Safety measures

• Some of the common hazards and risks for injury or harm in hospitalized children are:
  • Falls: the most frequent cause of injury in hospitalized children. Factors that increase the risk of falls include age, mobility, medication use, medical devices, environmental factors, and parental supervision2.
  • Medication errors: the administration of incorrect medication or dosage to a patient. Factors that increase the risk of medication errors include lack of standardization, communication barriers, calculation errors, look-alike or sound-alike drugs, and high-alert medications1.
  • Infection: the invasion of body tissue by microorganisms with potential to cause illness or disease. Factors that increase the risk of infection include immature immune system, frequent exposure to invasive procedures, contact with other sick children, and poor infection control practices2.
  • Equipment-related injuries: the damage or harm caused by medical devices or equipment. Factors that increase the risk of equipment-related injuries include malfunction, misuse, disconnection, entanglement, electrical shock, or burns2.
  • Procedure-related injuries: the damage or harm caused by diagnostic or therapeutic procedures. Factors that increase the risk of procedure-related injuries include pain, bleeding, bruising, infection, allergic reaction, or complications2.
  • Physical restraint injuries: the damage or harm caused by the use of devices or methods to restrict a patient’s movement. Factors that increase the risk of physical restraint injuries include skin breakdown, nerve damage, circulation impairment, aspiration, suffocation, or psychological distress1.
• Safety measures are the strategies and interventions to prevent or minimize the potential for injury or harm in hospitalized children. They are based on the principles of patient safety and quality improvement. They include:
  • Assessment: collecting data about the child’s health status, developmental stage, cognitive level, risk factors for injury or harm, and safety needs. Using standardized tools such as pediatric fall risk assessment scale (PFRA), pediatric early warning score (PEWS), pediatric sedation scale (PSS), etc.2.
  • Planning: setting goals and outcomes for safety and quality improvement. Developing policies and protocols for safety measures. Providing resources and equipment for safety measures. Collaborating with other health care professionals and agencies for safety measures1.
  • Implementation: carrying out the planned interventions to achieve the desired outcomes. Applying the strategies and interventions for safety measures such as:
    • Fall prevention: using age-appropriate crib and bedding; securing equipment and cords; maintaining bed in low position; keeping crib rails up when parent not at bedside; establishing list of approved visitors; staff communication when parent leaves; adolescent issues3.
    • Medication administration: following the six rights of medication administration (right patient, right drug, right dose, right route, right time, right documentation); using barcode scanning; double-checking calculations; avoiding abbreviations; labeling syringes; using smart pumps; reporting errors1.
    • Infection control: following standard and transmission-based precautions; performing hand hygiene; wearing personal protective equipment (PPE); cleaning and disinfecting environmental surfaces and equipment; disposing of waste properly; educating patients and families1.
    • Equipment safety: checking equipment function and calibration; following manufacturer’s instructions; securing tubing and wires; monitoring alarms and settings; removing unnecessary equipment; reporting malfunction2.
    • Procedure safety: obtaining informed consent; verifying patient identity; marking operative site; using time-out before procedure; monitoring vital signs; managing pain; preventing complications1.
    • Restraint safety: using restraints only as a last resort; obtaining order from provider; choosing least restrictive type and size; applying restraints correctly; monitoring skin integrity; removing one restraint at a time on a regular basis1.
    • Evaluation: measuring the effectiveness and outcomes of safety measures. Comparing the actual outcomes with the expected outcomes. Evaluating the child’s progress toward the goals and modifying the plan of care as needed. Evaluating the child’s satisfaction with the care and identifying areas for improvement. Evaluating the quality and safety of safety measures and reporting any errors or adverse events.
    • Education: educating the child and family about safety issues and prevention measures. Providing information and instructions about safety measures. Encouraging participation and feedback from the child and family. Reinforcing positive behaviors and correcting unsafe behaviors. Providing resources and referrals for safety measures.