patient safety

patient safety



in this video our subject is patient and resident safety we will discuss getting ready an introduction to restraints how to apply a vest restraint how to apply wrist and ankle restraints how to manage fire emergencies how to manage medical emergencies and finishing up one of your most important duties as a nursing assistant is to keep your patients and residents safe from hazards in the health care setting including those hazards sometimes posed by patients and residents to themselves by working closely with other members of the healthcare team to keep patients and residents safe you perform a valuable service not only to your patients and residents but also to their families yourself and the facility in which you work everyone benefits from your attention to patient and resident safety preparation that is getting ready to manage your work in a manner that is safe healthful and efficient is key to successful healthcare no matter what tasks you'll be performing during your shift whether those tasks are planned or unanticipated you will benefit from a routine of careful preparation begin each interaction with patients or residents by performing these steps wash your hands gather all needed supplies not before entering the person's room introduce yourself using your name and title and greet the person by name remembering that a friendly greeting helps establish rapport carefully identify the person adhering to your facility's approved method explain to the person the procedure you're about to perform and make sure the person understands before you begin if necessary show visitors where they can wait outside the room provide privacy by closing the door and curtains as appropriate drape the person for modesty and then throughout the procedure see to safety using proper body mechanics and following all safety precautions for equipment use and infection control special measures are sometimes necessary to help keep patients or residents safe for example when a person is at risk for getting up without calling for help at risk for wandering away from the facility because of dementia for example attempting to remove necessary medical devices or tubes demonstrating combative behavior while suffering from drug or alcohol withdrawal or on suicide precautions in each of these situations the use of a restraint may be necessary a restraint is something that restricts a person's freedom of movement and the restraint may be physical or chemical physical restraints are devices that are attached to or that are near a person's body in order to limit movement physical restraint types include vest wrist ankle mitt and lap chemical restraints are medications such as sedatives or tranquilizers that are used to help calm and anxious combative or agitated person guidelines for restraint use are clearly defined in legislation such as the Omnibus Budget Reconciliation act or obrah and by government agencies such as the Joint Commission on Accreditation of health care organizations or Jayco and the Food and Drug Administration or FDA according to Oprah restraining residents against their will can be considered false imprisonment today many healthcare facilities especially long-term care facilities strive to be restraint free many facilities that do employ restraints require that a licensed nurse initially apply the restraint but may allow nursing assistants to monitor the restrained person and reapply restraints after removing them for the person's exercise or ambulation be sure to follow the policies of your facility and make sure you are trained in the use of any restraints you may be called upon to apply or monitor now a key point to remember is that the use of restraints can cause physical and emotional harm that's why alternatives to restraint use should always be explored first restraint alternatives include changing the environment that is moving patients or residents to a place such as the nearest nurse's station where the health care team can keep an eye on them and also prevent them from feeling bored or isolated providing frequent attention accomplishes the same goals explaining procedures reassures the patient or resident and provides motivation for remaining calm enlisting help from family and volunteers can be an effective restraint alternative and improves the quality of life for the resident or patient using less restrictive measures such as a pressure-sensitive alarm system or as shown here a wanderer monitoring system can serve as a gentle reminder to patients or residents rendering restraint unnecessary a wander a monitoring system is a sensor that is attached to the person's wheelchair or worn around the wrist or ankle if the person tries to leave the facility through a doorway leading to an unsafe area an alarm will sound alerting the staff so that someone can guide the person back to safety wanderer monitoring systems are useful for patients or residents such as those with dementia who are likely to stray away from the facility a pressure-sensitive bed monitoring system includes a pressure sensing mat that is placed across the mattress under the sheet and located where the buttocks would rest the monitor is hung from the headboard if the person tries to get out of bed an alarm will sound alerting the staff that the person needs help similar systems are available for chair or wheelchair seats as well and are helpful for patients or residents who are likely to fall if they try to get up unassisted those are some of the most common alternatives to restraint but when a restraint has been ordered by the doctor follow your facility's policy regarding application documentation and monitoring as a nursing assistant you will be responsible for helping to monitor restrained patients and residents and providing for their needs after all without help they cannot use the bathroom and get a drink of water or even find a comfortable position so for medical reasons and to prevent the person from feeling lonely or abandoned make sure you attend to the person's needs frequently our mr. George how are you today your facilities should provide guidance as to just how frequently we recommend checking on restrained patients or residents at least once every 15 minutes paying particular attention to the person's position comfort and in the case of limb restraints the circulation of the restrained extremity a restraint that is applied too tightly can lead to poor blood flow leading to permanent tissue or nerve damage at least once every two hours you should completely remove the restraint for at least 10 minutes provide skin care and reposition or ambulate the person if the person is on bed rest perform range of motion exercises during this time be sure to meet the person's needs for food fluid and elimination then carefully reapply the restraint making sure to restore access to items such as a call light control or other remote control devices always make sure you record your observations in accordance with the policy of your facility noting the type of restraint used the time the restraint was applied removed and reapplied and the person's responses be sure to notify the nurse immediately if you observe that the person is having trouble breathing the person's hands or feet or pale blue or cold the person is feeling pain numbness or tingling or if the person has become more confused disoriented or agitated chemical restraints should not be administered in so high a dose that the person becomes unable to function normally so be sure to notify the nurse immediately if you observe that a person on the chemical restraint is experiencing excessive sleepiness or is unable to function at his or her normal level restraints have a very negative impact on a patient's or residents quality of life both physically and emotionally if we are to protect our patients or residents safety and dignity we must use restraints only with proper training caution and compassion and only when left with no alternative that's why restraints must be ordered by a doctor and used only in very specific situations a restraint should never be used to punish or be used merely for the convenience of caregivers most facilities only allow licensed nurses to apply restraints however you may be required to assist in the application of a restraint so in our next two sections we demonstrate techniques for applying the most common types of physical restraints to apply a vest restraint begin by completing the getting ready steps we described at the beginning of this video wash your hands then gather your equipment in this case a vest restraint of the appropriate size as part of your attention to safety position the bed at a comfortable working height consistent with proper body mechanics then make sure the wheels are locked if the side rails are in use lower them fan fold the top linens to below the person's waist assist the person to a sitting position by locking arms with him support the person's back and shoulders with one arm while using your free hand to slip the person's arms through the armholes of the vest clothing offers a layer of protection between the restraint and the person's skin to further protect the skin make sure there are no wrinkles across the front or back of the vest restraint apply the restraint according to the manufacturer's instructions the vest restraint should always cross the chest in front be aware that the most common danger associated with the use of a vest restraint is improper placement which can lead to strangulation position the ties or straps through the slots if the person is in bed attach the ties to the bed frame never the side rails next help the person to lie down make sure the person is comfortable and in proper body alignment if the person is in a chair thread the ties between the seat and the armrest or between the back of the seat and the back of the chair according to the manufacturer's instructions whether the person is in a chair or bed always use the quick-release not approved by your facility never double knot the straps typically a quick relief not begins as a regular overhand knot then slip a loop instead of the end of the strap through the first loop as shown here this type of quick release or slip knot will hold tightly if the restrained person pulls against it but can be undone quickly simply by pulling on the knots tails make sure the restraint is not too tight you should be able to slide a flat hand between the restraint and the person's body adjust the straps as necessary then draw the top linens over the person if the side rails are in use return them to the raised position lower the bed to its lowest position make sure the call light control is within reach then complete your finishing up steps as described in the final section of this video remember to check on the restrained person every 15 minutes also completely remove the restraint every two hours for at least 10 minutes to apply wrist or ankle restraints prepare by washing your hands and gathering your equipment in this case the necessary number of wrist or ankle restraints the doctor will specify the number of extremities that are to be restrained a two-point restraint involves two extremities a three point restraint three extremities and a four-point restraint four extremities raise the bed to a comfortable working height as part of your attention to safety make sure the person has been positioned comfortably and is in proper body alignment mr. Mayfield turned out to touch on that okay yeah just leave that alone okay I know it bothers you apply the wrist or ankle restraints following the manufacturer's instructions placing the soft part of the restraint against the skin secure the restraint so that it is snug but not tight you should be able to slide two fingers under the restraint attach the straps to the frame leaving enough slack to enable the person to move his hands and arms but not so much that he can reach medical devices such as intravenous lines nasogastric tubes and catheters always use the quick-release not approved by your facility when applying to point three point or four-point restraints follow these same guidelines as with vest restraints remember to check the person every 15 minutes with wrist and ankle restraints pay special attention to circulation at or below the restrained extremity report and record your actions be sure to notify the nurse immediately if you observe any problems such as pain numbness or tingling or blue pale or cold skin at or below the restraint body part finally complete these and all healthcare procedures by following your standard finishing up steps as shown in the final section of this video one of the most frightening situations that people encounter is fire how much more frightening then is a fire that threatens residents of a health care facility people who are often too ill or disabled to get out of the way on their own fire hazards exist whenever you have the three elements of fire in close proximity fuels such as bed linens paper chemicals or oils heat such as electrical cords open heating elements or open flames and oxygen such as an open window or an oxygen tank there are many situations in healthcare facilities that can lead to a fire look around your facility and be aware of any fire hazards that may exist such as people smoking open flames broken or worn out equipment or improperly stored flammable materials if you can anticipate the causes or conditions that lead to fires you will then be able to act to prevent fires electrical fires can be prevented by following specific safety rules do your part to maintain all electrical equipment in good working condition and that includes smoke detectors most of all avoid using frayed or worn electrical cords if you see a cord that appears damaged take it out of service until it is replaced or repaired residents of long-term care facilities often furnish their own radios lamps and other appliances so follow the same safety procedures you follow for facility owned equipment avoid plugging more than one appliance into an extension cord when the electricity for several appliances is routed through one outlet and one cord instead of several the cord will tend to become overheated in such cases it's far better to use a facility approved power strip with a built-in circuit breaker other types of fires can be prevented by following these safety rules always prevent smoking by patients or residents in bed and strictly enforce all other prevailing smoking rules or regulations to confine all permissible smoking to designated areas and keep smoking materials where children and confused patients or residents cannot reach them prevent contact between heating elements such as hot plates hair dryers or portable heaters and sources of fuel extinguisher supervise all open flames keeping them away from flammable materials thank you store all flammable chemicals or gases properly flammable materials should always be stored in approved containers and when possible located in isolated or secure locations always follow designated procedures when handling flammable materials and clean up spills immediately remember your training shortcuts often lead to emergency situations sometimes despite our best attempts to prevent a fire emergency a fire happens anyway then we must react quickly and efficiently putting into effect our facilities emergency procedures with confidence don't panic instead remember the race fire response plan the first and most important step is to remove to safety any patients or residents who are in immediate danger escort those who can walk use wheelchairs for unsteady people and when moving patients or residents who are bedridden follow your facility's policy activate the alarm using the method specified by your facility you may need to pull an alarm handle make an announcement over the public address system or phone emergency services next take steps to contain the fire by closing doors and windows this action slows the spread of the fire finally extinguish the fire or if the fire is large or spreading quickly evacuate the building or wing at every step of your race fire response plan you must try to remember your training follow procedures and stay calm if you are calm you will inspire others and help avoid panic and confusion a moment ago you may have noticed some quick decision-making by one nursing assistant as to whether or not to employ this a fire extinguisher in many instances a fire extinguisher can indeed stop a fire before it can do very much harm however what many of us forget is that the real fire extinguisher is the person handling this device without a trained knowledgeable operator a fire extinguisher could have no effect on a fire at all or it could even make things worse as we mentioned earlier a fire requires fuel heat and oxygen if you remove just one of these elements you can put out the fire but not all fires are alike fires are classified as type a type B or type C fire extinguishers such as this one clearly show which types of fires they are designed to fight this model is labeled a b c meaning it can safely be used to combat all types of fires including those in the category a which are fueled by common materials such as wood paper cloth leaves and grass as well as those in the B category fueled by petroleum products such as gasoline or automotive oil cooking oil or grease and those in the C category consisting of electrical fires it's important not to use a fire extinguisher on a fire it is not designed to fight for example unless an extinguisher is rated for B type fires it might spread the fire instead of fighting it and fighting a C type fire which is electrical in origin with water may get you electrocuted fire extinguishers differ not only in their type but also in their operation to use most fire extinguishers use the past technique pull out the safety pin aim the hose or nozzle towards the base of the fire squeeze the trigger or handle and spray the contents at the base of the fire looks like that fire is out but I'm still going to see that professional firefighters are called to make sure that it's out and of course I'm going to continue to evacuate our facility until the danger of fire has definitely passed then I'm going to have this fire extinguisher serviced right away so it's ready for the next fire emergency your primary role as a nursing assistant is not firefighting of course but rather providing quality health care to your facility's patients or residents so it follows that most emergencies you face will be medical emergencies and you must be just as prepared to meet those emergencies as fire emergencies medical emergencies take one of two forms they're either the result of a medical condition such as a heart attack or stroke or they stem from an accident as a nursing assistant you must be prepared to provide effective compassionate care to a patient or resident who is experiencing a medical emergency whatever its cause your first step is to recognize that an emergency exists an emergency is a condition that requires immediate evaluation treatment or other remedial action in order to prevent a patient or resident from dying or developing a permanent disability experience and training will prepare you to recognize and manage emergencies and your familiarity with your patients and residents will enable you to recognize subtle changes in behavior or appearance that might indicate that an emergency situation is brewing the most life-threatening conditions are respiratory arrest which means breathing has stopped and cardiac arrest which means breathing and circulation or heart function have stopped situations such as choking hemorrhaging which is losing large amounts of blood heart attacks and strokes can all lead to life-threatening emergencies next stay with the person remain calm and decide to act call the nurse and evaluate the situation next check for consciousness call for help by activating the emergency medical services or EMS system an EMS system is a network of resources that is organized to respond to emergencies hospitals typically have a code or procedure for calling EMS assistance from within the facility home health care agencies long-term care facilities and assisted living facilities however may require you to call 9-1-1 when you call be prepared to report all relevant details about the person's vital signs and level of consciousness your location and the situation in which you found the person then continue providing appropriate medical care until the help arrives start first aid of basic life support measures according to the situation and your level of training to be prepared know where your facility's emergency medical equipment is kept including oxygen the emergency card and the defibrillator immediately tell the nurse if you observe any of the following disorientation lack of responsiveness and new or changed physical signs of illness such as increased pain or changes in vital signs when calling for help your attention to these signs and symptoms may be of crucial importance to the nurse or medical team responding the second form of medical emergency after those arising from a medical condition consist of accidents a wide range of situations can place a patient or resident at risk for accidental injury medications can make a person drowsy dizzy or disoriented impaired mobility can predispose a person to falling sensory impairments such as impaired vision or hearing can hinder a person's ability to detect and respond to changing circumstances or environment and diminished awareness of the surroundings can make a person unaware of potentially dangerous situations accident prevention is a worthy goal and should be pursued at every opportunity but accidents happen despite the precautions taken by even the most conscientious of health care workers by understanding the sources of accidents and by following your training and your facility's procedures closely you can minimize accidents when an accident does occur remember to follow the same five response steps you will use for emergencies arising from medical conditions recognize the emergency decide to act check for consciousness call for help and provide appropriate care until help arrives while most health care facilities offer training in basic life-saving techniques to their employees don't let the lack of such training prevent you from getting training on your own reputable programs are offered by the American Red Cross the American Heart Association and other organizations consider such training a necessary and rewarding investment in your career when you have finished with a procedure always follow a routine of finishing up to ensure your patients are residents safety and comfort first confirm comfort and good body alignment whether the person is seated or in a bed leave the person's call light control within easy reach and do the same for any other items the person may want such as remote control devices the telephone or fresh water next see to safety if appropriate return the bed to its lowest position then make sure the wheels are locked for safety and place the side rails in ordered or requested positions if desired open the curtain or door and ask whether the person would like for visitors to return if you use gloves first discard them according to your facility's policy then wash your hands finally report and record all pertinent information about the procedure including the date and time of the procedure and your full name and title you

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