True safety.

When we hear the words safety and security related to nursing homes, what comes to mind? The feeling that your residents are safe because the doors are locked at night? Perhaps your housekeeping staff is conscientious about putting "wet floor" signs where they are mopping. But, what about the real injuries and life-threatening safety issues that may not be your first thoughts?

A nurse told me years ago of her "panicky feelings" every time she had to give someone Bactrim. Several years earlier in a long-term care facility where she had worked, a physician had given a telephone order for Bactrim DS following the results of a urinalysis showing bacterial growth. Neither the physician nor the nurse taking the order had checked the patient's records for allergies, nor had anyone else who had contact with the patient or managed his medications. The nurse relating this tragedy to me said she was the fourth person to give this patient the medication and she never even considered checking for allergies, even though she could perceive that the man was having a lot of discomfort. By the next day the man was in severe pain. By the sixth day he had what she described as "burned-looking splotches" over his entire body. I do not remember exactly how long it took him to die, but she said the post-mortem report showed that his allergic reaction had caused him to "burn" from the inside out, resulting in a slow and agonizing death.

Webster's dictionary gives the definition of safety as "A condition of being safe from injury or hurt." Since 1987, our industry has gone somewhat crazy with the term "restraint," while sometimes overlooking much more life-threatening issues. Restraint Proper is wonderful and needed, but Restraint Free is sometimes not appropriate and must be looked at in a holistic manner-with good judgment.

Take every problem one step at a time and avoid kneejerk reactions because you fear state survey. Your surveyors will look at the different steps or interventions your facility has tried and that you kept trying until you found a solution, and whether this is well documented.

Safety also refers to preventing injuries like bedsores and contractures. I will always contend that there are very few excuses for either. With the right pressure relief materials, appropriate turning and repositioning schedules, hydration, nutrition, toileting and skin assessments, a bedsore should be an extremely rare occurrence. With the proper activity and restorative programs including the appropriate restorative devices, many contractures can be prevented, and range of motion can certainly be improved - if not corrected - for persons who already have contractures.

If we allow someone to lose the ability to ambulate just because we have not seen to it that they walk enough, then we have allowed them to sustain injury. If we allow someone to lose the ability to bear weight because we have not made sure they have stood for long enough periods (which helps to maintain calcium in the long bones), then they have been injured.

How many persons have you seen that stay in bed and get pneumonia? How many of them die?

Security for an elderly person might be as simple as trusting the people who work in the facility. If they put their call light on, they need to feel secure that it will be answered in a timely fashion. If they ask for help to the bathroom, they need to know that someone will help them immediately before they have an accident or suffer the pain of trying to wait. They need to know that the person taking care of them understands what they are saying and makes an effort to communicate with them in a friendly and dignified manner, especially if the people in the long-term care facility are the only "family" they know. They need to feel human touch by a hug or at least a warm hand on their hand when you are talking to them. The very things that made you feel secure as a child may be the things that also help them to feel secure.

It is very easy to get so caught up in all the paperwork, meetings, changing regulations and employee problems that we miss the little things that really matter to these fragile people. Sometimes we just need to take a step back and look at the big picture. The safety, security and happiness of these people are our prime responsibility. If unnecessarily complicated paperwork and regulations are taking away from that, please contact your congressmen and let them know. If they hear from enough of us with real stories, we can effect change.

Karen L. Bonn, RN, ROF, a former director of nursing, is president of Restorative Medical, Inc., Brandenburg, KY.