| Safety Equipment and Fall Prevention | 安全裝置及防墜 |
| Assessment | 評估 |
| 1. Assess client's age, level of consciousness, degree of orientation, ability to follow directions, and ability to cooperate. | 評估病人年齡、意識程度、定位能力、執(zhí)行指令及合作能力 |
| 2. Assess client's mobility, hearing, and sight. | 評估病人移動能力、聽力和視力 |
| 3. Assess medications and alcohol intake. | 評估藥物和酒精服用情況 |
| 4. Assess history of hypotensive episodes or seizures. | 評估病人低血壓性發(fā)作和癲癇發(fā)作情況 |
| Implementation | 實(shí)施 |
| 1. Use Standard Protocol. | 采用標(biāo)準(zhǔn)護(hù)理協(xié)議 |
| 2. Explain use of call bell or intercom: | 解釋呼叫鈴或?qū)χv機(jī)使用方法 |
a. Provide client with glasses and/or hearing aid, if used.
b. Demonstrate use of call bell or intercom to client/family.
c. Have client/family return-demonstrate use.
d. Explain when call bell is to be used.
e. Secure call bell in accessible location. | a. 病人帶好眼鏡和/助聽器
b. 向病人/家屬示范如何使用呼叫鈴或?qū)χv機(jī)
c. 讓病人/家屬示范
d. 說明何時使用呼叫鈴
e. 將呼叫鈴固定于病人可及處 |
| 3. Describe use of hospital bed and side rails: | 描述如何使用病床和床檔 |
a. Keep bed in low position with wheels locked.
b. Explain purpose of side rails to client/family.
c. Keep side rails up for clients at risk of falls.
d. Leave one side rail down for ambulatory clients. | a. 放低病床，鎖住輪子
b. 向病人/家屬說明床檔的用途
c. 為有墜床危險病人豎好床檔
d. 為能行走病人放下一側(cè)床檔 |
| 4. Arrange necessary items within client's reach. | 將必需用品安置在病人可及之處 |
| 5. Safe use of wheelchairs: | 輪椅的安全作用 |
a. Lock both wheels for client transfers.
b. Raise foot plates before transfer. Lower foot plates and place client's feet on them after transfer.
c. Have client sit well back in seat with seat belt on.
d. Back wheelchair into and out of elevators.
e. Back down ramps or inclines. | a. 搬運(yùn)病人時鎖住兩個輪子
b. 搬運(yùn)前抬起腳底板。搬運(yùn)后放下腳底板，將病人雙腳擱于腳底板上
c. 讓病人靠背坐好，系上座位帶子
d. 倒進(jìn)、倒出電梯
e. 下坡時背朝前 |
| 6. Safe use of stretchers: | 擔(dān)架的安全使用 |
a. Lock wheels during transfers.
b. Use safety belts across client's upper thighs or raise rails.
c. Push stretcher from the end where client's head rests.
d. Enter elevator head first. | a. 搬運(yùn)時鎖住輪子
b. 在病人腰部系好安全帶或升起欄桿
c. 抓住病人頭端推動擔(dān)架
d. 進(jìn)電梯時頭朝前 |
| 7. Use Completion Protocol. | 按操作標(biāo)準(zhǔn)結(jié)束程序 |
| Evaluation | 評價 |
| 1. Identify client's risks for falls or injuries. | 確認(rèn)病人有無墜落或受傷危險 |
| 2. Observe appropriate use of call bell. | 遵守正確使用呼叫鈴 |
| 3. Evaluate client's/family's use of the equipment. | 評價病人/家屬的裝置使用情況 |
| Report and record | 報(bào)告和記錄 |
| 1. Risk for Falls Assessment tool. | 墜落危險評估工具 |
| 2. State factors that increase risk for injury. | 操作性損傷危險因素記錄表 |
| 3. Home Hazard Assessment. | 室內(nèi)危害評估表 |
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