NU140 Unit 4 Safety Analysis Example

A Full Bladder and a Late Dose at 2 a.m.: A Safety Analysis Pairing Each Fall Hazard for a Composite 81-Year-Old Man With Parkinson Disease on a Medical Unit With a Charted Countermeasure, Restraint-Free

[Student Name]

Purdue University Global

NU140: Nursing Fundamentals

Unit 4 Safety Analysis

[Instructor Name]

[Date]

The patient is composite; scores and times are bracketed where illustrative, and the analysis follows typical hospital fall-prevention practice.

The Patient and the Event

[Mr. B.], a composite 81-year-old retired carpenter with Parkinson disease, was admitted three days ago with pneumonia. At home he walks with a cane and takes carbidopa-levodopa four times a day. On his second night he was found sitting on the floor beside his bed at 2 a.m., unhurt, saying he needed to urinate. The next night he set off his bed alarm while already standing at the bedside. His fall risk score on admission was [high], and his wife reports two falls at home in the past year.

Why a Safety Analysis Rather Than a Restraint

His daughter has asked whether he can be tied in at night. Physical restraints and full bed rails do not prevent falls reliably and can cause serious injury, including entrapment and injuries from climbing over rails, as well as agitation and loss of mobility (Oliver et al., 2010). The approach here is to find each specific reason he gets up and is unsafe, and to address it directly.

Hazards Paired With Countermeasures

1. Hazard: delayed Parkinson medication. On the unit his levodopa doses were given up to [90] minutes late, and his evening dose was due at 10 p.m. but given near midnight. Late doses leave him stiffer and slower at night. Countermeasure: doses scheduled at his home times and flagged as time-critical on the medication record; charted with the exact time given.

2. Hazard: nighttime urgency and frequency. He wakes two to three times a night to urinate, common in Parkinson disease, and the pneumonia fluids add volume. Countermeasure: a scheduled toileting round at 11 p.m., 1 a.m. and 3 a.m., with a urinal within reach, offered rather than waited for; fluids front-loaded earlier in the day if his provider agrees.

3. Hazard: freezing and shuffling gait, worse when turning. Countermeasure: physical therapy consult; walker at the bedside instead of his cane, chosen with the therapist because the wrong device can add to instability (Bateni & Maki, 2005); staff taught to cue him with a count or a line on the floor if he freezes.

4. Hazard: orthostatic drop. Standing blood pressure falls [22] points. Countermeasure: lying and standing blood pressure charted daily; he is taught to dangle his legs over the bedside and count to sixty before he stands.

5. Hazard: bed alarm sensitivity. The alarm was set to sound only when he left the bed, by which time he was standing. Countermeasure: alarm changed to the earliest setting, triggered when he sits up, and placement charted each shift.

6. Hazard: unfamiliar room and poor lighting. Countermeasure: night-light on; path to the bathroom cleared; bed in the lowest position with brakes locked; call light, glasses and urinal within reach, checked on hourly rounds.

7. Hazard: footwear. He walked in socks. Countermeasure: nonslip socks or his own closed shoes at the bedside.

The 2 a.m. walk had a reason, a full bladder and a late dose; the plan answers the reason instead of preventing the walk.

Hazards Considered and Set Aside

Two other measures were considered. A sitter at the bedside overnight would watch him closely but was not needed once the reasons for his walks were addressed, and it would have taken a staff member from other patients. A sedative to help him sleep through the night was rejected, because sedating medicines worsen balance and confusion in older adults and would raise his fall risk rather than lower it.

Room Placement and Rounding

Mr. B. is moved to a room nearer the nurses' station. Purposeful hourly rounds at night include asking whether he needs to use the bathroom, which addresses the most common reason he gets up. A low bed and a floor mat on the side he exits reduce injury if he does fall.

Involving Mr. B. and His Family

Mr. B. is taught to use the call light and agrees to try it, though his memory for it at night is uncertain. His wife says he always gets up at 2 a.m. at home; that information shaped the toileting schedule. His daughter is told why restraints are not used and what is being done instead, and she is invited to stay in the evening if she wishes.

Evaluation

Over the next three nights, Mr. B. had no falls. He used the urinal on two of the three scheduled rounds and called for help once. His levodopa was given within [30] minutes of the scheduled time on every dose. The plan continues, and the safety measures are written into his discharge summary for his wife, along with a referral for a home safety evaluation, since most of his hazards will follow him home (Potter et al., 2023).

References

Bateni, H., & Maki, B. E. (2005). Assistive devices for balance and mobility: Benefits, demands, and adverse consequences. Archives of Physical Medicine and Rehabilitation, 86(1), 134-145. https://doi.org/10.1016/j.apmr.2004.04.023

Oliver, D., Healey, F., & Haines, T. P. (2010). Preventing falls and fall-related injuries in hospitals. Clinics in Geriatric Medicine, 26(4), 645-692. https://doi.org/10.1016/j.cger.2010.06.005

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). Fundamentals of nursing (11th ed.). Elsevier.