HygieneThe Need for Better Hand Hygiene• In Canada, healthcare associated infections (HCAIs) affectmore than 220,000 people every year and kill 8,000 – 12,000.1• Hand hygiene, a very simple action, remains the primarymeans to reduce HCAIs and the spread of antimicrobialresistant organisms.• HCAIs lead to long-term disability, preventable deaths, andadditional financial burden on the healthcare system.2• Compliance by healthcare workers with optimal handhygiene is considered to be less than 40%.3• Global research indicates that improvements in handhygiene activities could potentially reduce HCAI rates by upto 50%
When should hand hygiene be performed? In health care, hand hygiene is required:Before and after contact with any patient/resident, theirbody substances or items contaminated by themBetween different procedures on the same patient/residentBefore and after performing invasive proceduresBefore preparing, handling, serving or eating food or feedinga patient/residentAfter assisting patients/residents with personal care (e.g.assisting patient to blow nose, toileting or doing wound care)Before putting on and after taking off glovesAfter performing personal functions (e.g. using thetoilet, blowing your nose)When hands come into contact withsecretions, excretions, blood and body fluids (use soap andrunning water whenever hands are visibly soiled)
FALLS AND INJURIESThe Nursing best practice guidelines on the CNO and RNAOwebsites includes falls and injuries as one of the issues thatneeds active awareness and proper education.On the Safer Health Care Now website they have a ReducingFalls and Injuries from Falls Getting Started Kit . This kitexplains why Fall prevention awareness is so important.
According to the Canadian Institute for Health Information, falls werethe cause of 57% of all injury-related hospitalizations, and more thanthree quarters of all in-hospital deaths in those admitted for aninjury.• Among Canadians age 65 or older, most injury hospitalizations followed a fall (77% for males, and 88% for females).• Falls are also the second leading cause of both head and spinal cord injuries (35% and 37%, respectively).• The majority of specific fall-related hospitalizations for head injuries were falls on or from stairs or steps (25%), slipping, tripping or stumbling (17%) and falls from one level to another (11%).• Ninety percent of all hip fractures in seniors are the result of a fall, and 20% of those suffering such an injury die within a year of the fracture.• Families are often unable to provide care, and• 40% of all nursing home admissions occur as a result of falls by older people.
Falls and injury from falls have a significant impact on theindividual, organizations providing health care services andthe health care system overall.A PERSON CENTERED APPROACH TO CARE CANREDUCE THE RISKS OF FALLSBiological and medical risk factorsBehavioural risk factorsEnvironmental risk factorsSocial and Economic risk factors
Low beds, bed alarms, an emphasis on understandingpatient agitation and behavior, and other non-restraintinterventions introduced at an inpatient geriatricpsychiatry ward reduced the number of falls by closeto 60%,- according to Ben Inventor, C.N.P., of Rush MedicalCenter in Chicago, and colleagues.
This is not just an issue for psychiatry units.There are many in-patients that are high riskbecause of environmental factors or because ofsymptoms associated withstroke, dementia, medications, motor skilldeficiencies and mental deficiencies.
Helping families, health care providers and patients realizeALL the factors that contribute to falls will lead to safer careand support for patients during and after their stay.Teaching family members or the patients support network toperform health and safety inspections of their environmentwill lead to greater awareness for everyone and help reducepreventable injuries
Many dementia and stroke patients cannot communicateverbally what they are feeling. Sensations like pain, needingto use the bathroom, being hungry, being scared areexpressed behaviorally.This can lead to greater risk of injury to patients and staff.This can also be true for someone who has a languagebarrier.
The Canadian Falls Prevention Curriculum notesthat the most effective falls preventioninterventions use a multifactorial approachtargeting selected individuals or groups of olderpersons based on their risk profiles.Taking into account the best evidence andresearch, the Curriculum presents a comprehensivefalls prevention model, BEEEACH, incorporatingthe following categories:.
B.E.E.E.A.C.HBehaviour change--a common goal of all strategiesEducation--of program participantsEquipment--appropriate use of mobility aids andassistive devicesEnvironment--in the home and public placesActivity--physical and socialClothing and footwear--appropriate for riskreductionHealth management--including medicationreviews, vision tests, bone health, healthy nutritionand hydration and chronic disease management
Patient Centered care leads to a safer work environment.Ben Inventor and his colleagues at the Rush Medical Center in Illinoisconducted a study that showed patient centered care can significantlyreduce the amount of falls on a unit.http://www.medpagetoday.com/MeetingCoverage/DCC/10664)They conducted a study on a geriatric psychiatric unit where mostpatients also had other complex medical issues which led to elevated riskfor falls.The study was to see if changing the approach of care to one that wascalled “Person-centered care” would reduce falls and injuries.This method of care requires “A deeper understanding and appreciationfor why a person behaves the way he does”
Over the course of about two years, the team beefed upstandard fall prevention to include the following:-Soothing lighting and background music.-Low beds with bed alarms and soft floor mats on either side ofthe bed.-A six-bed intense monitoring area without other furniture forpatients with a higher risk of falls or under physical restraint dueto medical or behavioral reasons.-Reconfiguration of staffing to provide a full-time night shiftmonitor for the intense monitoring area.-Cushy chairs (Carefoam) that cradled patients in a recliningposition that both decreased restlessness and made it difficultto rise without assistance.-Medication review with modification of psychotropic drugs asneeded.
This combination of approaches reduced the number of falls to an average of 6.7 permonth in the unit by the end of the two-year period in February 2007. (prior to thisprogram the high average was 18 falls per months.)The frequency has since dropped to an average 4.5 falls per month, said PatrickOBrien, R.N., also of Rush and a co-author on the study.The interventions were unable to eliminate falls entirely, particularly among patientswho were subject to multiple falls, which chart review showed was frequently inassociation with agitation, unsteady gait, and attempts to move around withoutassistance.Once the foam chairs were introduced, these frequent fallers did not fall onsubsequent hospitalizations, which resulted in a dramatic drop in the units overallfall rate.The intense monitoring rooms also were consistently associated with lower fall ratesthan regular rooms over time.But no single intervention accounted for all the benefit, Inventor said. "Therefore, werecommend ... an interdisciplinary approach tailored to each individual need."
Some Ideas for Health and Safety AwarenessFALLS AND INJURIESLife size snakes and ladder type game on First Aid.- I madeseveral of these for a young women’s camp that I direct for aweek in the summer. The 190 young women ages 12-18 had funmoving around the life size game board and answering triviaquestions about first aid and emergency situations. The personslides down bandaids instead of snakes and climb up eitherthermometers, stethescopes or other items instead of ladders.There are challenge squares where the player has to splint andsling a person’s arm or show how to treat shock or somethingelse related to home injuries.Could work with “operation”,“Life” style games,
Jeopardy type game on home safety- A game designed to help develop awarenesson safety and wellness. Different health and safety categories Have departmentschallenge each other and have finals after a few weeks of challenges. Secure agrand prize for the champion at the end. This gives an opportunity to raiseawareness over monthsHealth and Safety Trivia game in cafeteria ( on tv screens or trivia cubes “ThinkOutside the Box” (trivia facts on Health and Safety on the outside of the box. Showways everyone can be active in community wellness)Fortune Cookie- Give or sell Health and Safety Fortune cookies. Put a health andsafety tip on fortunes as a fun way to raise awareness.
Health and Safety awareness design contest. Lots of thestaff, volunteers, patients and visitors at William Osler are verytalented and looking for a reason to show off those talents. Letthem make posters, video submissions, safety songs or othertalents to raise “Wellness and health and safety issues”.
Power point movies created on Health and Safety issues such as Hygiene, fallprevention, pandemics, etc. to be shown in cafeterias or on Osler net. Have a departmentchallenge to see who can make the best Health and Safety video. With points forcreativity, knowledge, involvement of unit members and overall best video. Have a “premiernight” and then have the videos on the website. Have a grand prize for the winning departmentof Lunch.“Health and Safety No Joke” Comedy and open mike night. Allow staff and their familiesperform their talents, in between acts there will be a power point movie clip or slide on asafety issue. The MC will tell a joke involving a situation and then goes into the clip on thesafety issue. Could even raise funds for campaign.Health and Safety blog with tips on safety issues, a forum for staff to share stories and a wayto open even more communication about Health and Safety Issues.This can include preventative health and wellness issues, work safety, mental and physicalwellbeing, etc.Health and Safety trivia facts placed on posters in bathroom stalls and on elevators.Health and Safety flyers and trivia game pages left in common areas and for patient and theirfamilies or handed out to staff. This could also be done with email or a website withgames, facts and tips for Health and Safety both at home and at work.
Units should have a portable dvd player with screen so thatpatients that are at high risk for falls or bed ridden can stillaccess patient education videos and could even view .jpgimages of test results when consulting on their care withphysicians. It would also be a method to let patients listen tomusic to calm them or lift their spirits.
Many prevention practices are in place to protect hospitalizedseniors from falls including educational activities for nursingand support staff, patient orientation activities, reviews ofprior falls, and modifications to the environment.Environmental modifications include reducing ward or roomobstacles, adding extra lighting and grab bars in bathrooms,and lowering bedrails and bed height. Other approachesaddress transfer and mobility issues with scheduledambulatory and physical therapy activities and attention tofootwear (e.g., non-skid socks).In addition, hospitals have incorporated strategies to assistcognitively impaired patients by: educating family members todeal with confused patients; minimizing sedating medications;and moving confused patients closer to nursing staff
Follow the Minimal Lift Policy so that you work smartlyand safely.Use another health care worker or a mechanical lift whenneeded
Since Health Care is such a demanding field it isVital to take care of your Joints, muscles, bones,And entire body.Proper exercise, nutrition, Stress management andOther healthy choices can Make the difference
Workplace Violence and HarassmentThe Ontario Hospital Association’s Health and Safetybulletin stated “The prevention of workplace violence and harassment isnot about doing the work safely but rather, it is aboutworking with each other in an environment of respect andtolerance. This extends beyond the workplace and considersthe individual’s work-life conditions.”There are many ways that to help create a more aware andrespectful work place. Education helps everyone realizehow they can make a difference in the environment andlives of those around them.
People are more accepting of eachother and work together moreeffectively when they can relate to theother person. Finding similarities ineach other’s stories and learning ofthe struggles that make a person whothey are is a way of breaking downbarriers and creating bonds that mayhave never been discovered.
When it is co-workers that are causing workstress it can be an almost overwhelming prospectfor victims to face each day. Research and studieshave shown that workplace bullies and abuse area very prevalent issue in hospitals. It can lead tolack of productivity, absenteeism, stress illnessesand employees leaving their jobs. Workshops and awareness campaigns can helpemployers work through these situations.
Some studies suggest that approximately 50% of the work force have experienced orWitnessed bullying
The Be One WorkshopThe workshop is designed foranywhere from 40 to 100 individuals. It can be done in smaller groups butis most effective in an environmentwhere more employees haveparticipated. It will begin with everyoneparticipating in some “get to knowyou” improvisational exercises. Thiswill hopefully help everyone feel morecomfortable with the group and tojust have fun while “de-stressing” sothat they can more easily open upand get the most out of the day
CHANGE- BE ONEThe participants then break up into small groupsof five. The groups will then complete a “I wishthat people understood about me….”Participants are asked to write their obituary. Tothink of what they want their legacy to be. If youcould share one thing about yourself to the worldwhat would it be…
”Your greatest fear…” exercise:Have health care provider participants to close their eyes andpicture their loved one in the hospital, or being a patientheaded for surgery in a hospital…think of the fear you wouldface….think of the stress of that scenario….What would make that better for you? How would staff helpcomfort you? Now add not being able to see clearlyanymore, not hearing clearly, not understanding the languageor being able to communicate back…Imagine all of a suddenneeding someone to do everything for you..and not being ableto communicate anything in return that is comprehended byothers. How does that feel? Are you scared?
(Each member of the group will have the chance toexperience this through foggy glasses, ear plugs, being“stuck” in a chair with Velcro, being challenged tocommunicate without words.) They will be giveninstructions in another language and having stimuli tocreate confusion around them…Think of how a patient feels…
Everyone has a story and you can be a bright chapter of it…
Be ONE…Every person around you is in need of something…a comfort- be One, a laugh- be one, a listening ear- BeOne, Compassionate care- Be One.The world is in need of heroes who will stand up and makea difference- Be One.Each participant is then given the opportunity to share howthey intend to “Be One” in their lives and with their “CallingTo Care”.These health care professionals then take what theylearned and implement it on their unit through example.
Health & Safety SlogansYour good health is your greatest wealthEven in a hi-tech world, your eyes are still your greatest asse"You must be the change you wish to see in the world." - Mahatma GandhiThe door to Safety swings on the hinges of common sense.Safety is success by purpose - Not Accident.Safety awareness saves lives.Check your shoes and dont let your day slip away.Be aware Take careSafety begins with No. 1Safety begins with teamworkWork smarter not harderWe need you - work safelySafety starts with S but begins with youThe door to safety swings on the hinges of common senseSafety is a state of mind - Accidents are an abscence of mindA wound neglected is a wound infectedNormal speed meets every needStop accidents before they stop youLook sharp dont get cutBefore you start be safety smartSafety is a full time job - dont make it a part time practice
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