The Joint Commission National Patient Safety Goals Essay

The Joint Commission National Patient Safety Goals Essay

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   The Joint Commission National Patient Safety Goals 

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Total:  100% The Joint Commission National Patient Safety Goals Essay

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SAFETY AND INFECTION CONTROL

  • SAFETY AND INFECTION CONTROL
  • CHAPTERS 27,28 FUNDAMENTALS OF NURSING
  • CHAPTER 10,11,12,13,14 ATI FUNDAMENTS
  • In patient safety, critical thinking is an ongoing process.
  • Standards have been developed by American Nurses Association and The Joint Commission.
  • Use of the nursing process when planning care promotes safety. The Joint Commission National Patient Safety Goals Essay

SAFETY AND INFECTION CONTROL

Safety in Health Care Organizations

A Safe Environment

  • Includes meeting patients’ physical and psychosocial needs
  • Applies to all places where patients receive care
  • Includes patients’ and health care providers’ well-being
  • Reduces risk of injury and transmission of pathogens
  • Maintains sanitation and reduces pollution

Environmental Hazards

  • Physical hazards: The Joint Commission National Patient Safety Goals Essay
  • Lighting
  • Obstacles
  • Bathroom hazards
  • Motor vehicle accidents
  • Poison
  • Fires

Falls

Transmission of pathogens

Pollution

Disasters

Natural

Man-made

Fire Safety

  • Keep open spaces (e.g., hallways) free of clutter. The Joint Commission National Patient Safety Goals Essay
  • Make sure fire exits are clearly marked.
  • Know the locations of all fire alarms, exits, and extinguishers.
  • Know the telephone number for reporting fires.
  • Know the agency’s fire drill and evacuation plans.
  • Never use the elevator in the event of a fire.
  • Turn off oxygen and appliances in the vicinity of a fire.
  • In the event of fire, maintain the respiratory status of a client on life support manually with the use of an Ambu-bag (resuscitation bag) until the client can be moved away from the fire. The Joint Commission National Patient Safety Goals Essay
  • Use the RACE mnemonic to set priorities in the event of a fire.
  • Use the PASS mnemonic to remember how to use a fire extinguisher. The Joint Commission National Patient Safety Goals Essay

Evacuation Procedures

  • Ambulatory clients may be directed to walk on their own to a safe area and may be able to help move clients in wheelchairs.
  • Bedridden clients are generally moved from the scene of a fire on stretchers, in their beds, or in wheelchairs.
  • Appropriate transfer techniques must be used to carry a client from the area of a fire.
  • Fire department personnel at the scene of a fire can help evacuate clients.
  • The Joint Commission National Patient Safety Goals Essay

Safety - The Primary concern when caring for clients

All employees need to know:

the institution's fire evacuation routine

the location of fire alarms

the location of fire extinguishers

how to use the fire extinguisher

the location of fire exits

The "hang tag“ (ON FIRE EXTINGUISHERS) should be checked for date of last inspection (usually annually)

List the phone number for reporting fires close to all phones in the facility

facility rescue plans: The Joint Commission National Patient Safety Goals Essay

FIRE SAFETY

FIRE EXTNGUISHERS

The most common water extinguishers are suitable for class A fires only. Never use water to extinguish  class C  fires due to the risk of electrical shock.

Dry chemical extinguishers come in a variety of types and are suitable for a combination of  class A, B, and C  fires (liquids and electrical fires)

filled with foam or powder and pressurized with nitrogen

may leave a harmful residue that reduces the likelihood of re-ignition

Carbon dioxide (CO2) extinguishers

used for  class B and C  fires

do not work well on  class A  fires because they may not be able to displace oxygen to put the fire out and the fire may re-ignite

do not leave a harmful residue

Electrical Safety. The Joint Commission National Patient Safety Goals Essay

  • Electrical equipment must be maintained in good working order and should be properly grounded.
  • Inform the client that any electrical equipment that the client brings into the healthcare facility must be inspected for safety before it is used.
  • Check electrical cords and outlets for exposed, frayed, or otherwise damaged wires and loose or missing parts.
  • Do no overload electrical circuits.
  • Read warning labels on all equipment; never operate unfamiliar equipment.
  • Use safety-type extension cords only when absolutely necessary, and secure them to the floor with the use of electrical tape. The Joint Commission National Patient Safety Goals Essay

Electrical Safety

  • Never run electrical wiring under a carpet.
  • Never pull a plug by the cord; always grasp the plug itself.
  • Never use electrical appliances near sinks, bathtubs, or other water sources.
  • Always disconnect a plug from the outlet before cleaning equipment or appliances.
  • If a client sustains an electrical shock, turn off the electricity before touching the client. The Joint Commission National Patient Safety Goals Essay
  • A malfunctioning piece of equipment must be removed from the client’s vicinity, and the appropriate hospital maintenance personnel must be notified

Electrical Safety

Electrical safety overview for home settings

To reduce the risk of electric shock, make sure that ground fault circuit interrupter (GFCI) protection is provided for outlets at kitchen counters, in bathrooms, and at outdoor receptacles; test GFCIs regularly

Check the wattage of light fixtures and lamps to make sure they are the correct wattage; incorrect wattage can cause overheating that can lead to a fire

Use safety closures to "child-proof" electrical outlets

Many avoidable electrical fires can be traced to misuse of electric cords, e.g., overloading circuits or extension cords, running cords under rugs

Handling Hazardous and Infectious Materials

Nursing Responsibilities
Identify situations that involve the potential for exposure to hazardous or infectious materials (e.g., radiation, infectious wastes, contaminated needles). Follow agency protocols for handling biohazardous and infectious materials. Ensure that nursing staff understand and follow these protocols. Handle all infectious materials as hazards. The Joint Commission National Patient Safety Goals Essay. Dispose of waste in designated areas only, using the proper containers for disposal. Ensure that infectious material is labeled properly. Dispose of all sharps immediately after use in a closed puncture-resistant disposal container that is leak proof and labeled or color coded. The Joint Commission National Patient Safety Goals Essay

Radiation Safety Precautions

  • Most nuclear medicine therapy clients are treated with radioactive iodine-131 (I-131). Iodine-131 has a half-life of 8 days and emits both beta particles and gamma rays. Gamma rays have properties like x-rays and present a potential external hazard. Some clients may be undergoing implant therapy, where a sealed source of radioactive material (usually a gamma emitter) is placed in a body cavity close to the tumor. The Joint Commission National Patient Safety Goals Essay
  • Use these simple techniques to reduce the hazards associated with gamma rays:

Radiation Safety Precautions

Mark the client's room with appropriate signage

Place client in a private room

Place wristband on client indicating that the client is receiving internal radiation therapy

Put on shoe covers and protective gloves before entering the client's room; remove equipment before exiting the room

Internal Radiation Implant Safety

Organize nursing tasks to minimize exposure to the radiation source. Rotate nursing assignments Do not allow a pregnant nurse to care for the client. Do not allow pregnant women or children visit the client. Limit visitors to 30 minutes per day and warn them to remain at least 6 feet from the source of radiation. Keep all bed linens and dressings in the client’s room until the implant is removed. Keep a lead container in the client’s room. The Joint Commission National Patient Safety Goals Essay

Radiation Safety Precautions

Wear gloves

When handling secretions/excretions of a client receiving systemic isotopes; flush toilet twice

When changing linens of clients receiving systemic isotopes

Plan care to minimize time at the client's bedside

Work quickly, but effectively and courteously

Maintain the greatest distance possible from the client consistent with effective care

Restrict care to a maximum of 30 minutes to one (1) hour every eight (8) hours

Prepare meal trays outside the room

Radiation Safety Precautions

Position items within client's reach so as to facilitate as much self-care as possible

Schedule only one radioactive client to a nurse at a time

Ensure a long handled forceps and a lead container are in the client's room in case of implant dislodgement

In the event that a source becomes dislodged, notify the Radiation Oncologist

Do not attempt to handle the dislodged implant unless trained to do so

Radiation Safety Precautions. The Joint Commission National Patient Safety Goals Essay

Wear a dosimeter film badge to measure radiation exposure while caring for client to monitor exposure; have it checked per agency policy

Wear a lead shield to reduce the transmission of radiation. The Joint Commission National Patient Safety Goals Essay

No pregnant nurses, visitors, or children should be allowed near the client

Read more about radiation safety on the Occupation Safety & Health Administration (OSHA) Web site. The Joint Commission National Patient Safety Goals Essay

Poison control

  • High risk groups are young children and older adults
  • Goals of therapies

before the body absorbs poison, remove it, (either through vomiting or gastric lavage) or neutralize it (using activated charcoal, for example)

give supportive care, i.e., manage shock, seizures, aspiration

give the correct antidote to neutralize poison

speed the elimination of any absorbed poison

Points to remember-Poisons

  • Never induce vomiting unless instructed to do so by a poison center or health care provider. The Joint Commission National Patient Safety Goals Essay
  • If you suspect someone has taken poison, take the poisonous substance with you to the emergency room.
  • Call the local poison control center to determine appropriate treatment for the specific poison. The Joint Commission National Patient Safety Goals Essay

Fall prevention

  • Assesses client for risk factors
  • Use Guidelines to prevent client falls
  • Use the mnemonic FRAIL MOM & DAD for assessing the geriatric client in the primary care setting:
    F alls
    R elative or caregiver strain
    A ctivities of daily living
    I ncontinence
    L iving situation
    M emory Impairment
    O culo-otic impairment (visual and auditory problems)
    M alnutrition
    D rugs
    A dvance directives
    D epression

The Joint Commission National Patient Safety Goals Essay

ERGONOMIC PRINCIPLES FOR HEALTHCARE WORKERS

  • To prevent injury, the nurse needs to use good body mechanics and observe ergonomic principles when providing care.
  • When planning to move a client, the nurse must assess the client’s ability to stand, balance, transfer, and use assistive devices to move about.
  • The nurse needs to ensure that staff members understand the principles of good body mechanics and use proper body mechanics. The Joint Commission National Patient Safety Goals Essay
  • The nurse needs to arrange for adequate help and use mechanical lifting aids as much as possible.
  • The nurse should provide information to the client about the lift or move and encourage the client to assist as much as possible.

When moving the client, the staff person with the heaviest load coordinates efforts of the team involved by counting to three.

The staff person positions self close to the client (or object being lifted). The Joint Commission National Patient Safety Goals Essay

The staff person keeps the back, neck, pelvis, and feet aligned and avoids twisting; the arms and legs (not the back) are used, and the knees are kept flexed and the feet kept wide apart.

The staff person sets (tightens) abdominal and gluteal muscles in preparation for the move.

When transferring a client onto a stretcher, a slide board should be used. The Joint Commission National Patient Safety Goals Essay

Ergonomic Principles for Healthcare Workers

Protect self from falls and injuries using correct body mechanics

When moving objects, avoid pulling; push instead

When moving clients or objects

arrange for help

lift simultaneously with assistance or, better yet, use mechanical aids

flex the knees

keep back, neck, pelvis, and feet aligned

widen the base of support, keeping feet apart

avoid twisting of the body

use arms and legs for lifting and moving, not the back

balance load and keep it centered on the

Incident Reports

An incident report is a form that is completed after an unanticipated occurrence. The Joint Commission National Patient Safety Goals Essay

  • This type of report is used as a tool for identifying risk situations and improving client care.
  • Other terms for “incident” include unusual event, irregular occurrence, and variance.

The Joint Commission National Patient Safety Goals Essay
Nursing Responsibilities

  • Be aware of the situations that require completion of an incident report.
  • Follow specific agency guidelines for documentation.
  • Fill out the report completely, accurately, and factually.
  • Contact the client’s physician to report the incident; the physician will need to complete the incident report and sign the report. The Joint Commission National Patient Safety Goals Essay
  • Ensure that the incident report form is not copied or placed in the client’s record and that no reference to completing an incident report form appears in the client’s record.
  • Document a complete entry in the client’s record regarding an incident. The incident report is not a substitute for documentation of the event. The Joint Commission National Patient Safety Goals Essay
  • When a client injury occurs or an error in care is made, assess the client frequently.

Home Safety

  • Nursing Responsibilities
  • Assess the home environment, taking into consideration the client’s condition and limitations; look for fire alarms, adequate lighting, stair and bathroom handrails, and safe appliances.
  • Initiate modifications to the client’s home as necessary.The Joint Commission National Patient Safety Goals Essay
  • Teach the client about safety related to the client’s condition and with regard to any equipment that the client is using (e.g., disposal of insulin syringes).
  • Teach parents about safety measures for the child; the toddler, the preschooler, and the young school-age child must be protected from accidental poisoning. The Joint Commission National Patient Safety Goals Essay

Home Safety

Ensure that parents understand car safety and the use of car seats for the infant and child.

Ensure safety for older adults. Diminished eyesight and impaired memory may result in accidental ingestion of poisonous substances or an overdose of a prescribed medication; a medication organizer will help prevent such errors.

The phone number for a poison control center should be displayed on the telephone itself; the number should be called in any case of suspected poisoning. The Joint Commission National Patient Safety Goals Essay

The nurse needs to provide instructions to laypersons about interventions to take in the event of an accidental poisoning.

Diagnosis

Nursing diagnoses for patients with safety risk:

Risk for falls

Impaired home maintenance

Risk for injury

Deficient knowledge

Risk for poisoning

Risk for suffocation

Risk for trauma

INFECTION CONTROL

Definition

An infection is the result of an interaction between a susceptible host and an infectious agent (bacteria, viruses, fungi, parasites) ; a clinical syndrome caused by the invasion and multiplication of a pathogen in the body. The Joint Commission National Patient Safety Goals Essay

Infection

  • A. Types of infections
  • 1. Community acquired
  • 2. Hospital acquired (also called nosocomial infections)

Health Care–Associated Infection

  • Types of HAI infection: The Joint Commission National Patient Safety Goals Essay

Health Care–Associated Infection

Risk factors

Number of health care employees with direct contact with the patient

Types and numbers of invasive procedures

Therapy received

Length of hospitalization

Major sites for HAI infection

Surgical or traumatic wounds

Urinary and respiratory tracts

Bloodstream

Nature of Infection

  • Communicable disease is the infectious process transmitted from one person to another.
  • If pathogens multiply and cause clinical signs and symptoms, the infection is symptomatic.
  • If clinical signs and symptoms are not present, the illness is termed asymptomatic. The Joint Commission National Patient Safety Goals Essay
  • Hand hygiene is the most important technique to use in preventing and controlling transmission of infection.
The Joint Commission National Patient Safety Goals Essay

Stages of an infectious process

Incubation period

The time between entrance of the pathogen and the first symptoms

Incubation periods vary with host and organism

If host defenses are successful, an infection may disappear without progression to next stage

Examples of incubation periods for specific diseases

Mumps: 18 days

Varicella (Chicken Pox): 2 to 3 weeks

Stages of an infectious process

Prodromal stage

Time from onset of nonspecific findings, i.e., fatigue, malaise, to more specific findings

The pathogen is multiplying

The host is most contagious

  • Not all diseases have prodromal periods. The Joint Commission National Patient Safety Goals Essay

Stages of an infectious process

Invasive phase (or period of illness)

When a person exhibits the specific findings of the disease

the host is trying to fight off the disease

Given unsuccessful host defenses, the invasive phase can progress to death

Examples of findings for specific diseases

Mumps: swelling of the parotid gland

  • Common cold: sore throat, congestion

Stages of an infectious process

Convalescence: when the acute findings begin to disappear and the body returns to normal health

Complications of infection

Relapse - some infections may reactivate, often because they were not treated thoroughly or the client did not comply with treatment

Local complications - local infections may form abscesses

Systemic complications - pathogen may enter bloodstream and cause septicemia

Defenses Against Infection

  • Normal flora: helps to resist infection by releasing antibacterial substances and inhibiting multiplication of pathogenic microorganisms. The Joint Commission National Patient Safety Goals Essay
  • Innate Defenses(born with): skin, mucous membranes, WBCs(phagocytosis), interferon, etc
The Joint Commission National Patient Safety Goals Essay

Chain of transmission

Causative agent (pathogen)

Reservoir

Portal of exit - way to get out of reservoir of host

Transmission route - way to reach susceptible host

Portal of entry - way to gain entrance

Susceptible host

After the pathogen enters the host, illness depends on 4 factors

Number of pathogen organisms

Duration of the exposure

Health status of host, including age, physical, mental, and emotional health

Genetic status of host's immune system

Medical Asepsis

Referred to as "clean technique"

Any therapy, protocol or medical procedure used to reduce the number and spread of microorganisms

Practices that reduce pathogens include:

Hand washing - the single most effective and important way to prevent the spread of microorganisms

Friction - loosens the microorganisms so they can be removed

Soap - non-antimicrobial soap and water -or- with antimicrobial soap and water if contact with spores, e.g., Clostridium difficile  or  Bacillus anthracis

Medical Asepsis

No artificial fingernails or extenders, particularly if duties include direct contact with individuals at high risk for infections, e.g., ICU or operating rooms

Use of disinfectants and antiseptics on people and objects

Disinfectant - a substance that reduces the number of microorganisms (but does not eliminate them)

Bleach solutions

Zephirin (and other quaternary ammonium compounds) The Joint Commission National Patient Safety Goals Essay

Medical Asepsis

Antiseptic - a substance that can be applied to skin to reduce the number of microorganisms

Alcohol

Betadine®

Practices that interrupt transmission

Use of personal protective equipment (PPE)

Gloves

Gown

Mask with shield or goggles

Equipment, i.e., 1-way valve in CPR mask

Surgical Asepsis

Surgical asepsis includes the practices that destroy all microorganisms and their spores

Steam under pressure

Gas

Radiation

Chemicals

Surgical Asepsis

Sterile technique involves procedures that keep an object or area free from living organisms

A sterile object remains sterile only when touched by another sterile object, or, in other words, sterile touching sterile remains sterile

The skin cannot be sterilized and is, therefore, non-sterile

Surgical Asepsis

Surgical asepsis is used for many procedures, including

Care of surgical wounds, i.e., dressing changes

Catheterizations

Tracheostomy care

Suctioning

Surgery

The Joint Commission National Patient Safety Goals Essay

Surgical Asepsis

Principles of surgical asepsis

Only sterile objects may be placed on a sterile field

Always hold your hands above the level of your elbows

Do not reach over the sterile field

The edges of a sterile field or container are considered contaminated (depending on the resource, this is approximately 1 to 2 inches surrounding the border)

Surgical Asepsis

A sterile object becomes contaminated under the following conditions: The Joint Commission National Patient Safety Goals Essay

Sterile touching clean becomes... contaminated

Sterile touching contaminated becomes... contaminated

Sterile touching questionable is... contaminated

A sterile object or sterile field that is not in the range of vision is... contaminated

An object held below a person's waist is... contaminated

When a sterile object comes in contact with a wet, contaminated surface, it is considered contaminated (through capillary action) The Joint Commission National Patient Safety Goals Essay

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A sterile object becomes contaminated with prolonged exposure to air

Standard precautions

used for care of all clients

used to prevent the spread of microorganisms

synthesizes the major features of universal precautions and body substance isolation

universal (blood and body fluid) precautions - designed to reduce the risk of transmission of bloodborne pathogens

body substance isolation - designed to reduce the risk of transmission of pathogens from moist body substances

Standard precautions

Apply to

blood

all body fluids, secretions, and excretions, except sweat, regardless of whether or not they contain visible blood

non-intact skin

mucous membranes

Hand hygiene includes using an instant alcohol hand antiseptic before and after providing patient care, washing hands with soap and water when they are visibly soiled, and performing a surgical scrub. The Joint Commission National Patient Safety Goals Essay

Handwashing is the act of washing hands with soap and water, followed by rinsing under a stream of water for 15 seconds.

Standard precautions

Personal protective equipment (PPE) - designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in health care settings

gloves

masks

gowns

protective eyewear

head covering

Transmission-based precautions

Contact: direct and indirect

direct contact transmission: microorganisms are transferred from one infected person to another person without a contaminated intermediate object or person

indirect contact transmission: transfer of an infectious agent through a contaminated intermediate object or person (especially contaminated hands of health care workers) The Joint Commission National Patient Safety Goals Essay

gown and glove for all contact

examples of opportunities for contact transmission: epidemiologically important organisms, e.g., VRE; excessive wound damage; fecal incontinence

Transmission-based precautions

Droplet precautions: transmission involves contact of the conjunctivae or the mucous membranes of the nose or mouth of a susceptible person with large particle droplets containing microorganisms generated from someone who either exhibits a disease or who is a carrier of the microorganism

requires close contact (typically within 3 feet or less) between the source client and a susceptible person

use of a standard surgical mask within 3 feet of the client is required

respiratory droplets are generated when an infected person coughs, sneezes, or talks, or during procedures such as suctioning, endotracheal intubation, cough induction by chest physiotherapy and cardiopulmonary resuscitation

examples of infectious agents transmitted through droplet route: group A streptococcus (for the first 24 hours of antimicrobial therapy), adenovirus, rhinovirus, Neisseria meningitis, pertussis, influenza virus

Cough Etiquette

Cover your nose/mouth with a tissue when you cough, and promptly dispose of the contaminated tissue.

Place a surgical mask on a patient if it does not compromise respiratory function or is applicable; this may not be feasible in pediatric populations. The Joint Commission National Patient Safety Goals Essay

Perform hand hygiene after contact with contaminated respiratory secretions

Maintain spatial separation greater than 3 feet from persons with respiratory infection

Transmission-based precautions

Airborne transmission: microorganisms dispersed over long distances that remain infective over time and distance

infectious agents remain active in the air over a long period of time and are dispersed over long distances by air currents, which are inhaled by susceptible individuals

preventing the spread of airborne pathogens requires

the use of special air handling and ventilation systems

wearing respiratory protection with NIOSH-certified N95 or higher level respirator for all health care workers

examples of microorganisms spread through airborne route: rubeola virus (measles), varicella-zoster virus (chickenpox), Mycobacterium tuberculosis

IMMUNIZATION

Acquired immunity

any form of immunity that is not “innate”

obtained during life

natural or artificial

naturally acquired immunity is obtained by

the development of antibodies resulting from an attack of infectious disease

the transmission of antibodies from the mother through the placenta to the fetus or to the infant through the colostrum

IMMUNIZATION

Artificially acquired immunity is obtained by

vaccination

injection of an antiserum, also called an immune globulin such as a hepatitis immune globulin, after hepatitis exposure

Passive or active

passive immunity results from antibodies that are transmitted through

the placenta to the fetus

the colostrum to an infant

injection of antiserum (immune globulin) for treatment or prophylaxis

IMMUNIZATION

Passive immunity is not permanent and does not last as long as active immunity

active immunity is when the body produces its own antibodies as a reaction to exposure to an antigen

REFER TO IMMUNIZATION TABLES HANDOUT

Disease reporting

  • Reporting of nationally notifiable diseases

voluntary - to the Centers for Disease Control and Prevention

mandated (by legislation or regulation) - at the state level

  • The list of notifiable diseases varies from state-to-state, but internationally quarantinable diseases, e.g., cholera, plague, yellow fever, are reported in compliance with the World Health Organization's International Health Regulations. The Joint Commission National Patient Safety Goals Essay

Points to remember-Infection

  • Infection control with the use of standard precautions, transmission precautions and medical and surgical asepsis decreases the spread of infection.
  • The major sites for nosocomial infections are urinary and respiratory tracts, blood, and wounds.
  • All nosocomial infections that occur in hospitals must be tracked and recorded by risk management.
  • Hand washing is the most effective method of preventing infection; friction is the most important variable.
  • Standard precautions are used for contact with all body fluids (except sweat). The Joint Commission National Patient Safety Goals Essay
  • Standard precautions are used for all clients and transmission precautions are used for all clients with transmittable organisms.
  • Special (N95) respirator masks are necessary to care for clients under airborne precautions who have tuberculosis or other airborne infectious conditions.
  • Protective (neutropenic) isolation is used for clients with immunosuppression and low white blood counts.
  • Disease reporting of "notifiable diseases" is mandated at the state level (through legislation or regulation).

Points to remember-Infection

Use of isolation precautions (refer to the Centers for Disease Control's Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings for more complete information) The Joint Commission National Patient Safety Goals Essay

Standard Precautions

Contact Precautions

Droplet Precautions

Airborne Precautions

DISASTER PREPAREDENESS

Overview of emergency preparedness and response

  • An emergency can be brought on by a disaster, which is any event initiated by a person or by nature, or a combination of both
  • A formal emergency preparedness plan of action is required to respond to a disaster

personal and family preparedness plan

formal institutional plan

DISASTER PREPAREDENESS

  • The Federal Emergency Management Agency (FEMA) identifies

four disaster management phases: The Joint Commission National Patient Safety Goals Essay

mitigation

preparedness

response

recovery

Three levels of disaster, ranging from minor (Level III) to major (Level I)

DISASTER PREPAREDENESS

DISASTER PREPAREDENESS

Various rating systems exist and nurses should know and understand the rating systems

treated first: individuals who have life-threatening injuries that are readily correctable

treated last: individuals who have no injuries, or noncritical injuries, and who are ambulatory, as well as individuals who are dying or are dead

DISASTER PREPAREDENESS

In the health care agency - emergency department triage involves dividing those who need care into one of the following three categories: The Joint Commission National Patient Safety Goals Essay

emergent – individuals who have life-threatening injuries and need immediate attention are given the highest priority

urgent – individuals with non-life-threatening injuries

nonurgent – individuals with no immediate complications and who can wait for treatment

DISASTER PREPAREDENESS

Specific hazards associated with disasters

  • Bioterrorism
  • Chemical emergencies
  • Radiation emergencies
  • Mass casualties
  • Natural disasters and severe weather
  • Recent outbreaks and incidents, e.g., salmonella

Bacterial agents

causative agent: Bacillus anthracis

exposure:

integumentary system (most common): direct skin contact with spores; in nature, contact with infected animals or animal products

respiratory tract: inhalation

gastrointestinal system: eating undercooked or raw infected dairy products

oropharyngeal

Bacterial agents

exposed individuals do not spread infection

clinical indicators of anthrax infection: symptoms can appear within 7 days of coming in contact with the bacterium for all types of anthrax

skin: localized itching followed by papular lesions that turns vesicular; becomes black eschar after 7 to 10 days

inhalation: initially low-grade fever, cough, malaise, fatigue, myalgias, sweating, and chest discomfort but progressing to high fever, respiratory distress, shock and death within 24 to 36 hours. The Joint Commission National Patient Safety Goals Essay

Bacterial agents

treatment

decontamination

remove clothing; do not pull anything over the head

decontaminate in area outside of treatment area: using large amounts of water, shower with soap or wash with soap and running water; flush eyes with running water for 15 minutes

antibiotics

ciprofloxacin hydrochloride (Cipro), drug of choice

penicillin G procaine (Wycillin)

doxycycline (Vibramycin)

note: do not use extended-spectrum cephalosporins or trimethoprim/sulfamethoxazole due to resistance of anthrax to these drugs

Bacterial agents

vaccine available, but not to the general public

  • Plague

causative agent:  Yersinia pestis

zoonotic infection carried on rodents and their fleas

Y. pestis destroyed by sunlight and dryness, although bacterium can survive for 1 hour after release

exposed individuals can spread infection

Bacterial agents

disease states: bubonic plague, pneumonic plague and septicemic plague

clinical indicators of pneumonic plague

rapidly deteriorating pneumonia

fever, chest pain, bloody or watery sputum

treatment: individuals with the plague need immediate treatment or death will occur within 24 hours after the first symptoms

Bacterial agents

isolate exposed individuals

treat with antibiotics

streptomycin

gentamycin (Garamycin)

doxycycline (Vibramycin) The Joint Commission National Patient Safety Goals Essay

ciprofloxacin hydrochloride (Cipro)

supportive treatment: oxygen, IV fluids and respiratory support are usually needed

f. vaccine: not available

Viral agents

  • Smallpox

Viral agents

causative agent: variola virus

exposed individuals can spread infection via direct contact or prolonged face to face contact

clinical indicators of smallpox disease

initially (sometimes contagious): high fever (101 to 104 degrees Fahrenheit), malaise, head and body aches

rash (most contagious): start as small, red spots on the tongue and mouth; the spots become open sores and then spread to the rest of the body becoming pustules that crust and scab-over

individuals are contagious until all scabs have fallen off

Viral agents

Treatment

no specific drug treatment or cure

if the smallpox vaccine is given within 1 to 4 days after exposure to the disease, illness may be prevented or be less severe

individuals diagnosed with smallpox and everyone they have had close contact with will need to be isolated

vaccine: The Joint Commission National Patient Safety Goals Essay

has not been given routinely in the U.S. since 1972

it is unknown how long immunity lasts after immunization

Viral hemorrhagic fever (VHF)

used to describe a severe multisystem syndrome caused by four different families of viruses, including arenaviruses, filoviruses, bunyaviruses, and flaviviruses

the vascular system is damaged and the body’s ability to regulate itself is impaired

usually accompanied by hemorrhage, but this is not the life-threatening aspect of these diseases

disease states include: Ebola, Marburg, yellow fever, Argentine hemorrhagic fever

Viral hemorrhagic fever (VHF

Viral hemorrhagic fever (VHF

the viruses are zoonotic, residing in and totally dependent on their animal hosts

an animal reservoir host, e.g., rodents

arthropod vector, e.g., ticks, mosquitoes

Biological toxins (chemical agents) The Joint Commission National Patient Safety Goals Essay

  • Sulfur mustard or mustard gas (H, HD, or HT): a blister agent/vesicant

human-made chemical warfare agent

powerful irritant and blistering agent that damages the skin, eyes, and respiratory tract

damages DNA

may smell like garlic, onions, or mustard

effects of sulfur mustard usually last 1 to 2 days in environment, but can be present for weeks to months in a cold climate

rarely fatal but potentially long term health effects

Viral hemorrhagic fever (VHF

clinical indications of VHF

initially: high fever, muscle aches, weakness

severe disease: subcutaneous and internal bleeding, bleeding from body orifices; shock, delirium, seizures, and coma

treatment: The Joint Commission National Patient Safety Goals Essay

supportive therapy

no effective treatment or cure

vaccine: vaccines only for yellow fever and Argentine hemorrhagic fever

Viral hemorrhagic fever (VHF

exposure to a vapor (released into the air), an oily-textured liquid (released into the water), or to a solid form

clinical indications of exposure

skin: redness and itching immediately after exposure eventually resulting in yellow blistering

eyes: irritation, pain, swelling, and tearing with mild to moderate exposure; severe exposure can cause light sensitivity, pain, or blindness lasting up to 10 days

respiratory tract: runny nose, sneezing, hoarseness, bloody nose, sinus pain, shortness of breath, and cough

digestive tract: abdominal pain, diarrhea, fever, nausea, vomiting

  • Post exposure treatment: remove sulfur mustard from the body

antidote: none

shower with soap or wash thoroughly with soap and running water; flush eyes with running water for 15 minutes but do not cover eyes with bandages

inhalation: leave area of exposure; get fresh air, provide oxygen, and support breathing

Sarin (GB) nerve gas

  • Sarin (GB) nerve gas

human-made chemical warfare agent

clear, colorless, tasteless liquid that can evaporate into a odorless gas

extremely toxic, acts very quickly

breaks down the enzyme acetylcholinesterase, which results in excessive concentrations of acetylcholine in nerve synapses and leads to overstimulation of parasympathetic nerves in the smooth muscles

impairs normal functioning of nervous system

can cause seizures, loss of consciousness, and respiratory failure in minutes

Sarin (GB) nerve gas

exposure via inhalation, ingestion, and/or absorption through eyes and skin

clinical indications of exposure

low to moderate doses: runny nose, watery eyes, blurred vision, drooling, cough and chest tightness, diarrhea, drowsiness, weakness, headache, changes in heart rate and blood pressure

large doses: loss of consciousness, seizures, paralysis, respiratory

Post-exposure treatment

post-exposure treatment

antidotes: soldiers typically have an antidote kit containing these two medications

atropine (Atropine): binds to one type of acetylcholine receptor on the post-synaptic nerve

pralidoxime chloride (2-PAM chloride): blocks sarin from binding to any free acetylcholinesterase

decontaminate before transport to treatment facility

flush eyes first for 15 minutes

remove clothing (without pulling over the head) and shower with soap and large amounts of water or 0.5 % solution of sodium hypochlorite (bleach), or use absorbent powders such as flour or talcum powder

Post-exposure treatment

do not induce vomiting if swallowed; administer activated charcoal

note: can contaminate rescuers by direct contact or off-gassing vapor of contaminated skin or clothing

supportive measures: maintain airway, assist ventilation, and protect client; administer diazepam for seizure activity

Strychnine. The Joint Commission National Patient Safety Goals Essay

  • a. the primary natural source: the plant Strychnos nux vomica
  • i. a strong poison; typically used to kill rats
  • ii. white, odorless, bitter crystalline powder
  • iii. very small amount able to cause extremely serious adverse effects
  • iv. impairs functioning of neurotransmitters resulting in severe, painful muscle spasms without affecting consciousness

Strychnine

exposure

injection (mixed with street drugs)

ingestion (food or water contamination)

inhalation (release into air, smoked or snorted in street drugs) The Joint Commission National Patient Safety Goals Essay

Strychnine

clinical indications of strychnine poisoning

initially or with low level exposure:

apprehension, agitation, painful muscle spasms

the client is conscious and in extreme pain

later findings or high level exposure: uncontrollable arching of back and neck, hyperreflexia and muscle twitches, rigid extremities, seizures, difficulty breathing, brain death

Strychnine

Post exposure treatment: most victims die of asphyxia before reaching the hospital

no specific antidote exits

decontaminate in area outside of treatment area

remove clothing; do not pull anything over the head to remove

using large amounts of water, shower with soap or wash with soap and running water

flush eyes with running water for 15 minutes

Strychnine

do not induce vomiting or give fluids to drink

supportive care

IV fluid resuscitation

cooling therapy for fever

anticonvulsants (diazepam, phenytoin, Phenobarbital), antispasmodic agents and muscle relaxants

Ricin

a plant protein toxin derived from the beans of the castor plant

exposure: through air, food or water

in the form of a powder, a mist, a pellet

may also be dissolved in water or weak acid

Ricin

clinical indications: effects depend on whether it was inhaled, ingested, or injected; death can occur within 36 to 72 hours of exposure

inhalation: respiratory distress, fever, cough, nausea, chest tightness; pulmonary edema

ingestion: vomiting and diarrhea that may become bloody; dehydration; low blood pressure; may include hallucinations, seizures and multi-system failure. The Joint Commission National Patient Safety Goals Essay

skin and eye exposure: redness and pain

Ricin

post exposure treatment

treatment: get ricin off or out of the body as quickly as possible

no available antidote

decontamination

shower with soap or wash with soap and running water thoroughly

flush eyes with running water for 15 minutes

Ricin

Inhalation:

leave area of exposure to get fresh air

provide oxygen and support breathing

Ingestion

do not induce vomiting; remain NPO

administer large dose of activated charcoal

gastric lavage

aggressive fluid resuscitation and electrolyte repletion

if necessary, medicate to control seizures and treat hypotension

Radiation emergencies

  • Causes of radiation emergencies

radioactive material contaminates food/water

a bombing or destruction of a nuclear reactor

exploding a nuclear weapon

nuclear weapon attack

radiation dispersal device (dirty bomb) The Joint Commission National Patient Safety Goals Essay

Radiation emergencies

Contamination via

wounds

ingestion

inhalation

Radiation emergencies

Severity of signs and symptoms of radiation sickness depends on how much radiation has been absorbed

mild radiation sickness (absorbed dose of 1-2 Gy): nausea and vomiting, headache, fatigue, weakness within 24 to 48 hours after exposure

very severe radiation sickness (absorbed dose of 3.5-5.5 Gy): nausea and vomiting less than 30 minutes after exposure to radiation, dizziness, disorientation, hypotension; usually fatal

  • Treatment

get inside and stay in an undamaged building

decontamination

remove clothing and shoes

gently washing with soap and water

for damaged bone marrow: The Joint Commission National Patient Safety Goals Essay

filgrastim (Neupogen): a protein-based medication which promotes the growth of white blood cells

pegfilgrastim (Neulasta): also increases white blood cells and prevents subsequent infections

Radiation emergencies

Radiation emergencies

For internal contamination (chelating agents)

potassium iodide (KI): used to prevent absorption of radioiodine in the thyroid gland

Prussian blue: a type of dye that binds to particles of radioactive elements (cesium and thallium) The Joint Commission National Patient Safety Goals Essay

diethylenetriaminepentaacetic acid (DTPA): binds to particles of the radioactive elements plutonium, americium and curium

supportive treatment for infections, headache, fever, diarrhea, dehydration; end-of-life care

Mass casualties

Explosions or blasts can cause unique patterns of injury

primary: injury from over-pressurization force impact

secondary: injury from projectiles

tertiary: injury from displacement of victim by the blast wind

quaternary: all other injuries, i.e., burns, toxic exposures

Predominant injuries involve multiple penetrating injuries and blunt trauma

  • All bomb events have the potential for chemical and/or radiological contamination

Mass casualties

Treatment

lung injuries

  • high flow oxygen sufficient to prevent hypoxemia via non-rebreather mask, CPAP or ET tube
  • ensure tissue perfusion but avoid volume overload
  • prompt decompression for clinical evidence of pneumothorax or hemothorax

abdominal injury: clinical signs can be subtle at first; observe for acute abdomen or sepsis

ear injuries: tinnitus or deafness will warrant written communication

admit 2nd and 3rd trimester pregnancies for monitoring

Mass casualties

crush injuries: sudden release of a crushed extremity may result in reperfusion syndrome (acute hypovolemia, renal failure, metabolic abnormalities) The Joint Commission National Patient Safety Goals Essay

  • IV fluid replacement (up to 1.5L/hour)
  • to help prevent renal failure: mannitol to maintain diuresis at least 300 mL/hour; dialysis may be needed
  • to treat acidosis: IV sodium bicarbonate until urine pH reaches 6.5 (to prevent myoglobin and uric acid deposition in the kidneys)

Mass casualties

  • monitor injured areas for the 5 P’s: pain, pallor, parasthesias, pain and pulselessness
  • monitor for sepsis

Natural disasters and severe weather

  • Clustered under this category are: earthquakes, extreme heat, floods, hurricanes, tornadoes, tsunamis, volcanoes, wildfires, landslides/mudslides, winter weather
  • Traumatic events following natural disasters are characterized by a sense of horror, helplessness, serious injury, or the threat of serious injury or death
  • Emergency preparedness includes being ready for any type of hazard

Mass casualties

injuries resulting in nonintact skin or mucous membrane exposure

  • hepatitis B immunization (within 7 days) The Joint Commission National Patient Safety Goals Essay
  • tetanus toxoid vaccine
  • Recent outbreaks and incidents, e.g., salmonella, E. coli , H1N1, melamine (in food products

REFERENCES

  • FUNDAMENTALS OF NURSING POTTER
  • ATI FUNDAMENTALS OF NURSING
  • NCSBN
  • HESI RESOURCES

Fire Extinguishers

Fire extinguishers are divided into four categories, based on different types of fires for which they are used.

Category Uses

Class A Ordinary combustible materials, such as paper, wood, cardboard, and most plastics

Class B Flammable or combustible liquids, such as gasoline, kerosene, grease, and oil

Class C Electrical equipment, such as appliances, writing, circuit breakers and outlets

Class D Chemical laboratories; for fires that involve combustible metals, such a s magnesium, titanium,

potassium and sodium

Infection Type Examples

central nervous

system infections

meningitis, encephalitis

childhood & vaccine-

preventable

infections

chicken pox, diphtheria, tetanus, mumps (infectious parotitis), pertussis

(whooping cough), poliomyelitis, rubella (also known as German

measles), rubeola (measles) The Joint Commission National Patient Safety Goals Essay

gastrointestinal

infections

staphylococcal food poisoning, botulism

acute bacterial, viral

gastroenteritis

salmonella, gastroenteritis, viral hepatitis

hemolymphatic

infections

mononucleosis, cytomegalovirus, toxoplasmosis

respiratory infections influenza, tuberculosis, histoplasmosis, pharyngitis, scarlet fever,

rheumatic fever, pneumonia

sexually transmitted

infections

gonorrhea, chlamydia, syphilis, genital herpes, chancroid, AIDS, genital

warts

urinary tract infections cystitis, pyelonephritis

The Joint Commission National Patient Safety Goals Essay