1) Discuss factors that affect people's ability to protect themselves from injury?

Age and Development: older adults have difficulty with movement and diminished sensory-neurologic acuity

Lifestyle:

unsafe work environments

residence in neighborhoods with high crime rates

access to firearms

insufficient income to purchase safety equipment

make necessary repairs

access to illicit drugs

risk taking behaviors

Mobility and Health Status: 

Paralysis; muscle weakness; diminished balance; lack of coordination

sensory-Perceptual Alterations: 

Impaired touch perception; hearing; taste; smell and vision

Cognitive Awareness:

people lacking sleep; unconscious or semiconscious; disoriented people who may not understand where they are or what to do; judgment altered; people who perceive stimuli that doesn't exist

Emotional State:  

Alter the ability to perceive environmental hazards

Ability to communicate:

Clients with aphasia, language barriers, or the ability to read

Safety Awareness: 

Lack of knowledge about unfamiliar equipment, such as oxygen tanks, intravenous tubing and hot packs

Environmental factors:

• Health care setting: medical errors, communication errors or failure to receive evidence based interventions.
• Workplace: machinery, industrial belts and pulleys and chemicals
• Home: flooring and carpets, non skid bath tub or shower surface, handrails, working smoke alarms, knowledge of fire escape routes. Outdoor areas may need ramps. Swimming pools safely secured, adequate lighting, both inside and out
• Community: Adequate street lights, safe water and sewage treatment, regulation of sanitation in food buying and handling, hazard free community.

Page 640-642

2) Describe methods to assess a client's risk for injury

• noting pertinent indicators in the nursing history and physical examination
• using specifically developed risk assessment tools
• evaluating the client's home environment

Page 643

3) Discuss the National Patient Safety Goals

• improve the accuracy of patient identification: use 2 identifiers
• improve effectiveness of communication among caregivers: report critical results of tests and diagnostic procedures in a timely manner
• improve the safety of using medication: label all medications; maintain and communicate accurate patient medication information
• reduce the harm associated with clinical alarm systems

• reduce the risk of health care-associated infections: comply with CDC
• prevent residents from falling
• prevent health care associated ulcers: assess and reassess
• identify patients at risk for suicide

Page 645 box 32-2

4) Identify common potential hazards throughout the life span

• newborns and infants: burns; suffocation or choking; automobile crashes; falls and poisoning
• toddlers: pools; busy streets
• preschoolers: keeping hazards such as matches, medicines and other poisons out of reach, busy streets, pools
• school age children: motor vehicle crashes; drownings; fires; and firearms
• adolescents: sports injuries, car crashes, suicide and homicide
• middle aged adults: car crashes; falls, fires, burns, poisonings and drownings
• older adults: falls; driving; fires; wondering

Page 645-649

5) Plan strategies to maintain safety in the health care setting, home and community, including prevention strategies across the life span for falls, seizures, thermal injury, fires, carbon monoxide and other types of poisoning, suffocation or choking, excessive noise, electrical hazards, firearms, radiation and bioterrorism 

6) explain interventions to prevent falls

• familiarize client with the environment
• teach back how to use call light
• keep call light within reach
• keep personal possessions within reach
• sturdy handrails in bathrooms, rooms and hallway
• keep bed in lowest position with brakes locked
• nonslip, well fitted footwear
• use night lights 
• floor surfaces clean and dry
• keep client area uncluttered

Page 651

7) Discuss implementation of seizure precautions

• introduce self and verify identity
• explain client what you are going to do, why it is necessary and he/she can participate
• perform PPE
• Privacy
• pad the bed, secure blankets around the head, foot and side rails of the bed
• put oral suction in place and test to ensure that it is functioning
• if a seizure occurs stay with the patient and call for assistance. Do NOT restrain the patient

page 655

8)Discuss the use and legal implications of restraints

Restraints are devises used to limit the physical activity of a patient or a part of the body. 

Legal Implications:used to ensure patient immediate physical safety

• seclusion may only be used for the management of violent or self destructive behavior that is an immediate threat to the patients physical safety
• restraint or seclusion may only be used as a last resort
• be the least restrictive
• must be implemented in accordance with safe and appropriate restraint and seclusion technique per policy.
• must be discontinued at the earliest possible time

Page 660

9) Describe alternatives to restraints

• ask family members to stay with patient
• reduce stimulation
• assign nurses in pairs so one nurse can observe the patient when other leaves the unit
• place patient in a closely supervised area
• provide frequent toileting
• monitor medications and if possible attempt to lower or eliminate dosages of sedatives or psychotropics
• position beds at lowest level
• use rocking chairs 
• use wedge pillows or pads against the sides of wheelchairs to keep patients safety positioned
• warm beverage, low lights, back rub or a walk   Page 661

10) List desired outcomes to use in evaluating the selected strategies for injury prevention

11) Verbalize the steps for:

• Using a bed or chair exit safety monitoring device

• Implementing seizure precautions

• Applying restraints

12) Recognize when it is appropriate to delegate using bed or chair exit safety monitoring device, implementing seizure precautions, and applying restraints of clients to unlicensed assistive personnel (UAP)

• bed or chair exit safety monitoring device: risk factors may be recorded by UAP but nurse is the reponsible and UAP may be used if UAP has been trained in their application and monitoring
• implementing seizure precautions: UAP to be familiar with establishing and implementing precautions and methods of obtaining assistance, care of the patient is the responsibility of the nurse due to the importance of careful assessment of resp. status and potential need for intervention
• applying restraints:application of ordered restraints and their temporary removal for skin monitoring and care may be delegated to UAP who have been trained in their use

Pages 653/654/663

13) Demonstrate appropriate documentation and reporting of using a bed or chair exit safety monitoring device, implementing seizure precautions and applying restraints

• bed or chair exit safety monitoring device

• implementing seizure precautions

• applying restraints