PROVIDING SAFE AND CLEAN ENVIRONMENT
Safety is defined as freedom from psychological and physical injury.
Healthcare provided in a safe manner and safe environment is essential for a patient’s survival and wellbeing.
Importance of safety
· Reduces the risk for illness and injury
· Helps contain cost of healthcare
· Improves/maintains patient’s functional status
· Increases sense of wellbeing
Environment includes the settings on which the nurse and patient interact such as the hospital, long term care facility, clinic, community center, school and home.
A safe environment includes meeting basic needs, reducing physical hazards, transmission of pathogens and controlling pollution, Physiological needs include sufficient oxygen, nutrition, optimum temperature.
i. Oxygen:Supplemental oxygen is sometimes needed to meet the oxygenation needs. Medical oxygen is stored in healthcare settings. Smoking is the leading cause of burns, fire, injuries and deaths involving medical oxygen use.
ii. Nutrition:Healthcare facilities are required to meet state board of health regulations such as Food Safety and Standards Authority of India. Foods that are inadequately prepared or stored under unsanitary conditions increase the patients risk for infections and food poisoning.
iii. Temperature:Temperature extremes affect comfort and safety. Severe cold causes frostbite hypothermia and extreme heat-heat stroke & heat exhaustion. Temperature of 68-72degree F (20-22degree C) should be maintained.
iv. Humidity:It is the amount of moisture in the air. Humidity of 40-60% is considered comfortable.
v. Ventilation:Ventilation means movement in the air. Ventilation can be maintained by opening doors and windows, use of conditioners etc.
vi. Noise:Noise produces irritability, restlessness, fatigue and exhaustion in an acutely ill patient. Noise caused by friction can be reduced by lubrication. Other methods include use of rubber tyres for wheel chairs, sound proof rooms, avoid dropping objects, loud talking, TV & radio sounds etc.
vii. Unpleasant odour & pests: Maintain good ventilation, cleanliness, proper disposal of excreta, use of room fresheners, use of insecticides for pests, mosquito repellents, use of sprays etc.
viii. Lighting:Provide natural light or artificial light, dim light at night, prevent glare, artificial light should not be too strong.
ix. Physical hazards: Reduce motor vehicle accidents, poisons, falls, fire, disasters.
Factors influencing patient safety
· Age and development
· Impaired mobility
· Sensory/communication impairment
· Lack of safety awareness
· Emotional state
· Environmental factors
Safety measures throughout the life span
Preventing specific hazards
a) Be aware of the fire safety regulations and fire prevention practices of the agency in which they work
b) Protect clients who are in immediate danger.
c) Report the fire
d) Contain the fire.
e) Extinguish the fire.
a) People of any age can fall, but infants and elders are particularly prone to falling and causes serious injury.
b) Ensure eyeglasses are functional.
c) Ensure appropriate lighting.
d) Mark doorways and edges of steps as needed.
e) Keep the environment tidy.
f) Set safe limits to activities.
g) Remove unsafe objects.
h) Wear shoes or well-fitted slippers with non-skid soles.
i) Use ambulatory devices as necessary (cane, crutches, walker, braces, wheelchair).
j) Provide assistance with ambulation as needed.
k) Monitor gait and balance.
l) Adapt living arrangements (o one floor if necessary.
m) Encourage exercise and activity as tolerated to maintain muscle strength, joint flexibility, and balance.
n) Ensure uncluttered environment with securely fastened rugs.
o) Keep the bed in the low position.
p) Install grab bars in bathroom.
q) Attach side rails to the bed if appropriate.
r) Keep the rails in place when the bed is in the lowest position.
s) Monitor orientation and alertness status.
3. Seizures: A seizure is a sudden onset of excessive electrical discharges in one or more areas of the brain. Clients are at risk for injury if they experience seizures that involve the entire body or any seizure that includes loss of consciousness.
a) Pad the bed of any client who might have a seizure. Secure blankets or other linens around the head, foot, and side rails of the bed.
b) Put oral suction equipment in place and test to ensure that it is functional. Rationale:
Suctioning may be needed to prevent aspiration of oral secretions.
c) If a seizure occurs: Remain with the client and call for assistance. Do not restrain the client,
d) If the client is not in bed, assist client to the floor and protect the head
e) e) Loosen any clothing around the neck and chest.
f) Turn the client to a lateral position if possible. Rationale: Turning to the side allows secretions to drain out of the mouth, decreasing the risk of aspiration and helps keep the tongue from occluding the airway
g) Move items in the environment to ensure the client does not experience an injury.
h) Do not insert anything into the client’s mouth.
i) Time the seizure duration.
j) Observe the progression of the seizure,
k) Apply oxygen.
l) Use equipment to suction the oral airway if the client vomits or has excessive oral secretions.
m) Administer anticonvulsant medications, as ordered.
i Identify the specific poison by searching for an opened container, empty bottle, or other evidence.
ii Lock potentially toxic agents
iii Do not remove container labels or reuse empty containers
iv Place poison warning stickers
v Do not refer to medicine as candy or pretend false enjoyment when taking medications in front of children
vi Provide antidotes
vii If poisoning is caused by skin or eye contact, irrigate the skin or eye with large amounts of water for 15-20 mins.
viii In case of inhalational exposure remove the victim from the potentially dangerous environment
ix If patient has collapsed initiate CPR if indicated
x Position head turned to one side
xi Never induce vomiting in an unconscious or convulsing patient
5. Suffocation or choking: Suffocation, or asphyxiation is lack of oxygen due to interrupted breathing. The emergency response is the Heimlich manoeuvre or abdominal thrust, which can dislodge the foreign object and re-establish an airway.
6. Electrical hazards:
i Check cords for signs of damage before using an appliance
ii Place protective covers over wall outlets
iii Never use electric appliances near sinks, bathtubs, showers, or other wet areas,
iv Keep electric cords and appliances out of the reach
7, Radiation:Radiation injury can occur from overexposure to radioactive materials used in and therapeutic procedures. Exposure to radiation can be minimized by:
a) Limiting the time near the source,
b) Providing as much distance as possible from the source,
c) Using shielding devices such as lead aprons when near the source.
· Restraints: restraints are protective devices used to limit the physical activity of the client or part of the body.
· Physical restraints: mechanical device, material or equipment is attached to the body
· Chemical restraint: medications e.g. sedatives
· Side rails: side rails help to increase a patient’s mobility or stability when in bed or moving from bed to wheel chair. Side rails are used to prevent fall from bed. Always ensure the latches securing the bed rails are stable
· Airway: When a patient’s airway is at risk of being obstructed or is obstructed an artificial airway is inserted to maintain airway patency
· Trapeze: Used for getting up in bed, for support,
Role of a nurse in providing safe and clean environment:
· Ensure optimum temperature of the ward
· Ensure units are well ventilated
· Ensure noise is within prescribed levels
· Provide sufficient light
· Ensure rodent/ pest control
· Update safety precautions for fire breakout
· Risk factors for falls are eliminated