the primary health care provider for any reason, but, because of the unclear handwriting, asking the nursing supervisor for clarification of the primary health care provider’s prescription is not the best action; the primary health care provider must make the prescription clear. Calling the pharmacy to ask about the usual dosage is incorrect, for the same reason; the primary health care provider must make the prescription clear. Asking the client about the usual dosage is incorrect, in part because the primary health care provider may have changed the dosage.
Nursing Responsibilities: Incident Report
- Be aware of the situations that require completion of an incident report.
- Follow specific agency guidelines for documentation.
- Fill out the report completely, accurately, and factually.
- Contact the client’s primary health care provider to report the incident; the primary health care provider will need to complete the incident report and sign the report
- Ensure that the incident report form is not copied or placed in the client’s record and that no reference to completing an incident report form appears in the client’s record.
- Document a complete entry in the client’s record regarding an incident. The incident report is not a substitute for documentation of the event.
- When a client injury occurs or an error in care is made, assess the client frequently.
Nursing Responsibilities: Incident Report
- Be aware of the situations that require completion of an incident report.
- Follow specific agency guidelines for documentation.
- Fill out the report completely, accurately, and factually.
- Contact the client’s primary health care provider to report the incident; the primary health care provider will need to complete the incident report and sign the report
- Ensure that the incident report form is not copied or placed in the client’s record and that no reference to completing an incident report form appears in the client’s record.
- Document a complete entry in the client’s record regarding an incident. The incident report is not a substitute for documentation of the event.
- When a client injury occurs or an error in care is made, assess the client frequently.
Self Check Question 2:
A client has a prescription for an intravenous (IV) infusion of 1000 mL of 0.9% normal saline solution with 10 mEq of potassium chloride at a rate of 100 mL/hr. The nurse obtains an infusion control device with which to administer the prescription and hangs the IV solution at 7 a.m. At 10 a.m. the nurse notes that 500 mL of solution has infused. The nurse assesses the client, checks the infusion rate, obtains a new infusion control device, and contacts the primary health care provider. The primary health care provider prescribes a decrease in the rate of infusion to 50 mL/hr and orders a serum potassium level. The potassium level is 3.5 mEq/L (3.5 mmol/L). Which information should be included on the incident report in regard to this event? Select all that apply.
► The primary health care provider was contacted.
► The serum potassium level at 10:30 a.m. was 3.5 mEq/L (3.5 mmol/L).
► A total of 200 mL of IV fluid was accidentally infused into the client.
► There was 500 mL of solution remaining in the IV bag at 10 a.m.
► The infusion control device malfunctioned causing an excess amount of IV fluid to infuse into the client.
► The primary health care provider was contacted.
► The serum potassium level at 10:30 a.m. was 3.5 mEq/L (3.5 mmol/L).
► There was 500 mL of solution remaining in the IV bag at 10 a.m.
RATIONALE:
The incident report should contain the client’s name, age, and diagnosis. The report should also contain a factual description of the incident, any injuries sustained by those involved, and the outcome of the situation. The nurse avoids the use of subjective data and documents objective data. The nurse also avoids any implication that an accident occurred or that an error was made. The statement that 200 mL of IV fluid was accidentally infused into the client implies that an accident resulted from an error. Likewise, the statement that the infusion control device malfunctioned, causing an excess amount of IV fluid to be infused into the client, poses an implication. The remaining statements identify factual and observable data free of unwanted implications.
Principles of FIRE SAFETY
► Keep open spaces (e.g., hallways) free of clutter.
► Make sure fire exits are clearly marked.
► Know the locations of all fire alarms, exits, and extinguishers.
► Know the telephone number for reporting fires.
► Know the agency’s fire drill and evacuation plans.
► Never use the elevator in the event of a fire.
► Turn off oxygen and appliances in the vicinity of a fire.
► In the event of fire, maintain the respiratory status of a client on life support manually with the use of an Ambu bag (resuscitation bag) until the client can be moved away from the fire.
► Use the RACE mnemonic to set priorities in the event of a fire.
► Use the PASS mnemonic to remember how to use a fire extinguisher.
RACE Mnemonic
R- rescue
A- alarm
C- contain
E- extinguish
PASS
P- pull the pin
A- aim at the base of fire
S- Squeeze handles
S- Sweep nozzle from side to side over fire
A nurse is setting up an intravenous pump that will be used for a client who will be receiving a continuous intravenous infusion of normal saline solution containing heparin. As the nurse prepares to plug the pump’s electrical cord into the wall socket, she notes that no socket is available because of other medical equipment being used in the room. Which action by the nurse is most appropriate?
► Allowing the pump to run in battery mode
► Obtaining an extension cord from the nurses’ lounge
► Moving the client into the hallway, near a wall socket
► Calling the hospital’s electrical department for assistance
► Calling the hospital’s electrical department for assistance
R: The nurse would most appropriately contact the hospital’s electrical department for assistance in safely setting up electrical equipment. Safety-type extension cords are used only if necessary, and although this may be an option, it is not the most appropriate one. Electrical outlets should not be overloaded, because this presents an electrical hazard. The nurse would not allow the pump to run on its battery for an extended period. It is inappropriate to place a client in a hallway. This would constitute an invasion of the client’s privacy.
Nursing Responsibilities: Handling Hazardous and Infectious Materials
► Identify situations that involve the potential for exposure to hazardous or infectious materials (e.g., radiation, infectious wastes, contaminated needles).
► Follow agency protocols for handling biohazardous and infectious materials.
► Ensure that nursing staff understand and follow these protocols.
► Handle all infectious materials as hazards.
► Dispose of waste in designated areas only, using the proper containers for disposal.
► Ensure that infectious material is labeled properly.
► Dispose of all sharps immediately after use in a closed puncture-resistant disposal container that is leak proof and labeled or color coded.
Nursing Responsibilities: INTERNAL RADIATION IMPLANT SAFETY
- Place the client in a private room with a private bath; a caution sign should be placed on the door.
- Organize nursing tasks to minimize exposure to the radiation source.
- Rotate nursing assignments.
- Limit exposure time to 30 minutes per care provider per shift.
- Wear a dosimeter film badge to measure radiation exposure.
- Wear a lead shield to reduce the transmission of radiation.
- Do not allow a pregnant nurse to care for the client.
- Do not allow pregnant women or children younger than 16 years to visit the client.
- Limit visitors to 30 minutes per day and advise them to remain at least 6 feet from the source of radiation.
- Keep all bed linens and dressings in the client’s room until the implant is removed.
- Keep a lead container in the client’s room.
- Do not touch a dislodged radiation source; use long-handled forceps to place the source in the lead container.
Nursing Responsibilities: HOME SAFETY
- Assess the home environment, taking into consideration the client’s condition and limitations; look for fire alarms, adequate lighting, stair and bathroom handrails, and safe appliances.
- Initiate modifications to the client’s home as necessary.
- Teach the client about safety related to the client’s condition and with regard to any equipment that the client is using (e.g., disposal of insulin syringes).
- Teach parents about safety measures for the child; the toddler, the preschooler, and the young school-age child. They must be protected from accidental poisoning.
- Ensure that parents understand car safety (Canadian) and the use of car seats for the infant and child.
- Ensure safety for older adults. Diminished eyesight and impaired memory may result in accidental ingestion of poisonous substances or an overdose of a prescribed medication; a medication organizer will help prevent such errors.
- The phone number for a poison control center should be displayed on the telephone itself; the number should be called in any case of suspected poisoning.
- The nurse needs to provide instructions to laypersons about interventions to take in the event of an accidental poisoning.
A nurse receives a telephone call from her next-door neighbor, who is frantically seeking help because her 3-year-old son has swallowed pills from a bottle of ibuprofen. The neighbor tells the nurse that her teenage daughter takes the pills for menstrual cramps and apparently forgot to put the bottle away before leaving for school this morning. After the nurse rushes to the neighbor’s house, which action should she take first?
► Calling the poison center
► Asking the mother to call an ambulance
► Assessing the child for airway patency and removing any visible material from the child’s mouth
► Asking the neighbor to call the school and ask her daughter how many pills remained in the bottle
► Assessing the child for airway patency and removing any visible material from the child’s mouth
R- In the event of an accidental poisoning, the nurse would first assess airway patency, breathing, and circulation. The nurse would remove any visible material from the child’s mouth and then try to identify the type and amount of substance ingested, because this may help determine the correct antidote. The Poison Control Center is also called, but airway is the priority. If the Poison Control Center says that the child should be taken to an emergency department, an ambulance is called. It may be necessary to contact the daughter at school, but this would not be the first action.
