Patient Safety
Falls, restraints, fire, seizures and medication safety
Fall prevention
- Screen on admission and every shift (e.g., Morse Fall Scale) and after any change.
- Bed in lowest position, wheels locked, call light and belongings within reach.
- Non-skid footwear; clear pathways; night light.
- Scheduled toileting (most falls happen on the way to the bathroom).
- Bed or chair alarms for high-risk patients; review sedating drugs.
- Side rails used to keep a patient from getting out of bed (e.g., all four up) count as a restraint and raise entrapment and fall-injury risk.
Restraints (CMS rules)
- Last resort, after less restrictive options fail; least restrictive type; never for staff convenience or discipline.
- Needs a prescriber's order, never "PRN".
- Violent or self-destructive behavior: order lasts up to 4 h (adults), 2 h (ages 9–17), 1 h (under 9); face-to-face evaluation within 1 hour.
- Non-violent (medical) restraints: renewed per hospital policy (commonly each calendar day).
- Monitor frequently per policy (often every 15 min); at least every 2 h: release, range of motion, skin, circulation, toileting, fluids.
- Tie to the bed frame (not the side rail) with a quick-release knot; two fingers fit under the restraint.
Fire
RACE
Rescue patients in danger · Alarm (pull it, call) · Confine (close doors) · Extinguish or Evacuate.
PASS (extinguisher)
Pull the pin · Aim at the base · Squeeze · Sweep side to side.
Evacuate horizontally first (to another unit on the same floor), then vertically. Ambulatory patients first, then wheelchair, then bed-bound (unless directed otherwise).
Seizure precautions
- Padded side rails, bed low, suction and oxygen at the bedside, IV access as ordered.
- During: stay, time it, turn on the side, protect the head, loosen clothing. Never restrain or put anything in the mouth.
- After: airway, suction, side-lying, neuro checks, reorient; document onset, duration, movements, aftermath.
- Seizure >5 min = status epilepticus: emergency.
Medication safety
Rights of medication administration
Right patient (2 identifiers: name + date of birth, not room number), drug, dose, route, time, documentation, plus right reason, response, and the patient's right to refuse.
Three checks
When pulling the drug, when preparing it, and at the bedside before giving it.
Don't
- Give a drug someone else prepared.
- Leave meds at the bedside.
- Crush extended-release (ER, XR, SR, LA), enteric-coated, or sublingual drugs.
- Use error-prone abbreviations (U, IU, QD, QOD, D/C, HS, trailing zeros).
If an error happens: assess the patient first, notify the prescriber, complete an incident report (not mentioned in the chart).
Older adults: Beers Criteria highlights
Avoid where possible: first-generation antihistamines (diphenhydramine), benzodiazepines and "Z-drugs" (zolpidem), anticholinergics, long-acting sulfonylureas (glyburide), muscle relaxants, routine NSAIDs, meperidine.