Ch 28: Safety, Security, and Emergency Preparedness

Factors Affecting Safety

Safety is influenced by a variety of factors, including developmental stage, patient environment, and functional ability. Understanding these factors is essential for preventing injuries and promoting health across the lifespan.

• Developmental considerations: Age and stage of life affect risk and types of hazards.

• Patient environments: Includes work, social, and home settings.

• Functional ability: Mobility, sensory perception, communication, and knowledge impact safety.

Developmental Considerations

Different age groups face unique safety risks. Awareness of these risks helps tailor prevention strategies.

Neonate and Infant

• Fetal considerations: Safety begins before birth; maternal health and environment are crucial.

• Mobility: Limited mobility increases risk of suffocation and falls.

• Car seats: Proper use prevents injury during travel.

Toddler and Preschooler

• Environment: Exploration increases risk of accidents.

• Poisoning: Ingestion of household substances is common.

• Asphyxiation: Risk from small objects and unsafe sleeping environments.

• Child abuse: Vigilance for signs of abuse is necessary.

School Age

• Accidents: Increased independence leads to more injuries.

• Child abduction: Awareness and education are key.

• Bullying: Can affect psychological and physical health.

Adolescent

• Driving: Motor vehicle accidents are a leading cause of death.

• Substance use, misuse, and abuse: Risk increases with peer influence.

• Piercings and tattoos: Potential for infection and injury.

• Firearms: Access increases risk of accidental or intentional injury.

• Internet and social media: Exposure to cyberbullying and exploitation.

• Sex trafficking: Vulnerability increases with unsupervised online activity.

Adult

• Drug use and poisoning: Includes prescription and illicit substances.

• Intimate partner violence: Physical and psychological harm.

Older Adult

• Falls: Leading cause of injury fatality.

• Motor vehicle accidents: Risk increases with age-related changes.

• Fire: Risk due to decreased mobility and sensory perception.

• Polypharmacy and poisoning: Multiple medications increase risk.

• Elder abuse: Includes physical, emotional, and financial harm.

Indications of a Concussion

A concussion is a mild traumatic brain injury. Recognizing its signs is important for prompt treatment.

• Physical: Headache, vomiting, balance problems, fatigue, dazed appearance.

• Cognitive: Mental fogginess, difficulty concentrating, confusion, memory issues.

• Emotional: Irritability, nervousness, emotional lability.

• Sleep: Drowsiness, trouble falling asleep, changes in sleep patterns.

Safety Considerations for Adults

Adults should be reminded of the impact of stress and lifestyle choices on safety and health.

• Enroll in defensive driving courses.

• Counsel about unsafe health habits (e.g., drug and alcohol use).

• Evaluate workplace for safety hazards.

• Counsel about domestic violence.

Safety Plan for Victims of Domestic Abuse

Developing a safety plan is essential for individuals experiencing domestic abuse.

• Safety while living with an abusive partner.

• Safety planning with children and pets.

• Safety planning during pregnancy.

• Strategies for leaving a relationship safely.

Safety Considerations for Older Adults

Older adults face unique safety challenges due to physical and cognitive changes.

• Identify and modify safety hazards in the environment.

• Attend driving courses for older adults.

• Encourage regular vision and hearing tests.

• Ensure hearing aids and eyeglasses are functional.

• Install and maintain smoke detectors.

• Document and report signs of neglect and abuse.

Patient Environments

The environment plays a significant role in patient safety.

• Work environment: Occupational hazards.

• Social environment: Support systems and community safety.

• Home environment: Physical layout and accessibility.

Functional Ability & Health

Functional ability and health status affect an individual's risk for injury.

• Mobility: Ability to move safely.

• Sensory perception: Vision and hearing impact hazard detection.

• Ability to communicate: Essential for expressing needs and understanding instructions.

• Knowledge: Awareness of risks and prevention strategies.

• Physical health state: Chronic conditions may increase risk.

• Psychosocial health state: Mental health affects judgment and behavior.

Assessing Fall Risk in the Older Adult

Falls are a major concern for older adults. Assessment helps identify those at risk.

• History of falls or accidents.

• Use of assistive devices.

• History of drug or alcohol abuse.

• Family support systems and home environment.

Factors That Contribute to Falls

Multiple factors increase the risk of falls in older adults.

• Poor gait and balance.

• Muscle weakness.

• Visual impairment.

• Foot problems.

• Comorbidities (multiple health conditions).

• Medications that increase fall risk.

• Orthostatic hypotension (drop in blood pressure upon standing).

• Hazards in the home or community.

• Vitamin D deficiency.

Safety Improvement Strategies

Various tools and programs are used to improve safety and prevent falls.

• Preventing Falls Targeted Solutions Tool (TST).

• Falls Toolkit.

• Falls Prevention Training Program.

• Root Cause Analysis (RCA): Systematic investigation of incidents to prevent recurrence.

Patient Outcomes for Safety

Desired outcomes focus on injury prevention and safe environments.

• Identify unsafe environmental situations.

• Implement safety measures.

• Use safety information resources.

• Incorporate accident prevention into daily activities.

• Remain free of injury.

Patient Safety in Health Care Facilities

Health care facilities must ensure patient safety through orientation, fall prevention, and appropriate use of restraints.

• Orienting patients to surroundings.

• Preventing falls.

• Using restraints only when necessary and with caution.

Physiologic Hazards Associated With Restraints

Restraints can cause significant physical and psychological harm.

• Increased risk of serious injury from falls.

• Skin breakdown and contractures.

• Incontinence.

• Depression, delirium, anxiety.

• Aspiration and respiratory difficulties.

• Death.

Types of Restraints Used for Adults and Children

Restraints may be physical (e.g., side rails, belts) or chemical (medications). Their use must be justified and monitored.

• Physical restraints: Devices that restrict movement.

• Chemical restraints: Medications used to control behavior.

Note: Side rails are not considered restraints if requested by the patient for safety and the patient can operate them independently.

Facility Safety

Facilities must address various safety concerns to protect patients and staff.

• Fire safety and alarm management.

• Preventing equipment- and procedure-related accidents.

• Filing safety event reports after incidents.

RACE: Fire Safety Protocol

The RACE acronym guides actions during a fire emergency.

• R—Rescue: Rescue anyone in immediate danger.

• A—Activate: Activate the fire code and notify appropriate personnel.

• C—Confine: Confine the fire by closing doors and windows.

• E—Evacuate: Evacuate patients and others to a safe area.

Procedure-Related Accidents and Errors

Errors during medical procedures can compromise safety.

• Administering medications or intravenous solutions.

• Transferring patients.

• Changing dressings.

• Applying external heat.

Safety Event Reports

Safety event reports document incidents that compromise safety in health care facilities.

• Describe circumstances and patient response.

• Completed immediately by the nurse.

• Not part of the medical record; should not be mentioned in documentation.

Health Teaching in Schools

Schools play a role in promoting safety and emergency preparedness.

• Monitor children's Internet use.

• Engage in school activities and safety committees.

• Ensure emergency preparedness plans are current.

Maintaining Emergency Preparedness

Preparedness for emergencies includes addressing various threats and planning for disasters.

• Biologic, chemical, and radiation threats.

• Cyber terror and mass trauma terrorism.

• Pandemic preparation.

• Identifying disaster resources.

• Addressing psychological aspects of disasters.

Chemicals Used for Mass Destruction

Chemical agents pose significant risks during mass destruction events.

Additional info: Emergency preparedness includes psychological support for victims and responders, as well as ongoing training and drills for all staff and community members.