INTRODUCTION TO RESPIRATORY THERAPY
2ND SEMESTER: MIDTERM
PATIENT SAFETY
SAFETY CONSIDERATIONS
• Safety is a very important part of ensuring high-
quality care. Importantly, patient safety must always • Ambulation should begin as soon as the patient is
be the first consideration in respiratory care.
• Although the RT usually does not have full control
over the patient’s environment, efforts must be made hospital stay and 30-day readmissions in
to minimize potential hazards associated with
respiratory care.
• The key areas of potential risk for patients, RTs,
and coworkers are patient movement and
ambulation, electrical hazards, fire hazards, and
general safety concerns.
• Each of these will be discussed as part of attention recommended by the American Thoracic Society/
to providing high-quality, safe care.
PATIENT MOVEMENT AND AMBULATION
BASIC BODY MECHANICS
• Posture involves the relationship of the body parts
to each other. A person needs good posture to
reduce the risk for injury when lifting patients or
heavy equipment. Poor posture may place
inappropriate stress on joints and related muscles
and tendons.
Moving the Patient in Bed
• Conscious people assume positions that are the
most comfortable. Bedridden patients with acute or
chronic respiratory dysfunction often assume an
upright position, with their arms flexed and their
thorax leaning forward.
• This position helps decrease their work of
breathing. In other cases, patients may have to
assume certain positions for therapeutic reasons
such as when postural drainage is applied.
Ambulation
• Ambulation (walking) helps maintain normal body
function. Extended bed rest can cause numerous
problems, including bed sores and atelectasis (low
lung volumes).
physiologically stable and free of severe pain.
Ambulation has been shown to reduce the length of
hospitalized heart failure patients.
• RTs may assist to ambulate patients while they are
on a mechanical ventilator or while on O2.
• Early ambulation in Intensive Care Units (ICUs)
while on mechanical ventilation has been linked to
shorter patient time on mechanical ventilation and is
American College of Physicians (ATS/ACP).
Safe patient movement includes the following steps:
1. Place the bed in a low position and lock its
wheels.
2. Place all equipment (e.g., intravenous [IV]
equipment, nasogastric tube, surgical drainage
tubes) close to the patient to prevent dislodgment
during ambulation.
3. Move the patient toward the nearest side of bed.
4. Assist the patient to sit up in bed (i.e., arm under
nearest shoulder and one under farthest armpit).
5. Place one hand under the patient’s farthest knee,
and gradually rotate the patient so that his or her
legs are dangling off the bed.
6. Let the patient remain in this position until
dizziness or lightheadedness lessens (encouraging
the patient to look forward rather than at the floor
may help).
7. Assist the patient to a standing position.
8. Encourage the patient to breathe easily and
unhurriedly during this initial change to a standing
posture.
9. Walk with the patient using no, minimal, or
moderate support (moderate support requires the
assistance of two practitioners, one on each side of
the patient).
10. Limit walking to 5 to 10 minutes for the first
exercise.
• Monitor the patient during ambulation.
• Note the patient’s level of consciousness, color,
breathing, strength or weakness, and complaints
such as pain or shortness of breath throughout the
activity.
• Ask the patient about his or her comfort level
frequently during the ambulation period.
• Ensure that chairs are present so emergency seats
are available if the patient becomes distressed.
• Ambulation is increased gradually until the patient
is ready to be discharged.
 INTRODUCTION TO RESPIRATORY THERAPY
2ND SEMESTER: MIDTERM

• Each ambulation session is documented in the enriched atmospheres (OEAs) are larger, more
patient chart and includes the date and time of intense, faster burning, and more difficult to
ambulation, length of ambulation, and degree of extinguish.
patient tolerance. • In addition some material that would not burn in
room air would burn in O2-enriched air.
Fundamentals of Electricity • Hospital fires are also more serious because
• Electricity moves from point A to point B because of evacuation of critically ill patients is difficult and slow.
differences in voltage. • For these reasons, hospital fires often cause more
• Voltage is the power potential behind the electrical injuries and deaths per fire than do residential fires.
energy.
• Most homes and hospitals are powered with 120- For a fire to start, three conditions must exist:
Volt power sources. (220 V in PH settings). • (1) flammable material must be present.
• Power sources that have high voltage have the • (2) O2 must be present.
potential to generate large amounts of electrical • (3) the flammable material must be heated to or
current above its ignition temperature
• The friction (resistance) offered by the pipe across
the length of the pipe influences the flow exiting the • Flammable material should be removed from the
other end. vicinity of O2 use to minimize fire hazards.
• Pipes with lots of friction reduce the water flow • Flammable materials include cotton, wool,
(current) greatly. If the friction (resistance) is polyester fabrics, bed clothing, paper materials,
minimal, the water flow (current) is plastics, and certain lotions or salves such
maximal. as petroleum jelly.
• Similarly, when voltage is high and resistance is • Removal of flammable material is particularly
low, electrical current flows easily through the object. important whenever O2 enclosures, such as O2
• Current is the flow of electricity from a point of tents or croupettes, are used.
higher voltage to one of lower voltage and is • Hyperbaric oxygen chambers are another potential
reported in amperes (amps). Current is hazard because they supply high concentration of
measured with an ampmeter. O2 in a pressurized enclosed environment.
• The resistance to electrical current is reported in • These chambers are designed with internal fire
ohms. suppressants, but steps should be taken to reduce
• We can determine the resistance to current for any all flammable material.
object by the following equation:
• Resistance (ohms [Ω] =) Voltage (V)/Current (amps Fire Extinguisher: PASS
[A]) Pull the pin. There may be an inspection tag
• Electric Shocks are classified into two types. attached.
• A macroshock exists when a high current (usually Aim the nozzle. Aim low at the bottom
>1 mA) is applied externally to the skin. of the fire.
• A microshock exists when a small, usually Squeeze the handle. The extinguisher has less than
imperceptible current (<1 mA) bypasses the skin and 30 seconds of spray time.
follows a direct, low-resistance path into the body. Sweep the nozzle across the base of the fire.

The core fire plan follows the acronym RACE:

Fire Hazards
• Hospital fires can be very serious, especially when
they occur in patient care areas and when
supplemental O2 is in use. Fires in O2-
• Rescue patients in the immediate area of the fire.
The person discovering the fire should perform the
rescue.
• Alert other personnel about the fire so they can
assist in the rescue and can relay the location of the
fire to officials. This step also involves pulling the fire
alarm.
• Contain the fire. After rescuing patients, shut doors
to prevent the spread of the fire and the smoke. In
patient care areas, follow your hospital policy
regarding turning off O2 zone valves.
• Evacuate other patients and personnel in the
areas around the fire who may be in danger if the
fire spreads.
 INTRODUCTION TO RESPIRATORY THERAPY
2ND SEMESTER: MIDTERM

GENERAL SAFETY CONCERNS MEDICAL GAS CYLINDERS

• Use of compressed gas cylinders by RTs requires \
DIRECT PATIENT ENVIRONMENT special handling.
• The immediate environment around the patient can • The physical hazards resulting from improper
create risk for patient safety. storage or handling of cylinders include increased
• Because RTs use medical equipment and risk for fire, explosive release of high-pressure
participate in direct patient care, it is necessary for cylinders, and the toxic effect of some gases.
RTs to be cognizant of the patient’s immediate • It is important to store and transport cylinders in
environment. appropriate racks or chained containers.
• To reduce the risk for patient falls and allow easy Compressed gas cylinders should never be stored
access to care, the patient care environment should without support.
be as free of impediments to care as possible.
• Use of respiratory supplies and medical equipment
by the RT creates an environment that could impede
access to care and create a fall risk.

MAGNETIC RESONANCE IMAGING SAFETY

• MRI exposes the body to powerful magnetic fields
and a small amount of radiofrequency.
• This powerful magnetic field can create a risk to
patients, healthcare workers, and equipment if metal
objects containing ferrous-based material, stainless
steel or nickel alloys are brought within specified
proximity to the field.
• There are safe proximity areas referred to as safety
zones or Gauss lines.
• Metal objects can be so forcefully attracted to the
magnet of the MRI that they can mimic a missile,
causing physical harm. Reports of accidents
associated with MRI have involved O2 cylinders,
stethoscopes, scissors, and IV poles.
• Deaths have been described when O2 cylinders
were pulled into the magnetic area where a patient
was lying to undergo an MRI examination.
• RTs need to become familiar with MRI-compatible
ventilators, O2 supplies, and ancillary equipment.
Each radiology department has specific rules and
safety precautions that need to be communicated
to all patients, caregivers, and healthcare personnel.