Client-Inherent, Procedure-Related, and Equipment Related Accidents
Client-inherent accidents are accidents (other than falls) where the client is primary reason for the accident. Examples of client-inherent are self-inflicted cuts, injuries and burns; ingestion or injection of foreign substance; self-mutilation or fire setting; and pinching fingers in drawers or doors.
A client-inherent accident may occur as a result of a seizure. A seizure is a hyper-excitation and disorderly discharge of neurons in the brain leading to a sudden, violent, involuntary series of muscle contractions that may be paroxysmal and episodic, as in a seizure disorder, or transient and acute, such as following a head injury. A generalized tonic-clonic or grand mal, seizure last approximately 2 minutes (no longer than 5) and is characterize by a cry, loss of consciousness with falling, tonicity (rigidity), clonicity (jerking), and incontinence.
During a fall, or as a result of muscle jerking, musculoskeletal injuries can occur. Before a convulsive episode, a few clients may report an aura, which serves as a warning or sense that seizure is about to occur. An aura may be a bright light, smell, or taste. During the seizure activity the client may have shallow breathing, cyanosis, and possibly loss of bladder and bowel control. Following the seizure, there is a postictal phase during which the client may have amnesia or confusion and may fall into a deep sleep.
Continuous seizures that last 15 minutes or a series of seizures over a 20 to 30-minute period in which the client does not regain consciousness between attacks is status epilepticus. This condition is a medical emergency and requires intensive monitoring and treatment. It is important that the nurse observe the client carefully before, during, and after the seizure so that the episode can be documented accurately.
Procedure-related accidents occur during therapy. They include medication and fluid administration errors, improper application of external devices, and accidents related to improper performance of procedures (e.g., Foley-catheter insertion).
The nurse can prevent many procedure-related accidents. For example, strictly following the procedure for administering medications will prevent medication errors. Proper administration of intravenous (IV) fluids prevents fluid overload or deficit. The potential for infection is reduce when surgical asepsis is used for sterile dressing changes or any invasive procedure, such as insertion of a Foley catheter. Finally, correct use of body mechanics and transfer techniques reduces the risk of injuries when moving and lifting clients.
Equipment-related accidents result from the malfunction, disrepair, or misuse of equipment or from an electrical hazard. For example, too rapid infusion of IV fluids may result from a dysfunctional IV pump. The JCAHO now requires that all general use and patient-controlled analgesic pumps have free-flow protection devices. To avoid accidents, the nurse should not operate monitoring or therapy equipment without instruction. A checklist should be used to assess fires, electrocution, or injury from faulty equipment. In health care settings, clinical engineering staff makes regular safety checks of equipment.