Key Takeaways
- Fall risk assessment should be performed on admission and with any change in patient condition
- Patients at high risk for falls include those with altered mental status, medication effects, mobility impairment, and history of falls
- Restraints are used only as a last resort when less restrictive measures have failed
- Environmental safety includes bed in low position, call light within reach, non-skid footwear, and clear pathways
- Patient identification must be verified using at least two identifiers before any treatment or medication
Accident and Injury Prevention
Patient safety is the foundation of nursing practice. The LPN/LVN plays a critical role in identifying risks, implementing preventive measures, and responding appropriately when accidents occur.
Fall Prevention
Falls are the most common adverse event in healthcare settings. Prevention requires systematic assessment and intervention.
Fall Risk Factors:
| Category | Risk Factors |
|---|---|
| Patient factors | Age over 65, history of falls, altered mental status |
| Mobility | Weakness, unsteady gait, use of assistive devices |
| Medications | Sedatives, opioids, antihypertensives, diuretics |
| Sensory | Visual impairment, hearing loss |
| Elimination | Urinary urgency, incontinence, nocturia |
| Environment | Wet floors, clutter, poor lighting, unfamiliar setting |
Fall Prevention Interventions:
| Intervention | Rationale |
|---|---|
| Bed in lowest position | Reduces fall height if patient falls |
| Call light within reach | Patient can request assistance |
| Non-skid footwear | Prevents slipping |
| Clear pathways | Removes obstacles |
| Adequate lighting | Improves visibility |
| Bed/chair alarms | Alerts staff to patient movement |
| Frequent rounding | Anticipates patient needs |
Patient Identification
The Joint Commission requires two patient identifiers before:
- Administering medications
- Performing procedures
- Collecting specimens
- Providing treatments
Acceptable identifiers:
- Patient name (ask patient to state)
- Date of birth
- Medical record number
- Photo identification
NOT acceptable:
- Room number
- Bed number
Always ask the patient to state their name and date of birth. Never ask, "Are you John Smith?" Instead ask, "What is your name?"
Restraint Use
Restraints are used ONLY when:
- Less restrictive alternatives have failed
- There is immediate risk of harm to self or others
- Ordered by a provider
- Regularly assessed and discontinued as soon as possible
Types of Restraints:
| Type | Examples | Use |
|---|---|---|
| Physical | Wrist restraints, vest, mitts | Prevent self-harm, removal of tubes |
| Chemical | Sedating medications | Emergency sedation for safety |
| Environmental | Enclosed beds, locked units | Prevent elopement |
Restraint Requirements:
| Requirement | Medical/Surgical | Behavioral |
|---|---|---|
| Provider order | Every 24 hours | Every 4 hours (adults) |
| Assessment | Every 2 hours minimum | Every 15 minutes |
| Document | Need, alternatives tried, patient response | Need, behavior, patient response |
| Release | Regular release for circulation, ROM | Regular release |
Restraint Alternatives (Try First):
- Reorientation and reassurance
- Family presence
- Diversional activities
- Covering IV sites with sleeves
- Moving patient closer to nursing station
- Bed/chair alarms
- Low beds with floor mats
Environmental Safety
| Hazard | Prevention |
|---|---|
| Wet floors | Post wet floor signs, clean spills immediately |
| Electrical | Check equipment cords, report damage |
| Fire | Know fire exits, RACE and PASS |
| Oxygen | No open flames, post oxygen signs |
| Sharps | Dispose properly, don't recap needles |
| Chemicals | Store properly, know MSDS locations |
Fire Safety: RACE and PASS
RACE (In Case of Fire):
| Letter | Action |
|---|---|
| R | Rescue - Remove patients from danger |
| A | Alarm - Pull fire alarm, call emergency |
| C | Confine - Close doors to contain fire |
| E | Extinguish/Evacuate - Use extinguisher or evacuate |
PASS (Using Fire Extinguisher):
| Letter | Action |
|---|---|
| P | Pull the pin |
| A | Aim at base of fire |
| S | Squeeze the handle |
| S | Sweep side to side |
Safe Patient Handling
Ergonomic principles:
- Use mechanical lifts when available
- Get help for patients who cannot bear weight
- Use transfer belts for ambulation assistance
- Keep objects close to your body when lifting
- Use leg muscles, not back
Never attempt to lift a falling patient. Instead, guide them safely to the floor.
Seizure Safety
For a patient having a seizure:
| Do | Don't |
|---|---|
| Lower to floor or bed | Restrain movements |
| Protect head | Put anything in mouth |
| Turn on side if possible | Leave patient alone |
| Note time and characteristics | Try to stop the seizure |
| Stay with patient | Hold patient down |
| Maintain airway after seizure | Give oral fluids during seizure |
On the NCLEX-PN
Expect questions about:
- Fall risk assessment and interventions
- When restraints are appropriate
- Fire safety procedures
- Patient identification procedures
An LPN is preparing to administer medication to a patient. The patient's armband is missing. What should the LPN do?
A confused patient keeps trying to remove their IV line. Which intervention should the LPN try FIRST?
The LPN discovers a fire in a patient's room. What should the LPN do FIRST?