Chapter 14
Safety
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Safe Environment
• This implies freedom from injury with a focus on
preventing falls, electrical injuries, fires, burns, and
poisoning.
• The nurse must be aware of potential safety
problems and must know how to report and respond
when safety is threatened.
• The responsibility for providing and maintaining a
safe environment involves the patient, visitors, and
members of the health care team.
• Both protection and education are primary nursing
responsibilities.
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Slide 2
Safe Environment
• Falls


The majority of patient falls occur during transfer
either to a bedside commode or to a wheelchair.
High risk
• The very young
• Older adults
• Individuals who become ill or who are injured

Unfamiliar environment and various symptoms and
signs associated with the patient’s diagnosis may also
place the individual at risk.
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Slide 3
Safe Environment
• Falls (continued)

Gait belts
• This is an added safety feature in ambulating patients.
• Apply gait belt securely around patient’s waist.
• Walk to the side of the patient, one arm around waist
and hand on the belt. Walk on the weaker side.
• Patient can support him- or herself by leaning or holding
onto nurse’s arm.
• Nurse should walk with his or her closest leg just behind
the patient’s knee.
• Walk with knees and hips flexed.
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Slide 4
Safe Environment
• Infants and Children


Ensuring the safety of the environment of infants and
children requires protection of the child and education
of the parents.
Accidents involving children are largely preventable,
but parents and caregivers need to be aware of
specific dangers at each stage of growth and
development.
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Slide 5
Safe Environment
• Older Adults

Changes associated with aging significantly affect
the ability of older adults to protect themselves
from injury.
• Unsteadiness in gait causes falls.
• Vision changes may affect the ability to see the height
of stairs.
• Vertigo may occur due to disease and/or medications.
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Slide 6
Accidental Poisoning
• Childhood poisoning is one of the major causes of
death in children under 5 years of age.
• The older adult is also at risk.

Changes associated with aging interfere with the
individual’s ability to absorb or excrete drugs.
 The older adult may share drugs with friends.
 Changes in eyesight may lead to an accidental
ingestion.
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Slide 7
Accidental Poisoning
• Hospitalized patients and those in other types of
health care facilities can be at risk for accidental
poisoning because there are many poisonous
substances in the environment.

Cleaning solutions
 Disinfectants
 Drugs
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Slide 8
Accidental Poisoning
• Preventing Poisoning



Remove toxic agents from areas where poisoning
could occur.
Toxic or poisonous substances should not be
removed from their original containers.
Poisonous substances should be labeled
conspicuously and stored appropriately.
• Poison control centers are valuable sources of
information when poisoning is suspected or does
occur.
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Slide 9
Applying Safety Reminder
Devices
• Safety reminder device (SRD)

Any one of numerous devices used to immobilize a
patient or part of the patient’s body, such as arms or
hands
• Used for various reasons





Patient safety
Maintain treatment
Prevent wandering
Prevent or reduce the risk of falls
Restrict movement of an aggressive patient to protect
other patients and staff
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Slide 10
Applying Safety Reminder
Devices
• Ethical and legal issues surround their use.
• The focus is on using alternative strategies before
SRDs are applied.
• Patient safety or the safety of others must be the
priority reason why an SRD is applied.
• The use of SRDs can also result in increased
restlessness, disorientation, agitation, anxiety, and a
feeling of powerlessness.
• Documentation about the need for the SRDs, the
type of device used, and the patient response is
crucial.
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Slide 11
Skill 14-1: Step 6a(3)
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Applying safety reminder devices.
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Slide 12
Skill 14-1: Step 6a(4)
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Applying safety reminder devices.
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Slide 13
Skill 14-1: Step 6b(1)
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Applying safety reminder devices.
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Slide 14
Skill 14-1: Step 6c(2)
Applying safety reminder devices.
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Slide 15
Skill 14-1: Step 6c(4)
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Applying safety reminder devices.
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Slide 16
Skill 14-1: Step 6d(1)
(From Potter, P.A., Perry, A.G. [2005]. Fundamentals of nursing. [6th ed.]. St. Louis: Mosby.)
Applying safety reminder devices.
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Slide 17
Skill 14-1: Step 7
Applying safety reminder devices.
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Slide 18
Skill 14-1: Step 15a
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.].
St. Louis: Mosby.)
Applying safety reminder devices.
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Slide 19
Skill 14-1: Step 15b
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.].
St. Louis: Mosby.)
Applying safety reminder devices.
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Slide 20
Skill 14-1: Step 15c
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.].
St. Louis: Mosby.)
Applying safety reminder devices.
Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 21
Skill 14-1: Step 15d
(From Elkin, M.K., Perry, A.G., Potter, P.A. [2004]. Nursing interventions and clinical skills. [3rd ed.].
St. Louis: Mosby.)
Applying safety reminder devices.
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Slide 22
Hospital/Health Care Environment
• The hospital environment is a source of potential
safety hazards for health care workers.

Biologic, chemical, and physical hazards
 Lasers
 Blood and body fluids
 Contaminated needles
 Radiation
 Vaccine-preventable diseases
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Slide 23
Safe Environment
• Left-Handed Patient



The typical hospital room environment is set up to
accommodate the right-handed patient.
Left-handed patients may struggle and strain to cope
by contorting the body, which creates a “risk for injury”
situation.
The discerning nurse will document in the patient’s
record the fact that the patient is left-handed.
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Slide 24
Safe Environment
• Safety Features for the Left-Handed Patient
Place all bathing articles at the patient’s left.
 Allow patient to turn to the right during back care.
 Place the drainage receptacle for the indwelling
catheter to patient’s left.
 Arrange meal trays by placing liquids on the left side.
 When ambulating, walk to the patient’s left side.
 Use the patient’s right hand and arm for IV therapy
and injections whenever possible.
 Allow more time for the patient to master skills.
 Adjust the patient’s environment by placing bed stand,
table, and call light to the patient’s left.

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Slide 25
Hospital/Health Care Environment
• National Institute for Occupational Safety and Health
(NIOSH)

Focuses on safety and issues related to health
• Hazard Communication Act of the Occupational
Safety and Health Administration (OSHA)


A national organization that provides guidelines to
help reduce safety hazards in the workplace
Requires hospitals to inform employees about the
presence of or potential for harmful exposures and
how to reduce the risk of exposure
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Slide 26
Hospital/Health Care Environment
• Centers for Disease Control and Prevention (CDC)


A federal agency that provides facilities and services
for the investigation, identification, prevention, and
control of disease
Provides guidelines for working with infected patients
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Slide 27
Ensuring Fire Safety
• Fires in health care facilities are often related to
•
•
•
•
smoking in bed or faulty electrical equipment.
An established fire safety program is mandatory for
all health care facilities.
Fire prevention includes good housekeeping,
maintenance, and employee discipline.
All employees should know the telephone number
and procedure for reporting a fire, as well as the
location of the nearest firefighting equipment.
Health care workers must know their roles in the
overall evacuation plan.
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Slide 28
Ensuring Fire Safety
• Types of Fire Extinguishers

Type A
• For paper, wood, or cloth fires

Type B
• For flammable liquid firesgrease and anesthetics

Type C
• For electrical

Type ABC
• For any type of fire
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Slide 29
Ensuring Fire Safety
• Patients in immediate danger should be rescued,
and then the facility’s procedure should be followed
for activating the fire alarm and reporting the location
and extent of the fire.
• Measures should then be taken to contain or
extinguish the fire if there is no immediate threat to
safety.

Close doors and windows, turn off oxygen and
electrical equipment, and use the appropriate fire
extinguisher.
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Slide 30
Ensuring Fire Safety
• Use the mnemonic RACE to set priorities in case of
fire

RRescue and remove all patients in immediate
danger.
 A  Activate the alarm.
 C  Confine the fire.
 E  Extinguish the fire using an extinguisher.
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Slide 31
Disaster Planning
• Disaster Situation

An uncontrolled, unexpected, psychologically
shocking event
 Earthquakes, hurricanes, floods, tornados, bombings,
arson, riots, and hostage-taking
 Health care facilities expected to receive victims and
survivors and to assist rescuers
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Slide 32
Disaster Planning
• External or Internal Disaster


External disaster originates outside the health care
facility and results in an influx of casualties brought to
the facility.
Internal disaster represents an extraordinary situation
that is brought about by events within the health care
facility.
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Slide 33
Disaster Planning
• Disaster planning represents the means by which
health care facilities and personnel meet the
responsibilities associated with managing the
disaster.
• Disaster Manual

Specifies departmental responsibilities; chain of
command; callback procedures; assignment
procedure; patient evacuation procedure and routes;
procedures for the receipt and management of
casualties; and policies related to the overall
management of supplies and equipment
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Slide 34
Terrorism/Bioterrorism
• Terrorism

A new potential environmental health threat is the
possibility of a terrorist attack.
• Biological, chemical, or nuclear weapons
• Bioterrorism


This is the use of biological agents to create fear and
threat.
Health care facilities must be prepared to treat mass
casualties from an attack.
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Slide 35
Terrorism/Bioterrorism
• Bioterrorism

Bioterrorism attacks
• If an attack occurs, it will most likely involve the use of
biological agents such as anthrax, botulism, smallpox,
or bubonic plague.

Biological attacks may be either overt (announced) or
covert (unannounced).
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Slide 36
Terrorism/Bioterrorism
• Features that should alert nurses to the possibility of
a bioterrorism-related outbreak include

A rapidly increasing incidence of a disease
 An unusual increase in the number of people seeking
care
 An endemic disease rapidly emerging at an
uncharacteristic time or in an unusual pattern
 Lower attack rates among patients who had been
indoors compared with people who had been
outdoors
 Clusters of patients arriving from a single locale
 Large number of rapidly fatal cases
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Slide 37
Terrorism/Bioterrorism
• Terrorism by Nuclear Exposure





Attack on a domestic nuclear weapon facility
“Dirty bomb”
Source of radiation on the contaminated patient: on
the body or clothing, ingested, or absorbed through a
skin opening
Less than 0.75 Gy absorbed: usually no symptoms
More than 8 Gy absorbed: fatal
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Slide 38
Terrorism/Bioterrorism
• Terrorism by Nuclear Exposure

More than 0.75 Gy absorbed: can develop acute
radiation syndrome
• Hematopoietic: deficiency of WBCs and platelets
• Gastrointestinal: loss of mucosal barrier and cells lining
the intestine
• Cerebrovascular/central nervous system: cerebral
edema, hyperpyrexia, hypotension, confusion, and
disorientation
• Skin: loss of epidermis and possibly the dermis
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Slide 39
Nursing Process
• Nursing Diagnoses


Risk for falls/injury
Impaired physical mobility
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Slide 40