Also falling under the broad topic of Safe and Effective Care Environment, these questions assess your ability to manage care that best reduces hazards and includes appropriate responses to emergencies that do occur. You’ll need to know about the things listed here and perhaps expand your knowledge in additional related areas.
Nurses are key players in the prevention of hazards to patient care including infection, accidents, injuries, and medical errors. In addition, nurses must know and practice principles that ensure the safety of healthcare personnel such as proper ergonomics, safe use of all equipment and technology, and proper handling of infectious and hazardous materials. Lastly, nurses must be aware of safety factors that may impact patients in their homes as well the nurse’s role in emergency response situations and security emergencies.
Your review of patient safety issues should begin with knowledge of the age-specific or developmental risks associated with each of these age groups:
Infants— Nurses must educate parents and caretakers of children in this age group that it is their responsibility to take precautions to prevent injury or accidents. Remind them of the importance of placing infants on their backs to sleep or after eating, and ensure that infants are properly restrained in car seats when transported by car. As mobility increases, it is important to highlight the increased risk of falls and burns in this group as well.
Toddlers— Fully mobile and curious about the world around them, toddlers are at increased risk for poisoning, choking, and drowning. Inform parents and caregivers about proper safety precautions including child-proofing cabinets and drawers where hazardous medications or potential poisonous cleaners, etc., are kept. Discussion of proper use of car seats is also important.
School-age children— Independence grows as more time is spent at school and with friends. This age group needs education and guidance on water, fire, and traffic safety as well as the dangers of strangers. Car seats and/or boosters are typically required by law until the child is 4’9” or 80 pounds (whichever comes first). Although this is usually between the ages of 8 and 12, requirements vary by state, so know the laws that are applicable to your geographic location of practice.
Adolescents— Independence, impulsivity, and a sense of invincibility create many risks in this age groups. Motor vehicle safety (both as driver and passenger) should be reviewed as well as the dangers of alcohol and substance abuse. Sexual health information and safe sex practices should also be discussed.
Adults— Many different risks exist for this group that relate to home, workplace, and leisure activities. In general, review the specific risks as they relate to motor vehicles, fire, and the use of firearms.
Older adults— Declines in physical and cognitive abilities increase the risks of falls as well as side effects with medications. Reaction times become delayed, increasing the risk of car accidents, and if caregivers are used or present in the home, the risk of elder abuse must be reviewed and discussed.
Regardless of patient age, nurses must be familiar with the safety risks and principles of accident prevention relative to the patient’s care environment.
Fall prevention program— In the hospital, falls are most common among infants and the elderly. Know the elements of such a program and the steps that are taken based on the age of your patient.
Seizure precautions— In those at risk, know the proper steps to ensure patient safety during and after a seizure.
Suction and oxygen equipment— Ensure that there is proper access to suction and oxygen as part of seizure precaution, and know when their use is indicated and appropriate.
Use of restraints— Restraints may be used to limit mobility in those at increased risk of falls and seizures as well as in those who pose a safety threat to themselves, other patients, or medical staff.
Understanding infection control requires that you know the definition of etiologic agent, which is any pathogen that is capable of causing infection. These may include: bacteria, fungi, protozoa, rickettsiae, and helminths among others. Understanding the chain of infection, or how infection is spread, is critical to understanding the methods and precautions used to prevent it. This involves the following six elements:
Pathogen— An infection-causing agent, such as a bacteria or a virus.
Reservoirs— An animate or inanimate environment that provides a favorable place for pathogens to grow and reproduce. Examples of human systems that serve as a reservoirs include the blood, respiratory, gastrointestinal, reproductive, and/or urinary systems.
Portal of exit— Any place where an infectious agent leaves a host. The above-named human systems may also serve as portals of exit for the organisms they harbor.
Method of transmission— The way that an infectious organism is transferred from the reservoir to another susceptible host. There are three, main methods of transmission: direct contact, indirect contact with a vector (carrier item), or via the air (airborne).
Portal of entry— The place where an infectious agent enters a susceptible host. Portals of entry may also be systems that act as reservoirs for pathogens.
Susceptible host— A patient, medical staff member, or other person who is at risk for infection.
Accident/error/injury prevention relies heavily on a nurse’s ability to identify individual risk factors at time of admission. Developmental factors discussed in the previous section, as well a patient’s lifestyle and knowledge of safety precautions will all factor into an assessment.
Client deficits— Sensory deficits such as sight, hearing, proprioception, and neuropathy may all raise the risk of an injury or accident.
Allergies— Medications and medication allergies are the largest source of medical errors. Always identify your patient prior to medication administration, and be prepared to deal with an allergic reaction. Assess and verify the appropriateness and accuracy of a treatment or medication order for your patient, and always follow the facility policy and use critical thinking to prevent medical errors.
Every healthcare facility is required by the Joint Commission to have an emergency response plan. You will be required to periodically drill in order to assess the efficacy of the response of your facility should an emergency occur. Fire safety and what to do in the event of a natural disaster are two of the possible scenarios where you will need to know your role in your facility’s plan.
Your role and responsibilities in the emergency response plan will vary, but most likely include ensuring the safety of the patients first, then securing your facility or helping to eliminate the threat of further harm or danger to the patients and staff.
In the event of a fire, your first priority will be to move patients out of harm’s way. You will then likely take steps to contain the fire and then evacuate patients out of the facility if necessary. This will likely include assessing patients that need to be evacuated in bed and on a stretcher (horizontally). A nurse will also be expected to educate and counsel patients on fire safety in the home: emergency numbers, installing/maintaining smoke alarms, and acquiring fire extinguishers may all be things you will need to know and review.
You must understand and utilize proper ergonomic principles when assisting patients to protect yourself from injury in addition to helping your patients ambulate, function, and avoid accidents and injuries. These principles will be heavily incorporated into your care plan for each patient.
Assessment of your patient’s baseline abilities will help you design a proper care plan that includes the use of assistive devices such as walkers, crutches, and canes. If your patient has a repetitive stress injury, you will need to instruct him or her as to the proper body positions to help prevent aggravation or reinjury. For more targeted conditions that involve single skeletal or muscular groups, you can provide instruction on proper positioning and stretches that help relieve stress on the area.
Using proper lifting techniques and assistive devices for your patients will help protect you and other staff from injury as well. Your assessment and care plan is critical not only for the protection and safety of your patient, but for your safety as well. Also be aware of and utilize proper postures and body positions when performing daily functions at technology-based workstations (desktop and/or mobile computers).