2019 Annual Mandatory Employee Inservice
1. Older Adult Abuse & Neglect
2. Safety In The Community
Take the following precautions before visiting a patient’s home:
Wear a name badge or something that clearly identifies you as a member of the medical community.
Call the patient’s home in advance of your first visit. Confirm directions to the residence.
Always have changed in your pocket for a phone call; do not carry a purse; lock it in the trunk of your car.
Precautions When Traveling
Keep your car in good working order and with a full tank of fuel. Obtain an automobile club membership for assistance with car problems.
Consider using a personal cellular phone to maximize communication and personal safety.
Store a blanket in your car in the winter.
If your car fails, turn on emergency flashers, contact the police. Do not accept rides from strangers. If you can, contact Home Health Specialists. If we can assist you, we will.
Keep your car locked when it is parked and when you are driving. Keep the windows rolled up if possible.
Park in full view of the patient’s residence. (Avoid parking in alleys or deserted side streets.)
In The Home Environment
Use common walkways in the building. Avoid isolated stairs or darkened, unlit areas.
Always knock on the door before entering a patient’s home.
**When you are scheduled, notify Home Health Specialists clinical manager of car trouble, auto accident or other incidents for further instructions when personal safety is in question.
*Never go into or stay in a home if you feel your personal safety is in question. Always respect and listen to your gut feelings.
Whenever possible, use equipment that is grounded.
Routinely check the condition of equipment, electrical cords, and outlets.
Do not use outlets that are cracked, show burn marks, or do not hold plugs securely.
Do not use any plug with bent prongs.
Do not use power cords that are nicked, frayed or otherwise damaged.
Equipment that has been obviously damaged had had fluid spilled on it, or is excessively dirty should not be used before calling the equipment supply company for further direction.
Avoid touching a patient and conductive or metallic surface at the same time.
Avoid touching 2 pieces of electrical equipment at the same time.
If you receive a shock (not static electricity) when touching any part of an electrical instrument, get back up equipment ready, unplug equipment immediately, disconnect patient – attach patient to back up equipment and call supply company for a replacement.
When plugging in equipment – hold plug cap, not the cord.
Insert and withdraw the plug cap in a straight line, not at an angle.
Before attaching a patient to equipment – first, plug into the wall with the power switch off. The patient should be disconnected from equipment before unplugging.
3. Infection Control
Occupational Exposure To Bloodborne Pathogens
Exposure to potentially infectious blood and body fluids is an occupational hazard unique to health care settings.
Always practice universal precautions with all patients. People of all ages and cultural and socioeconomic backgrounds can test positive for Hepatitis B Virus (HBV) or HIV. One in every 200 Americans is an HBV carrier.
For an infection to occur there must be a human portal of entry (host) and a microbe as a source (agent).
There are three modes of transmission:
Direct – transfer of an infection from a source through physical contact or droplets in the air.
Indirect – the spread of infection from inanimate objects and arthropods (mosquitoes).
Airborne – involves suspension, particles of dust and droplet nuclei.
Practical steps to prevent infection:
Use biohazard bags when transporting samples and specimens.
Dispose of sharp instruments in a puncture-proof container. Do not recap needles.
Hold contaminated linens away from your body when carrying them.
Use an intermediary (such as a dustpan and brush) to pick up broken glass contaminated with blood or body fluids.
Proper handwashing – handwashing is the single most important measure for preventing the spread of infection.
Gloves when handling blood or body fluids.
Masks, gowns, and shields if the possibility of blood or body fluids splashing.
Immunizations as protection from a number of infections.
4. Fire Safety
The fire triangle below lists the three ingredients needed for a fire to occur.
Last year fire in the home claimed 5,000 lives. The sad point is these deaths could be prevented with an ounce of prevention.
Home Fire Safety Tips – Prevention
Do not use overloaded electrical systems
Do not use frayed electrical wires
Smoke detectors – check batteries monthly – replace battery yearly
Never leave home with the clothes dryer running.
Kitchen fires – never put anything on the stove you don’t want to heat.
Keep a fire extinguisher mounted nearby.
Learn how to use your fire extinguisher before there is an emergency.
Establish a fire escape plan – every room should have 2 means of escape.
To report a fire call 911.
In case of fire do the following: GET THE PATIENT AND YOURSELF OUT, then call for help – 911.
How to Escape a Fire
Remember you have 2 minutes to escape a home fire. Most people die in the first 5 minutes of a fire. If a patient receives oxygen but not life support, the nurse should disconnect the oxygen and get the patient out immediately. After you are out, call 911.
If the patient is on life support, the nurse needs to maintain the client’s respiratory status manually with an ambu-bag and move the patient out immediately. After you are out, call 911.
A fire burning in a house for 1 minute grows to 3 times its original size. In 4 minutes it grows 11 times its size, and in 6 minutes, it reaches 50 times its original size.
Purchase an ABC type extinguisher – they extinguish all types of fires.
The fire department estimated that as many as half of the smoke detectors installed in homes don’t work because the batteries are dead or missing.
5. Prevention of Falls at Home
The Burden of Falls How Big is the Problem Nationally?
• In 2010, the total direct medical costs of fall injuries for people 65 and older, adjusted for inflation, was $30 billion.
• By 2020, the annual direct and indirect cost of fall injuries is expected to reach $67.7 billion (in 2012 dollars).
• Among community-dwelling older adults, fall-related injury is one of the 20 most expensive medical conditions.
THREE TYPES OF FALLS:
• Near fall
• Un-witnessed fall
SIGNS OF FALL AMONG THE ELDERLY
MULTIFACTORIAL AND INTERACTING CAUSES OF FALLS
Intrinsic Risk Factors
Extrinsic Risk Factors
CLASSIFICATION OF FALLS
Derived from extrinsic factors such as environmental considerations
Anticipated Physiologic Falls:
Derived from intrinsic physiologic factors, such as confusion
Unanticipated Physiologic Falls:
Derived from unexpected intrinsic events, such as a new onset syncopal event or a major intrinsic event such as stroke
Using this classification, approximately 78 percent of the falls-related to anticipated physiologic falls can be identified early, and safety measures can be applied to prevent the fall.
ASSESSING FOR FALL RISK FACTORS
Assessments generally include these factors:
- Cognitive impairment,
- Mobility impairment, agitation, confusion gait instability and
- Age balance problems - Incontinence/urinary
- Medication usage, frequency sedatives and hypnotic
- Sensory deficits drugs
- Acute/chronic illness
- General health status
- Previous history of falls
- Non-healing foot sores
ASSESSING FOR FOR RISK OF FALLS
Get Up and Go Test
Original purpose was to identify elderly patients at risk of falling. Created by Mathias, Nayak and Isaccs. Graded on a subjective 5-point scale in which 1 is normal and 5 severely abnormal.
1 = Normal – no evidence of being at risk of falling during the test
2 = Very slightly abnormal
3 = Mildly abnormal
4 = Moderately abnormal
5 = Severely abnormal – evidence of being at risk of falling during the test
Timed Up and Go Test
• Original purpose was to test basic mobility skills of frail elderly persons who are able to walk on their own.
• Adapted by Podsiadlo and Richardson from the original “Get Up and Go” Test, created by Mathias, Nayak and Isaccs.
• Measurement of the time in seconds for a person to rise from sitting from a standard armchair, walk 10 feet, turn, walk back to the chair and sit down.
<10 Freely Mobile
<20 Mostly independent
<20-29 Variable mobility
>30 Impaired mobility
Elements of a Post Fall Assessment History
Description of fall event from individual and/or staff
• Activities at the time of the fall, footwear, restraints, etc.
• Any injuries incurred from the fall
• Review of key sudden-onset symptoms
• Physical Examination
• Vital signs
Exercises for Strength and Balance
Strength, flexibility, balance and reaction time are considered the most readily modifiable risk factors for falls. (Otago) However, exercise alone will not decrease falls.
Balance and lower body strength exercises are aimed at improving the ability to control and maintain the body's position while standing still and moving.
Correct use of assistive devices
Medication review and modification, especially psychotropic medications
Treatment of postural hypotension and cardiovascular disorders
Provision of hip protectors
6. PREVENTION OF MEDICATION ERRORS
It is important for all nurses to become familiar with various strategies to prevent or reduce the likelihood of medication errors. Here are ten strategies to help you do just that.
1. Ensure the five rights of medication administration.
Nurses must ensure that institutional policies related to medication transcription are followed. It isn’t adequate to transcribe the medication as prescribed but to ensure the correct medication is prescribed for the correct patient, in the correct dosage, via the correct route, and timed correctly (also known as the five rights).
2. Follow proper medication reconciliation procedures.
Institutions must have mechanisms in place for medication reconciliation when transferring a patient from one institution to the next or from one unit to the next in the same institution. Review and verify each medication for the correct patient, correct medication, correct dosage, the correct route, and correct time against the transfer orders, or medications listed on the transfer documents. Nurses must compare this to the medication administration record (MAR). Often not all elements of a medication record are available for easy verification, but it is of paramount importance to verify with every possible source—including the discharging or transferring institution/unit, the patient or patient’s family, and physician—to prevent potential errors related to improper reconciliation. There are several forms for medication reconciliation available from various vendors.
3. Double check—or even triple check—procedures.
This is a process whereby another nurse on the same shift or an incoming shift reviews all new orders to ensure each patient’s order is noted and transcribed correctly on the physician’s order and the medication administration record (MAR) or the treatment administration record. Some institutions have a chart flag process in place to highlight charts with new orders that require order verification.
4. Have the physician (or another nurse) read it back.
This is a process whereby a nurse reads back an order to the prescribing physician to ensure the ordered medication is transcribed correctly. This process can also be carried out from one nurse to the next whereby a nurse reads back an order transcribed to the physician’s order form to another nurse as the MAR is reviewed to ensure accuracy.
5. Consider using a name alert.
Some institutions use name alerts to prevent similar sounding patient names from potential medication mix up. Names such as Johnson and Johnston can lead to easy confusion on the part of nursing staff, so it is for this reason that name alerts posted in front of the MAR can prevent medication errors.
6. Place a zero in front of the decimal point.
A dosage of 0.25mg can easily be construed as 25mg without the zero in front of the decimal point, and this can result in an adverse outcome for a patient.
7. Document everything.
This includes proper medication labeling, legible documentation, or proper recording of administered medication. A lack of proper documentation for any medication can result in an error. For example, a nurse forgetting to document an as needed medication can result in another dosage being administered by another nurse since no documentation denoting previous administration exists. Reading the prescription label and expiration date of the medication is also another best practice. A correct medication can have an incorrect label or vice versa, and this can also lead to a med error.
8. Ensure proper storage of medications for proper efficacy.
Medications that should be refrigerated must be kept refrigerated to maintain efficacy, and similarly, medications that should be kept at room temperature should be stored accordingly. Most biologicals require refrigeration, and if a multidose vial is used, it must be labeled to ensure it is not used beyond its expiration date from the date it was opened.
9. Learn your institution’s medication administration policies, regulations, and guidelines.
In order for nurses to follow an institution’s medication policy, they must become familiar with the content of the policy. This is where education comes into play whereby the institution’s educator or education department educates nurses on the content of their medication policy. These policies often contain vital information regarding the institution’s practices on medication ordering, transcription, administration, and documentation. Nurses can also familiarize themselves with guidelines such as the Beers’ list, black box warning labels, and look-alike/sound-alike medication lists.
10. Consider having a drug guide available at all times.
Whether it’s print or electronic is a matter of personal (or institutional) preference, but both are equally valuable in providing important information on most categories of medication, including trade and generic names, therapeutic class, drug-to-drug interactions, dosing, nursing considerations, side effects/adverse reactions, and drug cautionary such as “do not crush, or give with meals.”
Utilizing any or all of the above strategies can help to prevent or reduce medication errors. Nurses must never cease to remember that a medication error can lead to a fatal outcome and it is for this reason that med safety matters.