1. Safety Culture: From Blame to Learning

Non-punitive reporting → encourages learning from near-misses.

Focus on system improvement, not punishment.

Incident reports:

Internal risk-management tools—never document “incident report filed” in the chart.

Chart only objective facts and nursing actions.

2. Fall Prevention: Mnemonic FALLS

F – Floors clear and dry
A – Ambulation aids within reach
L – Lighting bright, especially to bathroom
L – Low bed position
S – Shoes/non-skid socks
Top priorities: Bed low, non-skid shoes, call light accessible, frequent rounding.

3. Pressure Injuries

Braden Scale ≤ 18 = High risk.

Reposition every 2 hours, offload heels completely.

Use pressure-relief surfaces.

4. Emergencies

Code Blue: Call for help, start CPR—CAB sequence.

Rapid Response: Activate team, stay with patient, reassess continuously.

Code Stroke: Time = brain. Prepare for stat CT, frequent neuro checks q15 min.

5. Fire Safety

RACE: Rescue → Alarm → Confine → Extinguish.

PASS: Pull pin → Aim low → Squeeze → Sweep.

6. Hazardous Materials

Chemo: Double gloves, chemo gown, black chemo-waste container.

Radioactive Implants: Time, Distance, Shielding; restrict visitors < 30 min; lead containers for waste.

7. Ergonomics / Zero-Lift Method

Bend knees, keep load close, push > pull.

Use hoists/slide sheets if > 50% assist needed.

8. Infection Control

Standard Precautions: Apply to every patient; hand hygiene before/after contact.

Airborne: N95 mask + negative pressure room (TB, measles, chickenpox).
Mnemonic: My Chicken Has TB.

Contact: Gown + gloves (MRSA, VRE, C diff).

C diff: Soap and water only—no alcohol sanitizer.

PPE Donning: Gown → Mask/Respirator → Goggles/Shield → Gloves.

PPE Doffing: Gloves → Goggles/Shield → Gown → Mask (outside room) → Hand hygiene.

9. Restraints

Last resort—never PRN.

Violent: Order valid 4 hrs, check q15 min.

Non-violent: Order valid 24 hrs, check q15–30 min.

Remove q2h for skin check, ROM, fluids, toileting.

Use quick-release knots only.

10. Security & Home Safety

Infant abduction: Matching ID bands + security tags.

Elopement: Wanderguard bracelets, room away from exit.

Home safety: Remove throw rugs, add grab bars & lighting.

Crib safety: No soft bedding, slats < 2⅜ in apart.

Hot water heater: < 120°F to prevent burns.

Critical Thinking Made Simple

When things go wrong, think system, not individual.
Was staffing safe? Was the environment optimized? Reporting and analyzing these issues strengthens safety culture.

Quick Recap

Safety culture > blame culture

Incident report = risk management tool

FALLS & RACE/PASS mnemonics

Airborne vs Contact precautions (PPE sequences)

C diff → soap and water

Restraint rules and time limits

Home safety teaching points

NCLEX Practice Question

A patient with C diff requires wound care. Which PPE combination is correct?
A) Gloves only
B) Gown + Gloves
C) Mask only
D) Gown + Mask

✅ Answer: B.
Rationale: Contact precautions require gown and gloves. Use soap and water after care.

Need to reach out? Send an email to BrookeWallaceRN@gmail.com