that this is part two of the information for module 8 or patient safety and we're going to look at some specific situations where we focus on safety so again on your reading guide the content is reading content is going to be coming from um the nursing fundamentals text again still from chapter fives in this case 5.6 5.7 5.9 there's also some links to um some sites on the internet where I want you to go and look at just look at some of the background information or supporting information so there's some fall facts from the CDC the Morse fall Co fall scale that is part of the slides and you can take a closer look at that again just to become familiar with and then at the bottom of looking body mechanics I would ask that you views the a safe patient handling and Mobility video um use the link to that get an idea of why are we concerned what's the importance of that topic so the first time we want to look at are falls falls are important they're not a just a concern about people being uncoordinating fall Falls um are potentially dangerous so looking at the stats here there's estimated by 2030 we are going to be experiencing seven fall deaths every hour based on the current trend and this is looking at fall death rates for our older individuals in our in our culture so from 2007 to 2016 we had a 30 increase and again if it continues that rate and we're going to hit that Mark of seven deaths related to Falls every hour on average by time we get to the end of this decade there's a number of risk factors that we can identify and generally we're looking at older adults that can affect any adults but as you look through the list you're going to know some of them are physiological issues so when we go back to Maslow we're looking at basic physiological needs we're looking at a lower body weakness that may come with age so we have a strength issue there we've got vision problem sensory problems the foot pain um maybe as a result of disease like diabetes or it may be from a safety issue of just not having proper Footwear in those cases you can also look at some of the risk factors or things that are involved with just the process of giving health care so when we look at medication safety or the risks of medication that can cause safety issues medications can become a risk factor for Falls and we also even look at things like environmental hazards when we're looking at a home situation in home care or Home Health we look at individual or environmental hazards around the house we also want to have that same focus when we're looking at our institutions where we're providing care whether it's hospital or Extended Care are we making sure that we're addressing environmental hazards so any of these types of things these kind of factors can increase the potential for an individual falling and as a result of the Fall either having a serious disability through fractures other damage or potentially death for some sort of basically the worst case scenario so in one of our the components of our nursing process is during the assessment phase um particularly when we're dealing working within an Institutional setting is to do a fall risk assessment the example in the text is the Morse fall scale your institutions that you go to for clinicals and that you're eventually work in will have their own scale they may modify Morse they may use another source but it will be part of usually your admission assessment when we talked about that that really broad cover all the basis type assessments they're going to be an area focused on fall risk and if an individual shows any indications of being a risk or having any of the risk factors an ongoing assessment is going to be part of your daily assessments um such as your shift assessments to make sure that we're paying close attention to those issues that may result in Fall so some of the things that go into the assessment is the patient history history of Falls is there coordination is just what medications are on that maybe is something that we need to adjust throughout a hospital stay we may introduce medications that makes moves the patient into being a fall risk category incontinence we need to be aware that patients aren't able to get to the bathroom or to commode whatever approach we need to use they're going to be probably want to try to get up when they feel the urge to urinate or defecate and if we have restrictions on them or anything that makes it hard for them for to become incontinent that creates an unsafe environment water urine on the floor becomes a fall risk of real high risk of sliding slipping equipment is also something under our control so equipment can be oxygen tubing if a patient's on oxygen the facts we have them Tethered to the wall with that if they go to get up we've created a risk for them if they are getting intravenous fluids so they're they have IV tubing attached to pull again as soon as they get up they have to maneuver not just themselves but they have to maneuver the pole all the equipment so equipment can be an issue so again as we look through fall risk it's all those things of both the individual condition abilities or disabilities or impairments as well as the environmental issues so we're looking at all this kind of risk factors assessing are they present and as any of them are present then we're going to make sure we are paying close attention and doing everything we can to ensure the patient does not experience a fall so the way we go about that process then is by instituting Fall precautions in this listing from the text these are Universal so where the patient has been rated as a high fall risk or not so there's a fall risk these are steps we can do with all of our patients to help keep their risk or fall down so again as you look through um it's simple things making sure they have a call light so if they're having trouble getting up there not getting up by themselves or calling for help to make sure they have assistance we make sure that the environment is clear we don't have things chairs tables anything between from where they're at and where they want to get that's going to cause problems for them um so again just look through this list of precautions uh whether a patient has been identified as a fall risk or not there are precautions that we can and need to have in place to protect our patients from falls again if they are an identifiable fall risk these become very critical to make sure we're following with any of our patients though being in an unfamiliar environment if they're in a hospital or if they're in an Extended Care Facility and have just come into that area and are not still getting used to it they are at risk for fall because of environmental issues so again these Universal fall precautions are things we're going to want to do with all of our patients and to decrease that risk for Falls happening that result in injury so as you look through some of them are environmental some of them are equipment related um they all seem very straightforward and very appropriate very logical sort of Common Sense thing but the common sense things are the things that often get missed so again familiarity familiarize yourself with this list of precautions that are Universal we would use them for all patients and you're going to be responsible for those as you go move into your clinical settings and then later into the workforce to make sure you're paying attention to these areas when we did comp when you do competencies the closing part of competencies that gets into our professionalism is going to be the issue or the observation or the verbalization that you're going to lower the bed to the lowest position you're going to have side rails up when appropriate to help or you're going to not have side drills up when they're considered to be a contributor to fall risk or other issues we're going to make sure patients have their call lights available so if they need assistance they call for residents and try and get up by themselves increasing their risk for a fall so again spend some time with universal fall precautions and um develop an awareness of them the next thing you want to look at are restraints restraints generally are used with Restless patients usually used with safety in mind but we need to be aware that even though we're in our thoughts we're using them to make the patient more safe we may be creating more issues for them there are various types of restraints the three main categories we think of are the physical or mechanical restraint these would be the wrist tie down straps or leather restraints basically to mobilize the patient or keep them confined to the chair or the bed we can also however chemically restrain patients that's using patient medications to sedate them so they just don't have the awareness or the level of energy necessary to get up and move around that is a restraint sometimes it's appropriate for their medical condition and we just incidentally have this restraint aspect but there are times we'll use them intentionally to restrain a Restless patient and then in some situations for confused Restless patients there may be uh does a desire or a step to seclude them to put them in a room and make it so they can't get out so at least we know where they're at again usually the providers and nurses reason for applying restraints can be described from a safety concern um but because of the restrictions it puts on the patient's ability to move because the psychological stress it puts on restraints often become a major risk factor deaths have happened because of misuse of restraints from the American Nurse Association the ideal is that restraints would not be used that would be the best practice is to avoid the use of restraints at all times however there are certain con certain situations where restraints are necessary for the patient's safety and safety of possibly of the staff depending on the type of restraints and the needs in those cases then a a has outlined specific guidelines if a patient is being restrained we need to practice and properly document what the need for the restraints were that we're assessing them we're implementing them properly and we're discontinuing them properly and we're on doing ongoing evaluation of its patient not just of their condition that called for the need for restraints but their overall safety and adjusting at the federal level through agencies like CMS we also have a set of guidelines restraints are not something that a nurse can independently implement so this is not going to be an independent action of a nurse whether an RN or an LPN to apply restraints that becomes one of the safety guidelines both from a a and from the federal levels it's going to require an order from a provider a physician nurse practitioner um medical assistance someone who is lice or medical Physician's assistants I'm sorry so a physician nurse practitioner physician's assistant who are licensed and authorized by the state and by their licensure to order the application restraints they can just order it um as an as needed or as an open-ended type order their order has to document why they are ordering the restraints they have to have direct awareness and knowledge of the patient's condition and the restraints being used and the restraints have to be time Limited while the restraints are on it has to be documented that safety issues physiological safety issues such as circulation as well as psychological and emotional status the patient are all being documented and again that restraints are removed as soon as possible so again restraints require an order it cannot be in open order it cannot be initiated independently by the nurse so again there are times when you will be involved in restraining patients but that becomes the least preferred approach um prior to getting to that point we're going to use Alternatives so it's alternatives to restraints since we're usually dealing with confused or Restless individuals we're going to be looking at some diversionary activities maybe TV it may be providing music maybe providing a quiet environment some things just to distract them or to keep them from a little more relaxed um if someone is just confused and doesn't always remember to call for help we may use things like bed and chair alarms that will sound so as soon as they start making movement staff can get in and help make sure that they're cared for and they're assisted isn't necessary it may also involve the use of Sitters of using staff who just sit at the bedside or in the room with the individual and help them address their needs as they come up and help re limit the need for the patient to get up so those would be some Alternatives that we'd be looking at for restraints so again restraints um should not be a First Choice option intelling care with Reef um confused or Restless patients and again we're talking not just physical restraints but also the use of medic of chemical restraints so last area I want to look at in this section is the idea of workplace safety and this is looking at safety of not just the patient but also the safety of the workers of the nurse of the staff who are involved so we're looking at having a healthy and safe environment one that's clean one's being cared for um one that is being really limiting the chances for issues to happen your readings talk about some specific areas where workplace safety can be addressed in ways we can go about it from a healthy environment we're looking at regular cleaning of sanitizing surfaces you know obvious places in surgery being everything washed down in sterilized but even out in the patient care even in the work area for the staff work area we need to routinely disinfect the areas to cut down the chance of spreading infection or spreading um pathogens that way all institutions are going to have a major focus on Sharps working with needles any sharp items that we use in care that increase the risk for blood exposure so that is going to be a major focus of any workplace safety activities what kind of supplies we get do needles have safety guards are we providing the appropriate PPE to help cut down on risk for exposure when we're doing something that is an invasive procedure that may expose us to blood that type of thing safe patient handling is also workplace safety issue again it's on not only safety for the patient to make sure that they are ambulated or transferred safely from their perspective without risk of fall but also that the staff the nurse the STNA anyone the therapist anyone involved in the care are also protecting themselves so again I'd encourage you to watch the video that is linked in the reading guide to get an idea of why is that so much of a concern not just it's convenient but it is a very costly issue for health care when as practitioners we do not follow good body mechanics we're going to end up harming ourselves as well as being a cost in a drain on the system overall in the last area that's looked at in the readings is the idea of PPE and we're going to talk about more of that in the next section the next module but just making available appropriate a PPE for the care that we're providing so these are all things that we can address from a workplace safety standpoint and again not only does it protect the patient and provide a safer environment for a safer environment for them it also provides safety for us as the nurses as the caregiver so again we'll move into the next module and be looking at issues of infection infection control infection precautions at that point