Client ID, falls, restraints and emergencies

Does it count as an identifier?

How: At least two identifiers before medications, treatments, blood or specimens. Ask the client to state their name and birth date, then check the wristband. Scanning adds a layer; it doesn't replace them.

Bands, orders and near misses

• Band missing or wrong: pause nonurgent care, use your approved two-identifier process, and replace the band. Don't delay emergency care for it.
• Order unclear or unsafe: hold it and clarify with the prescriber. Never change it yourself.
• A near miss is still reported, by incident report, not in the chart.
• An error reached the client: check the client first, then tell the provider.

Before procedures: the Universal Protocol

Speak up: Unless clinically necessary, no sedation until consent, marking and identification are done. Anyone who sees a problem speaks up, and the procedure waits until it's resolved.

Fall risk and prevention

• Assess on admission, after a fall or a change in condition or medicines, and as often as policy requires.
• Higher risk: a recent fall, new confusion, frequent toileting, sedating or blood pressure drugs, tubing, dizziness on standing.
• Pain medicines, antipsychotics, anticonvulsants and benzodiazepines are examples. Review each client's own medicines.
• Every client: orient, call light and belongings in reach, bed low and locked, non-slip footwear, night lights, clear floors.
• Hourly rounding: pain, toileting, position. Needs are met before the client gets up alone.
• Side rails: a restraint or not depends on whether they restrict that client's voluntary movement, not purpose alone.

Seizure precautions

• Oxygen and suction at the bedside; bed in its lowest position; padded rails if policy says.
• During: if not in bed, ease to the floor. Protect the head. Turn them on their side if you can. Move furniture away, loosen tight clothing, remove glasses.
• Never put anything in the mouth, and never hold the client down.
• Time it, and watch the eyes, consciousness, breathing, color and any incontinence.
• 5 minutes or more, or repeated seizures without recovery between, is status epilepticus: emergency care starts at 5 minutes, sometimes sooner.
• After: on the side so secretions drain; check the airway, vital signs and neuro status.

Is it a restraint?

Seclusion: Involuntary confinement alone, kept from leaving. Only for violent or self-destructive behavior that threatens immediate safety.

Restraint rules

• Only for immediate physical safety, never convenience or punishment. Alternatives first; the least restrictive type.
• An order from a licensed practitioner responsible for the client: never standing, never as needed.
• Violent behavior: up to 4 hours for adults, 2 hours ages 9 to 17, 1 hour under 9; renewable up to 24 hours, then the practitioner sees the client.
• Seen face to face within an hour by a practitioner, or a trained RN or physician assistant who promptly consults the practitioner.
• Ends as soon as it's safe, not when the order runs out.

Monitoring and alternatives

• Checks at intervals your policy sets: commonly continuous, or at least every 15 minutes. Release every 1 to 2 hours for movement and a skin check; meet fluids, food and toileting.
• Tie it to the bed frame, not the side rail, with a quick-release knot.
• Document the behavior, the restraint, the alternatives tried, time and site, teaching, the response and why it's still needed.
• Alternatives: routine and toileting, pain control, a medicine review, distraction, a supervised area, alarms, a sitter or family.

START triage

Goal: The most good for the most people. Triage is repeated as condition changes: a yellow can become red.

Fire and hazardous materials

• RACE: Rescue, Activate the alarm, Confine (close doors), Extinguish or evacuate. Rescue comes first.
• PASS: Pull the pin, Aim low at the base, Squeeze, Sweep side to side.
• Unfamiliar chemical spill: read its safety data sheet first.
• Biohazard waste: closable, leak-proof, labeled containers. Sharps containers are replaced before they overfill.

Exposures