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Safety Culture: From Blame to Learning**

Non-punitive reporting → encourages learning from near-misses.

Focus on system improvement, not punishment.

Incident reports:

Internal risk-management tools—never document “incident report filed” in the chart.

Chart only objective facts and nursing actions.

2. Fall Prevention: Mnemonic FALLS

F – Floors clear and dry
A – Ambulation aids within reach
L – Lighting bright, especially to bathroom
L – Low bed position
S – Shoes/non-skid socks
Top priorities: Bed low, non-skid shoes, call light accessible, frequent rounding.

3. Pressure Injuries

Braden Scale ≤ 18 = High risk.

Reposition every 2 hours, offload heels completely.

Use pressure-relief surfaces.

4. Emergencies

Code Blue: Call for help, start CPR—CAB sequence.

Rapid Response: Activate team, stay with patient, reassess continuously.

Code Stroke: Time = brain. Prepare for stat CT, frequent neuro checks q15 min.

5. Fire Safety

RACE: Rescue → Alarm → Confine → Extinguish.

PASS: Pull pin → Aim low → Squeeze → Sweep.

6. Hazardous Materials

Chemo: Double gloves, chemo gown, black chemo-waste container.

Radioactive Implants: Time, Distance, Shielding; restrict visitors < 30 min; lead containers for waste.

7. Ergonomics / Zero-Lift Method

Bend knees, keep load close, push > pull.

Use hoists/slide sheets if > 50% assist needed.

8. Infection Control

Standard Precautions: Apply to every patient; hand hygiene before/after contact.

Airborne: N95 mask + negative pressure room (TB, measles, chickenpox).
Mnemonic: My Chicken Has TB.

Contact: Gown + gloves (MRSA, VRE, C diff).

C diff: _Soap and water only_—no alcohol sanitizer.

PPE Donning: Gown → Mask/Respirator → Goggles/Shield → Gloves.

PPE Doffing: Gloves → Goggles/Shield → Gown → Mask (outside room) → Hand hygiene.

9. Restraints

_Last resort_—never PRN.

Violent: Order valid 4 hrs, check q15 min.

Non-violent: Order valid 24 hrs, check q15–30 min.

Remove q2h for skin check, ROM, fluids, toileting.

Use quick-release knots only.

10. Security & Home Safety

Infant abduction: Matching ID bands + security tags.

Elopement: Wanderguard bracelets, room away from exit.

Home safety: Remove throw rugs, add grab bars & lighting.

Crib safety: No soft bedding, slats < 2⅜ in apart.

Hot water heater: < 120°F to prevent burns.

When things go wrong, think system, not individual.
Was staffing safe? Was the environment optimized? Reporting and analyzing these issues strengthens safety culture.

Safety culture > blame culture

Incident report = risk management tool

FALLS & RACE/PASS mnemonics

Airborne vs Contact precautions (PPE sequences)

C diff → soap and water

Restraint rules and time limits

Home safety teaching points

A patient with C diff requires wound care. Which PPE combination is correct?
A) Gloves only
B) Gown + Gloves
C) Mask only
D) Gown + Mask

✅ Answer: B.
Rationale: Contact precautions require gown and gloves. Use soap and water after care.

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