Safety

This is about nursing admissions, transfers, & Discharges.   Information comes from Davis Advantage for Fundamental Nursing Care by Marti Burton and David Smith

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Welcome back to Nursing Together. I am Michelle Hogan, your host, and today we are gonna be talking about something that should be at the center of everything you do as a nurse, safety. And I wanna start today's episode with a statement that I hope stays with you throughout your nursing career safety is at the foremost in your mind when you care for any patient, not only the safety of the patient, but your own safety as well. Think about it for a moment. As a nurse, we are trained to focus on our patients. We ask, "Is my patient safe? Could this patient fall? Could this medication harm my patient? Does my patient need assistance?" But we also have to ask, "Am I safe?" Because an injured nurse cannot safely care for patients, and sometimes the greatest safety risks aren't dramatic. They are small, simple things that we become accustomed to. A cluttered hallway, a patient trying to get up alone, a bed too high, a call light that hasn't been answered, a nurse who is exhausted. Safety is about recognizing those risks before something happens. So let's talk about how you develop that safety mindset. Patients come into the healthcare facility expecting to be protected while they're receiving care. They trust us, but the healthcare environment can also introduce risks. A patient may experience injury or illness because of an appropriate safeguard that wasn't in place, and a nurse faces risks too. Back injuries are the major cause of disability among nurses. Nurses can also be exposed to communal diseases, blood and bloody fluids, chemicals, medications, and radiations. So safety isn't the responsibility of one person. Everyone on the healthcare team has a role, and as an LPN student, you are already becoming a part of that team. You probably have already heard the term national patient safety goals throughout your nursing education. The Joint Commission established national standards addressing specific patient safety concerns. These include correctly identifying a patient, improving communication, using medication safety, using alarms, preventing infections, identifying patient safety risks, and preventing surgical mistakes. Let's focus on one that seems to be incredibly simple: patient identification. Before providing care, patients are identified by using two identifiers. Some examples are the actual patient's name, the date of birth, the medical record number, a photograph, a patient armband. Why two identifiers? Because relying on just one piece of information can contribute to an error. Imagine two patients with similar names. You walk into the room and say, "Are you Mr. Smith?" The patient says yes. You go ahead and send them to surgery. You later discover that there were two Mr. Smiths on the unit. That is why safe nursing requires A deliberate patient identification. Slow down enough to get the basics right. Here's something I want you to understand about your patients. You know the hospital, the room, the call light, and what it looks like. You understand IV tubing, oxygen, and the purpose of a bedside commode, but your patient may understand none of those. The hospital can feel like a maze. Everything seems unfamiliar. And the cords and alarms and equipment might confuse the patient even more. Different people coming in and out can be scary, and the patients are often wearing unfamiliar clothing or footwear. Your patient is trying to navigate an unfamiliar environment while sick, weak, frightened, or medicated. So don't assume that because something that is obvious to you is obvious to your patient. Let's think about the two groups that are super vulnerable, that are children and older adults. Young children may not understand what is happening to them or what is expected of them. Older adults may be... become confused because of cognition impairs, medication, and unfamiliar environment. And an older confused patient might see a tube attached to them and simply think, "I need to get up," or, "Why do I have this tube?" They also are weak and forget to call for help. That is why safety instructions need to be repeated and reinforced. Think about the patient who has just had surgery, and they've been lying in a bed for several days. They stand up, and their legs are weak, their balance isn't good, and there are tubes and there are cords everywhere, and suddenly they're trying to walk. That is a recipe for falls. A patient who are weak, unsteady, and unable to bear full weight should receive assistance when ambulating. Equipment, cords, and tubes become hazardous when combined with impaired mobility Before you actually help someone though, pause. Ask yourself, "Can this patient do this safely? What kind of assistance do I need? Is there equipment that I need?" That pause can prevent injury Next, I also want you to think about communication. Suppose you just tell your patient, "Call me when you get up." Sounds reasonable, right? But what does that "call me" actually mean? Do they yell? Do they use a telephone? Do they press a button? That's why safety instructions need to be specific. Instead of saying, "Call me when you get up," you need to specifically state what you want them to do. "Press this button and tell us that you need to get up," or, "Tell us that you need some help, and someone will come help you." And if your patient doesn't understand English well enough to understand the instructions, use an interpreter. Do not rely on that family member. Safety is important. Communication isn't just about being polite. Communication is a patient safety intervention. Here's another important concept. A patient in pain may make an unsafe decision. Imagine a patient sitting in a chair, and they've been told, "Please call before you get up." The pain increases. They think, "If I could just get back to bed, everything will be okay." So they stand up, and they try to walk, but they fall. Pain causes patients to discard safety precautions. The same thing can also happen when a patient urgently needs to use the restroom. So when a patient repeatedly attempts to get up, don't automatically assume that they're being difficult. Ask, "Why do you try to keep getting up?" Maybe they're in pain. Maybe they need to go to the bathroom. maybe it is because they are confused, and maybe they're just uncomfortable. Understanding the reasons allows you to address the underlying problem Another safety concern that I want us to really look at is answering the call light. A patient may call for help and wait. If the assistance doesn't come promptly, the patient might decide just to do it themselves, which can also lead to a fall. So remember, a call light is not an interruption. It is a request for assistance, and that request may represent a safety issue. A safety issue that can lead to falls. Healthcare facilities use fall risk assessment tools to identify patients who may be at an increased risk. The higher the score on many assessments tool is the greater risk for a patient once a patient is identified as being a risk, additional precautions may be implemented according to the facility policies. But here's a key. A fall risk score is not a supplemental for nursing judgment. You still have to look at the patient. Are they confused? Are they weak? Are they taking medications that are affecting the alertness or balance? Are there cords? Is there a call light? Safety is an ongoing process There are simple strategies you can use. A patient at risk for falls may benefit from a room near the nurse's station. You may need to stay with the patient while they are on a bedside commode. Don't simply say, "Call me when you're finished." If the patient is confused, impulsive, they may wanna stand up without calling. Keep the bed at the lowest appropriate level. Provide regular toileting. Offer fluids or snacks when appropriate. Address pain and nausea. Provide appropriate stimulation or distraction. Use a nightlight when appropriate. Check on high-risk patients frequency. Notice something about these interventions. Many aren't complicated. They are simply intentional. Let's put your nursing judgment to work. Imagine you are walking down the hallway, and you hear a loud thud. You look towards the room, no emergency light is flashing, but you decide to investigate. You enter the bathroom, and you find your patient on the floor. What do you do? Well, first and foremost, you wanna assess that patient for obvious injuries. Look for bleeding, assess for level of consciousness, look for signs of a hip fracture, look for deformities, assess for weakness. Then call for help. Don't simply try to lift this patient up yourself. Next, take vital signs. Why? Because the fall itself may not be the only problem. The patient may have fallen for some underlying cardiac or neurological problem. If the patient is unconscious- has unstable vital signs and isn't breathing or has no pulse, initiate the appropriate emergency response according to the facility policies. A conscious patient should be assisted back to bed with appropriate help and according to the facility policies. Then notify the healthcare provider and document the incident according to the facility requirements. The important lesson here is do not panic. Assess, call for help, stabilize, notify, document. Now let's talk about one of the most understood safety topics, and that is restraints. Restraints should not be your first answer. Try alternatives first. Why? Because being in restraints can be frightening, especially for a confused older adult, younger patients, and patients who do not understand why they are being restricted. Instead of immediately thinking, "Let's go ahead and restrain this patient," ask, "Why is this patient trying to get up?" Or, "What are they trying to pull at?" Or, "Are they confused?" Other things might be they may be in pain, they might be hungry, thirsty, bored, they need to use the bathroom, or they simply might just be frightened. Address the cause whenever possible. If restraints become necessary after all other alternatives have been exhausted, It is necessary for a healthcare provider to order and have specific information that should be included in this order. The principal thing to remember is use the least restrictive interventions necessary to maintain safety, and restraints are never to be used simply because they are convenient for the staff But if you do have to use restraints, once the restraints are applied, the patient requires frequent assessments. Check that patient every thirty minutes and remove the restraints every two hours for appropriate care, including fluids, toileting, repositioning, assessment of circulation, assessment for sensitivity and function, skin assessment, ambulation when appropriate. The patient should be monitored and the care documented according to policy. There's a very important technical point here. When restraints are applied, you should be able to put at least two fingers between the patient's body and the restraint, And restraints are tied using a quick-release knot, so they can be released quickly in an emergency. Always follow your facility's policies and manufacturer instructions. Incorrectly applied restraints can cause serious injury, including choking injuries. So remember, restraints require assessment, monitoring, and accountability. Now imagine that you're in a patient's room and suddenly notice smoke. What do you do? You need to know your facility's fire procedures before a fire occurs. But a very common acronym is RACE. R, rescue. Remove patients from immediate danger. A, alarm. Activate the alarm according to the facility's policies. C, confine. Close the doors and help contain the fire. E, extinguish. Only attempt to extinguish a small fire when appropriate. RACE is something you want to know before that emergency happens. You don't want your first response to this acronym to be when smoke is filling up the hallway. If you are trained and it is appropriate to extinguish a small fire, another acronym to remember is PASS. P, pull the pin. A, aim at the base of the flames. S, squeeze the handle. And S, sweep from side to side at the base of the flames. And remember that different types of fires require different extinguishers. Now let's talk about oxygen. Oxygen itself is an explosive, but oxygen supports combustion. That means a fire can burn faster and hotter when oxygen is present. Therefore, no smoking, no open flames, and be aware of anything that could produce a spark. This applies especially when teaching your patients who are using oxygen at home. Teach them and their families about avoiding smoke, candles, open flames, and other potential ignition sources. Now let's move from an environmental emergency to an individual emergency. Imagine you're walking into a patient's room and you find them unresponsive. What can you do? You need to know, of course, your facility's procedures for activating a code blue. Once the emergency has been activated, begin the appropriate rescue measures within your training and your facility's protocol. Continue the desired response until the team arrives and takes over. And remember something else, the family matters too. During an emergency, the family members may be frightened and overwhelmed. Someone should be available to provide emotional support and help them find a private space when possible. Nursing care does not stop at the bedside. Now let's think bigger. What happens when an emergency isn't one patient? What if there are dozens, hundreds, or even thousands of victims? That is a mass casualty event. Disasters could include such things as hurricanes, tornadoes, floods, fires, buildings collapsing, bombing, earthquakes, et cetera. During a disaster, normal standards of care may have to shift because resources are limited. This is where a disaster triage becomes important. Healthcare organizations may have a plan for responding to these events, and One of your responsibilities is to know the facility's disaster plan and the emergency codes used at that organization now let's bring that focus right back to you. Nurses are exposed to three broad categories of hazards: chemical, physical, biological. Physical hazards can include back injury, joint injuries, repetitive motion injuries, radiation, and laser exposure. Chemical hazards include chemotherapy medications, other hazardous medications, cleaning chemicals. Biological hazards includes the exposure to blood and bodily fluids and infectious organisms. You need to know what hazard exists in your environment, and you need to know how to protect yourself. Now let's talk about something nurses hear repetitively: body mechanics. Your body is designed to move in certain ways. Use your body to your advantage. Plan the task before you start. Raise the bed to a comfortable working height. Keep your feet approximately shoulder-width apart. Avoid twisting. When lifting something from a lower level, bend your knees rather than your back. Keep objects close to your body. And whenever possible, push, pull, or slide rather than lift. And perhaps the most important thing is ask for help when needed. Let's talk about something that nursing students and nurses sometimes underestimate: fatigue. When you're exhausted your ability to think clearly can decrease, your attention can decrease, your reaction time may be affected, and your risk for making errors increase. So when you hear someone say, "I'm exhausted, but I'll be fine," remember that fatigue isn't just about feeling tired. Fatigue can become a patient safety issue. Radiation is another occupational hazard. When caring for patients undergoing procedures involving radiation, appropriate protective measures are necessary. The use of a lead apron during procedures involving X-rays and fluoros. Personnel who regularly work around radiation may also use monitoring badges to measure the accumulative exposure. Patients receiving internal or implanted radiation, exposure time should be limited according to the applicable safety precautions and facility policies. The lesson is know the hazard, know the protection, and use it. Chemicals are everywhere in healthcare, in cleaning products, medications, chemotherapies, disinfectants, and sometimes a chemical that seems harmless can become dangerous if it spills or mixed with another substance. Your facility should maintain a safety data sheet or an SDS for chemical use in their organization Finally, let's talk about one of the most important things that you can do to protect yourself and your patients, hand hygiene. And the basic principle is one you've heard repeatedly. Wash your hands before and after contact. Use gloves when there is a risk of exposure to blood or bodily fluids. And there's another safety issue here, needles and sharps. Needle stick injuries can expose a healthcare worker to a serious infection. Never recap a used needle. Dispose of the needles and other sharps in appropriate puncture-resistant sharp containers. That one action can protect you from potentially life-changing exposures I wanna end with something that is bigger than an individual safety procedure, and that is speaking up. If you see something unsafe, don't ignore it. If you notice a patient trying to get up alone, intervene. If equipment appears damaged, report it. If a coworker appears impaired, follow the appropriate confidential reporting process. If you are unsure how to safely move a patient, ask for help. Being a safe nurse doesn't mean you know everything it means recognizing when you need help and taking actions safety is your responsibility. Be as vigilant about your s- own safety as you are about the safety of your patients. Anticipate potential unsafe situations and take action to prevent them from happening. Thank you for joining me on another episode of Nursing Together. Keep learning, keep observing, keep asking the question, and most of all, never become compliant about safety.