Safety checklist

Safety Procedures Checklist BED OR CHAIR EXIT SAFETY MONITORING DEVICE Procedure 30-1: Using a Bed or Chair Exit Safety Monitoring Device Performed Preparation 1.

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Assess: • Mobility status • Judgment about ability to get out of bed safely • Proximity of client’s room to nurses’ station • Position of side rails • Functioning status of call light Determine: • Appropriate location for the device • If the device will be applied to a thigh, ensure that the location has intact skin. Assemble equipment and supplies: • Alarm and control device • Sensor • Connection to nurse call system (optional) Procedure Explain to the client what you are going to do, why it is necessary, and how she can cooperate. Wash hands and observe appropriate infection control procedures. Provide for client privacy. Explain to client and support persons the purpose and procedure of using safety monitoring device. Explain that the device does not limit mobility in any manner; rather, it alerts the staff when the client is about to get out of bed. Explain that the nurse must be called when the client needs to get out of bed. Test the battery device and alarm sound.

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Apply the sensor pad or leg band. Place the leg band according to the manufacturer’s recommendation. Place the client’s leg in a straight horizontal position. For the bed or chair device, the sensor is usually placed under the buttocks area. For a bed or chair device, set the time delay for determining the client’s movement patterns from 1 to 12 seconds. Connect the sensor pad to the control unit and the nurse call system. Instruct the client to call the nurse when the client wants or needs to get up, and assist as required. When assisting the client up, deactivate the alarm. Assist the client back to bed, and reattach the alarm device. Ensure client safety with additional safety precautions. Place call light within client reach, lift all side rails, and lower the bed to its lowest position. Place ambulation monitoring stickers on the client’s door, chart, and Kardex. Document the type of alarm used, where it was placed, and the effectiveness of alarm in the client record. Record all additional safety precautions and interventions discussed and employed.

Procedure 30-2: Implementing Seizure Precautions Performed Preparation 1.

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Assess: • History of seizures • Last seizure event Assemble equipment and supplies: • Blankets or other linens to pad side rails • Oral suction equipment • Oral airway or padded tongue depressor • Oxygen equipment Procedure Explain to the client what you are going to do, why it is necessary, and how he can cooperate. Wash hands and observe appropriate infection control procedures. If the client is actively seizing, apply clean gloves in preparation for performing respiratory care measures. Provide for client privacy. Pad the bed. Secure blankets or other linens around the head, foot, and side rails of the bed. Place oral suction equipment in place, and test to confirm that it is functional. If agency policy prescribes, tape the tongue depressor that has been wrapped with gauze padding or an oral airway within reach of the head of the bed. If a seizure occurs: Remain with the client and call for assistance, if needed. If the client is not in bed, assist client to the floor and protect the head in your lap or on a pillow. According to policy, insert the airway or tongue depressor between the client’s upper and lower teeth. Apply oxygen by mask. Turn the client to a lateral position, if possible. Time the seizure duration.

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Move items in the environment to ensure the client does not experience an injury. Observe the progression of the seizure, noting the sequence and type of limb involvement. Observe skin color. When the seizure allows, check pulse and respirations. Administer ordered anticonvulsant medications. Use equipment to suction the oral airway if the client vomits or has excessive oral secretions. When the seizure has finished, assist client to a comfortable position. Provide hygiene as necessary. Allow the client to verbalize feelings about the seizure. When the seizure has subsided, document pertinent information in the client record.

APPLYING RESTRAINTS Procedure 30-3: Applying Restraints Performed Preparation 1.

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Assess: • The behavior indicating the possible need for a restraint • Underlying cause for assessed behavior • What other protective measures may be implemented before applying a restraint • Status of skin to which restraint is to be applied • Circulatory status distal to restraints and of extremities • Effectiveness of other available safety precautions Review institutional policy for restraints. Assemble equipment and supplies: • Appropriate type and size of restraint Procedure Explain to the client and family what you are going to do, why it is necessary, and how they can cooperate. Wash hands and observe appropriate infection control procedures. Provide for client privacy, if indicated. Apply the selected restraint.

Belt Restraint (Safety Belt) Determine that the safety belt is in good order. If a Velcro safety belt is to be used, make sure that both pieces of Velcro are intact. If the belt has a long portion and a shorter portion, place the long portion of the belt behind (under) the bedridden client and secure it to the movable part of the bed frame. Place the shorter portion of the belt around the client’s waist, over the gown. There should be a finger’s width between the belt and the client. Or:

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Attach the belt around the client’s waist, and fasten it at the back of the chair. Or: If the belt is attached to a stretcher, secure the belt firmly over the client’s hips or abdomen.

Jacket Restraint Place vest on client, with opening at the front or the back, depending on the type. Pull the tie on the end of the vest flap across the chest, and place it through the slit in the opposite side of the chest. Repeat for the other tie. Use a half-bow knot to secure each tie around the movable bed frame, or behind the chair to a chair leg. Fasten the ties together behind the chair using a square (reef) knot. Ensure that the client is positioned appropriately to enable maximum chest expansion for breathing.

Mitt Restraint Apply the commercial thumbless mitt to the hand to be restrained. Make sure the fingers can be slightly flexed and are not caught under the hand. Follow the manufacturer’s directions for securing the mitt. If a mitt is to be worn for several days, remove it at least every 2–4 hours. Wash and exercise the client’s hand, then reapply the mitt. Check agency practices about recommended intervals for removal. Assess the client’s circulation to the hands shortly after the mitt is applied and at regular intervals.

Wrist or Ankle Restraint Pad bony prominences on the wrist or ankle, if needed to prevent skin breakdown. Apply the padded portion of the restraint around the ankle or wrist. Pull the tie of the restraint through the slit in the wrist portion or through the buckle. Using a half-bow or a square knot, as appropriate, attach the other end of the restraint to the movable portion of the bed frame.

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Document: Behavior(s) indicating the need for the restraint All other interventions implemented in attempt to avoid the use of restraints and their outcomes The time the physician was notified of the need for restraint Also record: The type of restraint applied, the time it was applied, and the goal for its application The client’s response to the restraint The times that the restraints were removed and skin care given Any other assessments and interventions Explanations given to the client and significant others Adjust the plan of care as required.