2/20/14

Rubber Bags

Example: hot water bottles, ice bags should be drained and dried

They should be inflated with air and closed to prevent the sides from sticking together

Rubber Tubing
• Should be washed with warm, soapy water
• The inside should be flushed and rinsed well

Study questions:
1. State some of the important general instructions for nursing procedures.
2. List items commonly found in patient unit.
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Care of Pick Up Forceps and Jars

Pickup forceps: is an instrument that allows one to pick up sterile equipment.
Sterile equipment: material, which is free of all forms of microorganism.

Pick up forceps should be kept inside the jar in which 2/3 of the jar should be filled with antiseptic solution
• Wash pick up forceps and jars and sterilize daily
• Fill jar with disinfectant solution daily such as detol or preferably carbolic solution
• Care should be taken not to contaminate tip of the forceps
• Always hold tip downward
• If tip of forceps is contaminated accidentally, it should be sterilized before placing it back in the jar to avoid contamination.
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Care of Linen and Removal of Stains

• Clean linen should be folded properly and be kept neatly in the linen cupboard.
• Dirty linen should be put in the dirty linen bag (hamper) and never be placed on the floor.
• Torn linen should be mended or sent to the sewing room.
• Linen with blood should be soaked in cold water to which a small amount of hydrogen peroxide is added if available.
• Linen stained with urine and feces is first rinsed in cold water and then washed with soap.
• Iodine stained linen- apply ammonia, rinse and then wash with cold water.
• Ink stained linen – first soak in cold water or milk for at least for 24 hrs then rub a paste of salt and lemon juice on the stain and allow the article to lie in the sun.
• Tea or coffee stains – wash in cold water and then pour boiling water on the stain.
• To remove vitamin B complex stains dissolve in water or sprit.
• Mucus stains – soak in salty water.
• Rust - soak in salt and lemon juice and then bleach in sun.
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Care of Equipment in General

• Rinse used equipment in cold water. Sock materials in recommended antiseptic solutions. Remove any sticky material. Hot water coagulates the protein of organic material and tends to make it adhere.
• Wash well in hot soapy water. Use an abrasive, such as a stiff-bristled brush, to clean equipment.
• Rinse well under running water.
• Dry the article.
• Clean the gloves, brush and clean the sink.
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General Instructions for Care of Hospital Equipment

• Use articles only for the purpose for which they are intended.
• Keep articles clean and in good condition. Use the proper cleaning method.
• Protect mattresses with rubber sheets.
• Use protective pillowcases on pillows.
• Do not boil articles, especially rubber articles and instruments longer than the correct time.
• Do not sterilize rubber goods and glass articles together wrap glass in gauze when sterilizing it by boiling.
• Protect table tops when using hot utensils or any solution that may leave stain or destroy the table top.
• Report promptly any damaged or missing equipment.
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General Rules for Cleaning

• Dry dusting of the room is not advisable.
• Dusting should be done by sweeping only.
• Use a damp duster for collecting dust.
• Dust with clear duster.
• Collect dust at one place to avoid flying from place to place.
• Dusting should be done without disturbing or removing the patients from bed.
• Dusting should be done from top to bottom i.e. from upward to downward direction.
• While dusting, take care not to spoil the beds or walls or other fixtures in the room or hospital ward.
• While dusting, wounds or dressing should not be opened by other staff.
• There should be a different time for dusting daily.
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2/9/14

Tips for child safety

• Lock away all household cleaners and medicines.
• Always keep pet food and water out of reach.
• When travelling by car always secure your children with a seat belt, safety seat or harness.
• Never leave a hot stove or barbecue unattended.
• Always bolt bookshelves to the wall.
• Keep some ipecacuanha syrup in the home to induce vomiting in poisoning.
• Limit exposure to the sun.
• Be sure they know what to do in the event of fire or other emergency.
• Check the recommended age limits for toys.
• Use safety gates on stairways.
• Install covers over unused electrical sockets and do not leave plugged-in appliances such as irons unattended.
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Assessing an individuals ability to maintain a safe environment

Remember that assessment of an individual’s ability to maintain a safe environment is only part of a holistic nursing assessment and should not be undertaken in isolation without reference to or consideration of the client’s other activities of living.

Specific points to consider when assessing an individual’s ability to maintain a safe environment include:

• Physical
Degree of mobility
Level of consciousness
Level of aggression

• Psychological
Knowledge of condition
Depression
Risk of self-harm
Confusion
Stress
Anxiety
Irritability
Anger

• Sociocultural
Health beliefs and values
Level of family support
Support from external agencies
Hobbies/pastimes

• Environmental
Client awareness of safety issues
Spillages
Confidentiality
Communication systems
Type of accommodation
Ability to negotiate stairs
Type of employment

• Politico-economic
Limited finances/dependants
Living conditions
Employed/unemployed
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Fire Extinguisher Procedures‎

Training is required for the use of fire extinguishers within the health care setting and this occurs at mandatory training sessions. Staff are advised to tackle fires only if they feel safe and happy to do so; containment, that is, closing a door on the fire, or evacuation are otherwise strongly advised.

Current European legislation means that the colour of fire extinguishers within health care settings is changing to reduce confusion and bring the UK in line with the rest of Europe. This is a gradual change as equipment is replaced following annual testing.

The fire extinguishers and equipment found commonly within health care settings are given in Table 4.2. The key issues involved with responding in the event of a fire are:

• knowing the procedure for your working environment
• how to contact the emergency services
• who to call in an emergency

Type and colour
Type of fire
How it works
How to use
Foam
Red with cream
panel (New),
cream (Old)
Wood, paper, linen,
fabric, furnishing,
liquid, oils, paints,
solvents
NOT ELECTRICAL
FIRES
Cools
Forms a film on liquid
surface
Direct foam at base of
fire, working across
area. If fire vertical
aim at top and work
down. If liquid aim at
outer edge and work
around: do not aim
directly onto liquid –
this causes spread
Carbon
dioxide
Red with a black
panel (New),
black (Old)
Live electrical equipment
Displaces oxygen required
to maintain combustion
Switch off at mains if
safe to do so.
Aim carbon dioxide in
and around vents of
electrical equipment
Fire
blanket
Small fire, e.g. clothing,
cooking, pans, oils or
liquids
Smothers the fire thus
reducing oxygen required
for combustion
Place blanket over
fire, protecting face
and hands. Turn off
energy source if safe
to do so.

• when to evacuate and how to evacuate everyone safely from the area
• where exit and avoidance areas are situated
• what practical fire-fighting steps you can perform safely.

If we ensure that we understand all of the above we can act efficiently and effectively in maintaining the safety of clients, visitors, staff and ourselves.
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Responding in the event of a fire

Fires within health care settings pose a major threat to all occupants in the building, clients obviously being the most vulnerable; fire safety strategies are therefore primarily based on the avoidance of fires.

Annual attendance at fire lectures is mandatory for all health care personnel to ensure that all staff are aware of their responsibilities in a fire situation and are conversant with how to reduce the risks of a fire occurring. Fire Safety Advisers are employed within all hospitals and most other health care settings, their role being to ensure that legislation is updated and applied to and within the workplace.

Whilst strategies may differ slightly for each health care setting due to, for example, building structure and numbers of staff, key principles underpinning the actions to be taken in the event of a fire and to reduce the potential for fire are based on the following legislation.

• The National Health Service and Community Care Act (1990)
• The Fire Precautions Act (1971) (amended by the Fire Safety and Safety at Places of Sport Act 1987)
• The Health and Safety at Work Act (1974)
• The Buildings Regulations Act (1991)

The basic principles are as follows:
• to ensure if at all possible that fires do not occur
• to ensure that fires are discovered rapidly, alarms are used and the fire brigade contacted immediately
• to ensure that the fire is extinguished quickly
• basic fire-fighting practice should be attempted only by staff that have been trained and only if it is considered safe to do so
• to provide safe means of escape or avoidance for everyone in all areas
• the spread of the fire is contained and delayed by structural and other means for as long as possible
• rehearsed evacuation routines are undertaken quickly
• evacuated areas are checked for the presence of clients and others and that a roll call is completed.
Action point
Rationale
Attend annual fire lecture
To ensure understanding of current fire procedures and policy
Observe no-smoking policies
To reduce the risk of fire from discarded cigarette
Observe parking restrictions within
ground of workplace
To ensure easy access for emergency
services
Identify all escape routes from the working area and ensure that these routes remain clear at all times
To allow efficient and effective management
of evacuation
Ensure understanding of positioning and identification of all fire-fighting equipment within working area
To ensure efficient and effective use of all
equipment as necessary
Ensure that fire doors are not wedged open
To ensure containment of fire
Do not use lifts to evacuate if fire present or fire alarm sounding
To ensure safety; reducing risk of smoke
inhalation from lift shaft vacuum or risk of
becoming trapped
Electrical equipment
Ensure annual testing of all electrical
equipment and report any defective
piece of equipment for immediate repair.
Reporting to manufacturer or in-house
repairs department
To assess for faults thus reducing risk
Switch off non-essential equipment
when not in use
Potential fire hazards
Do not leave televisions on stand-by
Potential fire hazard
Client’s own electrical equipment or
adapters must be tested by in-house
department prior to use
To ensure safety of all equipment
If safe to do so electrical equipment
must be switched off at the wall socket
if source of fire
Ensuring personal safety first – this action
could slow down or stop the development of
a fire
Gas
Report any smell of gas immediately
via emergency switchboard
To ensure immediate response and
assistance
Do not switch on or off any item of electrical equipment
To reduce risk of fume ignition
Evacuate clients and staff
To ensure safety and evacuation from risk
of inhalation or explosion
Ventilate area if possible and safe to do so
To reduce risk of inhalation and reduce concentration
of gas collection
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Drug errors

The Nursing and Midwifery Council (NMC 2002) encourages an open culture in relation to reporting drug errors. When investigating allegations of misconduct related to such errors the Council take great care to identify contextual issues, such as whether the error occurred due to incompetence; whether there was immediate disclosure in the client’s best interests or, conversely, whether it was in some way concealed; or, indeed, whether the error may have resulted from some external cause, such as work pressures.

The NMC therefore urges ward managers to review each case individually and to consider the following:
• the type of drug involved
• the effect on the client
• whether the incident was disclosed and the timeframe involved
• hospital policies
• NMC guidelines
• the environment of care
• any other possible influencing factors
• the nurse(s)’s experience and whether they have been involved in any previous incidents.

In acting in the best interests of clients the procedure given below is recommended in the event of a drug error.
Procedure
Rationale
Inform the following people immediately:
medical staff
ward manager
pharmacist
client and their relatives if necessary
To alert medical and pharmaceutical staff to
the error and request immediate review of client’s condition. Ward manager informed to assess nursing practice and review possible cause for error. To maintain trust and confidence
Undertake any treatment or intervention prescribed by medical/pharmaceutical staff
To reduce risk of further complications and/
or to counteract the error
Complete an untoward incident form
To identify risk and report to appropriate personnel. To record personal account of incident for further investigations by ward manager
Document the incident in client’s records
Legal requirement to safeguard client and
maintain communications through effective documentation
Monitor the client’s condition and report
any alteration in condition
To maintain client safety and well-being
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Administering medicines to children

As most children find it difficult to swallow tablets, suspensions are usually prescribed. These are normally administered by using an oral syringe directly into the side of the child’s mouth whilst their head is slightly tilted. However, some children prefer to use a medicine spoon; it is therefore always best to check with them before dispensing the medicine. The required volume should be calculated as follows:
             
                                       prescribed dose
Required volume   =  ___________________  x    stated volume
                                       amount of drug in
                                          stated volume

For example:
You require 250 mg of a drug and you have a bottle with 500 mg of the drug in every 5 ml of liquid

                                              5
Required volume    = 250 x _____  =  2.5ml
                                            500

The child therefore requires 2.5 ml of liquid.
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Procedure for the safe administration of medicines

In April 2002 the Nursing and Midwifery Council (NMC 2000a) revised the guidelines for the administration of medicines, and these should be adhered to at all times. The following procedure is based on those guidelines and gives the rationale for each element. If ever in doubt remember ‘the six Rs’.

• Right drug
• Right dose
• Right route
• Right form
• Right time
• Right client

Also remember to become familiar with your local policies related to the administration of medicines before participating in this procedure (see below).
Procedure
Rationale
Wash and dry hands thoroughly
To reduce the risk of crossinfection
Collect prescription sheet and ensure that the client is available and willing to take any prescribed medications
To gain consent and avoid wastage
Ensure that the prescription is dated, legible and
signed by a doctor
To fulfil legal requirements related to drug administration
Prior to administration ensure you are knowledgeable about the drug(s) to be administered. This should include: therapeutic use, normal dosage, routes/ forms (see Table 4.1), potential side effects, contra-indications
To ensure safety and wellbeing of client and to enable you to identify any errors in prescribing
Confirm identity of client verbally and with
identification band against prescription, checking full name, home address, date of birth, age, identification number, RIGHT CLIENT and ensure that the drug has not already been given
To ensure that the correct drug is being administered to the correct client
Check the prescription carefully, ascertaining
RIGHT DRUG, DOSE, ROUTE, FORM and TIME
To ensure client safety. If any errors of prescribing are noticed then withhold the drug and inform the medical officer
Check client understands the need for the drug and answer any questions he or she may have prior to administration
To ensure that consent is informed
Be familiar with the client’s care plan and past
medical history
To ensure that only the medications currently required are administered. Knowledge of past medical history assists in identifying contra-indications specific to client
Select the appropriate medication and for a second
time check the drug, route, dose, time, form and
co-existing therapies prior to administration
To ensure safe administration of the medication
Check the expiry date of all medications to be
administered
To protect the client from harm. Medicines that have expired can be dangerous, as products deteriorate over time. Expired medications should be returned to pharmacy for appropriate disposal
Check that the client is not allergic to the drug or any of its derivatives prior to administration
To protect the client from harm. If the client is allergic inform medical staff without delay to review prescription
Administer the medication in the appropriate form, by the prescribed route, at the correct dosage to the correct client and make sure that they have taken/ received it
To fulfil your responsibilities and prevent any untoward occurrences
Following administration of the medication ensure clear, accurate and immediate documentation. This includes refusal of medicines by client or any intentionally withheld drugs
Legal requirement to document treatment and safeguard client through effective communication. Student nurses or midwives must not administer any drug unsupervised and all signatures must be countersigned by a registered practitioner
Controlled drugs must be checked by two nurses/ midwives, one of whom must be registered, and the appropriate additional documentation completed
Legal requirement relating to Misuse of Drugs Regulations 1985 and the Misuse of Drugs (Safe Custody) Regulations 1973
Clear away all equipment and ensure safe storage of medications as per local policy
To adhere to health and safety regulations

If you are unsure about any aspect of the medicines prescribed it is advisable to contact the pharmacy staff, who will be only too happy to advise and guide you.
Table 4.1 Advantages and disadvantages of different routes
Route
Advantages
Disadvantages
Form(s)
Oral (O)/
Sublingual (S/L)
(under the tongue)
Buccal (Buc)
(between lip and gum)
• Comfortable
• Non-invasive
• Easy to use
• Inexpensive
Cannot use if client has:
• Nausea or vomiting
• Reduced gut motility, bowel
disease or malabsorption
• Difficulty swallowing
• Impaired consciousness
• OR if the client is to remain
nil by mouth (NBM)
Tablet
Capsule
Elixir
Gel
Intramuscular
injection (I/M)
• Rapid and assured absorption
• Effective if client unable to
use oral medication
• Can sometimes combine
drugs into one injection
• More expensive
• Client anxiety and discomfort
on administration
• Increased risk of side
effects with rapid
absorption
• Risk of introducing
infection
• Risks involved with sharps
usage
• Slower absorption if client
is cold
Single-use glass or plastic
Vial Liquid solution or powder
requiring reconstitution
Subcutaneous
injection (S/C)
• Slow sustained absorption
• Virtually pain free
• Suitable for repeated injections or infusion
• Risk of ulceration, infection
or atrophy of skin if
injection site not rotated
• More expensive
• Client anxiety
• Risks involved with sharps
usage
Single- or multi-use vial
of a drug or pre-filled syringe
Intravenous (IV)
injection
• Very rapid and assured
absorption therefore effective in critical care
• Enables combined drug usage
• Effective when unable to use oral routes
• Increased risks of side
effects due to rapid
absorption
• Client anxiety and
discomfort
• Requires patent IV access
via a cannula or central line
• Increased risk of
introducing infection
• Risks involved with sharps
usage
• Can only be administered
by an advanced nurse
practitioner or doctor
• Much less time to rectify
adverse reactions
Single- or multi-use glass
or plastic vial or pre-mixed infusion
Topical (Top)
• Painless
• Inexpensive
• Easy to use
• Low risk of side effects
• Local effect
• Cannot be used on
broken skin
• Difficult to use if client
has reduced mobility
• May stain skin or soil
clothing
Cream
Gel
Paste
Mucous
membranes
which include:
sublingual
(see Oral)
buccal
eyes
ears (Aural)
nose (Nasal)
vagina (PV)
rectum (PR)
• Effective if client unable to
use oral route
• Rapid absorption due to
systemic blood supply
• Direct application to
source, e.g. infection
• Risk of side effects
• Client anxiety
• Embarrassment and
discomfort
• Some routes cannot be
used following surgery
• Must have functional GI
tract for rectal drugs

• Underlying complications
prevent use, e.g. ruptured
eardrum
Tablet
Capsule

Cream
Drops

Drops
Spray

Cream
Pessary

Suppository
Cream
Enema
Inhalation
i.e. Inhalers (Inh) and
nebulizers (Neb)
• Rapid effect for relief of
some respiratory
symptoms
• Sometimes used
prophylactically presurgery
• Some side effects including
sore mouth and throat (this
can be reduced by using
spacer device)
• Client anxiety
• Difficult to use with elderly
or children
• Support and teaching
required for inhaler use
• Expensive nebulizer equipment
if used in chronic
illness at home
Single-use plastic nebule
or multidose inhaler
(differing types)
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