Client Safety

Nurses collaborate with healthcare team members to ensure the safety of their clients in diverse healthcare service settings including hospitals, clinics, and homes.

This learning experience will instruct learners on assessing their clients’ environments for potential health and well-being hazards, prevent injuries, and ensuring the security of their clients.

2.1 Environmental Assessment

Nurses and other healthcare team members bear the responsibility of ongoing assessment of their clients’ environments for potential health hazards, making necessary modifications to ensure safety. It is important to educate clients, their families, and caregivers about deficits, assisting them with necessary modifications and improvements. The areas under assessment encompass extrinsic/environmental factors such as lighting and mobility assistive devices, as well as intrinsic client characteristics such as age, cognition, diseases, and disabilities (Burke, 2023a). If the client at home, access to emergency phone number(s) is imperative (Burke, 2023a).

Nurses are expected to adhere to safety policies and procedures in every healthcare environment, with hospital and ambulatory settings representing more controlled environments compared to homes. Therefore, the focus of environmental assessment will be on evaluating the client’s home.

According to Burke (2023a), specific areas in the home that should be assessed include:

• Emergency alert systems: Both smoke and carbon monoxide alarms should be present in the home, with the number and placement depending on the size and number of levels in the home.
• Emergency evacuation: Clients and their families should have an evacuation plan in the event of smoke, fire, or natural disaster such as floods, hurricanes, or tornadoes. They should also be aware of the shelters where their medical needs can be addressed.
• Carbon monoxide: A carbon monoxide detector is necessary in the home because overexposure to this colorless and odorless gas can lead to death. Clients may be exposed to carbon monoxide if their vehicles are running in an enclosed space like a garage or any other confined area. The author has heard of cases where people died from carbon monoxide poisoning due to the use of generators placed too close to their homes.
• Oxygen use: Check whether clients on oxygen therapy are adhering to the specific policies and procedures.
• Electrical safety: Assess for electrical hazards, such as overloaded sockets, exposed wires, and items immersed in water. Additionally, check for a working smoke detector and fire extinguisher, correcting any identified problems immediately.
• Food safety: Pathogenic microorganisms such as Escherichia coli and salmonella can contaminate food and make at-risk clients ill. High risk clients include those who are immunocompromised, infants, elderly individuals, and pregnant women with an immature or diminished immune system, respectively.
• Assistive devices and hardware: Clients with impaired mobility may use assistive devices, and those with disabilities may use assistive hardware. Assess their working condition and how clients use them.
• Cleanliness and sanitation: Assess for dust, dirt, and poor sanitation, as these can lead to pest infestation.
• Lighting: Evaluate both internal lighting, such as in their bedroom and bathroom, and external lighting in their driveway and exits.

2.2 Injury Prevention

Healthcare facility administrators dedicate time to establishing policies and procedures aimed at preventing injuries to their clients. It is the nurse’s responsibility to strictly adhere to these facility policies, actively participate in mandatory trainings sessions and drills. Firstly, it is important to educate clients about injury prevention policies and procedures, enabling them to comprehend and actively engage. For instance, explain to a very weak elderly client who relies on a walker the importance of requesting assistance when getting out of bed to prevent potential injuries from falls. Secondly, nurses must ensure that all equipment used in client care is in the proper working condition, and clients are familiar with their usage. Finally, numerous measures pertaining to fall prevention should be ensured, including:

• Adequate lighting.
• Clean and dry floor.
• Absence of loose rugs on the floor.
• Availability of assistive devices for clients with mobility problems.
• Provision of non-slip tread socks for ambulatory clients.
• Easy access to glasses and hearing aids for clients with visual and auditory impairments, respectively.

2.3 Security

Nurses must be well-informed about and adhere to the security plans by the healthcare facility of their employment. These security plans are crafted based on recommendations and regulations from authoritative bodies such as The Centers for Medicare and Medicaid, the Joint Commission on the Accreditation of Health Care Organizations, and the International Association for Healthcare Security and Safety (Burke, 2023b). The identified risks to clients encompass infant abduction, elopement, the potential entry of dangerous and violent individuals into the facility, and the risk of computers hacking leading to information or data theft (Burke, 2023b). Nurses are required to actively participate in mock drills and mandatory trainings sessions. The security systems in place issue warnings of violations, and mitigation strategies outlined by Burke (2023b) include:

• Application of electronic bands to the wrist of newborns and their mothers, signaling an abduction through a code pink warning via the security alert system.
• Installation of security doors at entrances and exits.
• Utilization of staff and visitor identification badges to authorize entry to facilities.
• Monitoring high-risk areas, such as the emergency department, through closed-circuit equipment and alarms.
• Familiarity with procedures, including evacuation, in the event of security like active shooting or bomb threat.
• Knowledge of the specially trained team assigned to respond to security breaches.

According to Burke (2023b), if clients require evacuation, the nurse need to apply the following principles:

• Firstly, discharge and relocate clients who do not need assistance and are ambulant.
• Secondly, prioritize stable clients who need assistance, discharging them after the first set of clients mentioned above.
• Finally, focus on the most severely ill clients, - those who are unstable, unpredictable and in critical care - relocating or discharging them only if there is a severe threat or crisis within the facility.

By the end of this learning experience, learners will gain insight into client safety, emphasizing environmental assessment, injury prevention, and client security.

The resources provided will enable learners to develop proficiency in ensuring the safety and security of their clients across diverse healthcare settings. The primary goals include success on the NCLEX examination and in the workplace.

After reviewing the resources, identify specific areas for improvements and concentrate on addressing those identified areas.

• Burke, A. (2023a, September 27). Home Safety: NCLEX-RN. https://www.registerednursing.org/nclex/home-safety/#educating-client-home-safety-issues
• Burke, A. (2023b, August 15). Security Plans: NCLEX-RN. https://www.registerednursing.org/nclex/security-plans/

Readings

• Ullman, A. J., & Davidson, P. M. (2021). Patient Safety: The Value of the Nurse. Lancet, 397, 1861-1863. https://doi.org/10.1016/S0140-6736(21)00981-8

Videos

• Nexus Nursing. (2020, July 15). Patient safety-NCLEX practice QnA [Video]. YouTube. https://youtu.be/j6W2I5_QLvU?si=5dhOi6ezAn57vqF3