Download Restraint Alternative

Safety
Concept: Safety
• Safety is often defined as freedom from
psychological and physical injury. Safety refers
to the prevention of patient injury caused by
health care errors.
• The QSEN safety competency for a nurse is
defined as “Minimizes risk of harm to patients
and providers through both system
effectiveness and individual performance.”
TO ERR IS HUMAN:
BUILDING A SAFER HEALTH SYSTEM
• Health care in the United States is not as safe as it
should be--and can be. At least 44,000 people,
and perhaps as many as 98,000 people, die in
hospitals each year as a result of medical errors
that could have been prevented, according to
estimates from two major studies. Even using the
lower estimate, preventable medical errors in
hospitals exceed attributable deaths to such
feared threats as motor-vehicle wrecks, breast
cancer, and AIDS.
BUILDING A SAFER HEALTH SYSTEM
• Medical errors can be defined as the failure of a
planned action to be completed as intended or
the use of a wrong plan to achieve an aim.
Among the problems that commonly occur
during the course of providing health care are
adverse drug events and improper transfusions,
surgical injuries and wrong-site surgery, suicides,
restraint-related injuries or death, falls, burns,
pressure ulcers, and mistaken patient identities.
• Published Nov. 1999
Patient Identification
• FIRST and best way to identify for the RIGHT patient
is to have them STATE their name and birthday.
• SECOND is to check the name bracelet.
• BOTH of these should be done prior to any patient
contact
• Bar Scan when giving
medications
FALLS
• A patient fall, defined as
a sudden, unintentional
change in position,
coming to rest on the
ground or other lower
level, is among the most
commonly reported
adverse hospital events,
with more than 1
million occurring
annually.
FALLS
• Approximately 30% of
falls result in some type
of injury, and 10% result
in serious injury, such as
head trauma and
fracture. Among older
adults, falls are
especially dangerous
because of their
increased causation of
morbidity and mortality.
Fall Assessment Tools
• Assessment of a patient’s risk factors for
falling is essential in determining specific
needs and developing targeted interventions
to prevent falls.
– Morse Fall Scale: used at Community Hospital
– Hendricks II Fall Risk Scale
– John Hopkins Fall Risk Scale: used at the IU Health
Hospitals
Morse Fall Scale
Item
Scale
Scoring
1. History of falling; immediate or within 3
months
No 0
Yes 25
No 0
Yes 15
______
2. Secondary diagnosis
3. Ambulatory aid
Bed rest/nurse assist
Crutches/cane/walker
Furniture
0
15
30
4. IV/Heparin Lock
No 0
Yes 20
5. Gait/Transferring
Normal/bedrest/immobile
Weak
Impaired
6. Mental status
Oriented to own ability
Forgets limitations
Risk Level
No Risk
MFS Score
0 - 24
Low Risk
25 - 50
High Risk
≥ 51
______
______
______
______
0 10 20
______
0 15
Action
Good Basic Nursing Care
Implement Standard Fall Prevention
Interventions
Implement High Risk Fall Prevention
Interventions
Hendrick II Fall Risk Model
Risk Factor (≥ 5 = High Risk)
Risk Factor
Risk Points
Confusion/disorientation
4
Depression
2
Altered elimination
1
Dizziness/vertigo (subjective)
1
Gender (male)
1
Any prescribed antiepileptics
2
Any prescribed benzodiazepines
1
Get-up-and-go
“Rising from Chair”
Able to rise in single movement
Pushes up, successful in one attempt
Multiple attempts but successful
Unable to rise without assistance
0
1
3
4
Johns Hopkins Fall Risk Assessment
Tool
Complete the Following and Calculate Fall Risk Score
Age (Single-Select)
60-69 years (1 point)
70-79 years (2 points)
≥ 80 years (3 points)
Fall History (Single-Select)
One fall within 6 months before admission (5 points)
Elimination, Bowel and Urine (Single-Select)
Incontinence (2 points)
Urgency or frequency (2 points)
Urgency/frequency and incontinence (4 points)
Medications: Includes PCA/opiates, Anticonvulsants, Antihypertensives, Diuretics,
Hypnotics, Laxatives, Sedatives, and Antipsychotics(Single-Select)
On one high risk drug (3 points)
On two or more high-risk drugs (5 points)
Sedated procedure within last 24 hours (7 points)
Johns Hopkins Fall Risk Assessment
Tool
Complete the Following and Calculate Fall Risk Score
Patient Care Equipment: Any equipment that tethers patient (e.g. IV infusion, chest
tube, indwelling catheters, SCDs, etc.) (Single-Select)
One present (1 point)
Two present (2 points)
Three present (3 points)
Mobility (multi-select, choose all that apply and add points together)
Requires assistance or supervision for mobility, transfer, or ambulation (2
points)
Unsteady gait (2 points)
Visual or auditory or impairment affecting mobility (2 points)
Cognition (Multi-select, choose all that apply and add points together)
Altered awareness of immediate physical environment (1 point)
Impulsive (2 points)
Lack of understanding of one’s physical and cognitive limitations (4 points)
Mod Risk: 6-13 points
High Risk >13 points
Total Points _____
Automatic Fall Risk
FALL RISK FACTOR CATEGORY
Scoring not completed for the following reason(s) ( check any that apply):
Complete paralysis, or completely immobilized. Implement basic safety (low fall
risk) interventions.
Patient has a history of more than one fall within six months before
admission. Implement high fall risk interventions throughout hospitalization.
Patient has experienced a fall during this hospitalization. Implement high fall
risk interventions throughout hospitalization.
Patient is deemed high fall risk per protocol (e.g. seizure precautions).
Implement high fall risk interventions per protocol.
Restraints and Restraint Alternatives
Restraint
Any manual method, physical or mechanical device,
or material or equipment that immobilizes or reduces
the ability of a patient to move his or her arms, legs
or head freely.
Restraint Alternative
Devices or techniques employed to avoid the use of
restraints. Depending on the intent and how it is
used, it can be an alternative or a restraint.
Escalating Progression
• Prevention- Distraction
• Alternative- Covering the line
• Less Restrictive- Self-release lap
belt
• More Restrictive- Lap belt patient
cannot release
Prevention- Environment
•
•
•
•
•
•
Repositioning
Alarms
Sitter at bedside
Low Bed
Decrease stimulation
Swaddling (infants)
Prevention- Diversion Activities
•
•
•
•
•
•
Conversations
Videos
Lego's
Fold Towels
TV Channels
Ambulate
On-going Monitoring
• Patient Comfort
–
–
–
–
Food
Hydration
Toileting
ROM
• Continuation/Discontinuation
– Mental Status
– Cognitive Functioning
– Level of Distress/Agitation
• Patient Safety
–
–
–
–
Vital Signs
Circulation Checks
Skin Integrity
Correct Application
Criteria to Discontinue Restraints
•
•
•
•
•
•
Able to follow directions
Able to participate in care
Able to participate in program
Behavior improves/changes
Lines tubes discontinued
Positive response to medication
intervention