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Chapter 38: Client Safety
Bonnie M. Wivell, MS, RN, CNS
JCAHO 2010 National Patient
Safety Goals
 Identify patients correctly – 2 identifiers
 Improve staff communication – read back, not using certain
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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
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.
Environmental Safety
 Basic Needs
 Oxygen
 CO2 poisoning
 Nutrition
 Keeping perishable foods fresh
 Temperature and Humidity
 Extreme cold and heat
Physical Hazards
 Fractures are the most serious health
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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
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
Environment Safety Cont’d.
 Pollution
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Air
Land
Water
Noise
 Terrorism
 Bioterrorism
Risks at Developmental Stages
 Infant, Toddler, Preschool: Injuries are the
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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
Individual Risk Factors
 Lifestyle
 Impaired Mobility
 Sensory or communication Impairment
 Lack of Safety Awareness
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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
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Medication errors
Falls
Patient-Inherent Accidents: self-inflicted
Procedure-related Accidents: occur during therapy
Equipment-related Accidents: malfunction, disrepair, or
misuse
Safety and the Nursing Process
 Assess
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Activity and exercise
Medications
History of falls
Home maintenance and safety
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
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
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 patient’s safety.
 Restraint orders must be specific and
time-limited.
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
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
Complications from Restraints
 Skin breakdown
 Constipation
 Pneumonia
 Incontinence
 Urinary retention
 Nerve damage
 Circulatory damage
Other Safety Issues
 Fires
 Poisoning
 Electrical Hazards
 Seizure precautions
 Radiation safety
 Bioterrorist attack
 Bomb threats
Chapter 39: Hygiene
Patient Hygiene
 Oral Care
 Bathing
 Shaving
 Hair care
 Perineal care
 Foot care
 Bed making
 Occupied/unoccupied
Goal
 What is the goal of hygiene in the health
care setting?
a) Moving the patient to a higher level of health
b) Check the box on the nursing
documentation sheet
c) Prevent Infection
d) All of the above
Self-Assessment
 Have you ever
bathed another
adult person?
 Someone not in
your family?
Why is Hygiene Important?
 Personal hygiene affects a patient’s
comfort, safety, and sense of well-being.
 A variety of personal, social, and cultural
factors influence hygiene practices.
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
Factors Cont’d.
 Social practices
 Personal preferences
 Body image
 Socioeconomic status
 Health beliefs and
motivation
 Cultural variables
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?
Critical Evaluation
 What is the ability of the person to care for
themselves?
 Physical disabilities
 Mental disabilities
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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
Types of Baths
 Complete bed bath
 Partial bed bath
 Sponge at the sink
 Tub bath
 Shower
 Bath in a bag
Critical Evaluation
 Are there any cultural issues that need to be
addressed prior to bathing?
 What is your patient’s 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
Critical Evaluation
 Involve patient as much as possible in
bathing decisions
 When
 Where
 Type
 Tub
 Shower
 Bed bath
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
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
Other
 Hair Care: Gather supplies (plastic trough,
towels, shampoo, drainage wash basin)
 Shaving: Check doctor’s orders
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Anticoagulants
 Perineal Care (see page 877)
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Independent
Needs assist
Dependent
 Foot Care (see page 880)
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Do not soak feet of patients with DM and/or vascular
insufficiency
Care of Patient with Sensory Aids
 Glasses/Contacts (pg. 894)
 Dentures (pg. 891)
 Hearing Aids (pg. 895)
 Prosthetic Eyes
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
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