identify the underlying stress and to attempt to relieve the immediate and obvious source of anxiety. This is as simple as communicating, through your care and understanding of the patient as an individual, that Navy medicine is pleased to provide a caring service.
In the introductory section of this chapter, we established the primary goal of the health care provider as maintaining, sustaining, restoring, and rehabilitating a physical or psychological function of the consumer. To achieve this goal, health care facilities and providers are charged with developing policies and implementing mechanisms that ensure safe, efficient, and therapeutically effective care. The theme of this discussion is safety and will address the major aspects of both environmental and personal safety.
For purposes of this discussion, the environment is defined as the physical surroundings of the patient and includes such things as lighting, equipment, supplies, chemicals, architectural structure, and the ever present accident potential activities of both patient and staff personnel. Maintaining safety becomes even more difficult when working with people who are ill or anxious and cannot exercise their usual control over the environment. Loss of strength, decreased sensory input, and disability often accompany illness. Because of this, the health care provider must be constantly alert and responsive to maintaining a safe environment.
Both JCAH and the National Safety Council of the American Hospital Association (AHA) have identified four major types of accidents that continually occur to patients. These hazards consist of falls, electrical shocks, physical and chemical burns, fires, and explosions. The most basic of hospital equipment, the patients bed, is a common cause of falls. Falls occur among oriented patients getting in and out of bed at night in situations where there is inadequate lighting. Falls occur among disoriented or confused bed patients when bedrails are not used or used improperly. Slippery or cluttered floors contribute to patient, staff, and even visitor falls. Patients with physical limitations or those being treated with sensory altering medications fall when attempting to ambulate without proper assistance. Falls result from running in passageways, carelessness when going around blind corners, and personnel and equipment collisions. Unattended and improperly secured patients fall from gurneys and wheelchairs.
Health care personnel can do much to prevent the incident of falls by following some simple procedures, such as properly using side rails on beds, gurneys, and cribs; and locking the wheels of gurneys and wheelchairs when transferring a patient or leaving one unattended. Safety straps must also be used to secure patients on gurneys as well as those in wheelchairs. Maintaining dry and uncluttered floors markedly reduces the number of accidental falls. Patients with physical or sensory deficiencies should always be assisted during ambulation. Those using crutches, canes, or walkers must receive adequate instructions in ambulating with the aids before being permitted to ambulate independently. The total care environment must be equipped with adequate night lights to assist orientation and to prevent falls resulting from an inability to see potential hazards.
The expanded variety, quantity, and complexity of electrical and electronic equipment used for diagnostic and therapeutic care has markedly increased the hazards of burns, shock, explosions, and fire. It is imperative that health care providers at all levels be alert to such hazards and exert a continued effort to maintain an electrically safe environment. Knowledge and adherence to the following guidelines will contribute markedly to providing an electrically safe environment for all personnel whether they be patients, staff, or visitors.