Part Two
- Safe use policy and prevent the fall of patients
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Policy: the probability of the risk of falling of each patient upon admission to the hospital, including the potential risk associated with the patient's treatment regimen, is assessed in the form for this in the nursing assessment part.
* Measures must be taken to prevent falls.
Purpose: to prevent the fall of patients by assessing and re-evaluating cases with regard to the possibility of falling and taking the necessary measures and precautions to prevent this.
Definition:
Falling: is the occurrence of any change in the patient's position from a level to a lower level, which leads to the patient's contact with the ground or any surface at a lower level.
Precautions to be followed to prevent patients from being at risk of falling:
* Environmental factors
* Distinguish patients who are at risk of falling.
* Educating patients at risk of falling and their families.
* Environmental factors:
The hospital / department takes into account various environmental factors and influences that provide security and safety to the patient and prevent the possibility of falling, therefore, the department nurse or her representative periodically make sure that:
* The safety of patients ' beds and free from any breakage or malfunction.
* The safety aspects of the patients ' beds and that they do not have a malfunction.
* Safety brake beds of patients and they work efficiently.
* Safety of the trolley used to transport patients between departments.
* Not to move patients while the department workers are doing the cleaning process to avoid patients from falling in the meantime.
* Ensure the safety and quality of lighting.
* Ensure that there are no obstacles in the corridors.
* Ensure that the bell in the toilets is working properly.
* Ensure and keep the floors dry and clean so as not to increase the risk of slipping and falling.
1-distinguish patients at risk of falling
The nurse evaluates the patient for the risk of falling according to the items in the nursing assessment form when the patient is admitted.
In the case of a patient who may be at risk of falling, nursing does the following:
* Raise the sides of the bed.
* Placing the symbol (F) on the patient's identification bracelet .
* Put the symbol (F) on the door of the patient's room and/or his bed if the room contains more than one patient.
* Repeatedly asking about the desire to go to the toilet.
2-educating patients at risk of falling and their families through treating doctors and nursing
* Alerting the patient to the need to notify the nursing in case of feeling dizzy, falling or unbalanced............Etc
* Warning the patient not to resort to sudden movements when changing the position from sleeping to standing or sitting.
* Warning the patient not to bend down to pick up anything from the floor.
* Consider the use of comfortable shoes without heels and not conducive to slipping.
* Consider keeping the bell near the patient's bed.
* The need to commit not to leave unwanted things on the comodino next to the bed or in the bathroom .
* Alert the patient to ask for help while walking and moving.
* Do not place any sharp instruments near the patient.
* Ease of movement of the medical team, patients and their families in the roads and rooms of the hospital by not occupying them with any tools or equipment.
* Encourage the patient to use wall supports while walking to prevent falls, if any.
* Registration of health education for patients and their relatives in the patient's medical record.
3 - in the event of a patient suffering from a fall, the following should be followed:
* The nurse measures vital signs before moving or helping the patient to move or stand.
• When the patient may be injured or broken, the patient is not permanently moved.
* The nurse notifies the doctor to examine the patient and determine the method of lifting him.
* The nurse assists the patient and puts him in the wheelchair after making sure that the brakes are lifted to prevent movement.
* The nurse records the incident in the incident report form.
* The responsible nurse will re-evaluate the patient when there is any change in the condition of the patient who is prone to falling, provided that she documents any change in the condition as follows :
o the Triple name of the nursing evaluator.
o valuation date.
o hour of evaluation.
o The New result of the assessment.
List of patients prone to falls:
* A patient with a disorder of the degree of awareness of all its types and causes
* Patient convulsions of all kinds and causes.
* Patients with limb fractures.
* Diabetic coma patient.
* High blood pressure patient a, low.
* Geriatric patient.
* A psychiatric patient, especially if he has suicidal tendencies.
* Disequilibrium patient (stroke patient + hemiplegia).
* Pediatric patients.
* Patients treated with sedative drugs, diuretics, blood pressure reducers.
In charge:
* Members of the nursing staff.
* Doctors.
* Maintenance.
* Responsible for environmental safety.
References:
- world standard standards for patient safety.
- Egyptian accreditation standards
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Politics :
The safety and security of the patient is maintained and his right not to restrict his freedom is preserved only if there is harm to the patient or those around
The patient is restricted for as little time as possible after evaluating the patient and making sure that the restriction is necessary using the least means
The patient is restrained on the order of a qualified attending physician
Purpose:
to preserve the patient's rights and dignity and prevent harm to himself or others.
Restriction: it is a means that reduces or prevents the patient's movement, and there are two types:
Either physical: it is a method of restraining the patient from the hands, feet and trunk of the body .
Or pharmacological: it is a drug given with the aim of reducing the patient's movement and calming his behavior .
Isolation: it is the determination of the patient's stay in a special room or area in cases of violence and aggressive behavior of the patient towards himself or those around him from workers, patients and others .
Reasons for restriction:
* A patient who suffers from mental disorders that make him capable of harming himself or those around him.
* A patient with neurological diseases who suffers from a cerebral trauma and in a state of agitation makes him capable of unconscious movement and capable of harming himself and others.
* A postoperative patient in a state of agitation, which leads to harming himself and others.
* A liver patient suffering from a state of pre-hepatic coma and in a state of agitation.
* The patient is conscious but has a history of harming himself before or taking off the devices installed in him, such as the monitor - the central vein - or injection and pumping devices.
Reasons for isolation: the patient in the presence of behavioral diseases is isolated in a room alone until he is transferred to another hospital and the patient's parents are informed.
Actions :
First: evaluation of the patient :
Responsible nursing determines the patient's need for admission based on his behaviors
The Attending Physician registers the restriction order in the patient's medical file, indicating the following :
* The reason for the restriction
* Type of restriction required
* The time of giving the restriction order / the specified duration of the restriction
The restriction began:
The restriction is carried out by the fastest available method, whether pharmacological or physical, only after consulting a consultant, but in some cases it is forbidden to use the pharmacological method .
Method of restriction:
Nursing uses a leather belt, gauze and cotton bands, or other means to restrain parts of the body, and the four limbs are often used for restraint, except in cases such as when eating diets and personal hygiene .
Female: the nurse in charge rolls the legs together and then handcuffs them to the foot of the bed.
Male: the responsible nurse restricts each leg of the patient individually at the foot of the bed.
The oral restriction order is signed by the attending physician within 24 hours from the time he was informed about the case .
Nursing takes care not to harm the patient psychologically or physically during the restriction .
Nursing takes into account the preservation of patient privacy .
Patients whose freedom is legally restricted are prohibited from participating in their restriction except when there is a purely medical necessity (Article 35 of the ethics of the profession-resolution 238 of 2003)
Second: follow-up of the patient :
The nurse registers the follow-up of the patient with the form for this, including the following data :
* Patient behaviors-vital signs - blood circulation - skin condition
The responsible nurse follows up the patient under restriction and for medical and surgical reasons at least every two hours with documentation in the patient's medical file .
The nurse follows up the patient under restriction for psychological reasons at least every half hour and the observations are recorded in the patient's medical file with the form for the patient's restriction .
Third: renewal of the restriction order:
Restriction orders that are made for medical and surgical reasons, the attending physician must renew the order at least every 24 hours based on the continuing need
Restriction orders that are made for psychological reasons the attending physician must renew the order at least every 6 hours based on the continued need
Fourth: termination of the restriction:
Specifications of ending the restriction: it either completely improves the patient's state of consciousness or its deterioration and the occurrence of a coma .
The trained nurse terminates the patient's restriction according to the doctor's orders, according to the patient's condition and according to medical evidence, provided that the time and date of termination of the restriction are recorded .
Fifth: training:
The person responsible for the hospital's patient care policies provides practical training to doctors and nurses in the internal and care department on how to perform the policy.
Sixth: health education of the patient and his relatives : the doctor / members of the nursing staff responsible for familiarizing the patient and his relatives with the following
* The extent to which the patient needs to be restrained
* Duration of restriction
* Average rating during the restriction .
Responsible: - the Attending Physician.
Forms: restriction and follow-up order form.
References:
- Egyptian quality standards
- Joint International Committee standards
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