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Chapter 19
Safety
Bethann Davis , MSN, NP
Quincy College PNU
Fall 2015
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Learning Objectives
• Discuss the purpose of the National Patient Safety goals
and methods
• Give an example of one common injury that
predominates during each developmental stage (Infancy
through older adulthood).
• Name six injuries that result from environmental
hazards.
• Identify at least two methods for reducing latex
sensitization.
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Learning Objectives Continued
• List four areas of responsibility incorporated into most
fire plans.
• Describe the indications for using each class of fire
extinguishers
• Discuss five measures for preventing burns
• Name three common causes of asphyxiation.
• Discuss two methods for preventing drowning.
• Explain why humans are susceptible to electrical chock
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Learning Objectives Continued
• Name at least six common substances associated with
poisonings.
• Discuss four methods for preventing poisonings.
• Discuss the benefits and risks of using physical restraints
• Explain the basis for enacting restraints legislation and
the Joint Commission’s accreditation standards.
• Differentiate between a restraint and a restraint
alternative.
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Learning Objectives Continued
• Give a least four criteria for applying a physical restraint.
• Describe two areas of concern during an accident.
• Explain why older adults are prone to falling.
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National Patient Safety Goals
• Description
• Purpose
• Potential methods for implementation
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Safety
• Major nursing responsibility (Joint
Commission)
• Death from hospital errors: ranked
between 5th – 8th leading cause of death
by National Center for Health Statistics
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Age-Related Safety Factors
• Infants
– Falling off changing tables
– Unrestrained in automobiles
• Toddlers
– Climbing; accidental poisoning; falling
downstairs or from high chairs; burns;
electrocution; drowning
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Age Related Safety Factors (cont’d)
• School-aged children and adolescents
– School-aged children: play-related
injuries
– Adolescents: sports-related injuries
• Adults: ignoring safety issues, fatigue,
sensory changes, effects of disease
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Environmental Hazards
• Latex sensitization
• Thermal burns
• Asphyxiation
• Electrical shock
• Poisoning
• Falls
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Environmental Hazards (cont’d)
• Latex sensitization: allergic response to the
latex proteins
– Latex is natural rubber sap
– Component of many household items
– Predisposition to latex sensitivity
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Environmental Hazards (cont’d)
• Types of latex reactions
– Contact dermatitis
– Immediate hypersensitivity
– Possible cross-reaction to fruits or
vegetables
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Environmental Hazards (cont’d)
• Preparing a latex-free room
– Stock room with latex-free equipment,
including gloves, client care equipment,
and resuscitation equipment
– Wipe room clean of glove powder
– Communicate with other departments the
need to use only latex-free equipment
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Environmental Hazards (cont’d)
• Safeguarding clients and personnel
– Prevent latex sensitization
– If using latex gloves, avoid oil-based
hand creams
– Wash hands thoroughly after removing
gloves
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Question
• Is the following statement true or false?
When using latex gloves, a nurse should use
oil-based hand creams.
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Answer
False.
When using latex gloves a nurse should avoid
the use of oil-based creams.
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Environmental Hazards (cont’d)
• Burns
– Thermal burns or chemical burns
– Burn prevention: exits identified, lighted,
unlocked; ensure functioning sprinkler
system
– Fire plans
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Environmental Hazards (cont’d)
• Burns (cont’d)
– Fire management: RACE
o Rescue
o Alarm
o Contain
o Extinguish
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Environmental Hazards (cont’d)
• Burns (cont’d)
– Roles and responsibilities at and
away from fire’s origin
– Use of fire alarm system
– Agency fire plan concepts
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Environmental Hazards (cont’d)
• Burns (cont’d)
– Rescue and evacuation; proper use of
equipment
– Building compartmentalization for
containing smoke and fire
– Fire extinguishers
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Environmental Hazards (cont’d)
• Burns (cont’d)
– Fire extinguishers
• Class A: wood, paper
• Class B: liquids, grease
• Class C: electrical
• Class ABC: combination
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Evacuation of Clients
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Environmental Hazards (cont’d)
• Asphyxiation
– Airway obstruction
– Carbon monoxide (CO)
o CO binds with hemoglobin
o CO poisoning: symptoms similar to flu,
except for cherry-red skin color
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Environmental Hazards (cont’d)
• Drowning
– Fluid occupies airway, interferes with
ventilation
– Accidental drownings
– Resuscitation
– Immediate CPR
– CPR certification in nurses
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Environmental Hazards (cont’d)
• Electrical shock
– Body prone to electric shock
– Macroshock; microshock
– Grounded equipment reduces electrical
shock potential
– Measures to prevent electrical shock
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Environmental Hazards (cont’d)
• Poisoning
– Caused by ingestion, inhalation, or
absorption of toxic substance
– More common in homes than in health
care institutions
– Accidental poisonings; medication errors
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Environmental Hazards (cont’d)
• Poisoning prevention
– Educate children; teach parents
– Cognitive-impaired adults: use prefilled
medication containers
– American Association of Poison Control
Centers
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Environmental Hazards (cont’d)
• Falls
– Most common accident with the most
serious consequences in older adults
– Contributing factors: visual impairments;
disorders affecting gait, balance, and
coordination; medications to lower blood
pressure
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Environmental Hazards (cont’d)
• Falls (cont’d)
– Contributing factors (cont’d)
o Urinary urgency
o Social, environmental factors
o Accumulation of clutter
o Hospitalization
o Confusion, impaired judgment
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Environmental Hazards (cont’d)
• Assessment
– Determine risk factors
– Fall prevention measures
– Keep emergency numbers near phone
– Daily phone tree
– Personal response services
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Definition
• Restraints are devices or chemicals that restrict
movement. They are used with the intention to subdue a
client’s activity.
• Types include cloth limb restraints, bedrails, chairs with
locking lap trays, and sedative drugs.
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Restraints
• Physical restraints
• Chemical restraints
• Purpose: client or staff safety
• Use of restraints is closely regulated
• Restraints may not be used for disciplinary
reasons
• Last intervention used after all others
exhausted
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Restraints (cont’d)
• Risks of use:
– Increase client confusion
– Cause chronic constipation, incontinence,
infections (pneumonia)
– May cause pressure ulcers
– Experience progressive decline in ability
to perform ADLs independently
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Restraints (cont’d)
• Legislation
– Law incorporated; compliance mandatory
since 1990
• Accreditation standards
– Restraint protocol; medical orders;
monitoring and documentation
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Restraints (cont’d)
• Restraint alternatives: protective or adaptive
devices that promote client safety and
postural support which the client can release
independently
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Nursing Implications
• Recognize safety hazards
• Identify clients at greatest risk for injury
• Identify several nursing diagnoses
• Client safety; allegations of malpractice
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General Gerontologic Considerations
• Number of falls and severity of injury
• Falls rob client of independence
• Well-fitting enclosed shoes, nonskid soles
• Most falls occur in clients 65 years or older,
at home
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General Gerontologic Considerations
(cont’d)
• Factors contributing to falls in older adults:
health conditions; situations such as
environmental hazards, inadequate
lighting, general clutter, assistive devices
• Osteoporosis
• Fear of falling; history of falling
• Cognitive impairment
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