An element of uncertainty and helplessness is almost always present when death occurs. Assessment and respect for the patient’s individual and cultural value system are of key importance in planning the care of the dying. As healthcare personnel, we often approach a dying patient with some feelings of uncertainty, helplessness, and anxiety. We feel helpless in being unable to perform tasks that will keep the patient alive, uncertain that we are doing all that we can do to either make the patient as comfortable as possible or to postpone or prevent death altogether. We feel anxious about how to communicate effectively with patients, their family, or even among ourselves. This is a normal response since any discussion about death carries a high emotional risk for the patient as well as the healthcare provider. Nevertheless, communicating can provide both strength and comfort to all if done with sensitivity and dignity, and it is sensitivity and dignity that is the essence of all healthcare services. PATIENT SAFETY LEARNING OBJECTIVE: Identify patient safety concerns in a medical treatment facility. The primary goal of the healthcare provider is maintaining, sustaining, restoring, and rehabilitating a physical or psychological function of the patient. To achieve this goal, healthcare facilities and providers a r e c h a rg e d w i t h d e v e l o p i n g p o l i c i e s a n d 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. ENVIRONMENTAL 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 activities of both patient and staff personnel. Maintaining safety becomes even more difficult when working with people who are ill or anxious and who cannot exercise their usual control over their environment. Loss of strength, decreased sensory input, and disability often accompany illness. Because of this, you must be constantly alert and responsive to maintaining a safe environment. Both JCAHO 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, and fire and explosions. Patient Fall Precautions The most basic of hospital equipment, the patient’s 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 are used improperly. Slippery or cluttered floors contribute to patient, staff, and even visitor falls. Patients with physical l i m i t a t i o n s o r p a t i e n t s b e i n g t r e a t e d w i t h sensory-altering medications fall when attempting to ambulate without proper assistance. Falls result from running in passageways, carelessness when going around blind corners, and collisions between personnel and equipment. Unattended and improperly secured patients fall from gurneys and wheelchairs. Healthcare personnel can do much to prevent the incidence of falls by following some simple procedures. These preventive measures include properly using side rails on beds, gurneys, and cribs; locking the wheels of gurneys and wheelchairs when transferring patients; and not leaving patients unattended. Safety straps must also be used to secure patients on gurneys or 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. Patients using crutches, canes, or walkers must receive adequate instructions in the proper use of these 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. Electrical Safety Precautions 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 healthcare providers at all levels be alert to such hazards and maintain an electrically safe environment. Knowledge and adherence to the 2-24