Patient Safety, Comfort, &
Mobility
NEO111
M. Jorgenson, RN BSN
Patient Safety
Fall Prevention:
Everyone’s Responsibility
FALLS
 are the fifth leading causes of death among
Americans aged 75 years and older
 the second leading cause of mortality from
related injuries in adults >65 years
Elderly person who sustains a fall are more likely
to die within a year’s time of the fall.
Considine J, Botti M. Who, when and where? Identification of patients at risk of an in-hospital adverse event: implications for nursing practice. Int J Nurs
Pract. 2004;10(1):21–31.
Restraints
Physical restraints
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considered as a last resort after other care alternatives have
been unsuccessful
The least restrictive restraint should be used and it should be
removed at the earliest possible time
Must be ordered by a MD or other licensed independent
practitioner
Special monitoring/ assessment
Must be reassessed by ordering MD in 24 hours and new order
obtained
Alternatives to Restraints
Ask family to stay with patient
Rule out physical causes for agitation
Reduce stimulation
Use electronic alarm system
Check for environmental hazards
Offer diversion activities
Consider relocation closer to nurse’s
station
Conceal tubes and tubing necessary for
care
Types of Restraints
Extremity restraints
Jacket or vest restraint
Hand Mitt
Elbow restraints
Leather restraints
Mummy restraints
Bed alarms
Restraints cont.
Must be able to insert 2 fingers between restraint and pt’s ankle or
wrist
Restraint must be fastened on moveable part of bed frame, NEVER
side rail
Use a quick-release knot to tie
Must be able to insert a fist between vest restraint and patient
When assessing a restraint, must assess CMS
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Circulation
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Motor
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Sensation
Call bell must be within reach
Mobility
Effects of Immobility
Cardiovascular system
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Increased cardiac workload, orthostatic hypotension and venous
thrombosis
Respiratory system
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Decreased ventilatory effort and increased secretions
Gastrointestinal system
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Poor digestion and utilization of food
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Constipation
Urinary system
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UTI and renal calculi
Effects of Immobility cont.
Musculoskeletal system
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Atrophy, osteoporosis
Metabolic system
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Decrease in metabolism
Integument system
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Skin breakdown
Psychological well-being
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Diminished self-esteem, social disturbances
Preparing for Activity.
Be organized and plan ahead
Anticipate changes/complications
Prevention versus treatment
Develop good habits
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Proper alignment
Planning
Check MD orders, Nursing plan of care, PT notes, and
history for any limitations on mobility
Conduct a pain assessment and provide appropriate
interventions
Talk with the patient
Talk with other members of the team
Gather equipment
Develop a plan
Planning cont.
Know policies and procedures for facility
Ensure adequate assistance for nurse and patient safety
Prepare for smooth, coordinated transfer-only one leader
Engage brakes on equipment
Body Mechanics
Comfortable working height
Good posture
Feet shoulder width apart (wide base of support)
Use large leg/arm muscles (not back)
Gluteal and abdominal muscles engaged (internal girdle)
Low center of gravity
Body Mechanics cont.
Flex knees (and hips)
Head up
Back straight –no twisting
Smooth, coordinated movements
Position self close to object
Rocking motion (forward-push/back-pull)
Patient Positioning
Bed position
 Arms across chest
 Knees flexed and feet flat
Ensure proper body alignment
Trapeze bar
Avoid friction/shearing
Special Considerations
Change patients positions frequently
Smoothe clothes and linens
Encourage deep breathing and coughing
Apply antiembolism stockings
Pad bony prominences
Bed in lowest position
Pillows
Positioning
& Protective Equipment
Mattresses
Hand splints
Side rails
Trochanter rolls
Adjustable beds
Heel boot
Trapeze bar
Foam pads
Hand rolls
Footboard
Range of Motion
Promotes circulation, prevents contractures, and
provides joint mobility.
Move each joint until there is resistance but not pain
Incorporate into ADLs
Teach patient and family
Encourage pt to do as much as possible
Anti-embolism Stockings
Used to enhance blood flow and venous
return
Patient should be measured for the correct
size.
Assess extremity for pulses, edema,
movement, sensation (CMS)
Remove and check skin q 8 hours