Safety Basic Body Mechanics
Safety Basic Body Mechanics
Nursing 125
Patient Safety:
Technically the biggest safety system in healthcare is the minds and hearts of the workers who keep intercepting the flaws in the system and prevent patients from being hurt. They are the safety net, not the cause of injury.
Don Berwick
Patient Safety #1
A clients health and wellness depend upon safety. Safety is the number 1 priority in all aspects of care. Nurses need to be aware of safety. The hospital setting is complex, potentially dangerous & unfamiliar to clients.
Reduces length of stay & cost of treatment Reduces frequency of treatment Reduces potential for law suits Reduces the number of work-related injuries to personnel
Estimated 48,000-98,000 deaths per year from medical errors. Adverse events ranked as the 8th leading cause of death, ahead of MVAs, breast cancer and AIDS Extrapolating from the U.S. data, adverse events would account for 4,000-10,000 deaths per year in Canada.
Adverse events have a tremendous cost to the system in extended hospital stays & additional medical procedures Adverse events expose health organizations to legal liability
3.
A safe environment is one in which basic needs are met, physical hazards are reduced or eliminated, transmission of organisms is reduced and sanitary measures are carried out.
Falls
Fall risk, especially in the elderly, is growing. In hospitalized patients, 4-12 falls occur per 1,000 bed days, ranking them among the 10 most common claims presented to insurance agencies
Nursing Management, September 2002
30% of people 65 yrs and older (in the community) fall at least once each year.
Focus Assessment:
To ensure patient safety the nurse should conduct a focus assessment during every nurse-patient encounter which includes:
A visual scan of the environment for potential hazards A quick appraisal of patient related factors
Appropriate furniture and lighting Call bell easily accessible/personal items within reach Traffic areas free from obstruction Secure/remove loose carpets or runners Eliminate clutter Grab bars in appropriate areas in washroom
Orient client to physical surroundings Explain use of call bell Assess clients risk for falling
Body Mechanics
The coordinated efforts of the musculoskeletal & nervous system to maintain balance, posture & body alignment during lifting, bending, moving & performing ADLs.
Knowledge & practice of proper body mechanics protect the client and nurse from injury to their musculoskeletal systems. Correct body alignment reduces strain on musculoskeletal structures, maintains muscle tone, & contributes to balance.
Body balance is achieved when a wide base of support exists, the center of gravity falls within the base of support & a vertical line can be drawn from the center of gravity through the base of support. When lifting an object, come close to the object, enlarge the base of support & lower the center of gravity.
Proper body mechanics facilitates movement without muscle strain & excessive use of muscle energy.
Improper body mechanics can lead to injury for both the nurse & the patient, especially back injury when lifting.
In 1990, Canadian hospitals reported 30,487 time loss injuries. Fifty-three percent were sustained by nurses. Almost half (of the injuries) were back injuries. Back injury is now recognized as one of the major reasons for illhealth retirement from nursing. Not only is it the most frequent injury sustained by nurses, it is the most debilitating
Action
When planning to move a client, arrange for adequate help. Use mechanical aids if help is unavailable. Encourage client to assist as much as possible. Keep back, neck, pelvis and feet aligned. Avoid twisting. Flex knees; keep feet wide apart. Position self close to client (or object being lifted).
Rationale
Two workers lifting together divide the workload by 50%.
This promotes the clients abilities & strength while minimizing workload. Reduces risk of injury to lumbar vertebrae & muscle groups. Twisting increases risk of injury. A broad base of support increases stability. The force is minimized. 10 lbs at waist height close to the body is equal to 100 lbs at arms length.
Action
Use arms and legs (not back) Slide client toward yourself using a pull sheet.
Rationale
The leg muscles are stronger, larger muscles capable of greater work without injury. Sliding requires less effort than lifting. Pull sheet minimizes shearing forces, which can damage clients skin. Preparing muscles for the load minimizes strain.
Person with the heaviest load coordinates efforts of team involved by counting to three.
Frequent movement improves muscle tone, respiration, circulation & digestion. Proper positioning at rest also prevents strain on muscles, prevents pressure sores (decubitus ulcers within 24 hours) & joint contractures (abnormal condition of a joint, characterized by flexion & fixation & caused by atrophy & shortening of muscle fibers or by loss of normal elasticity of the skin).
Pressure Sores tissues are compressed, decreased bld supply to area, therefore, decreased oxygen to tissue & cells die.
Correct Positioning
Is crucial for maintaining body alignment and comfort, preventing injury to the musculoskeletal system, and providing sensory, motor, and cognitive stimulation. It is important to maintain proper body alignment for the patient at all times, this includes when turning or positioning the patient.
Aim least possible stress on patients joints & skin. Maintain body parts in correct alignment so they remain functional and unstressed. Patients who are immobile need to be repositioned q 2 hrs.
Assessment
Comfort level & alignment while lying down Risk factors - Ability to move, paralysis Level of consciousness Physical ability/motivation Presence of tubes, incisions, equipment
Nursing Diagnosis
Planning Know expected outcomes good alignment, increased comfort Raise bed to comfortable working height Remove pillows & devices Obtain extra help if needed Explain procedure to client Implementation Wash hands Close door/curtain Put bed in flat position Move immobile patient up in bed Realign patient in correct body alignment (pillows etc.)
Evaluation
Assess body alignment, comfort Ongoing assessment of skin condition Use of proper body mechanics (nurse)
Restraints
Prevent falls & wandering Protect from self-injury (pulling out tubes) Prevent violence toward others
Use of physical restraints may violate these inherent rights. The CRNNS does not endorse the use of physical restraints.
While restraint-free care is ideal, there are times that restraints become necessary to protect the patient & others from harm.
Highly agitated, violent individual Physical/Chemical restraints Intubated patient pulling out endotracheal tube Suicide patient - ? Chemical restraints
Use of Restraints:
Use only when absolutely necessary. Attending physician is responsible for the assessment, ordering & continuation of restraint. Can be instituted on your nsg judgment must have a doctors order ASAP. Continued use of restraints must be reviewed daily by the RN & documented on the health record.
Always explain what you do & why, to reduce anxiety & promote cooperation.
Family member to sit with patient Geri chair vs. bed Non restraint measures safety belt, wedge pillows, lap tray
Consider restraints as a temporary measure decrease likelihood of injury from restraint use. Remove restraints as soon as the patient is no longer at risk for injury.
Hazards of immobility
Death Pressure sores, pneumonia, constipation, incontinence, contractures, decreased mobility, decreased muscle strength, increased dependence Altered thought processes Humiliation, fear, anger & decreased self-esteem
Side rails stop patient from rolling out, but does not stop them from climbing out side rail down when working on that side. Jackets & Belts patient who is confused & climbing over rails may need a jacket or belt to restrain them to bed. Sleeveless with cross over ties, allows relative freedom in bed. Arm & Leg Undesirable, limits patients movement, injury to wrist/ankle from friction rubbing against skin use extra padding. Restrain in a slightly flexed position, if too tight could impair circulation. Never tie to a bed rail.
Mitts are used for those confused & pulling at@ edges of dsgs, tubes, ivs, wounds. Doesnt limit arm movement, soft boxing glove that pads the hand, remove, wash & exercise. Ensure not too tight Use quick release tie for all restraints
Chemical Restraints
Medication
Patient must be closely observed and assessed frequently post medication. Remains a high risk for injury.
Supporting Documentation
Rationale for the use of restraints, including a statement describing the behavior of the patient. Previous unsuccessful measures or the reason alternatives are not feasible. Decision to restrain with the type of restraint selected and date & time of application. Observations regarding the placement of the restraint, its condition and the patients condition, including the frequency of observation (not just at
Care of the patient which may include re-positioning, toileting, mobilization and/or skin care
Civil Actions
Most civil cases are based on allegations of negligence. Important to support your judgment/actions with quality documentation
Promoting Safety
Measures designed to promote client safety are the result of individualized assessment findings. Often it is the conclusion of the nurse that a clients safety is at risk, and subsequent nursing interventions are implemented. Assessment of a clients safety should occur in the home, healthcare facility, and community environment.
(Perry and Potter, 2002)
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Patient bends knees, feet firmly on bed, 1st nurse at HOB arms under head & shoulders, face foot of bed, 2nd nurse under hips facing foot of bed, on same side count to 3.
After turning use aids i.e. pillows, towels, washcloths, blankets, sandbags, footboards etc. Joints should be slightly flexed b/c prolonged extension creates undue muscle tension & strain Supine
Low or flat pillow (prevents neck flexion) Trochanter role (supports hip joint prevents external rotation) Hand roll used if hands are paralyzed (thumb & fingers flexed around it) High top sneakers, foot board, sandbags (support feet with toes pointing upward. Prolonged plantar flexion leads to foot drop (permanent plantar flexion & inability to dorsiflex)
Tips (cont.)
Side lying
Even if paralyzed on one side a patient can be placed on that side. Take care not to pull on the affected extremity.
Head on low pillow, pillow along back supports back & holds body in position, underlying arm comes forward & flexed onto pillow used for head, top arm flexed forward & resting on pillow in front of body, hand rolls if necessary, flex top leg forward & place on pillow, feet at right angles with sandbag.