Patient Safety & Care Coordination

A. Coordinated Care

Advance Directives & Legal Rights (Informed Consent, Patient Rights)

1.1 Purpose and Role of Advance Directives

• An advance directive is a legally recognized document that communicates an individual’s preferences for medical care in situations where they can no longer voice their decisions.
• It guides healthcare teams and families to follow the patient’s expressed values and treatment goals.

1.2 Common Forms of Advance Directives

• Living Will: Outlines what types of interventions (like life-support or artificial nutrition) the individual accepts or declines under critical conditions.
• Healthcare Proxy (Durable Power of Attorney for Healthcare): Appoints someone trusted to make care-related choices if the patient is incapacitated.
• DNR (Do Not Resuscitate): Directs healthcare professionals not to attempt resuscitation when breathing or heart function stops.
• POLST (Physician Orders for Life-Sustaining Treatment): A document signed by a healthcare provider that clearly details specific interventions a seriously ill patient wants or doesn’t want, such as CPR or tube feeding.

1.3 Legal Aspects and Guidelines

• To be valid, advance directives must meet legal signing and witnessing standards set by the state.
• Patients with mental capacity can revoke these documents at any time, either orally or in writing.
• Medical providers and institutions are legally bound to inquire about and comply with legitimate directives.

1.4 Understanding Informed Consent

• Definition: A process through which patients give authorization for treatment based on a clear understanding of its nature, risks, expected benefits, and alternatives.
• Key Elements:
  Mental Competence: The patient must grasp the situation and consequences.
  Freedom of Choice: The consent must be given willingly, without pressure.

1.5 Upholding Patient Rights

• Right to Information: Patients must be given thorough and truthful details about their condition and care options.
• LPN’s Responsibilities:
  May be asked to observe the signing of forms (per facility protocols).
  Clarify general questions or concerns, while the provider explains complex details.
  Report to a registered nurse or doctor if the patient seems uncertain or confused.
• Right to Personal Privacy: Protected under regulations like HIPAA, which restrict the sharing of health information.
• Right to Confidential Communication: Patient data should only be disclosed to those with permission or legitimate need.
• Right to Decline Medical Care: Patients can say no to treatments, even if doing so puts their health at risk, provided they are mentally competent.
• Right to a Secure and Respectful Environment: This includes being safeguarded from mistreatment, abuse, or neglect during care.

Comparison of Common Advance Directives

Type	Main Purpose	Legally Enforceable	Authority for Decisions	How It Can Be Revoked
Living Will	Indicates what life-saving treatments the individual accepts or rejects	Yes	Written instructions by the individual	Patient may revoke anytime if mentally capable
Durable Power of Attorney for Healthcare	Assigns someone to speak for the patient in healthcare matters	Yes	Chosen healthcare representative	Patient can withdraw authorization at any time
Do Not Resuscitate (DNR)	Tells medical staff not to start CPR if breathing or heart stops	Yes, with proper documentation	Based on patient’s stated preference	Can be voided anytime by the competent patient
POLST	Provides clear doctor-validated orders for serious illness interventions	Yes, functions as clinical directives	Developed jointly by patient and doctor	Typically changed through conversation with provider

Ethical Practice & LPN Scope of Responsibilities

2.1 Core Ethical Values in Nursing

• Autonomy: Supporting patients in making their own well-informed healthcare decisions.
• Beneficence: Promoting the well-being and best outcomes for those receiving care.
• Nonmaleficence: Intentionally preventing harm or injury to patients.
• Justice: Ensuring that care, support, and medical resources are distributed fairly.
• Fidelity: Staying true to professional responsibilities and maintaining trust.

2.2 Professional Ethics and Relationship Standards

• Maintain a professional, therapeutic dynamic with patients—personal involvement is inappropriate.
• Decline any offers that may compromise impartiality (e.g., costly or inappropriate gifts).
• Safeguard all private patient data and maintain discretion in communication.

2.3 LPN Role and Authorized Functions

• LPN duties are regulated by state laws (Nurse Practice Act) and institutional policies.
• Common responsibilities may include:
  • Giving medications (by mouth, under the skin, into muscle, and in some states, certain IV routes).
  • Gathering and reporting health information (like vital signs and physical changes).
  • Assisting with routine care activities (such as managing wounds and urinary catheters).
  • Participating in care planning under guidance from RNs and the care team.
  • Reiterating instructions that were initially explained by RNs or other licensed staff.
• Typically not within the LPN’s scope:
  • Creating the first version of the care plan (assigned to RNs).
  • Carrying out high-risk IV therapies or certain IV medications (varies by state rules).
  • Diagnosing nursing problems independently (usually reserved for RNs).

Delegation and Oversight (Roles of RNs, LPNs, and UAPs)

3.1 Key Concepts

• Delegation: Assigning a nursing-related task to another qualified individual while retaining responsibility for the outcome.
• Supervision: Providing ongoing oversight, feedback, and assessment of the delegated work to ensure proper completion and patient safety.

3.2 The Five Rights of Delegation

• Right Task: Only assign duties that align with the team member’s role and verified abilities.
• Right Circumstance: Delegation is suitable when the environment is controlled and the patient’s condition is predictable.
• Right Person: The designated individual must be trained, qualified, and working within their legal role.
• Right Instructions/Communication: The task must be explained with detailed expectations, including outcomes and timeframes.
• Right Oversight/Follow-Up: The delegating nurse remains responsible for supervision and final evaluation of the task.

3.3 Role-Specific Duties

• Registered Nurse (RN):
  • Performs initial evaluations, formulates care plans, and makes nursing judgments.
  • Oversees the performance of LPNs and UAPs.
  • Manages patients who require critical thinking and clinical expertise, especially those with changing or complex conditions.
• Licensed Practical Nurse (LPN):
  • Delivers routine care and provides most medication administration (based on regional regulations).
  • Observes and records patient status and updates the RN with relevant changes.
  • May direct UAPs, but generally under RN supervision.
• Unlicensed Assistive Personnel (UAP):
  • Carries out basic care duties like hygiene assistance, meal support, and taking vitals.
  • Communicates observations such as skin breakdown or unusual behavior.
  • Operates under the instruction and oversight of RNs or LPNs.

Illustrations of Delegating Tasks According to Job Position

Task	RN	LPN	UAP
Initial Assessment	Yes (Leads the assessment process)	No (Can assist with data gathering)	No (Can share basic observations only)
Wound Care/Dressing Changes	Yes	Yes (If allowed by facility guidelines)	No
Medication Administration (PO/IM)	Yes	Yes (May vary based on state regulations)	No
IV Medication Push	Yes (As permitted by license)	Yes (Only if within authorized practice)	No (Usually not allowed)
Bathing and Hygiene	Yes	Yes	Yes
Feeding a Stable Patient	Yes	Yes	Yes
Documentation of Care	Yes	Yes	Yes (Only for care they are allowed to provide)

Case Coordination & Team-Based Communication

4.1 Understanding Case Management

• A structured, team-based method used to organize, oversee, and adjust care to meet the patient’s health needs in an efficient, goal-oriented way.
• Frequently applies to patients with complex or chronic conditions that demand collaboration among different services (e.g., rehabilitation, social support, in-home care).

4.2 LPN Involvement in Case Coordination

• Assists in collecting relevant clinical data to support the RN or case manager’s decisions.
• Monitors the patient’s status and reports observations to the broader care team.
• Repeats and clarifies discharge instructions or care guidelines previously explained by licensed providers.
• Works alongside various health professionals—including doctors, therapists, and social service staff—while being directed by an RN or case coordinator.

4.3 Communication in Collaborative Teams

• Communicate using organized tools like SBAR to ensure messages are brief yet complete (Situation, Background, Assessment, Recommendation).
• Be actively involved in care planning discussions, such as team huddles or case meetings.
• Record patient updates, actions taken, and outcomes clearly in documentation.
• Maintain a courteous and professional tone when interacting with other members of the care team.

4.4 Advantages of Interdisciplinary Teamwork

• Patient outcomes are strengthened through collective decision-making.
• Promotes continuity of care and reduces gaps in treatment.
• Streamlines processes, making better use of time and available resources.
• Encourages a more satisfying patient experience through cohesive care planning and unified communication.

Prioritization & Managing Time in Nursing

5.1 Guidelines for Prioritizing Care

• Airway, Breathing, Circulation (ABC): Life-threatening concerns related to oxygenation and circulation should be handled first.
• Maslow’s Hierarchy: Physical survival needs (e.g., food, fluid, elimination) should be prioritized over psychological or social needs.
• Urgency of Condition: Immediate action is usually needed for new or worsening conditions over long-standing issues.
• Risk Level: Address high-risk or potentially life-threatening concerns before routine or non-urgent tasks.

5.2 Applying the Nursing Process to Prioritization

• Assessment: Collect relevant data to understand what requires urgent attention.
• Diagnosis: Determine which health issues are most pressing (e.g., difficulty breathing vs. emotional stress).
• Planning: Organize resources and task order based on severity and patient needs.
• Implementation: Begin with interventions that address the most critical concerns, such as stabilizing vital signs.
• Evaluation: Recheck priorities frequently as patient conditions evolve.

5.3 Time Management Techniques

• Prepare Ahead: Review assignments at the start of the shift and outline tasks by priority.
• Group Interventions: Combine multiple care activities during each room visit (e.g., assessments, medication, patient education).
• Delegate Wisely: Assign appropriate, routine tasks (like hygiene or vital signs) to trained support staff to free time for skilled care.
• Act Early: Begin important or complex tasks early in the shift to reduce last-minute delays.
• Timely Charting: Document during or right after providing care to prevent forgotten details and ensure accuracy.

5.4 Frequent Mistakes to Avoid

• Missing Early Changes: Being too task-focused may result in failing to notice subtle clinical shifts.
• Lack of Team Communication: Poor handoffs and unclear communication can lead to duplicated or missed tasks.
• Outdated Priorities: Failing to reassess care plans can result in inappropriate or delayed interventions as patient conditions change.

Sample Approach to Organizing Daily Responsibilities

Time	Task	Priority	Rationale
07:00–07:30	Get Report & Check Provider Orders	High (Preparation)	Sets the groundwork for organizing care and understanding patient needs
07:30–08:00	Morning Checks & Initial Observations	High (Evaluation)	Helps recognize immediate concerns like abnormal signs or discomfort
08:00–09:00	Administer Routine Medications	High (Timeliness)	Maintains therapeutic levels and supports treatment schedules
09:00–10:00	Assign Basic Care Tasks to UAP	Medium	Delegation allows focus on duties that need licensed judgment
10:00–11:00	Reassess & Complete Charting	High (Ongoing Care)	Tracks patient progress and ensures care records are up-to-date
11:00–12:00	Health Teaching / Info Review	Medium	Valuable but can wait if more pressing clinical needs are present

Improving Care Quality & Reporting Unexpected Events

6.1 What Is Quality Improvement (QI)?

• A continuous, team-based strategy to assess and improve how patient care is delivered in terms of effectiveness and safety.
• Focuses on discovering care-related issues, trying out changes, and evaluating whether those changes made a measurable impact.

6.2 Typical Quality Improvement Approaches

• PDSA Cycle (Plan-Do-Study-Act)
  • Plan: Determine a specific area that needs enhancement and outline a targeted solution.
  • Do: Put the plan into action in a controlled or limited setting.
  • Study: Review collected data and examine whether improvements occurred.
  • Act: Modify and apply the improved process on a wider scale based on what was learned.
• Root Cause Analysis (RCA):
  • A retrospective, in-depth review that explores the main factors behind a negative event with the goal of eliminating future risks.

6.3 How LPNs Contribute to Quality Improvement

• Observing and Gathering Information: Track indicators related to patient well-being and clinical outcomes (e.g., post-op infections, vital signs trends).
• Reporting Unusual Findings: Communicate patterns, deviations, or unsafe practices to the healthcare team or quality department.
• Following Updated Practices: Apply revised care protocols or routines that stem from QI findings.
• Supporting Evaluation: Help during internal reviews or evaluations by supplying requested documentation or sharing clinical insights.

6.4 Understanding Incident Reporting

• Definition: A structured report used to document events that deviate from expected care delivery or safety procedures (e.g., falls, errors, broken equipment).
• Goal:
  • Promote a safer healthcare environment by recognizing and addressing root causes.
  • Use incident patterns to drive process improvements and reduce risk.
• Steps to Follow:
  • Provide immediate care to the affected patient and stabilize the situation.
  • Inform designated team members such as supervisors or physicians.
  • Complete a nonjudgmental, objective report that adheres to institutional policy.
  • Avoid referencing the incident report in the patient’s chart; instead, document the actual event, your observations, and the care provided in response.

Legal Standards and Patient Safety Regulations

7.1 HIPAA: Protecting Patient Privacy

• Goal: Safeguard the confidentiality and integrity of personal health data.
• Main Elements:
  • Need-to-know access: Health information should only be accessed or disclosed when essential for care delivery or operations.
  • Secure communication: Patient records must be stored safely, and digital communication should follow approved encryption and privacy protocols.
  • Patient privileges: Individuals can review their health records, request corrections, and must be informed if their data has been compromised.
• Breach Consequences: Infractions can lead to monetary penalties, job sanctions, or even loss of professional licensing in extreme cases.

7.2 OSHA: Workplace Health and Safety

• Goal: Promote a hazard-free environment for healthcare staff.
• LPN Duties:
  • Comply with safety practices like proper disposal of needles, lifting techniques, and chemical handling procedures.
  • Report risks such as faulty equipment or environmental hazards to supervisors.
  • Consistently wear protective gear (e.g., gowns, face shields) in line with exposure risks.

7.3 When Reporting Is Required

• Suspected Abuse or Mistreatment: Nurses must inform proper authorities if they suspect harm toward children, seniors, or vulnerable adults.
• Public Health Notifications: Infectious disease cases like COVID-19 or hepatitis may need to be disclosed to public agencies.
• Concerns About Colleague Fitness: When a staff member may pose harm due to substance misuse or mental distress, nurses are typically legally obligated to report this to leadership or regulatory bodies.

7.4 Other Legal Protections and Duties

• Good Samaritan Acts: Offer limited protection when nurses provide urgent care outside of clinical settings, such as at an accident scene.
• Malpractice Insurance: Some LPNs carry personal liability coverage for legal defense in case of negligence claims.
• State Practice Acts: Define the boundaries of LPN roles and stipulate consequences for violating professional standards.

Navigating Healthcare Resources and Patient Referrals

8.1 Role of Resource Management

• Promotes effective use of supplies, services, and providers to deliver safe and affordable care.
• Helps bridge transitions between care settings such as from hospital to home or rehab.

8.2 Making and Supporting Referrals

• What It Is: The process of sending a patient to a specialist or service that better suits their specific health needs (e.g., a dietitian for nutrition plans).
• LPN Contributions:
  • Identify when a patient might benefit from added services (e.g., falls risk requiring physical therapy).
  • Inform the RN or care coordinator so a formal referral can be made.
  • Help patients understand why they’re being referred and what the next steps involve.

8.3 Supporting Care at Home

• Objective: Deliver healthcare and supportive services to patients who are recovering, disabled, or chronically ill—right in their homes.
• LPN Functions in Home Settings:
  • Carry out tasks and assessments under RN supervision, as allowed by local laws.
  • Teach family members about managing medications, wounds, or chronic illnesses.
  • Watch for clinical changes and communicate them to the nurse or physician.
  • Keep clear, timely notes on patient visits and interventions.

8.4 Local and Community-Based Support Services

• Service Examples:
  • Community health centers that offer vaccinations and health screenings.
  • Behavioral health programs offering therapy or psychiatric evaluation.
  • Assistance programs like food delivery services or transit options for those with mobility issues.
  • Peer networks and education groups for long-term conditions (e.g., heart failure, asthma).
• LPN Responsibilities:
  • Assess whether patients may benefit from outside help (e.g., emotional support, income-related resources, daily living needs).
  • Share brochures, referral contacts, or direct patients to reputable agencies.
  • Motivate patients to engage with these services to enhance continuity of care and overall well-being.

Frequently Used Local Support Services

Resource	Type of Assistance	Target Population
Public Health Services	Vaccinations, wellness checks, disease prevention	All community members
Community Behavioral Health	Therapy sessions, mental health evaluations	People experiencing emotional or psychological concerns
In-Home Care Providers	Medical support, rehabilitation, daily living help	Individuals recently discharged who require continued support
Human Services Agencies	Help with finances, shelter access, healthcare programs	Economically disadvantaged or vulnerable groups
Senior Meal Programs	Nutritious food delivery to homes	Older adults or physically impaired individuals needing assistance

B. Safety and Infection Control

9.1 Universal and Condition-Specific Infection Control Measures

Overview of Universal Precautions

• Universal precautions represent essential protective steps taken with all patients, regardless of known or suspected infections.
• These practices aim to minimize exposure to germs from both noticeable and hidden sources of infection.

9.2 Essential Elements of Universal Precautions

• Hand Washing: Clean hands before and after touching patients, after removing gloves, and when visibly dirty.
• Protective Wear (PPE): Use gloves, gowns, masks, or eye gear based on the potential contact with fluids or secretions.
• Injection Safety: Maintain sterility, avoid sharing vials, and dispose of sharps appropriately.
• Cough & Sneeze Etiquette: Cover the mouth, throw away tissues properly, and sanitize hands afterward.
• Clean Environment: Adhere to protocols for cleaning patient care areas and tools.

9.3 Condition-Specific Protective Measures

Definition:

• These are added safeguards for patients with diseases that spread through contact, droplets, or the air.
• They supplement universal precautions for extra protection.

9.4 Categories of Condition-Specific Precautions

• Contact-Based:
  • Applied for illnesses passed by physical touch (e.g., C. diff, MRSA).
  • Protective Gear: Gloves and gowns are necessary.
  • Room Setup: Preferably isolate the patient or group with others infected by the same microbe.
• Droplet-Based:
  • Used for diseases passed through respiratory droplets (e.g., flu, pertussis).
  • Protective Gear: Surgical masks when close to the patient; add gloves and gown if there’s risk of exposure to secretions.
  • Room Setup: Separate room is ideal.
• Airborne-Based:
  • Reserved for conditions spread through fine airborne particles (e.g., TB, chickenpox).
  • Protective Gear: N95 respirators; gloves and gown if needed.
  • Room Setup: Specialized negative-pressure room required.

9.5 Guidelines for Using Protective Gear (PPE)

• Gloves: Replace between tasks, especially if switching from soiled to clean areas.
• Gowns: Use when exposure to fluids is likely; remove and wash hands before exiting the care area.
• Masks: Use surgical masks for droplet concerns and respirators for airborne protection.
• Eye Protection: Goggles or face shields are used when splashes are likely to reach the eyes.

Suggested Personal Protective Equipment According to Precaution Category

Precaution Type	Conditions	Examples of PPE Required	Room Requirements
Standard	Applied to all patient interactions	Use gloves when handling body fluids; add mask/eye shield for splashes	No special room—follow routine hygiene protocols
Contact	C. difficile, VRE, MRSA	Wear gloves and gown when touching patient or their environment	Private room or shared room with others with same issue
Droplet	Mumps, Pertussis, Seasonal Flu	Surgical mask required; gown and gloves based on exposure risk	Private room ideal for reducing spread
Airborne	Measles, TB, Chickenpox	N95 or higher-level respirator; add gloves and gown as appropriate	Airborne infection isolation room (AIIR) needed

Infection Control Practices (Hand Sanitation, Aseptic Methods, Sterile Procedures)

10.1 Hand Sanitation

• Primary Prevention Method: Thorough hand cleansing remains the most effective action for minimizing infection risks in healthcare environments.
• Washing with Soap and Water:
  • Required when visible dirt or exposure to infectious gastrointestinal illnesses like C. difficile occurs.
  • Hands should be scrubbed for no less than 20 seconds, making sure to clean all hand surfaces.
• Using Alcohol-Based Sanitizers (ABHS):
  • Suitable when there is no visible contamination.
  • Hands must be rubbed until dry, typically lasting 20–30 seconds.

10.2 Comparison: Clean vs. Sterile Techniques

• Clean Technique (Medical Asepsis):
  • Aims to limit the spread and growth of germs but does not eliminate them completely.
  • Includes actions like hand hygiene, glove use, and general surface cleaning.
• Sterile Technique (Surgical Asepsis):
  • Focuses on removing all microorganisms and maintaining a contamination-free space.
  • Includes use of sterile gloves, tools, and fields.

10.3 Guidelines for Sterile Practices

• Creating a Sterile Field:
  • Open sterile materials by unfolding the farthest flap first.
  • The sterile area must remain visible and above waist height.
• Key Sterility Principles:
  • Only sterile-to-sterile contact preserves sterility.
  • The outer inch of the sterile area is assumed to be unclean.
  • Limit air disturbance near the sterile area to avoid contamination.

10.4 Other Infection Control Measures

• Managing the Environment:
  • Clean frequently touched items like bed controls and door handles often.
  • Dispose of used medical materials, especially sharps, in containers designed to prevent injuries.
• Protecting Patient Health from Staff:
  • Healthcare providers should avoid work when sick.
  • Vaccinations (such as flu shots or hepatitis B) should be kept current to reduce transmission risks.

Managing Hazardous Exposure (Chemo Agents, Radiation)

11.1 Handling Antineoplastic Agents Safely

• Safety Guidelines for Chemo Exposure:
  • Wear approved gloves designed for chemotherapy and use gowns that cover and protect the skin.
  • Use closed-transfer devices when possible to reduce leaks and airborne particles.
  • Excretions from patients on chemo may carry the drug for up to 48 hours, so precautions must continue during this time.
• Waste Disposal Procedures:
  • Items like used tubing, gloves, or vials must be placed in containers marked for hazardous waste.
  • Facilities must have proper protocols for handling and cleaning up hazardous spills, including use of spill kits.

11.2 Radiation Safety

• Types of Radiation Used in Healthcare:
  • Ionizing radiation is utilized for diagnostic purposes such as X-rays and CT scans, as well as for treatment in radiation therapy.
• Fundamental Protection Strategies:
  • Time: Reduce the duration of exposure; rotate staff to minimize individual risk.
  • Distance: Maximize the space between personnel and radiation sources whenever possible.
  • Shielding: Wear lead aprons, gloves, and thyroid protectors as needed to block radiation.
• Care of Patients with Internal Radiation (Brachytherapy):
  • Isolate the patient in a private room and display clear radiation hazard signs.
  • Limit the amount of time visitors spend in the room; advise visitors to keep at least 6 feet away from the patient.
  • Use designated containers for radioactive waste and handle contaminated linens following facility protocols.

11.3 Disposal of Hazardous Materials

• Biohazardous Waste: Includes items contaminated with blood, body fluids, or sharp objects; dispose of in red biohazard bags or sharps containers.
• Chemical Waste: Manage according to specific Safety Data Sheets (SDS) for each chemical.
• Radioactive Waste: Store and discard according to instructions from the radiation safety officer.
• Pharmaceutical Waste: Certain drugs and their residues, such as narcotics and chemotherapy agents, require special disposal procedures.

Fall Prevention, Ergonomics, and Safe Body Mechanics

12.1 Preventing Falls in Healthcare

• Fall Risk Factors:
  • Intrinsic: Factors like advanced age, previous falls, limited mobility, vision problems, cognitive issues, and certain medications (e.g., sedatives).
  • Extrinsic: Environmental hazards such as clutter, insufficient lighting, loose rugs, and improper use of assistive devices.
• Fall Risk Evaluation:
  • Use standardized tools (e.g., Morse Fall Scale) on admission, after condition changes, and regularly as per policy.
• Prevention Strategies:
  • Keep beds in the lowest setting and lock wheels on beds and wheelchairs.
  • Ensure call bells, personal belongings, and assistive devices are easily accessible.
  • Provide adequate lighting and clear walkways of obstacles.
  • Use alarms on beds or chairs for patients identified as high risk.

12.2 Ergonomics and Proper Body Mechanics for Staff

• Objective: Reduce risk of musculoskeletal injuries and ensure patient safety.
• Key Techniques:
  • Maintain a neutral spine posture; bend at hips and knees rather than the waist.
  • Lift using large leg muscles and keep the load close to the body.
  • Avoid twisting; turn by pivoting or stepping to the side.
  • Keep feet shoulder-width apart for stability.
  • Use assistive equipment like mechanical lifts and transfer belts whenever possible.

12.3 Safe Handling and Moving of Patients

• Patient Transfers:
  • Use gait belts to aid ambulation.
  • Support patient’s feet and use transfer aids such as slide sheets or boards as needed.
• Team Lifts:
  • For heavy or fully dependent patients, ensure assistance from at least two caregivers or use mechanical devices.
• Preventing Injury to Caregivers:
  • Immediately report any discomfort or injury.
  • Engage in ergonomic training and adhere to facility safety guidelines.

Emergency Response (Disaster Preparedness, Fire Safety, Code Blue)

13.1 Preparing for Disasters

• Disaster Types: Includes natural events like hurricanes and earthquakes, as well as human-caused incidents such as terrorism or chemical spills.
• Facility Emergency Plans:
  • Each healthcare facility maintains protocols for evacuation, communication, and allocation of resources during disasters.
  • LPNs should understand their responsibilities and the command structure during emergency situations.
• Emergency Supplies:
  • Know where essential emergency equipment is stored (e.g., flashlights, battery-powered radios, extra blankets, IV supplies).
  • Participate in emergency drills regularly to maintain preparedness and proficiency.

13.2 Fire Safety

• Important Acronyms:
  • RACE: Rescue individuals in danger, activate the Alarm, Confine the fire by closing doors/windows, then Extinguish or Evacuate as needed.
  • PASS: Pull the pin from the fire extinguisher, Aim at the fire’s base, Squeeze the handle, Sweep the nozzle side to side.
• Steps to Respond to Fire:
  • Rescue any people immediately threatened by the fire.
  • Trigger the fire alarm system and notify emergency personnel.
  • Contain the fire by shutting doors and windows to prevent spread.
  • Attempt to put out small fires only if trained and it is safe; otherwise, prioritize evacuation.
• Evacuation Sequence:
  • First, move patients who can walk independently.
  • Next, assist those in wheelchairs or stretchers.
  • Follow directions for vertical evacuation (stairs) if safe and instructed.

13.3 Code Blue (Cardiac or Respiratory Arrest)

• Definition: A critical event when a patient experiences heart or breathing stoppage.
• LPN Duties:
  • Start CPR immediately if the patient is unresponsive and not breathing or only gasping (according to local policies and certification).
  • Call or activate the emergency response system or declare a Code Blue.
  • Retrieve and use an AED or defibrillator if authorized within the scope of practice.
  • Carry out assigned tasks during resuscitation under team leadership (e.g., chest compressions, assisted ventilation if trained).
• After Resuscitation:
  • Help stabilize the patient and prepare for transfer to an intensive care unit or higher-level care.
  • Accurately document the incident, including timing, interventions performed, and patient condition.

Restraints and Alternatives

14.1 What Are Restraints?

• Physical Restraints: Devices or methods (such as vests, wrist/ankle ties, mitts) used to restrict a patient’s movement.
• Chemical Restraints: Medications given to control behavior or movement that are not part of standard treatment or dosage.

14.2 When Are Restraints Used?

• Only as a last option after other less restrictive methods have failed to protect the patient or others.
• Must have a physician’s order detailing the type and duration of restraint use.

14.3 LPN Responsibilities

• Assessment: Participate in evaluating the need for restraints initially and throughout use.
• Application: Apply restraints safely and according to facility policies.
• Monitoring:
  • Regularly assess circulation, skin condition, and joint mobility (typically every 2 hours or as per policy).
  • Watch for signs of distress such as difficulty breathing or agitation.
• Documentation:
  • Record the reason for restraint, alternatives attempted, type and location of restraints, time applied, assessments, and removal time.
• Order Review: Restraint orders expire after a set period (often 24 hours) and require reassessment to renew.

14.4 Alternatives to Restraints

• Adjust the environment with adequate lighting, bed alarms, and low beds.
• Use orientation aids and distraction methods such as reorienting patients, providing music or TV, and keeping personal items nearby.
• Conduct frequent rounds to address needs like toileting, pain, and comfort.
• Increase supervision by assigning sitters or using video monitoring when possible.

Medication Safety

15.1 Why Medication Safety Matters

• Medication errors can cause serious harm or even death.
• High-alert drugs (e.g., insulin, blood thinners) pose a greater risk if mishandled.

15.2 High-Alert Medications

• Examples include insulin, heparin, warfarin, opioids, chemotherapy drugs, and concentrated electrolytes like potassium chloride.
• Safety practices include:
  • Verifying doses with another licensed nurse.
  • Using smart infusion pumps with programmed drug libraries.
  • Storing these medications separately and clearly labeling them.

15.3 Look-Alike/Sound-Alike (LASA) Medications

• Medications with similar spellings or pronunciations that may cause confusion (e.g., hydroxyzine vs. hydralazine).
• Strategies to reduce errors:
  • Use “tall man” lettering to highlight differences (e.g., hydrOXYzine vs. hydrALAzine).
  • Store look-alike meds separately on pharmacy shelves and dispensing units.
  • Confirm medication orders by double-checking with the patient (when appropriate) or re-verifying the prescription.

15.4 The “Six Rights” of Medication Administration

• Correct Patient: Verify the patient’s identity using two identifiers (such as full name and birthdate) and cross-check with the medication administration record (MAR).
• Correct Medication: Examine the medication label carefully three times—when taking it from storage, prior to preparing it, and just before giving it to the patient.
• Correct Dose: Double-check dosage calculations, especially for vulnerable groups like children and elderly patients.
• Correct Route: Ensure the medication is given by the intended method (oral, intramuscular, intravenous, subcutaneous, etc.).
• Correct Timing: Administer medications according to prescribed schedules, accounting for any special timing needs such as as-needed doses or giving with meals.
• Correct Documentation: Immediately document the administration details, including the injection site when applicable.

Methods to Prevent Medication Mistakes

Strategy	Description
Unit-Dose System	Medications packaged individually with clear labels from the pharmacy.
Barcode Medication Administration (BCMA)	Using barcode scans of patient ID and meds to verify correct administration.
Independent Double-Checks	A second nurse verifies high-risk drugs or dosage calculations.
Medication Reconciliation	Reviewing and matching patient’s current meds with hospital orders during admission, transfers, and discharge.