M. Jorgenson, RN BSN

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2 Νοε 2013 (πριν από 4 χρόνια και 8 μήνες)

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M. Jorgenson, RN BSN

Patient Safety, Comfort, &

Patient Safety


are the fifth leading causes of death among
Americans aged 75 years and older

the second leading cause of mortality from
related injuries in adults >65 years

Elderly person who sustains a fall are more likely
to die within a year’s time of the fall.

Considine J, Botti M. Who, when and where? Identification of patients at risk of an in
hospital adverse event: implications for
nursing practice.
Int J Nurs



Fall Prevention:

Everyone’s Responsibility

Physical restraints

considered as a last resort after other care alternatives have
been unsuccessful

The least restrictive restraint should be used and it should be
removed at the earliest possible time

Must be ordered by a MD or other licensed independent

Special monitoring/ assessment

Must be reassessed by ordering MD in 24 hours and new order


Ask family to stay with patient

Rule out physical causes for agitation

Reduce stimulation

Use electronic alarm system

Check for environmental hazards

Offer diversion activities

Consider relocation closer to nurse’s

Conceal tubes and tubing necessary for

Alternatives to Restraints

Extremity restraints

Jacket or vest restraint

Hand Mitt

Elbow restraints

Leather restraints

Mummy restraints

Bed alarms

Types of Restraints

Must be able to insert 2 fingers between restraint and pt’s ankle or

Restraint must be fastened on moveable part of bed frame, NEVER
side rail

Use a quick
release knot to tie

Must be able to insert a fist between vest restraint and patient

When assessing a restraint, must assess CMS




Call bell must be within reach

Restraints cont.


Cardiovascular system

Increased cardiac workload, orthostatic hypotension and venous

Respiratory system

Decreased ventilatory effort and increased secretions

Gastrointestinal system

Poor digestion and utilization of food


Urinary system

UTI and renal calculi

Effects of Immobility

Musculoskeletal system

Atrophy, osteoporosis

Metabolic system

Decrease in metabolism

Integument system

Skin breakdown

Psychological well

Diminished self
esteem, social disturbances

Effects of Immobility cont.

Be organized and plan ahead

Anticipate changes/complications

Prevention versus treatment

Develop good habits

Proper alignment

Preparing for Activity.

Check MD orders, Nursing plan of care, PT notes, and
history for any limitations on mobility

Conduct a pain assessment and provide appropriate

Talk with the patient

Talk with other members of the team

Gather equipment

Develop a plan


Know policies and procedures for facility

Ensure adequate assistance for nurse and patient safety

Prepare for smooth, coordinated transfer
only one leader

Engage brakes on equipment

Planning cont.

Comfortable working height

Good posture

Feet shoulder width apart (wide base of support)

Use large leg/arm muscles (not back)

Gluteal and abdominal muscles engaged (internal girdle)

Low center of gravity

Body Mechanics

Flex knees (and hips)

Head up

Back straight

no twisting

Smooth, coordinated movements

Position self close to object

Rocking motion (forward

Body Mechanics cont.

Bed position

Arms across chest

Knees flexed and feet flat

Ensure proper body alignment

Trapeze bar

Avoid friction/shearing

Patient Positioning

Change patients positions frequently

Smoothe clothes and linens

Encourage deep breathing and coughing

Apply antiembolism stockings

Pad bony prominences

Bed in lowest position

Special Considerations



Side rails

Adjustable beds

Trapeze bar

Hand splints

Trochanter rolls

Heel boot

Foam pads

Hand rolls



& Protective Equipment

Range of Motion

Promotes circulation, prevents contractures, and
provides joint mobility.

Move each joint until there is resistance but not pain

Incorporate into ADLs

Teach patient and family

Encourage pt to do as much as possible

embolism Stockings

Used to enhance blood flow and venous

Patient should be measured for the correct

Assess extremity for pulses, edema,
movement, sensation (CMS)

Remove and check skin q 8 hours