Patient Safety
Home Safety
One of the critical aspects of providing care in the home is the assessment of safety within the home setting. It is important for one to evaluate each and every home setting as part of evaluating whether home care is the appropriate site for ongoing care. The initial assessment in the home should encompass not only what the patient needs in the home but also the physical structure and layout of the home itself.
There may be many safety hazards in a patient's home. Areas of consideration during the home safety assessment are fire safety, medication safety, patient abuse and neglect and fall prevention. The following are a series of overviews that may be used to evaluate patient safety in the home. Prevention of patient abuse will be covered in a separate article.
Fire Safety
In homecare it is critical to stress the importance of fire safety to the family and patient. There are a few simple steps to safeguarding against home fires:
- Smoking - Careless handling of cigarettes, matches and other smoking materials spark fires. Numerous fatalities result from smoking in bed or smoldering cigarettes falling into upholstered furniture. Stress the importance of "no smoking in bed".
- Smoke detectors - Verify that the patient has adequate smoke detectors, CO2 detectors and fire extinguishers in the home. Smoke detectors should be installed in the kitchen, hallways near bedrooms and on each floor level. The family should check smoke detectors monthly and batteries should be replaced.
- Oxygen – Oxygen safety instructions are usually provided by the medical equipment supplier but it is still important to assess for oxygen safety hazards and provide education. There should be no smoking in the home. The oxygen should not be within 5 feet of an open flame and away from heat sources and electrical equipment.
- Closing doors - This is a simple safety precaution to take, but can be one of the most important. A closed door can stall the time it takes for a fire to spread.
- Escape plan - The family and patient should be able to identify and verbalize the evacuation route they would take in the event of a fire. Plans to assist the patient are a critical point in developing an evacuation plan. Encourage periodic drills.
The Role of Caregivers In Case of a Fire
If you are in a patient's home and a fire occurs follow the R-A-C-E steps:
- Rescue - anyone in immediate danger and get them to the closest safe area. Know the predetermined evacuation plan in case of fire and use it.
- Alarm - Dial 911. If your community does not have 911 capabilities, know where the fire departments number is posted in your patients' home.
- Confine - Shut off all oxygen immediately if in use. Close all doors and around the fire to block its progress.
- Extinguish - Put out the fire using portable fire extinguisher, baking soda, or water where safe to do so. Remember never put water on a grease or electrical fire.
Medication Safety
It is important for the nurse to review all of the patient's medication, both prescriptions and over-the-counter for adverse reactions and interactions. An adverse drug reaction can cause death or hospitalization or the need to discontinue the drug and/or to administer additional drugs to treat the adverse reaction. A drug interaction occurs when the effect of one drug is altered by the presence of another drug or the body diminishes the effectiveness of the medication.
In reviewing the patient's medication the nurse should check the name on the prescribed medication, the dosage, route of administration and duration of therapy. The patient's knowledge will be assessed regarding the safe and effective use of medication.
The nurse should provide patient teaching when needed on:
- Purpose and use
- Storage
- Side Effects
- Administration techniques
- Contamination safeguards
- Proper disposal
Fall Prevention
The initial home safety assessment is completed by a professional staff member and should be assessed each visit to identify risk factors that contribute to falls.
Risk Factors
- Osteoporosis and degenerative arthritis
- Visual decline and hearing impairments
- Frailty and incontinence
- Mental State
- Muscular and neuromuscular reaction time
- Household hazards
- History of previous falls
- History of dizziness
- Use of multiple medications
Fall Prevention Techniques
Understand that a patient's home or health status can change; therefore it is important to identify anything in the patient's surroundings that may cause a patient to fall. The following are areas to address in the patient's home to prevent falls:
Electrical Cords
- Make sure that all electrical cords are out of the way of traffic including telephone cords. If this is not possible make sure that the cords are taped to the floor or rug to avoid tripping.
- Remove area rugs or have a family member tape or nail edges down
- Keep traffic areas and the floor free of clutter
- Instruct patients to avoid polished/wet floors and to immediately wipe up spills
- Make sure all rooms and hallways are well lit.
- Make sure that the patient has bright night lights in hallways and rooms to make it safe if the patient needs to get up at night. Adequate lighting decreases the chance of falls.
- If the patient is having a problem with seeing the edges of steps, edge them with bright colored tape. This might help the patient see the edge of the step better.
- Make sure that the patient has either nonskid strips or a bath mat on the floor of the bathtub or shower before bathing.
- If the patient is having trouble getting in or out of the bathtub consider a shower or tub seat or other assistive devices to assist them.
- It is very important that the patient uses appropriate well fitting footwear. Improperly fitted or worn shoes can be a hazard. Shoes should have firm non skid, non friction soles.
- Advise the patient to avoid excessively long clothing. Clothing that is too long or too loose can contribute to falls; pants or robes that are too long can trip a patient.
Ambulation Aids and Safety Assistive Devices
Properly locking wheelchairs, using transfer devices, adding equipment that assists the patient (assistive devices) like grab-rails, etc in bathrooms, hallways and stairs can also decrease the chance of falls. If the patient has an assistive device, you should be oriented on the proper use of the device.
Wheelchair: Remind the patient to lock the wheels when transferring. The wheels should also be locked when the chair is in a stationary position.
Cane and Walker: Make sure that there are rubber tips at the bottom of the cane/walker, and that the devices are in good condition and the patient is wearing appropriate shoes.