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Chapter 38: Client Safety

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Title: Slide 1 Author: Bonnie Last modified by: Bonnie Created Date: 7/13/2010 4:29:14 AM Document presentation format: On-screen Show Company: home – PowerPoint PPT presentation

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Title: Chapter 38: Client Safety


1
Chapter 38 Client Safety
  • Bonnie M. Wivell, MS, RN, CNS

2
JCAHO 2010 National Patient Safety Goals
  • Identify patients correctly 2 identifiers
  • Improve staff communication read back, not
    using certain abbreviations, SBAR
  • Uses medicines safely label, look alike/sound
    alike, blood thinners
  • Prevent infection hand hygiene, NO HAIs
  • Reconcile medications across the continuum of
    care
  • ID patient safety risks suicide
  • Prevent falls
  • Help patients to be involved in their care
  • Watch patients closely for changes in their
    health and respond quickly if they need help
    Rapid response teams
  • Prevent errors in surgery

3
Environmental Safety
  • A safe environment includes meeting basic needs,
    reducing physical hazards, reducing the
    transmission of pathogens, maintaining
    sanitation, and controlling pollution.
  • A safe environment also includes one where the
    threat of attack from biological, chemical, or
    nuclear weapons is prevented or minimized.

4
Environmental Safety
  • Basic Needs
  • Oxygen
  • CO2 poisoning
  • Nutrition
  • Keeping perishable foods fresh
  • Temperature and Humidity
  • Extreme cold and heat

5
Physical Hazards
  • Fractures are the most serious health consequence
    of falls
  • Almost 90 of all fractures among older adults
    are due to falls
  • Lighting
  • Obstacles
  • Bathroom Hazards burns, poisoning, falls
  • Security fire safety, lead poisoning,
    contaminated soil and water

6
Transmission of Pathogens
  • Pathogen any microorganism capable of producing
    an illness
  • Hand hygiene most effective method of limiting
    transmission
  • Immunization resistance to an infectious
    disease is produced or augmented

7
Environment Safety Contd.
  • Pollution
  • Air
  • Land
  • Water
  • Noise
  • Terrorism
  • Bioterrorism

8
Risks at Developmental Stages
  • Infant, Toddler, Preschool Injuries are the
    leading cause of death in children over age 1
  • School aged child Sports injuries
  • Adolescent Risk taking behaviors
  • Adult Lifestyle habits
  • Older Adult Physiological changes result in
    increased risk for falls, burns, MVAs

9
Individual Risk Factors
  • Lifestyle
  • Impaired Mobility
  • Sensory or communication Impairment
  • Lack of Safety Awareness

9
10
Risks in the Health Care Agency
  • 3 Types of medical errors accounted for almost
    60 of the client safety incidents
  • Post-op infections
  • Bed sores
  • Failure to diagnose and treat in time
  • Medication errors
  • Falls
  • Patient-Inherent Accidents self-inflicted
  • Procedure-related Accidents occur during therapy
  • Equipment-related Accidents malfunction,
    disrepair, or misuse

11
Safety and the Nursing Process
  • Assess
  • Activity and exercise
  • Medications
  • History of falls
  • Home maintenance and safety

12
Nursing Diagnosis
  • Risk for injury
  • Related to
  • General weakness
  • Right or Left sided weakness
  • Side effects of medication
  • Poor eyesight
  • As evidenced by
  • Recent falls
  • New CVA
  • Confusion
  • Macular degeneration

13
Implementation
  • Nursing Diagnosis
  • Risk for injury related to (r/t) generalized
    weakness as evidenced by recent falls
  • Goal
  • Pt. will ask for help to the bathroom
  • Pt. will remain free from injury during
    hospitalization
  • Interventions
  • Nurse will ensure call light is in reach
  • Nurse will work with other care providers to make
    sure patient is seen every hour
  • Nurse will work with other care providers to
    ensure pt. receives required assistance with
    ADLs/activities

14
Use of Restraints in the Health Care Setting
  • Physical or chemical means of stopping a patient
    from being free to move.
  • 4 bedrails up is considered a restraint
  • Used only in emergency situations to ensure the
    patients safety.
  • Restraint orders must be specific and
    time-limited.

15
Other Mechanisms to Prevent Falls
  • Tab Alarms
  • Arm Bands
  • ID outside of Patient room
  • Notice Inside the Patient room
  • Colors of gowns, slippers, blankets
  • Bed Alarms
  • Chair Alarms

16
Restraint Use
  • Must have a physician order
  • Order must be rewritten every 24h.
  • Restraint policies are specific to health care
    setting
  • Nursing documentation must occur at least every
    two hours

17
Complications from Restraints
  • Skin breakdown
  • Constipation
  • Pneumonia
  • Incontinence
  • Urinary retention
  • Nerve damage
  • Circulatory damage

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24
Other Safety Issues
  • Fires
  • Poisoning
  • Electrical Hazards
  • Seizure precautions
  • Radiation safety
  • Bioterrorist attack
  • Bomb threats

25
Chapter 39 Hygiene
26
Patient Hygiene
  • Oral Care
  • Bathing
  • Shaving
  • Hair care
  • Perineal care
  • Foot care
  • Bed making
  • Occupied/unoccupied

27
Goal
  • What is the goal of hygiene in the health care
    setting?
  • Moving the patient to a higher level of health
  • Check the box on the nursing documentation sheet
  • Prevent Infection
  • All of the above

28
Self-Assessment
  • Have you ever bathed another adult person?
  • Someone not in your family?

29
Why is Hygiene Important?
  • Personal hygiene affects a patients comfort,
    safety, and sense of well-being.
  • A variety of personal, social, and cultural
    factors influence hygiene practices.

30
Factors Influencing Hygiene
  • Physical Condition
  • Ability to care for self
  • Energy level
  • Sensory deficits
  • Incontinence of urine and/or stool
  • Dexterity and ROM
  • Sedation, Pain level
  • Chronic illnesses
  • Psychiatric conditions

31
Factors Contd.
  • Social practices
  • Personal preferences
  • Body image
  • Socioeconomic status
  • Health beliefs and motivation
  • Cultural variables

32
Assessment
  • Skin wounds, infection
  • Feet and Nails PVD, diabetic patient with foot
    issues, foot fungus around toe nails
  • Patients with poor circulation to the feet and
    lower legs needs close assessment of those areas
  • Oral Cavity condition of the mouth and teeth
  • Hair tangles, lice
  • Eyes, Ears, and Nose Does the patient have any
    sensory deficits?

33
Critical Evaluation
  • What is the ability of the person to care for
    themselves?
  • Physical disabilities
  • Mental disabilities

33
34
Specific Issues Needing to be Addressed at Bath
Time
  • Foot care
  • Normal vs Diabetic
  • Do not soak feet of patients with DM and/or
    vascular insufficiency
  • Sensitive skin
  • Infestations
  • Infections
  • Incontinence

35
Types of Baths
  • Complete bed bath
  • Partial bed bath
  • Sponge at the sink
  • Tub bath
  • Shower
  • Bath in a bag

36
Critical Evaluation
  • Are there any cultural issues that need to be
    addressed prior to bathing?
  • What is your patients developmental status?
  • Teen, Young adult, Adult, Older Adult, Elderly
  • How does that affect their hygiene needs and
    attitudes?
  • What do you do with this information about the
    patient?
  • Care Plan

37
Critical Evaluation
  • Involve patient as much as possible in bathing
    decisions
  • When
  • Where
  • Type
  • Tub
  • Shower
  • Bed bath

38
Nursing Diagnosis
  • BATHING/HYGIENE SELF-CARE DEFICIT R/T CONFUSION
    AEB POOR PERSONAL HYGIENE
  • BATHING/HYGIENE SELF-CARE DEFICIT R/T DECREASED
    CEREBRAL CIRCULATION (RECENT CVA) AEB RIGHT SIDED
    WEAKNESS

39
Oral Care
  • Oral care is an essential nursing intervention
  • Assess for decreased saliva, infection, coated
    tongue, cracked lips
  • Brush all tooth surfaces using a soft bristle
    brush
  • Observe for complications such as bleeding gums
  • Oral care for the patient who is not conscious
  • Oral care for the patient with partial paralysis
    of the mouth
  • Oral care for the patient who has had mouth
    surgery or injury

40
Other
  • Hair Care Gather supplies (plastic trough,
    towels, shampoo, drainage wash basin)
  • Shaving Check doctors orders
  • Anticoagulants
  • Perineal Care (see page 877)
  • Independent
  • Needs assist
  • Dependent
  • Foot Care (see page 880)
  • Do not soak feet of patients with DM and/or
    vascular insufficiency

41
Care of Patient with Sensory Aids
  • Glasses/Contacts (pg. 894)
  • Dentures (pg. 891)
  • Hearing Aids (pg. 895)
  • Prosthetic Eyes

42
Basic Principles
  • Remember body mechanics
  • Raise the bed to a comfortable height
  • Follow medical asepsis when making a bed
  • Wear gloves if linen is soiled
  • Keep linen away from uniform
  • Do not place soiled linen on the floor

43
Bed Making Occupied/Unoccupied
  • Linen
  • Use appropriate linen for the patient
  • Chucks and linen savers
  • Draw sheets
  • Therapy beds
  • Learn to place a bottom flat sheet when there are
    no fitted sheets
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