Safety

• OSHA


  Occupational Safety and Health Administration - Secures safe and healthful working conditions for working individuals
• Body Mechanics


  • Lower back and shoulder injuries common
• OSHA Standards


  • Hazard Communication Standard
  • Bloodborne Pathogens Standard
  • Fire Safety Standard
  • Personal Protective Equipment (PPE)
• Licensure


  For nursing
• Nursing Licensure Agencies


  • National Council of State Boards of Nursing (NCSBN)
  • National Council Licensure Examination (NCLEX)
  • North Carolina State Board of Nursing (NCBON)
• NIOSH


  National Institute for Occupational Safety and Health - Focuses on safety and issues related to health, part of Centers for Disease Control (CDC)
• Hazard Communication Act


  Part of OSHA, provides guidelines to help reduce safety hazards in the workplace, requires hospitals to inform employees about harmful exposures and how to reduce risk

  
• CDC


  Centers for Disease Control and Prevention - Federal agency that provides facilities and services for the investigation, identification, prevention, and control of disease, provides guidelines for working with infected patients
• Agencies under Department of Health and Human Services (DHHS) and U.S. Public Health Service (USPHS)

  • Food and Drug Administration (FDA)
  • Centers for Disease Control and Prevention (CDC)
  • National Institutes of Health (NIH)
  • Health Resources and Services Administration (HSA)
  • Substance Abuse, and Mental Health Administration (SAMHSA)
  • Agency for Healthcare Research and Quality (AHRQ)
  • Agency for Toxic Substance and Disease Registry (ATSDR)
  • Indian Health Services (IHS)
• Standard Precautions


  Not following can lead to transmission of infectious agents between patients and healthcare workers
• Hourly Rounding


  Not just asking if patient needs anything, also address pain, potty/bathroom, positioning, personal items, IV pumps, additional needs, and when you'll be back
• What to do during a safety inspection of the environment

  Check for appropriate signs, ID bands, call bell access, bed position, side rails, medical equipment, medication/IV storage, trip hazards, and handling of soiled linens/hazardous waste
• Environmental Safety Checks in Client's Room

  • Appropriate signs at client's door
  • ID band on client
  • Other armbands as necessary
  • Call bell in reach and client knows how to use it
  • Bed in lowest position, wheels locked
  • Head of bed at safe, ordered, and/or comfortable position
  • Side rails up (never all 4)
  • Appropriate medical equipment available
  • Medications, IV bags, IV tubing properly labeled, stored and lines not tangled
  • Other medical devices stored correctly
  • Trip hazards removed
• Environmental Safety Checks in Hospital/Unit


  • Safe use of cleaning supplies
  • Education on all equipment you're using
  • Process for getting non-functional equipment removed and repaired
  • Prompt clean up of spills
  • Equipment stored properly/not in hallway or walkways
  • Fire safety
  • Knowledge of disaster/emergency procedures
• Precautions/Alerts


  • Fall precautions
  • Seizure precautions
  • Aspiration precautions
  • Log roll precautions
  • Limb alert
  • Suicide precautions
  • Isolation precautions
• Other Safety Buzzwords


  • DNR
  • Allergy
  • SBAR
  • Dual verification
  • Time out
  • Look-alike, sound-alike medications
  • No pass zone
• What interventions are included in fall precautions

  1. Safe environment (clean, clutter free, good lighting, no trip hazards, oxygen, use of brakes, bed in low position)

  2. Conditions that increase fall risk (knee instability, decreased strength, slower movement, medications, low blood pressure, impaired coordination, sight/hearing, cognition)
• What to do during a seizure

  Stay with client, prevent injury, maintain airway, suction as needed, administer medications, note duration/sequence/type of movement/precipitating events, assess LOC/VS and provide comfort in postictal phase

  
• BEFAST for CVA/Stroke


  1. Balance- off balance/dizziness

  2. Eyes- vision changes

  3. Face- drooping

  4. Arms- arm/leg weakness

  5. Speech- difficulty speaking

  6. TIME- notify supervisor/call 911
• Conscious Choking


  Prevent by upright position for meals, small bites; if grabs throat, encourage coughing, call for help, stay with person; if cannot speak/cough, perform Heimlich Maneuver
• Restraints


  Patients have the right to be free from restraints; using restraints should not interfere with other medically necessary interventions or treatments; nurse responsible for knowing applicable laws, regulations, and policies
• Alternatives to Restraints


  • Distractions/diversional activities
  • Calm, quiet environment
  • Toileting schedule
  • Address needs (hydration, food, personal objects)
  • Bed/chair alarms
  • Frequent reorientation to environment and call bell
  • Physical activity or task
  • Move close to nurses' station
• Restraint Orders


  Ordering provider must evaluate the client face-to-face at the time of or, in an emergency, within 1 hour of restraining the client; order may never be PRN; orders for behavioral restraints are good for 4 hours for adults, 2 hours for 9-17 years, 1 hour for under 9; orders for medical purposes are good for 24 hours; new order needed if restraints released and client needs to be restrained again
• Nursing Assessment & Interventions for Restraints


  Apply with quick-release knot/buckle, tied to movable part of bed frame, explain need and behavior for release, assess every 15 minutes, evaluate need, document, release every 2 hours for toileting, hydration, range of motion, skin, circulation, hygiene, body alignment
• Sentinel Event


  Healthcare associated injuries causing death, permanent harm, or severe harm
• No Harm Event


  Patient safety event that reaches the patient but does not cause harm
• Near Miss Event


  Patient safety event that had no impact on a patient but could have if it was not aborted or discovered