In this chapter, we will discuss the basics of safety in health care. You will learn how to protect yourself, your patients, and your coworkers. The chapter concludes with a five-question self-assessment drill.

IDENTIFY AND REPORT

Abuse or Neglect of Patients

Health care workers must always report abuse according to agency, state, and federal guidelines. There are several kinds of abuse, including the following:

• Physical abuse - Intentionally inflicting harm on the patient

• Financial abuse- Spending the patient's money or using his or her assets for reasons other than that patient's wellbeing

• Psychological or emotional abuse - Intentionally inflicting harm through insults or verbal assaults

• Sexual abuse - Nonconsensual sexual activity

• Basic rights abuse - Violations of basic rights that are protected by state and federal law (e.g. privacy or freedom of religion)

Evidence of abuse includes the following:

• Lack of personal care - Uncombed hair, wrinkled clothing, poor oral care, and dirty fingernails

• Malnourishment - Poor skin condition, muscle wasting, or weakness

• Dehydration - Lack of fluids results in dry mucous membranes, sunken eyes, and dry skin

• Pressure sores - Open areas on bony prominences, coccyx, elbows, or hips

• Overt physical signs of trauma - Scratches or bruises

• Restraint trauma - Rope burns or welts

• Inconsistency in the explanation of how an injury occurred

• Undue anxiety, trembling, helplessness, thoughts of suicide, evasiveness, and lack of eye contact

• A caregiver will not read mail to a patient

• A patient is not given the opportunity to speak without the presence of a caregiver

• Overmedication or oversedation

If you identify any of these signs, report them to a nurse and follow agency, state, and federal guidelines.

Recognize that sometimes abuse appears to be occurring, but it is not. Be aware that caregiver stress can cause unintentional abuse. Lack of education regarding patient care can also account for some of the symptoms. Different lifestyles can account for other behaviors. Ask a professional to assess any questionable signs of abuse.

Education by your agency can help stop the abuse. In addition, inform the patient's family about resources that help with patient care.

Sexual Harassment Involving Patients or Staff

Sexual harassment occurs when a person of power makes unwanted sexual advances that relate to the victim's employment, academic status, or success. This includes sexual advances, requests for sexual favors, inappropriate touching, or inappropriate comments. Remember that both males and females perpetrate sexual harassment.

According to the Equal Employment Opportunity Commission (EEOC), there are four forms of sexual harassment. These are determined by whether or not submission to the perpetrator:

1. Is a condition of employment

2. Interferes with job performance

3. Is the basis for an employment decision

4. Creates a hostile and intimidating work environment

If a patient acts inappropriately towards you, clearly ask the patient to stop. Some neurological disorders, delirium, confusion, and psychiatric problems cause patients to act inappropriately. If you feel you are being harassed, immediately report it to your supervisor and to human resources. If a supervisor is causing the harassment, contact human resources.

Substance Abuse Involving Patients or Staff

A health care worker under the influence of drugs or alcohol is a danger to patients and to other workers. If you suspect drug or alcohol abuse from a coworker, inform the nurse. Most facilities and agencies have a no-tolerance policy. Supervisors can ask workers to undergo drug testing at any time.

There are noticeable symptoms of substance abuse:

• Lack of concentration

• Inability to complete tasks

• Signs of withdrawal (e.g. shaking or sweating)

• Emotional changes during a shift

• Deteriorating personal appearance

• Complaints of verbal abusiveness or roughness

• Unexplained errands during work hours

• Excessive absenteeism

• Excessive, long breaks

Patients must be protected from health care workers with substance abuse problems. Many certification boards will revoke the certification of such an individual until he or she has completed a rehabilitation program.

Domestic Violence Involving Patients or Staff

Domestic violence happens at all levels of society. It can include verbal abuse, physical abuse, or sexual abuse. It is very complex issue, because of the nature of the relationship between the victim and the abuser; victims are often financially or emotionally dependent upon their partners. Report any such abuse to a nurse. Be sure to include all details needed for further evaluation.

Transport Patients Safely Using Proper Body Mechanics

When lifting and moving patients, proper positioning is extremely important. Back injuries are a very common problem related to body mechanics. Keep the following points in mind:

• Keep your body centered when lifting patients

• Do not lock your knees

• Use your thigh muscles to move the weight

• Point your forward-most foot in the direction to which you are transferring the patient (for a better center of balance)

• Keep your abdominal muscles tight (to strengthen your spine)

• Always wear appropriate footwear (not high heels or platform shoes)

• Always keep your spine straight

• Use available assistance when transferring patients (e.g. slide boards, gait belts, or other staff members)

Stand straight when pushing wheelchairs or gurneys. This puts less stress on your back and other musculoskeletal areas. Struggling to reach a falling patient can cause injury to the patient and to the health care worker. Be ready to stabilize yourself and your patient at any time.

Transfer Patients Safely Using Proper Body Mechanics

The most important precaution to take when transferring a patient is to make sure the equipment is locked. When transferring a patient from a wheelchair, make sure the wheelchair is locked. When transferring to a bed, make sure the bed is locked. When transferring from a bed to a gurney, make sure the bed and gurney are locked (to prevent their separation).

Monitor Patient's Environmental Safety

Darkness, obstacles, and sickness can cause falls. Furthermore, health issues can cause falls. Such issues include poor vision, hypotension, dizziness, substance abuse, poor gait, strokes, cognitive impairment, and advanced age.

Putting safety features into a home can help to prevent falls. For example, the patient could install bath tub rails and remove any throw rugs. Educating patients to rise slowly when taking antihypertensive or diuretic medications can prevent dizziness. Walkers, canes, and crutches can also be used to help with stability.

There are a number of other precautions that can improve a patient's environmental safety. If a patient is using an electric bed, the bed should be checked annually by a biomedical technician. Blood pressure equipment should also be checked frequently for accuracy. Patients should be taught how to take their own vital signs and how to interpret the results.

Prevent Workplace Injuries by Following OSHA Guidelines

The Occupational Safety and Health Administration (OSHA) regulates all workers' safety. OSHA requires the following basic safety practices.

Biological hazards - Danger caused by infectious agents such as bacteria, viruses, fungi, or other parasites. Remember your patients' body fluids contain biohazards.

Chemical hazards - These hazards involve damage caused by chemicals used in a medical laboratory. This includes exposure to toxic, carcinogenic, or caustic substances. All chemicals and reagents containing hazardous ingredients in a concentration greater than 1% must have a Material Safety Data Sheet (MSDS) on file. The MSDS contains information on physical and chemical characteristics, including:

• Safe handling

• Clean up

• Primary routes of entry

• Exposure limits

• Carcinogenic potential

• Fire, explosion, reactivity, and health hazards

• Emergency first aid

Radiological hazards- These hazards involve x-rays and other radioactive materials. If x-ray equipment is being used, wear a lead apron. If caring for a patient with radioactive implants, consider time, distance, and shielding. If a health care worker frequently encounters these hazards, he or she will be issued a radiation badge.

Electrical hazards- High-voltage equipment can cause burns and shock. The following steps can prevent electrical injuries:

• Avoid extension cords

• Ground and maintain electrical equipment

• Dry hands before using electrical equipment

• Position electrical devices away from sinks, faucets, and other sources of water

Electrical equipment cannot be used in a hospital without biomedical engineering examining and approving the device. If you find a frayed cord or a malfunction, immediately tag the item. Most facilities have an area where equipment that needs cleaning and checking is placed. Never use equipment that has been tagged for repair.

Fire or explosive hazards- Bunsen burners, oxygen, and chemicals can cause burns or other injuries. To prevent damage from fire, follow the policies of the facility. These policies will include routes of exit and evacuation. Be aware of the location of all fire extinguishers and fire alarms. Furthermore, smoking is not allowed in any facility.

Physical hazards- Heavy lifting can cause sprains, back injuries, and strains. To avoid physical injury, you should wear proper attire, do not overextend your reach, use a gait belt, lift with your legs, and move objects closer to your body before lifting.

Wet floors can cause falls. If water or moisture is on the floor, clean it up, or

have it cleaned.

Should you become injured, report the injury to a supervisor and make out an incident report. If the injury is serious, have a physician treat the injury. Most facilities have a time frame in which you can report such an injury.

Recognize and Respond to Emergency Situations

All facilities give orientation for fire, biohazard, and hostage situations. Follow your facility's guidelines, as well as those listed below.

If you are involved in a fire, remember the acronym RACE:

• R- Rescue

        •Rescue anyone in immediate danger from the fire (if it does not endanger your life).

• A- Alarm

        •Sound the alarm and dial 911.

• C- Confine

        •Confine the fire by closing all doors and windows.

• E - Extinguish or Evacuate

        •Use a fire extinguisher or evacuate the area (if the fire is too large).

To use fire extinguishers correctly, remember the acronym PASS:

• P - Pull

        •Pull the pin on the fire extinguisher.

• A-Aim

        •Aim the nozzle at the base of the fire.

• S- Squeeze

        •Squeeze or press the handle.

• S- Sweep 

        •Sweep from side to side, at the base of the fire (until it is out).

Hostage situations

For hostage situations, policies vary by facility. Know your facility's policy and what actions you are expected to take.

If you are safe from the situation, call 911 for assistance. If you have patients, keep them safe. Hide until help arrives, and stay as calm as possible.