CARE OF VULNERABLE PATIENTS. PPT.pptx

The document outlines how hospitals should assess and care for vulnerable groups like the elderly and children, ensuring their safety, family involvement, and proper documentation. Facilities must provide needed care or transfer high-risk patients as required and train staff to minimize risks when treating vulnerable groups.

1. Care of vulnerable patients BY- BANDITA PATRA ASSOCIATE PROFESSOR

2. Definition A patient who is or may be for any reason unable to protect and take care of him or herself, against significant harm or exploitation.

3. Assessment of Vulnerable Elderly: Neurological status Psychological and mental status Ability to meet Activities of Daily Living General physical assessment Assessment for suspected nutritional and functional risks Assessment for the risk of fall injury Skin integrity assessment

4. Assessment of Vulnerable Young Children: General conditions Medical or surgical conditions Assessment for a suspected abuse or maltreatment

5. Following type of patients can be identified as vulnerable patients Below 12 years. Above 65 years. Terminally ill patients. Patient with intense and chronic pain(Pain more than 6). Women experiencing terminations and pregnancy. Patients with emotional psychiatric disorders. Patients receiving Chemotherapy. Patient whose immune systems are compromised. Patient Suspected of Drug and alcohol dependency

6. Policy on Vulnerable patients Staff nurse shall assess Fall risk assessment for all patients, twice a day(Morning and Night) initiate appropriate interventions and ensure these are documented. Fall risk assessment need to be reassessed on internal transfer of patient from one unit to another& in case of patients’ clinical condition alters(e.g. Surgical intervention, clinical deterioration). Assess the patient condition and provide care according to their condition Provide education on safety first program and same need to be documented.

7. Fall Risk Assessment tool Risk Factor Scale Score History of Falls Yes 25 NO Secondary Diagnosis/Elimination problem Yes 15 No Ambulatory Aid Furniture 30 Crutches/Cane/Walker 15 None/Nurse Assist/Bed Rest/Wheelchair CNS/CVS Medication Yes 20 No Gait Normal/Bed rest/Wheelchair Weak 10 Impaired 20 Mental Status Oriented to own Ability Overestimation and forgetfulness 15

8. MORSE Fall Score Risk Score High Risk >45 Moderate Risk 25-44 Low Risk 0-24

9. Problems faced By Vulnerable Patients Vulnerable patients are prone to face following problems during their stay in the hospital 1. Fall from bed or in washroom or while transporting from one place to another. The physical and mental limitation makes it difficult for these patients to avoid falls 2. Harms due to medical errors such as wrong medication, wrong diet etc., as they are unable to be watchful about the care being given to them 3. Neglect, abuse (verbal or physical) and similar other behaviors by some staff 4. Infringement of their rights, such as privacy, informed consent, confidentiality, respect etc. 5. Acquiring of healthcare-associated infections, as these patients may not be observant about infection prevention practices

10. Care For Vulnerable Patients Vulnerable patients so identified can be given a patient ID band of a Orange color, or a safety first labeled on their medical file for the information of healthcare staff. Fall leaf is displayed on patient cot. 2. Fall risk assessment - One of the prevalent risk, all vulnerable patients face is the risk of fall. Hence, as a prevention measure, all patients identified as vulnerable must be assessed for risk of fall. ‘Morse fall scale’ can be used for this purpose, which gives a risk score. Necessary measures can be taken for a patient

11. Safety Of The Vulnerable   They shall be accompanied by an attendant while going to washroom or any other area. The washroom that they use must have grab bars, anti-skid mats and call alarm system. While they are on bed safety railings should be put up in place to prevent fall from bed. While being transported on wheelchairs or stretchers, safety belt shall be put up.

12. Cont... Within the hospital the all vulnerable elderly and children will be given all-necessary care needed with consideration. If the patient’s condition demands further care which is not available in our hospital , patient will be transferred to the other hospitals/facilities. While transferring the patients a staff nurse will be accompany the patient along with the caregiver. If the patient’s condition is critical , will be escorted by a doctor and a nurse while transferring them form hospital to hospital. Staff taking care of high risk patients must have adequate training and skills. The identified vulnerable patients will be under close monitoring at all times during their hospitalization to minimize risks of health care services.

13. Cont...  All healthcare providers will maintain a safe environment, related but not limited to: equipment, wheelchairs, bed rails, mobility needs, fall precautions . All healthcare providers will encourage family involvement and support in care delivery, education and decisions as appropriate. Special consent considerations will be taken when needed for each individual case following the hospital approved consenting policies Once the patient is stabilized with the disease process, they will be fit for the discharge. The discharge patient will be discharged with follow-up advise. All documentation required for the team to work and communicate effectively in the care of high risk patients must be maintained as per hospital documentation policy.

14. Maintaining a safe environment for all patients  Patients are nursed in an appropriate bed Orientate all patients, parents/ carer to room and ward Keep beds in low position with brakes on and bed ends in place Side rails and cot sides are raised for appropriate age and patient groups Appropriate non slip footwear for ambulating patients Nurse call within reach; educate patients and families on its functionality Maintain adequate lighting in patient’s room; low level lighting at night  Keep floors clear of clutter including equipment and toys incase of pediatrics. Secure and supervise all patient with a safety belt or harness in wheelchairs, stretchers Hourly rounding will support the provision of proactive care such as the need for assistance to the bathroom Assist unsteady patients with ambulation; refer to physiotherapy notes where available Place necessary items a patient may need within reach (drinking water, phone, etc) Patients who have received sedation or general anesthetic may be unsteady and require supervision Ensure equipment is well maintained and serviced appropriately (such as wheelchairs and commodes)

15. Documentation of a fall event Record the incident including: description of event (location, activity occurring, time, who was present), assessment findings, interventions and patient outcomes, notification of the incident to the relatives. Report the incident through the hospital incident reporting system, All falls, including near misses should be reported. The information from reported falls is used to gain insight of the causes of falls for patients at the hospitals and continuously improve the local falls prevention program. A fall has occurred What factors contributed to the fall. Outcome of post-fall assessment. What additional protective measures have been put in place.

16. ENVIRONMENTAL ISSUES   Activities that aim to reduce environmental risks include: Decreasing obstacles and clutter Night lights at bedside and toilet Stabilizing beds and bed side furniture Having grab bar inside toilets All repairs to be attended without delay. If an equipment or furniture requires repair, patient's admitted to the room only after the issue is fixed. Caution board stating “wet floor” must be placed in case of wet floor or during routine mopping

17. ELIMINATION NEEDS Interventions to support the patient’s elimination needs include: Placing patients with urgency near toilets  Checking patients who are receiving laxatives and diuretics Toileting at risk patients routinely (offering bed pan and urinal at regular intervals) Instructing male patients prone to dizziness to sit while urinating If need to stand, ensure someone is there with the patient Emergency call bell must be placed inside toilets

18. MEDICATIONS & MOBILITY MEDICATIONS Activities related to medication include:  Assessing patients receiving laxatives, diuretics, anti- hypertensives etc. Non-skid footwear Providing physiotherapy Instructing patients to rise slowly Assistance while walking for patients Repeating activity limitation instruction to patient and family Assisting “patients during transfer Assisting patients to increase mobility by walking in corridor if there is no medical contraindication

19. MENTAL STATE, BED REST MENTAL STATE Altered mental status is one of the common identified risk factor for falling and the intervention include: Reorienting confused patients regularly Orienting patients to the hospital environment Keeping confused patients near nurse’s station Using family members to be with confused patients at all times BED REST  Interventions that aim to reduce the risk of falling while patient is on the bed include: Ensure bed is in “Low” position Ensure bed is locked. Ensure bed side-rails are in “UP” position Ensure patients can reach necessary items

20. WHEEL CHAIRS & CHAIRS To prevent fall involving wheel chairs include: Use safety straps or seat belts in chairs Ensure support to prevent slipping from chairs  Selecting suitable chairs for sitting. Orange colour ID Band to identify vulnerable patients call bell Foot stool Call in bath room Side rails and fall leaf Grab bar Safety belt in wheel chair