Six Ways This Unit Harms a Patient

Strip 1 · Restraints

• Least restrictive intervention first, with the alternatives tried and documented before application.
• An order is required. A restraint is never ordered as needed.
• Emergency application is permitted, with the order obtained immediately afterward.
• A face-to-face evaluation is required within the timeframe the current regulation states for violent or self-destructive behavior, and renewal intervals differ by patient age. Print only the figure the current CMS Conditions of Participation state, confirmed by the reviewer rather than recalled by the writer.
• Tie to the movable bed frame, never a side rail, using a quick-release knot.
• Raising all side rails may itself be a restraint.
• Document monitoring, circulation checks, range of motion, hydration, toileting, and the continued need.

Strip 2 · Falls

• Screen on admission, after any change in condition, and after transfer.
• Bed low and locked, call light in reach, non-skid footwear, scheduled toileting, adequate lighting, clutter cleared, hourly rounding.
• Orthostatic change and a newly started sedating medication are the two most tested precipitants. Drug names and doses belong to → BOOK 05 · P7.
• After a fall, assess before moving.

Strip 3 · Fire

• RACE, in order: Rescue anyone in immediate danger, Activate the alarm, Confine by closing doors, Extinguish or evacuate.
• PASS, in order: Pull the pin, Aim at the base of the fire, Squeeze the handle, Sweep side to side.
• Class A ordinary combustibles, B flammable liquids, C electrical, K kitchen fires.
• Oxygen raises the risk in every one of these.

Strip 4 · Electrical

• Grounded three-prong plugs. No daisy-chained cords or extension cords for patient equipment. Damaged cords removed from service. Equipment kept away from wet floors. Biomedical inspection current.

Strip 5 · Radiation

• Time, distance, shielding. Dosimeter worn on every entry.
• Staff who are pregnant and visitors who are children are not assigned to, and not admitted to, a sealed-implant room.
• A dislodged implant is lifted with long-handled forceps into the lead container kept at the bedside. Never with hands.
• A patient receiving external beam therapy is not radioactive.

Strip 6 · Hazardous materials

• The Safety Data Sheet is the authority for every substance on the unit.
• Contain the spill, use the spill kit and the PPE it specifies, flush exposed skin or eyes for the duration the sheet states, then report.

Memory hookRescue people, then fight fire.

Margin noteAssess before you move the patient who fell.

Watch outPicking up a dislodged radioactive implant with a gloved hand delivers a dose to the hand that no later shielding reverses.

TakeawayEach of these six has a fixed first action, and the exam tests the first action rather than the full protocol.