Safety in Caring for Children and Families

NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning, LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC 9781284375473_CH03_029_045.indd 29 Families for Children and inCaring Safety UNIT II CHAPTER 3 NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC Essential Safety Models NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC © Jones & Bartlett Learning, LLC. NOT FORSALEORDISTRIBUTION. © Jones&Bartlett Learning,

© Rawpixel.com/Shutterstock NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning, LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC 06/07/17 2:08 PM NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning, LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC 9781284375473_CH03_029_045.indd 30 C Models Essential Safety NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC HAPTER 3 7. 6. 5. 4. 3. 2. 1. LEARNING OBJECTIVES OBJECTIVES LEARNING handoff protocols andmnemonics. for children across clinicalsettings, including canprovideconcept thinking asafer environment Evaluate how variouscommunication tipsand they dooccur. reduce oftheseerrors onfamiliesif theimpact oferrors inpediatriccarethe majortypes and Identify andapplymethods to both prevent errors inpediatricnursingcare across settings. reduce ofmedicalandmedication thefrequency Identify andapplysetting-specifi c methodsto daycare, andplay areas. ous nonclinicalsettingssuchasthehome, school, Analyze ofsafety andapplyprinciples inthevari- caregivers. guidance offered to parents, educators, and Incorporate safetyinto principles anticipatory care ofchildren across clinicalsettings. for Nurses(QSEN) competencies relate to direct Analyze andSafety how Education theQuality children andtheirfamiliesinnursingpractice. Apply thegoalsofnational safety initiatives for NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC © Jones & Bartlett Learning, LLC. NOT FORSALEORDISTRIBUTION. © Jones&Bartlett Learning,

Seil needs Special andSafety EducationQuality for Nurses(QSEN) Mnemonics Informatics Holistic practice Evidence-based learning Concept-based KEY TERMS TERMS KEY NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC

NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC NOT FORSALEORDISTRIBUTION © Jones&BartlettLearning,LLC

06/07/17 2:08 PM National Safety Initiatives 31

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORIntroduction SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION e concept of safety within pediatrics is a key component of holistic (i.e., caring for the whole person, including not only his or her medical condition, but also any mental, social, and environment© Jonesconcerns) & andBartlett comprehensive Learning, LLC © Jones & Bartlett Learning, LLC pediatric nursing care.NOT Young FOR children SALE are OR inherently DISTRIBUTION NOT FOR SALE OR DISTRIBUTION unsafe and require more than just supervision; that is, they require safe environments in which to play, grow, develop, and thrive. ey require responsible adults to provide© Jonesanticipated & Bartlettsafety measures Learning, at home LLC and in day- © Jones & Bartlett Learning, LLC care, NOTschool, FOR and playground SALE OR settings, DISTRIBUTION and they require NOT FOR SALE OR DISTRIBUTION an emerging sense of safety within that manifests as safe decisions as they mature. Neither infants nor young toddlers Figure 3-1 can be expected to understand what is “safe” and what is © Africa Studio/Shutterstock “unsafe,” but by a child’s third birthday, there should be © Jones &a basic Bartlett understanding Learning, that certainLLC behaviors will put the© Jones• Drowning & Bartlett or near Learning, drowning LLC NOT FORchild SALE in harm’s OR DISTRIBUTIONway. NOT •FOR Sports, SALE recreation, OR DISTRIBUTION and related injuries Many national organizations have developed safety • Poisoning guidelines for children of all ages. Pediatric nurses are in the Multiple national safety initiatives have been created unique position of being able to discuss safety regardless of to provide a safety structure for those persons caring for the clinical setting in which© Jones they see & a Bartlettpatient. e Learning, Society children.LLC Each year, approximately© Jones 9 million & children Bartlett seek Learning, LLC of Pediatric Nurses, AmericanNOT FOR Academy SALE of Pediatrics, OR DISTRIBUTION and care in U.S. emergency departmentsNOT forFOR injuries; SALE 225,000 OR DISTRIBUTION Association of Critical Care Nurses all promote safety as a children require hospitalization for injuries; and 9000 high priority. Being an excellent safety role model is one of children die (Centers for Disease Control and Prevention the most important responsibilities of the pediatric nurse, [CDC], 2015). Both governmental bodies and professional so as to teach families, caregivers, teachers, and children organizations have published guidelines to conceptualize © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC what is and is not safe, and how to plan for safety (advice and anticipate safety concerns for children. givenNOT as part FOR of anticipatory SALE ORguidance). DISTRIBUTION e pediatric nurse NOT FOR SALE OR DISTRIBUTION is instrumental in demonstrating safe care for children all QSEN Competencies across the developmental period, including those with One of the most recently introduced national initiatives special needs (i.e., disabilities in medical, psychological, for nurses on safety across the lifespan is Quality and or mental functioning that aect a child’s development), © Jones & Bartlett Learning, LLC © JonesSafety Education& Bartlett for Learning,Nurses (QSEN) LLC. e QSEN project such as developmentally disabled or medically fragile NOT FOR SALE OR DISTRIBUTION NOTwas FOR launched SALE in 2005OR toDISTRIBUTION address some of the challenges children. is chapter discusses pediatric safety concerns encountered when trying to prepare nurses for professional and provides guidance on how to plan ahead for safe practice (Cronenwett et al., 2007; Dolansky & Moore, 2013; environments for children. Sherwood & Zomorodi, 2014). e project, which is funded by the Robert Wood Johnson Foundation, focuses on the National Safety ©Initiatives Jones & Bartlett Learning,knowledge, LLC skills, and attitudes© Jonesneeded to& consistentlyBartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONand continuously improve theNOT practice FOR of SALEprofessional OR DISTRIBUTION Every year, a staggering number of children experience nursing. Multidisciplinary teams worked collaboratively signicant unintentional injuries. Children are exposed to create guidelines for six competencies: patient-centered to a large number of risks and hazards while they grow, care, evidence-based practice (best practice based on the learn, and explore their environments (Figure 3-1). No- © Jones & Bartlett Learning, LLC integration of© clinical Jones expertise, & Bartlett scientic Learning, evidence, and LLC the tably, their inexperience and curiosity contribute to many NOT FOR SALE OR DISTRIBUTION patient’s and NOTfamily’s perspectives), FOR SALE OR quality DISTRIBUTION improvement, childhood injuries. Most injuries across childhood occur teamwork and collaboration, informatics (the application in the following general areas: of information and computer science to health care), • Falls and safety. e founders partnered with organizations • Burns related to heat and re that represent current practice and proposed a set of © Jones & •Bartlett Motor vehicle Learning, accidents LLC as either a pedestrian or a © Jonesknowledge, & Bartlett skills, and Learning, attitudes required LLC for safe nursing NOT FOR SALEpassenger OR DISTRIBUTION NOTeducation FOR SALE and practice. OR DISTRIBUTION Table 3-1 summarizes the main • Suocation, asphyxiation, or choking safety competencies within this initiative.

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALETABLE OR31 DISTRIBUTIONQSEN Competencies: A Summary of Application to NOTPediatrics FOR SALE OR DISTRIBUTION 1. Patient-Centered Care: Recognizes the family as a full partner in care and the source of control for the child, and provides compassionate coordinated care based on a foundation of the child’s and family’s needs, preferences, and cultural practices/values. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Knowledge: Pain theory, ethics, legal implications, effective communication principles, cultural care, care for specific forms of special medicalNOT or behavioral FOR SALE needs. OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Skills: Assessment of pain or suffering, providing emotional support, coordinating care needs, applying effective treatments and nursing interventions, facilitating informed consent, resolving conflicts, recognizing the need for boundaries, and providing comprehensive safety. © JonesAttitudes: Valuing& Bartlett partnerships; Learning, acknowledging LLC tension; appreciating shared© Jones decision making;& Bartlett respecting Learning, individual LLC NOTexpressions FOR SALEof values, OR needs, DISTRIBUTION and preferences; and recognizing the need toNOT continuously FOR SALE improve ORone’s DISTRIBUTIONown conflict and communications skills. 2. Evidence-Based Practice: The investigation, application, and integration of the best current evidence found for the improvement of clinical expertise and family preferences. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Knowledge: Know the scientific research process, apply principles of literature searching and critiquing, secure reliable and NOT FOR SALEreputable OR DISTRIBUTION sources of information, and discriminate betweenNOT bestFOR published SALE practices OR DISTRIBUTION and current clinical practice. Skills: Apply skills of data collection, research review, criticism, and protocol revision. Attitudes: Appreciate scientific-based practice and the importance of frequent assessment of relevant and accessible knowledge. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 3. Quality Improvement:NOT FOR Consistently SALE monitor OR DISTRIBUTION outcomes of care and use methods of changeNOT to improve FOR all SALE aspects ofOR the DISTRIBUTION safety and quality of healthcare systems. Knowledge: Learn about outcome theory, recognize the parts of systems that can be reviewed, validate processes of outcome measurements, and learn how to approach making changes in care within systems. © JonesSkills: Use &the Bartlett outcomes ofLearning, quality improvement LLC projects, participate in such© Jones projects, &identify Bartlett gaps in Learning, best practice, andLLC NOTapply FOR new skillsSALE to care OR scenarios. DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Attitudes: Appreciate the importance of quality improvement projects, value measurement skills, and be open to change. 4. Teamwork and Collaboration: Within nursing and interprofessional teams, the nurse functions effectively, fosters strong open communication, promotes mutual respect, and applies the principles of shared decision making to the team © Jones & Bartlettmembers Learning, and to the combinationLLC of the family and team© Jones members. & Bartlett Learning, LLC NOT FOR SALEKnowledge OR DISTRIBUTION: Describes the scope of practice, the roles NOTof team FOR members, SALE and personal OR DISTRIBUTION strengths and limitations, and understands the impact of team function and communication on the outcome of patient safety and quality of care provided. Skills: Initiates a plan for self-improvement, functions within the scope of practice, integrates the skills and contributions of team members, ©and Jones solicits input & Bartlett from members Learning, of the care LLC team. © Jones & Bartlett Learning, LLC Attitudes: AppreciatesNOT the FOR importance SALE of OR teamwork, DISTRIBUTION values the perspectives of others, and respectsNOT teamFOR members’ SALE unique OR DISTRIBUTION attributes. 5. Informatics: Communicate using information technology that assists with managing knowledge and supports decision making. © JonesKnowledge &: UnderstandBartlett theLearning, importance LLC of information and technology, ©describe Jones how & technology Bartlett and Learning, information LLC NOTmanagement FOR SALE improve OR quality DISTRIBUTION and safety, and understand the time and skillNOT needed FOR to effectivelySALE OR use the DISTRIBUTION tools. Skills: Seek information and technology skill improvements, navigate the technology using the assistance of others, and use the information generated to understand and improve patient outcomes. Attitudes: Appreciate the need for lifelong learning that continuously provides opportunities for improvement and change, © Jones & Bartlettand value Learning, the care coordination, LLC error prevention, safety© improvements,Jones & Bartlett and decision Learning, making that LLC information and NOT FOR SALEtechnology OR DISTRIBUTION provide. NOT FOR SALE OR DISTRIBUTION (continues)

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR TABLESALE 31 ORQSEN DISTRIBUTION Competencies: A Summary of Application to PediatricsNOT (continued) FOR SALE OR DISTRIBUTION 6. Safety: Maximize assessment of safety issues and minimize risk of harm to patients. Knowledge: Describe unsafe practices (poor communication, use of do-not-use abbreviations, and work-arounds), discuss strategies to eﬀectively reduce reliance on memory, and describe factors that promote a culture of safety for individuals, © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC teams, and healthcare systems. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Skills: Use technology, practice new methods of error reduction, communicate unsafe practices, engage in root-cause analysis, and participate in designing safe systems. Attitudes: Value the creativity and contributions of safety measures, value the nurse’s own role in error prevention, and value vigilance, monitoring, and implementation strategies. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Data fromNOT QSEN Institute. FOR (2014). Pre-licensureSALE KSAs. OR Retrieved DISTRIBUTION from http://qsen.org/competencies/pre-licensure-ksas NOT FOR SALE OR DISTRIBUTION

Thinking in Concepts to Promote Safety © Jones &Applying Bartlett the QSENLearning, competencies LLC to pediatrics provides a© Jones & Bartlett Learning, LLC NOT FORholistic SALE foundation OR DISTRIBUTION for safety, but the care of children alsoNOT FOR SALE OR DISTRIBUTION requires a thinking process whereby the nurse reects on the knowledge needed to predict a child’s care requirements; the skills required to provide safe, evidence-based holistic care; and the attitudes assumed by a pediatric nurse who is committed to change and© Jones improving & qualityBartlett and Learning,safety in LLC © Jones & Bartlett Learning, LLC all aspects of care. GivenNOT the vast FOR amount SALE of knowledge OR DISTRIBUTION that NOT FOR SALE OR DISTRIBUTION a pediatric nurse must have to function with competency and safety, nurses can feel overloaded with information. e application of concept-based learning—a dynamic approach© Jones to the ever-growing& Bartlett Learning,body of scientic LLC nursing © Jones & Bartlett Learning, LLC knowledgeNOT thatFOR focuses SALE on learningOR DISTRIBUTION key concepts that can NOT FOR SALE OR DISTRIBUTION be applied to various situations and settings—promotes building a mental bridge between large quantities of factual knowledge and conceptual understanding. ese bridges allow one to rely less on facts and more on organizing © Jones &concepts Bartlett that Learning,create mental LLClinks. Instead of memorizing© Jones & Bartlett Learning, LLC Figure 3-2 NOT FORfacts SALE and tryingOR DISTRIBUTION to retrieve them, the nurse uses conceptsNOT © Tetra FOR Images/Shutterstock SALE OR DISTRIBUTION to quickly link and integrate information within patient scenarios to provide “the big picture.” Safety as a concept is widely used to promote a cascade of thinking about following questions: What is the best way to prevent the identifying harm, reducing errors, and promoting safety. child from touching the wound or pulling out sutures © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC inking conceptually about safety allows the nurse to in light of her developmental delay? How can the child’s readily transfer existingNOT knowledge FOR SALEto an actual OR clinicalDISTRIBUTION caretakers best avoid medicationNOT errors FOR or interactions SALE OR in DISTRIBUTION situation (Figure 3-2). the medications used for her postsurgical therapy—and Safety, as a concept, reects the many needs of a what are the potential risks of such mistakes? How can person. By studying exemplars of clinical situations and the nurse ensure that the child’s pain is adequately treated thinking© Jones through & theBartlett components Learning, of safety LLC present in in light of her© special Jones needs? & Bartlett How can Learning,these concerns LLC be thoseNOT scenarios, FOR the SALE nurse ORcan improveDISTRIBUTION his or her rapid addressed bothNOT in FORthe clinical SALE setting OR andDISTRIBUTION in the home application of integrated safety knowledge. For instance, aer the child is discharged? Using safety as a concept if a nurse encounters a child with developmental delay in care should trigger a cascade of potential and actual who has a new postoperative incisional wound, cannot concerns for the child. When such a conceptual lens is provide basic care for herself, and requires many treat- not used, the nurse must rely on memorization and su- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ments and medications, the nurse can use the concept percial thinking and is unlikely to develop the deeper NOT FORof SALE safety toOR think DISTRIBUTION about all of the safety concerns thatNOT understanding FOR SALE that OR accompanies DISTRIBUTION integrated thinking might arise for the child. ese concerns include the (Miller, 2012).

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Injury prevention and safety education for families based NOT FOR SALEQUALITY OR AND DISTRIBUTION SAFETY NOT FOR SALE OR DISTRIBUTION on the child’s specic developmental stage is a nursing Conceptual Thinking: Pediatric Safety imperative. Such education should also incorporate the • Definition of the concept: The minimization of harm special needs of children with intellectual or physical dis- to both patients and providers through safe individual abilities. Table 3-2 lists injury prevention topics based on © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC practice and safe effective systems. developmental stage that should be discussed with families. • Prevalence andNOT populations FOR at SALE risk: Pediatric OR patientsDISTRIBUTION NOT FOR SALE OR DISTRIBUTION from birth to adolescence. • Personal risk factors: Identifying personal aspects that Identifying and Addressing Safety may increase error or harm. • Mechanism and consequences: Outcomes of unsafe Issues in the Community © Jonespractice or& unsafe Bartlett environments/systems. Learning, LLC A child’s environment© Jones &can Bartlett be a source Learning, of safety concerns. LLC • Clinical manifestations: Medical and medication NOT FOR SALE OR DISTRIBUTION IndustrializedNOT areas FOR contain SALE hazards OR in DISTRIBUTION the air, water, and errors, bodily injury, acts of omission and commission. • Clinical management: Application of safety models, soil. Urban households in high-trac zones may be exposed practices, and protocols with continuous quality to automobile-related hazards due to both increased risk improvement processes to evaluate best practices. of pedestrian accidents and poor air quality. e pediatric © Jones & Bartlett• Interrelated Learning, concepts: LLC Development, ethics, account-© Jonesnurse & must Bartlett assess aLearning, family’s concerns LLC about the environ- NOT FOR SALEability, OR DISTRIBUTIONadvocacy, effective communication, and pro- NOT FORment in SALE which theOR child DISTRIBUTION lives (Figure 3-3). Areas to assess fessional behavior. include the following: • Concept exemplars: The study of clinical cases that illuminate the components of safety (i.e., a clinical case • Water contamination. Water contamination is a of child abuse and severe neglect of a young child global concern for children. In the United States, who relies on others© Jones to provide & Bartlettall aspects of Learning, nutrition, LLC contaminated well water© isJones a threat & monitored Bartlett by Learning, LLC elimination, warmth, hygiene and safety) (Miller, 2012). NOT FOR SALE OR DISTRIBUTIONthe National Institute ofNOT Environmental FOR SALE Health OR DISTRIBUTION (Mishamandani, 2015). Arsenic-, lead-, and mercury-contaminated water can aect a child’s cognitive development and behavior. Dirty and contaminated water is considered the planet’s big- ©Another Jones safety & Bartlett issue present Learning, in contemporary LLC pediatric gest health© Jones threat & to Bartlettchildren (National Learning, Resources LLC nursingNOT is FOR the identication SALE OR of DISTRIBUTIONneglect. Children can suer DefenseNOT Council, FOR 2015). SALE OR DISTRIBUTION safety issues associated with intentional or unintentional • Lead poisoning. Children can be exposed to lead neglect of their basic needs. According to Mennen, Kim, through water, food, air, deteriorating paint, dust, Sang, and Trickett (2010), child neglect is most prominent and contaminated soil. Although use of lead is now in families who are considered child welfare clients. Ne- banned in both gasoline and paint products, lead © Jones & Bartlettglect for these Learning, high-risk LLCfamilies was found to be 71.0%© Jones poisoning& Bartlett remains Learning, a serious LLC safety concern owing NOT FOR SALEwith 95% OR of theDISTRIBUTION cases associated with other forms of childNOT FORto SALE lead’s persistent OR DISTRIBUTION presence in the soil, old paint, maltreatment. Pediatric nurses must associate cases of industrial emissions, and air. Health eects of lead child neglect with other forms of safety issues and assess exposure may include delays in mental and physical for other forms of child abuse. development, increased behavioral problems, and short attention span. Younger children are more Model of Thinking: Basics© Jones of Safety & Bartlett During Specific Learning, LLC sensitive to the damage© of Jones lead exposure & Bartlett as their Learning, LLC Developmental StagesNOT FOR SALE OR DISTRIBUTIONbones grow and tissuesNOT are more FOR susceptible. SALE OR DISTRIBUTION • Air quality. According the U.S. Environmental Pro- Children between 1 and 4 years of age and adolescents tection Agency (2017), millions of children live in age 15 and older have the highest rates of accidental injuries areas where air quality poses potential and actual in the United States. According to the CDC (2016), boys © Jones & Bartlett Learning, LLC serious© threatsJones to & their Bartlett health withLearning, low-income LLC are twice as likely as girls to die from accidents associated families and communities of color being at high NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION with unintentional injuries. e younger the child, the risk. Air pollution is linked to development of greater the chance the injury will be related to transpor- bronchitis and asthma, with these conditions being tation (pedestrian, motor vehicle, or bicycles) or related especially prevalent in urban areas with heavy traf- to drowning or burns. Infants and toddlers are at greater c (Milligan, Matsui, & Sharma, 2016). Asbestos—a © Jones & Bartlettrisk for aspiration, Learning, choking, LLC or poisoning deaths. Young© Jones mineral& Bartlett ber usedLearning, in building LLC construction materi- NOT FOR SALEchildren OR have DISTRIBUTION newly mastered locomotion, yet have NOTno FORals, SALE insulation, OR andDISTRIBUTION re-retardants—has detrimental real sense of danger versus safety—factors that put them health eects as well. Second-hand smoke poses at high risk of accidents. serious health risks for children in both the short

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR TABLESALE 32 ORDevelopmental DISTRIBUTION Stage–Related Injury Prevention NOT FOR SALE OR DISTRIBUTION Young Infants › Prevent aspiration and choking by diligently stopping the infant from reaching toys smaller than the diameter of the center of a toilet paper roll. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC › Keep plastic bags away from their reach. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION › Strap infants down for diaper changes; never leave an infant on a surface where the child could roll and fall. › Do not ever drink hot liquids while holding an infant. Older Infants › As© infants Jones become & Bartlett mobile, prevent Learning, falls and injuries LLC related to stairs and poisonings© Jones as they & move Bartlett and explore Learning, their LLC environments.NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION › Never leave a child unattended in a high chair, shopping cart, or motor vehicle. › Make sure older infants are provided with foods that they can eat safely. Do not give hard foods such as carrots, and chop soft foods up into very small pieces. © Jones &Toddlers Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR › SALEPrevent OR falls, DISTRIBUTIONdrowning, electrical burns, and heat burns by NOTproviding FOR constant SALE supervision OR DISTRIBUTION while the child is awake, at play, and outside. › Do not allow toddlers to climb on surfaces or chairs to reach desirable items. › Use safety gates, window guards, cabinet locks, and toilet seat locks throughout their environments. › Turn pot handles toward© Jones the back & of Bartlettthe stove. Learning, LLC © Jones & Bartlett Learning, LLC › Do not allow toddlersNOT near unsupervisedFOR SALE pets. OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION › Have toddlers wear helmets while learning to ride a tricycle. › Do not leave electrical appliances plugged in and do not let electrical cords hang down. Teach toddlers what “hot” and “danger” mean. › © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC PreschoolersNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION › Teach preschoolers about car/pedestrian safety. › Require preschoolers to consistently wear safety devices such as helmets, padding, and straps. › Never call medicine “candy.” © Jones &› BartlettContinue to Learning, use safe barriers, LLC safety gates, and locked cabinets.© Jones & Bartlett Learning, LLC NOT FOR › SALETeach animalOR DISTRIBUTION safety. NOT FOR SALE OR DISTRIBUTION › Teach and practice saying “no” to others when in an uncomfortable situation or environment. School Age › Teach school-age children ﬁre safety. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC › Keep matches stored in a safe area. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION › Insist on seat belt safety and sports safety devices. › Teach about car safety, stranger safety, and animal safety. › Practice a ﬁre escape plan and a natural disaster plan. › Teach© Jones Internet & safety. Bartlett Learning, LLC © Jones & Bartlett Learning, LLC AdolescentsNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION › Role model safety, as teens will mimic and follow what adults do in most situations. Wear seat belts, do not participate in substance abuse, and do not smoke. › Talk frankly with teens about sex, drugs, alcohol, and risk taking. © Jones &Special Bartlett Needs Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR › SALEIdentify OR safety DISTRIBUTION concerns particular to the mental, emotional,NOT or physical FOR impairment SALE OR of a special-needsDISTRIBUTION child (e.g., the need for a 504 Plan or individualized education plan [IEP] in school).

9781284375473_CH03_029_045.indd 35 06/07/17 2:08 PM 36 Chapter 3 Essential Safety Models

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FORCenter SALE for Children OR inDISTRIBUTION Poverty (2016), in 2014, 32% of U.S. children lived in a family at the poverty level—dened as a household with income less than $24,008 per year for a family of four. Forty-eight percent of children live in low-income families. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Clinicians should be aware of and screen for the many NOT FOR SALE OR DISTRIBUTIONhealth and safety issues relatedNOT to FORpoverty SALE (Chung OR et al., DISTRIBUTION 2016). Families from lower socioeconomic backgrounds may have safety issues associated with their residence in lower-income neighborhoods, exposure to crime, and © Jones & Bartlett Learning, LLC risk of substance© Jones abuse & (Consumer Bartlett Federation Learning, of America LLC NOT FOR SALE OR DISTRIBUTION [CFA], 2013).NOT Lower-income FOR SALE homes OR may DISTRIBUTION lack supervision, as not all working parents can aord complete childcare Figure 3-3 coverage. Children from lower-income households also © Amble Design/Shutterstock have more chronic illnesses such as asthma (Clark et al., 2015), reduced access to routine preventive health care © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC and long terms; notably, it is directly linked to de- (Center for Poverty Research, 2014), and greater risk of NOT FOR SALEvelopment OR DISTRIBUTION of ear infections, bronchitis, asthma, andNOT FORunintentional SALE injuries OR DISTRIBUTION generally as well as specically from sudden infant death syndrome (SIDS) (Treyster & pedestrian, re, burn, drowning, and fall injuries than do Gitterman, 2011). other children (CFA, 2013). Poverty exacerbates concerns • Sun exposure. Most lifetime sun exposure occurs in such as food insecurity and exposure to environmental the rst 18 years© ofJones life. Children & Bartlett must be Learning, protected LLChazards such as lead paint, which© Jones may aect & Bartlett child develop Learning,- LLC from the harmfulNOT consequences FOR SALE of lengthy OR DISTRIBUTION sun ex- ment (Chung et al., 2016). NOT FOR SALE OR DISTRIBUTION posure and sunburns, as these events are directly e pediatric nurse should be aware of the various resources linked to development of skin cancer, premature available within the community and refer families in need to aging, inammation of the cornea and conjunctiva specic community organizations that can provide needed of the eye, accelerated cataract development, and assistance. ese resources may include low-cost childcare © eectivenessJones & Bartlett of the immune Learning, system (World LLC Health services or© early Jones childhood & Bartlett education programsLearning, such LLCas Head NOTOrganization, FOR SALE 2001). OR DISTRIBUTION Start, publicNOT health FOR clinics, SALE low-cost OR immunization DISTRIBUTION clinics, community-based safety fairs, food banks, and community kitchens where free or low-cost meals can be secured. RESEARCH EVIDENCE © Jones & BartlettWell Water Learning, Contamination LLC and Intelligence © Jones & Bartlett Learning, LLC NOT FOR SALEThe U.S. OR Environmental DISTRIBUTION Protection Agency has found that NOT FOR RESEARCH SALE EVIDENCE OR DISTRIBUTION children who are exposed to drinking water containing hildren who have been diagnosed with attention-deﬁcit/ levels of arsenic greater than 5 µg/L experience a reduction Chyperactivity disorder (ADHD) are at a much greater risk of of 5–6 points in most aspects of measured intelligence. injury than children without ADHD, as they are distracted quite Arsenic, which is naturally© Jones found in& the Bartlett groundwater Learning, in LLCeasily and experience more motor© Jones vehicle-versus-pedestrian & Bartlett Learning, LLC certain geographic areas,NOT can FOR have seriousSALE health OR con-DISTRIBUTIONaccidents. Research has shownNOT that although FOR SALEthey may ORfollow DISTRIBUTION sequences for children, including increasing their risks of curbside behaviors, children with ADHD are at a higher risk neurodevelopmental disruption, diabetes, and cardiovas- due to their failure to process safety factors while crossing cular disease (Wasserman et al., 2014). streets and are especially prone to choosing small traﬃc gaps © Jones & Bartlett Learning, LLC while crossing© Jones (Nikolas & et Bartlettal., 2016). Learning, LLC SafetyNOT at FOR Home SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Children live in a variety of settings—rural, farm, urban, One major concern for families who cannot aord and suburban. Socioeconomic factors play a large role aer-school care is “latchkey” children, referring to children in determining the safety of the environment in which a who are not supervised by a responsible adult aer school. © Jones & Bartlettchild lives. Learning,Unsafe neighborhoods LLC where crime, drug traf©- Jones e percentages& Bartlett of latchkeyLearning, children LLC have been reported as NOT FOR SALEcking, OR and DISTRIBUTIONunemployment levels are high create greaterNOT FOR2% of 8-year-olds,SALE OR 4% DISTRIBUTION of 9-year-olds, 6% of 10-year-olds, safety concerns for children. According to the National 11% of 11-year-olds, and 14% of 12-year-olds (Bureau of

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT •FOR Ask aSALE trustworthy OR DISTRIBUTIONneighbor or friend to be a backup. • Reinforce self-protection by locking windows and doors. • Keep keys handy but out of sight (do not wear © Jones & Bartlett Learning, LLChouse keys around neck).© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION• Provide and support aer-schoolNOT FOR activities. SALE OR DISTRIBUTION • Set clear rules as to what is expected regarding friends, food preparation, screen time, and homework. © Jones & Bartlett Learning, LLC • Set controls© Jones for media, & BartlettTV, and computers. Learning, LLC NOT FOR SALE OR DISTRIBUTION Creating NOTa safe FORhome SALEenvironment OR DISTRIBUTION for children is considered paramount, though the specic risks dier to some extent for boys and girls. Girls typically experience injuries within the house (burns, falls, and bodily injury), whereas boys experience injuries outside or in © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC garage or storage areas (burns, suocation, drowning, NOT FOR SALE OR DISTRIBUTION NOTand FOR bodily SALE injury). OR Preparing DISTRIBUTION the home environment requires understanding the physical and mental capacities of children across the developmental period. Emergency preparedness, re safety (Table 3-3), and knowledge © Jones & Bartlett Learning, aboutLLC medication safety are key© areas Jones where & families Bartlett need Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

TABLE 33 Prevent Burns Through Fire Safety © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC › Teach the family a fire escape plan and practice fire drills FigureNOT 3-4 FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION as a family. © Ronnachai Palas/Shutterstock › Keep the fireplace clean and safe with tight-fitting screens or doors. Keep fire extinguishers up-to-date and check their © Jones &the Bartlett Census, 1991). Learning, Approximately LLC 10% of children age© Jones› & Bartlett Learning, LLC 4–12 years in 2013 spent 3 or more hours alone on each expiration dates annually. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION school day, and 51% of latchkey children showed poor › Know how to use a fire extinguisher. academic performance (Lant, 2013). Latchkey children have › Use safe, reliable, and double-checked smoke detectors increased safety risks, including unsafe food preparation and in each room. cooking, unsupervised computer play, unsupervised social Store lighters, matches, candles, and cigarettes away contacts, and emotional© concerns Jones such& Bartlett as fear, loneliness, Learning, LLC› © Jones & Bartlett Learning, LLC from children. stress, and feelings of abandonmentNOT FOR (SALEFigure 3-4 OR). Overall, DISTRIBUTION NOT FOR SALE OR DISTRIBUTION they are twice as likely to participate in drugs and sexual › Store gasoline or any flammable substances away activity as children who have adult aer-school supervision from children, heat, and sparks. Do not store them in (Lant, 2013). accessible locations. One© Jonesmodel of & safety Bartlett proposed Learning, for latchkey LLC children › Keep children© Jones out of the & kitchenBartlett while Learning, cooking, LLC includes the following measures to decrease their risks use safety gates as needed, and cook on the back NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION (Lant, 2013): burners only. • Have consistent contact times during the unsuper- › Do not store food in cabinets above the stove or oven. vised time at home. › Keep children away from gas or charcoal grills or outdoor • Have unannounced visits or come home early with- fireplaces or pits. © Jones & Bartlettout notice. Learning, LLC © Jones & Bartlett Learning, LLC › Teach children how to “stop, drop, and roll,” and practice NOT FOR SALE• Assign OR chores DISTRIBUTION and praise the child for completing NOT FOR SALE OR DISTRIBUTION this technique often. responsibilities.

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC anticipatory guidance, as these issues aect all children. NOT FOR SALE OR DISTRIBUTION NOT FORPrevention SALE of OR Poisonings DISTRIBUTION at Home For example, an estimated 500,000 children younger than 5 years of age accidentally ingest medications each • Post the poison control center’s number by the phone and near poisonous materials and substances year. Approximately 15% of these victims end up in the (800-555-1212). emergency department—one child every 8 minutes—and © Jones & Bartlett Learning, LLC • Keep medications in the© original Jones child-proof & Bartlett Learning, LLC 70% of these patients are children age 2 years or younger. containers—never in unlabeled pill organizers or in (Safe Kids Worldwide,NOT 2012a, FOR 2012b) SALE OR DISTRIBUTIONpurses, briefcases, or otherNOT storage FOR areas SALE where OR DISTRIBUTION A study in the Journal of Pediatrics examined more than children are interested and have access. 540,000 cases of children younger than age 5 who were • Do not ever call medications “candy.” treated in an emergency department for medicine poison- • Store all chemicals, cleaning agents, and paint supplies in locked cabinets. ing over a period of 8 years. Nearly 95% of single-agent © Jones & Bartlett Learning, LLC • Keep© all Jones plastic bags & Bartlett(kitchen, dry Learning, cleaning, and pack-LLC poisoningsNOT FOR were SALE self-administered—that OR DISTRIBUTION is, the child agingNOT materials) FOR away SALE from children. OR DISTRIBUTION ingested medications kept in an unsafe location such as • Keep potentially harmful materials and substances in an open bottle, open purse, bathroom counter, kitchen their original packaging with clear labels, and make counter, table, or shelf—and 55% involved prescription sure they have tight child-safety lids. medications belonging to a parent or grandparent, such • Materials such as cleaners, vinegar, or bleaches with © Jones & Bartlettas oral hypoglycemic Learning, agents, LLC opioids, and sedatives. e© Jones &ammonia Bartlett should Learning, never be used LLC or stored together. NOT FOR SALEauthors OR concluded DISTRIBUTION that the inadequacy of safety measuresNOT FOR• KeepSALE poisonous OR DISTRIBUTION and toxic substances locked up and out of reach of children. intended to keep medications out of children’s hands was a • Do not store gasoline in the garage. signicant factor in these outcomes (Bond, Woodward, & • Be consistent with children about not touching any- Ho, 2011). thing stored, locked, or dangerous. Children are at ©high Jones risk for & emergency Bartlett hospitalizaLearning,- LLC © Jones & Bartlett Learning, LLC tions when they haveNOT access FOR to andSALE ingest OR prescription DISTRIBUTION Medications and SubstancesNOT for FOR Poisonings SALE OR DISTRIBUTION medications in the home (Lovegrove, Mathew, Hampp, Recommendations are to call the poison control center Governale, Wysowski, & Budnitz, 2014). (800-222-1222) for guidance. • Ipecac syrup is an emetic that, when taken with a quantity of water, induces vomiting. Its long shelf life FAMILY© Jones EDUCATION & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION has leftNOT many FOR households SALE with OR the DISTRIBUTION medication avail- Home Preparation for Emergencies able, but it is not recommended for poisonings. • Charcoal is an adsorbent used in patients with intact • Keep a clear and easy-to-read large-print record of airways to adsorb (bind) toxic substances in the stom- emergency numbers, including phone numbers for ach. After charcoal is ingested, a nasogastric tube law enforcement, poison control, the local hospital, should be used to lavage the toxin or substance as pediatricians, 911, and a local taxi service. © Jones & Bartlett Learning, LLC © Jones &rapidly Bartlett as possible. Learning, LLC NOT FOR SALE• HaveOR all DISTRIBUTION members of the family who are old enough NOT FOR SALE OR DISTRIBUTION take cardiopulmonary resuscitation (CPR) classes; recertify often. • Keep emergency flashlights, matches, and candles handy but out of reach. FAMILY EDUCATION • Keep a well-stocked© Jones first-aid &kit. Bartlett Learning, LLC © Jones & Bartlett Learning, LLC • Take the American Red Cross first-aid course; Motor Vehicle Restraints: Applying Safety Across recertify often. NOT FOR SALE OR DISTRIBUTIONChildhood NOT FOR SALE OR DISTRIBUTION • Maintain an appropriate emergency supply box in Anticipatory guidance on state car seat laws is one of the case of flood, fire, earthquake, or other regional emer- most important discussions that can take place between gency. Stock this box with water, food, clothes, space a pediatric nurse and the families the nurse serves. Motor blankets, candles, matches, medications and copies of vehicle accidents (MVAs) are a leading cause of injury and © Jonesprescriptions, & Bartlett extra eyeglasses, Learning, pet supplies, LLC and solid © Jones & Bartlett Learning, LLC deaths for children between 1 year and 12 years of age. Of NOTshoes FOR for allSALE members OR of theDISTRIBUTION family. NOT FOR SALE OR DISTRIBUTION • Know the location of the gas, water, and electrical the 638 children younger than 12 who died from MVAs in emergency shut-off switches. 2013, nearly 40% were not wearing seat belts (CDC, 2013). • Teach children how to call 911. Numerous resources are available for explaining to parents • Have a family plan for where to meet and how to how car restraints should be used for different age groups. © Jones & Bartlettreach Learning, one another if LLCan emergency happens. © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION (continues)

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Safety at Play NOT FOR FAMILYSALE EDUCATIONOR DISTRIBUTION continued NOT FOR SALE OR DISTRIBUTION Children need guidance and supervision while at play. Websites such as http://www.dmv.org and https://www Nurses, in turn, should provide support and anticipatory .safercar.gov/parents/index.htm clarify a multitude of safety guidance to families concerning safe play. Each develop- issues related to children in and around cars. In addition, © Jones & Bartlett Learning, mentalLLC stage is associated with ©its ownJones set of & ne Bartlett and gross Learning, LLC numerous YouTube videos show how to install car seats cor- NOT FOR SALE OR DISTRIBUTIONmotor milestones, and play activitiesNOT FOR can SALEpromote OR the DISTRIBUTION rectly, and many local police or ﬁre departments are willing achievement of those milestones. Promoting safety during to inspect car seats and assist parents with their correct instal- play includes being aware of the potential injuries or ac- lation. Nurses should keep a list of such resources available cidents that can occur, and providing rules and structure for guiding parents. to prevent them. e following list outlines concerns that Talking© Jones to Parents & Bartlett About Car Learning, Safety LLC should be anticipated© Jones during & Bartlett play: Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION • Children should not be left alone in a car if the keys • Children must consistently wear protective gear are in the ignition. and helmets (e.g., during skateboarding, biking, • Children younger than age 7 should never be left in a snow sports, contact sports, and extreme sports). car without a person who is at least 12 years old. • Supervision must be provided to prevent deviations • Drivers must be careful to “look before they lock,” as © Jones & Bartlettheatstroke Learning, from leaving LLC a quiet or sleeping child in a © Jonesfrom & sportsBartlett rules Learning, (e.g., young childrenLLC swimming NOT FOR SALElocked OR car DISTRIBUTION with the windows up can be fatal. NOT FORwithout SALE life vests OR orDISTRIBUTION safety oatation devices). • Children need to be taught about blind zones • Climbing structures should be free of splinters, because of the risk of “frontovers” and “backovers”; loose screws, or nails, and should have padding or discuss the blind zones of a car. so material underneath for protection during falls. • Children should not be allowed to play on equip- Parents must know ©how Jones to properly & Bartlett and safely Learning,install a LLC © Jones & Bartlett Learning, LLC car seat. Double-checking that the car seat or booster seat ment, bikes, or other devices not made for their NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION is belted into the car, and not just the child into the car seat, age or developmental level (e.g., toddlers on can save lives. skateboards).

FAMILY EDUCATION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION PreventingNOT Injuries FOR During SALE Sports OR Activities: DISTRIBUTION Safety at Daycare Centers and Schools Anticipatory Guidance for Parents Daycare programs, preschools, and schools should all be • Role-model safety by always wearing seat belts, sports safety gear, and helmets. a safe place for children to play, learn, and thrive. Each • Insist on children of all ages wearing safety gear setting, whether private or public, should have safety pro- © Jones & Bartlett Learning, LLC © Jonesappropriate & Bartlett to the Learning, sport. LLC cedures that are written down and periodically reviewed. NOT FOR SALE OR DISTRIBUTION NOT FOR• Check SALE for proper OR ﬁtting; DISTRIBUTION as children grow, they will Nurses can be instrumental in reviewing facilities, play- need larger sizes. grounds, procedures, sports equipment, and safety devices • Provide mouth gear and safety devices for protecting for safety deciencies. Playgrounds should have shade, teeth. so padding under climbing structures, safety fences to prevent wandering or intruders,© Jones and & supervision Bartlett Learning,between LLC © Jones & Bartlett Learning, LLC classes and during breaksNOT and FOR recesses. SALE Policies OR shouldDISTRIBUTION Safety in Clinical SettingsNOT FOR SALE OR DISTRIBUTION include safety procedures for when children are departing the facility, whether accompanied by a parent, riding on Hospitals a school bus, or walking or biking home by themselves. Hospitals are inherently unsafe places for children. Hospi- Policies should also cover caring for an injured child tal environments are oen fast-paced, chaotic, lled with © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC and protocols for administering rst aid; at least some acutely or critically ill patients, busy with a host of healthcare personnelNOT supervising FOR SALE children OR shouldDISTRIBUTION have specic rst professionals,NOT and populatedFOR SALE with OR complicated DISTRIBUTION security aid and CPR training. Emergency phone numbers for re, measures. It is the pediatric nurse’s priority to provide a poison control, and 911 calls for ambulance and police safe environment to hospitalized children—and doing so should be posted in all rooms of all buildings. Policies eectively takes concerted eort (Figure 3-5). Environ- © Jones &against Bartlett bullying, Learning, violence, LLCdrugs, smoking, and alcohol© Jonesmental sweeps& Bartlett for safety Learning, concerns needLLC to be conducted NOT FORshould SALE be ORenforced. DISTRIBUTION NOTon FOR every shi,SALE and OR prompt DISTRIBUTION reporting of unsafe conditions,

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FORTABLE SALE 34 Checklist OR DISTRIBUTION for Keeping Children Safe in the Hospital › Ensure young children have an alert system such as a bracelet or anklet that emits an alarm when the child leaves the premises or comes close to stairwells and elevators; © Jones & Bartlett Learning, LLC check frequently that the device© Jones is intact &and Bartlett operational. Learning, LLC NOT FOR SALE OR DISTRIBUTION› Cover all electrical outlets NOTand minimize FOR theSALE presence OR of DISTRIBUTION electrical equipment. › Never leave unsafe items at the bedside or crib, including scissors, medications, hemostats, needles, or sharps of © Jones & Bartlett Learning, LLC any form.© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION › Double-checkNOT FORthat crib SALE rails are ORclicked DISTRIBUTION into place and side rails are up. › Select beds that are safe for the child’s age, developmental stage, and size (e.g., high-top covered © Jones & Bartlett Learning, LLC © Jonescribs & Bartlett for young childrenLearning, who stand). LLC NOT FOR SALE OR DISTRIBUTION NOT FOR› Do SALE not allow OR parents DISTRIBUTION to sleep in hospital beds with their infant. › Assess infants and toddlers for strangulation injuries related to wires, tubes, and monitoring equipment. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONRates of Medical and MedicationNOT Errors FOR in PediatricSALE CareOR DISTRIBUTION Medical errors are responsible for more deaths among adults and children alike than motor vehicle accidents, according to Bleich’s (2005) report from the Commonwealth Fund. © Jones & Bartlett Learning, LLC While the ©majority Jones of medication & Bartlett errors Learning, occur in adults—as LLC FigureNOT 3-5 FOR SALE OR DISTRIBUTION many as 14NOT errors FOR per 100 SALE doses—children OR DISTRIBUTION experience from © PhotoAlto/Laurence Mouton/PhotoAlto Agency RF Collections/Getty approximately 2.3 to 6 adverse drug events per 100 hospital admissions (Sharek & Classen, 2006). Pediatric medication doses must be calculated using a weight-based measurement broken equipment, or safety breaches is required. It is (such as milligrams per kilogram or milligrams per body sur- © Jones & Bartletteveryone’s Learning,responsibility LLC to prioritize safety for children© Jones & Bartlett Learning, LLC face area) and double-checked for safety. Due to the need to NOT FOR SALEin the hospital. OR DISTRIBUTION Young children are particularly vulnerableNOT FOR SALE OR DISTRIBUTION calculate doses individually for children, pediatric patients are to adverse eects as they explore their environment and up to three times more likely to experience “near-miss” errors test limits (Table 3-4). (Kaufmann, Laschat, & Wappler, 2012; Kaushal et al., 2001). Four major issues have been identied that put hos- Some pediatric institutions require that all medications pitalized children at greater safety risks (Lacey, Smith, & © Jones & Bartlett Learning, LLCadministered to children be ©subjected Jones to & double-checking Bartlett Learning, LLC Cox, 2008): NOT FOR SALE OR DISTRIBUTIONby nursing sta members NOTagainst FOR documentation SALE OR and DISTRIBUTION • A child’s uid developmental status, as new mile- electronic/written signatures (Figure 3-6). Examples of stones are implemented and boundaries are tested medications/infusions for which pediatric registered nurses • e dependency level inherent to children, espe- may be expected to double-check the rights of medication cially the nonverbal status of young children © Jones & Bartlett Learning, LLC administration© Jones (right patient,& Bartlett drug, dose,Learning, time, and LLC route) • An acute (rather than chronic) episode, which leads include the following therapies: NOTto a FORhigher SALElevel of requiredOR DISTRIBUTION care NOT FOR SALE OR DISTRIBUTION • Poverty, racial, and ethnic disparities, which place • Cardiac medications such as antihypertensives and children at greater risk for poor outcomes antiarrhythmics (digoxin) • Blood products Other concerns inherent to hospitalization of children • Insulins and hypoglycemics © Jones & Bartlettinclude medical Learning, errors, medicationLLC errors, communica©- Jones• Total& Bartlett parenteral Learning, nutrition and LLC intralipids NOT FOR SALEtion errors, OR falls,DISTRIBUTION injuries, abductions, and poor outcomesNOT FOR• Chemotherapies SALE OR DISTRIBUTION and any medications associated directly linked to hospital stang. with cancer treatments

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FORAccording SALE to McDowell,OR DISTRIBUTION Ferner, and Ferner (2009), medication errors can be thought of as having a “patho- physiology” in that errors can be classied in one of many types: when an action that was intended to take place is not performed; when errors take place due to inadequate © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC knowledge known as a mistake; when a well-formulated plan NOT FOR SALE OR DISTRIBUTIONis not executed (slip) and an erroneousNOT FOR act or SALE lapse of OR the DISTRIBUTION plan occurs; or when inaccurate calculation of the required dose occurs. ese authors stress that healthcare systems are complex and errors occur at various stages and steps of © Jones & Bartlett Learning, LLC orders, communication,© Jones preparation,& Bartlett and Learning, administration. LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Impact of Errors in Pediatric Care Young children are inherently vulnerable, as they do not Figure 3-6 question or monitor their care. e impact of errors on young © Ermolaev Alexander/Shutterstock children exceeds the eects on adults, with such errors causing © Jones & Bartlett Learning, LLC © Jonesmore harm & Bartlettand having Learning,a more signicant LLC impact on pediatric NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION • Anticoagulants patients’ safety. Children need to be protected from errors, • Electrolytes and pediatric nurses must adhere to safety protocols to • Narcotics ensure that the risks of errors are reduced. e implementation of electronic order entry and computerized medication Types of Errors in Pediatric© Care Jones & Bartlett Learning, administrationLLC programs (scanning)© Jones has reduced & Bartlett the number Learning, LLC In general, medication errorsNOT inFOR pediatrics SALE can OR be classied DISTRIBUTION of errors, but communication remainsNOT the FOR single SALE most impor OR- DISTRIBUTION into one of four categories: tant factor in errors involving pediatric patients. Reducing the impact of errors in the pediatric population requires indi- • Acts of omission vidual dedication, team eort, and institutional commitment. • Acts of commission • Scheduling© Jones misperceptions& Bartlett Learning, LLC © Jones & Bartlett Learning, LLC • NoncomplianceNOT FOR SALE on the OR part DISTRIBUTION of the family or child BEST PRACTICESNOT FOR SALE OR DISTRIBUTION Omissions are errors where a team member did not do Reducing Miscommunications and Errors by Using or provide something for a child that should have been Handoff Bundles implemented. Omitting a dose of antibiotic, forgetting Handoff bundles have been shown to reduce medical errors © Jones &to openBartlett the clamp Learning, on an intravenous LLC electrolyte replace-© Jonesin pediatric & Bartlett healthcare Learning, settings by reducing LLC miscommunica- NOT FORment SALE solution OR toDISTRIBUTION correct a signicant serum depletion,NOT tion. FOR In research SALE conducted OR DISTRIBUTION by Starmer et al. (2014), the use and missing a prescribed application of a topical steroidal of a standardized communication tool, handoff training, anti-inammatory drug are all errors of omission. team handoff structure, and a verbal mnemonic reduced Acts of commission occur when a pediatric team errors from 33.8 errors per 100 admissions to 18.3 errors member does something in error to a child that was not per 100 admissions. Use of the SIGNOUT? mnemonic was supposed to happen. Examples© Jones include & Bartlett treating a Learning,child for LLCrecognized as a key factor in the improved© Jones rates, & alongBartlett with a Learning, LLC a condition that the childNOT has notFOR been SALE diagnosed OR with DISTRIBUTION and “patient summary,” “to-do list,” andNOT “contingency FOR SALE planning.” OR DISTRIBUTION administering a medication to a child who does not have The SIGNOUT? mnemonic, which was developed by Horwitz, a standing order for this therapy. Moin, and Green (2007), includes the following elements: Scheduling misperceptions involve the incorrect timing S = Sick? Do not resuscitate? Unstable? of a medication© Jones or & treatment, Bartlett such Learning, as administering LLC a pain I = Identifying© Jones data, gender, & Bartlett weight, age, Learning, and diagnosis LLC medicationNOT FORbefore SALEit is due orOR administering DISTRIBUTION an antibiotic G = GeneralNOT course FOR of hospitalization SALE OR DISTRIBUTION to a child recently transferred from the emergency depart- N = New events of the day, including vital signs, diagnostics, ment who just received the medication in the emergency lab results, and medications department (i.e., giving the medication too soon aer the last O = Overall health status/clinical condition dose). Compliance concerns may arise regarding whether U = Upcoming possibilities, with their plan and rationale © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC the family participated in administering a medication or T = Tasks to complete, plan, rationale, and time frame NOT FORtreatment SALE ORas it wasDISTRIBUTION ordered, or whether the family lled aNOT FOR? = Any SALE questions? OR Concerns?DISTRIBUTION prescription that was ordered for a child.

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALECommunication OR DISTRIBUTION Tips NOT FORfor each SALE age, and OR knowing DISTRIBUTION how and to whom the nurse orough professional communication in the eld of should report a change. pediatrics will reduce the chance of errors. Areas where Mnemonics for Safety communication mishaps are prone to happen include Many healthcare professionals promote the use of mental handos between caregivers© Jones (also & Bartlett known as Learning,handovers, LLC © Jones & Bartlett Learning, LLC mnemonics to encourage safe practice. Mnemonics are sign-os, and shi NOTreports) FOR and handosSALE OR between DISTRIBUTION units NOT FOR SALE OR DISTRIBUTION or departments, such as between the emergency depart- memory tools used to rapidly recall complex informa- ment and the nursing unit, or between the nursing unit tion, sets of steps for skills, or components of treatment and the radiology department. Handos include not only plans. Most mnemonics are intended to help practitioners the communication of essential care information, but either recall information or recall steps of behaviors. also© theJones transfer & ofBartlett primary Learning,responsibility LLC and authority ese tools© promoteJones safety& Bartlett in that Learning,they allow for LLC ready forNOT the child. FOR Consistently SALE OR using DISTRIBUTION a formal hando format recall of standardsNOT FOR agreed SALE upon ORin professional DISTRIBUTION practice that provides structure, critical information, and safety (Hagerman, Varughese, & Kurth, 2014). CAB is an example; assurance is a best practice for minimizing errors. Con- it is used to recall the rst three steps of cardiopulmo- versely, insucient handos may cause safety breaches nary resuscitation—compression, airway, breathing. e and failures in safe care. Best Practices: Using Mnemonics feature highlights © Jones & Bartlett Learning, LLC © Jonesthis kind& Bartlett of memory Learning, tool for double-checkingLLC use of NOT FOR SALE OR DISTRIBUTION NOT FORmedications SALE in OR children. DISTRIBUTION

BEST PRACTICES ime-outs” are a ©sound Jones safety communication& Bartlett Learning, technique LLC © Jones & Bartlett Learning, LLC “Tthat must be usedNOT prior FOR to anySALE medical OR procedure, DISTRIBUTION BEST PRACTICES NOT FOR SALE OR DISTRIBUTION medical diagnostic procedure, or surgical procedure. Before Using Mnemonics beginning the procedure, the team involved with the child’s An example of a mnemonic that assists with a child’s safety care should gather together around the child and conduct is one used to remember which medications, at a minimum, a safety time-out. All team members should listen for and should be double-checked by two licensed caregivers. (Some confirm© Jones the accuracy & Bartlett of one Learning,team member’s LLC review of the © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION institutionsNOT will have FOR additional SALE requirements, OR DISTRIBUTION so the nurse child’s name, birthday, medical record number, presence of should always check the specific institution’s policy.) The a name band, ordered procedure, correct location for the mnemonic D’BITCH’EN can be used to remind a caregiver procedure, consent secured, parent’s whereabouts during the which categories of medications should be doubled-checked procedure and contact cell number, and a review of medica- with a second nurse: tions used or anesthetic used for the procedure. The Joint © Jones & Bartlett Learning, LLC © Jones D& = Bartlett Digoxin or Learning,any heart medication LLC NOT FOR SALECommission OR DISTRIBUTION (2005) encourages that a visual reminder of theNOT FOR SALE OR DISTRIBUTION need for time-outs be placed strategically in the procedural, B = Blood products of any kind, including red blood cells, treatment, or surgical room. platelets, plasma, intravenous immunoglobulin (IVIG), and clotting factors I = Insulins and oral hypoglycemics © Jones & Bartlett Learning, LLC T = Total parenteral nutrition© Jones and lipids & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONC = ChemotherapeuticsNOT and any FOR medication SALE given OR as DISTRIBUTION One of the most important aspects of promoting safety part of cancer treatments, including oral prednisone or for children is rapidly identifying any change in the patient’s intravenous steroidal anti-inflammatory drugs clinical status, and then rapidly reporting the change to H = Heparin or any anticoagulant the proper physician for guidance or orders. Children’s E = Electrolytes given to replace serum values or given conditions© Jones can & change Bartlett very Learning,abruptly; thus, LLC an important as ©a treatment, Jones &such Bartlett as magnesium Learning, for intractable LLC skillNOT for nursesFOR isSALE the ability OR to DISTRIBUTION quickly assess a child and asthmaNOT symptoms FOR SALE OR DISTRIBUTION discover a change in clinical status, and then know when N = Narcotics or any pain medication that has the potential and to whom to report this change. Safety in pediatric to cause altered mental status, respiratory depression, nursing is based on skills that are tailored toward chil- or any other significant symptoms © Jones & Bartlettdren, including Learning, knowing LLC the expected average vital signs© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Case Study © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION At a home-based toddler care program, a 2-year-old boy 3. Which of the following represents an appropriate level of was playing in the backyard with 12 other children. Three intervention to improve the safety profi le of the facility? A. A nurse should visit the facility and perform a safety supervising adults were engaging in play with the other sweep of the facility yard to identify hazards. toddlers. The young boy ran along the side of the home, B. Recommend to the facility’s owner that all employees over© to Jones some trashcans & Bartlett that had Learning, collected water LLC during a be provided© Jones with training& Bartlett in fi rst aidLearning, and CPR on LLC a recentNOT rainstorm. FOR TheSALE child threwOR DISTRIBUTION a toy into one of the cans, regularNOT basis, FORat least SALEannually. OR DISTRIBUTION and then scrambled up onto a bush next to the trashcan C. A nurse should create a binder of educational resources so he could climb in and retrieve the toy. The child fell into to give to the facility’s owner so that employees can approximately 9 inches of water; he was quickly found but be off ered safety training when they are fi rst hired. was unconscious. D. All of these actions described should be off ered to © Jones & Bartlett Learning, LLC © Jones &the Bartlett facility as part Learning, of a comprehensive LLC and ongoing Emergency medical personnel were called and brought to NOT FOR SALE OR DISTRIBUTION NOT FORtraining SALE program. OR DISTRIBUTION the scene. The child was resuscitated at the site and brought The toddler in this case study is being cared for in the PICU. into the local emergency department, where his heart rate To the parents’ relief, initial indications are that the child was after administration of epinephrine was found to be 50 beats resuscitated quickly enough to avoid severe neurologic injury. per minute, his respiratory rate was 8 breaths per minute, and However, less than 24 hours after admission, a nurse monitor- his blood pressure was© 72/30 Jones mm Hg. & The Bartlett child was Learning,admitted LLC © Jones & Bartlett Learning, LLC ing the child notices that he has developed a low-grade fever into the pediatric intensive care unit (PICU) and quickly placed NOT FOR SALE OR DISTRIBUTIONjust before she is due to go off shift.NOT FOR SALE OR DISTRIBUTION on a ventilator for respiratory support. The child’s admitting 4. Which of the following actions represents an appropriate diagnosis was hypoxic ischemia encephalopathy, also known response to ensure the child’s safety in the PICU when as a “near-drowning.” the nurse goes off shift? A. Note the change and the time of observation on Case© StudyJones Questions & Bartlett Learning, LLC the child’s© Jones chart and & recommendBartlett Learning,administration LLCof 1. NOTState theFOR safety SALE breaches OR found DISTRIBUTION within the home-based antibiotics.NOT FOR SALE OR DISTRIBUTION toddler care program described in the scenario. B. Verbally communicate that the child has developed 2. What are the immediate needs of the family during the a fever to another nurse coming in on the next shift. child’s emergency room stay and transfer to the PICU? C. Formally hand off the child to the next-shift nurse using both verbal and written forms of communica- © Jones & AsBartlett the Case Learning, Evolves. . . LLC © Jones &tion, Bartlett including Learning,all background LLC information, current NOT FOR SALEFollowing OR the near-drowningDISTRIBUTION incident in this case study, theNOT FORstatus, SALE and ORconcerns DISTRIBUTION raised by the change in status. D. Remain for 1 hour after the shift ends to ensure that facility’s owner seeks training for employees to prevent similar the child’s status does not further deteriorate. incidents from happening again.

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Chapter SummaryNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ◆ Safety is a critical issue in holistic and comprehensive ◆ e Quality and Safety Education for Nurses (QSEN) pediatric nursing care. Young children are inherently project was created to address challenges encountered unsafe© Jones and require & Bartlett more than Learning, supervision; LLC that is, they when trying© Jones to prepare & Bartlettnurses for Learning, professional LLC safe require safe environments in which to play, grow, develop, practice. is program focuses on the knowledge, skills, andNOT thrive. FOR SALE OR DISTRIBUTION and attitudesNOT needed FOR to SALE consistently OR andDISTRIBUTION continuously ◆ Many national organizations have developed safety improve the practice of professional nursing while pro- guidelines for parents of children of all ages, including viding a foundation of safety. the American Academy of Pediatrics and the Society ◆ Safety as a concept is widely used to trigger a cascade of © Jones & Bartlettof Pediatric Learning, Nursing. LLC © Jonesthinking & Bartlett about identifying Learning, harm, LLC reducing errors, and NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

9781284375473_CH03_029_045.indd 43 06/07/17 2:09 PM 44 Chapter 3 Essential Safety Models

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEpromoting OR DISTRIBUTION safety. inking conceptually about safetyNOT FORCenters SALE for Disease OR Control DISTRIBUTION and Prevention (CDC). (2013). Child allows the nurse to transfer existing knowledge about passenger safety: Get the facts. Retrieved from http://www.cdc this issue to an actual clinical situation. .gov/motorvehiclesafety/child_passenger_safety/cps-factsheet.html ◆ Injury prevention and safety education for families Centers for Disease Control and Prevention (CDC). (2015). Injury across developmental stages is a nursing imperative. prevention & control: Protect the ones you love: Child injuries © Jones & Bartlett Learning, LLCare preventable. Retrieved from© Joneshttps://www.cdc.gov/safechild & Bartlett Learning, LLC ◆ Neither infants nor young toddlers can be expected NOT FOR SALE OR DISTRIBUTIONCenters for Disease Control and NOTPrevention FOR (CDC). SALE (2016). OR Protect DISTRIBUTION to understand what is “safe” and what is “unsafe.” By a the ones you love: Child injuries are preventable. Retrieved from child’s third birthday, however, children should have https://www.cdc.gov/safechild some understanding that certain behaviors will put Chung, E. K., Siegel, B. S., Garg, A., Conroy, K., Gross, R. S., Long, them in harm’s way. D. A., . . . Fierman, A. H. (2016, April 18). Screening for social ◆ ©Children Jones require & Bartlett responsible Learning, adults to LLCprovide antici- determinants© Jones of health & among Bartlett children Learning, and families livingLLC in NOTpated FORsafety measuresSALE OR at home, DISTRIBUTION in daycare or school poverty:NOT A guide FOR for clinicians. SALE Current OR DISTRIBUTION Problems in Pediatric facilities, and on playgrounds, and they require an and Adolescent Health Care. [Epub ahead of print]. pii: S1538- emerging sense of safety within that manifests as safe 5442(16)00034-1. doi: 10.1016/j.cppeds.2016.02.004 decisions as they mature. Clark, N. M., Lachance, L., Benedict, M. B., Little, R., Leo, H., ◆ Lower household income is associated with a number Awad, D. F., & Wilkin, M. K. (2015). e extent and patterns of © Jones & Bartlettof safety Learning, issues and risk LLC factors that clinicians should© Jones multiple & Bartlett chronic conditionsLearning, in low-income LLC children. Clinical Pediatrics (Philadelphia), 54(4), 353–358. doi: NOT FOR SALEunderstand, OR DISTRIBUTION assess, and help families to mitigate throughNOT FOR SALE OR DISTRIBUTION Consumer Federation of America (CFA). (2013). Child poverty, available resources. unintentional injuries, and foodborne illness: Are low-income ◆ Pediatric nurses are in a unique position to oer antici- children at greater risk? Retrieved from http://www.consumerfed patory guidance to parents and caregivers about safety .org/pdfs/Child-Poverty-Report.pdf for children. Safety© Jones must be & ensured Bartlett in play, Learning, school, LLCCronenwett, L., Sherwood, G., Barnsteiner,© Jones J., Disch,& Bartlett J., Johnson, Learning, J., LLC and home environments,NOT FOR and SALE nurses shouldOR DISTRIBUTION provide Mitchell, P., . . . Warren, J. (2007).NOT Quality FOR and SALE safety education OR DISTRIBUTION education on measures to achieve this goal. for nurses. Nursing Outlook, 55(3), 122–131. ◆ In pediatric clinical settings, thorough professional Dolansky, M. A., & Moore, S. M. (2013, September 30). Quality and communication will reduce the risk of errors. Areas Safety Education for Nurses (QSEN): e key is systems thinking. that are especially prone to communication mishaps Online Journal of Issues in Nursing, 18(3), Manuscript 1. ©include Jones handos & Bartlett between Learning, caregivers and LLC handos be- Hagerman, ©N. S.,Jones Varughese, & BartlettA. M., & Kurth, Learning, C. D. (2014). LLC Quality NOTtween FORunits orSALE departments. OR DISTRIBUTION and safetyNOT in pediatric FOR anesthesia:SALE OR How DISTRIBUTIONcan guidelines, check- lists, and initiatives improve the outcome? Current Opinion in ◆ One of the most important aspects of promoting safety Anaesthesiology, 27(3), 323–329. for children is the rapid identication of a change Horwitz, L., Moin, T., & Green, M. (2007). Development and in clinical status, followed by the rapid reporting of implementation of an oral sign-out skills curriculum. Journal © Jones & Bartlettthe change Learning, to the proper LLC physician for guidance or orders.© Jonesof &General Bartlett Internal Learning, Medicine, 22(10), LLC 1470–1474. NOT FOR SALE◆ Many OR healthcare DISTRIBUTION professionals use mental mnemonicsNOT FORJoint Commission, SALE OR International DISTRIBUTION Center for Patient Safety. (2005). as means to encourage safe practice. Mnemonics allow Strategies to improve hand-o communication: Implementing recall of standards agreed upon in professional practice. a process to resolve questions. Retrieved from http://www.jci patientsafety.org/15274 Bibliography Kaufmann, J., Laschat, M., & Wappler, F. (2012). Medication errors in © Jones & Bartlett Learning, LLCpediatric emergencies: A systematic© Jones analysis. & Deutsches Bartlett Ärzteblatt Learning, LLC Bleich, S. (CommonwealthNOT Fund). FOR (2005). SALE Medical OR errors: DISTRIBUTION Five years International, 109(38), 609‒616.NOT FOR SALE OR DISTRIBUTION aer the IOM report. Retrieved from http://www.commonwealth Kaushal, R., Bates, D. W., Landrigan, C., McKenna, K. J., Clapp, fund.org/usr_doc/830_Bleich_errors.pdf M. D., Federico, F., & Goldmann, D. A. (2001). Medication errors Bond, G. R., Woodward, R. W., & Ho, M. (2011). e growing impact and adverse drug events in pediatric inpatients. Journal of the of pediatric pharmaceutical poisoning. Journal of Pediatrics, American Medical Association, 285, 2114–2120. ©160 Jones(2), 265–270. & Bartlett Learning, LLC Lacey, S., Smith,© Jones J. B., & Cox, & K. Bartlett (2008). Pediatric Learning, safety and quality.LLC In BureauNOT of theFOR Census. SALE (1991). ORStatistic DISTRIBUTION brief: Who is minding the kids? R. G. HughesNOT (Ed.). FOR Patient SALE safety and OR quality: DISTRIBUTION An evidence-based Retrieved from www.census.gov/prod/2013pubs/p70-135.pdf handbook for nurses (Chapter 15). Rockville, MD: Agency for Center for Poverty Research, University of California, Davis. Healthcare Research and Quality. Retrieved from https://www (2014). How is poverty related to access to care and preven- .ncbi.nlm.nih.gov/books/NBK2662 tive healthcare? Data from the Centers for Disease Con- Lant, K. (2013). Latchkey kid: Make home-alone time happy and © Jones & Bartletttrol. Retrieved Learning, from http://poverty.ucdavis.edu/faq/how LLC © Joneshealthy. & Bartlett Retrieved Learning, from http://www.education.com/magazine LLC NOT FOR SALE-poverty-related-access-care-and-preventive-healthcare OR DISTRIBUTION NOT FOR/article/latchkey-kid SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORLovegrove, SALE M.OR C., Mathew,DISTRIBUTION J., Hampp, C., Governale, L., Wysowski,NOT Safe FOR Kids Worldwide.SALE OR (2012a). DISTRIBUTION New research reveals medications D. K., & Budnitz, D. S. (2014). Emergency hospitalizations for are the leading cause of accidental poisoning deaths among unsupervised prescription medication ingestions by young children today. Retrieved from https://www.safekids.org/press children. Pediatrics, 134(4), e1009–e1016. -release/new-research-reveals-medications-are-leading-cause McDowell, S. E., Ferner, H. S., & Ferner, R. E. (2009). e pathophysi- -accidental-poisoning-deaths-among ology of medication errors:© Jones How and & where Bartlett they arise. Learning, British SafeLLC Kids Worldwide. (2012b). Safe storage,© Jones safe dosing, & Bartlett safe kids: ALearning, LLC Journal of Clinical Pharmacology,NOT FOR 67(6), SALE 605–613. OR DISTRIBUTIONreport to the nation on safe medication.NOT FORRetrieved SALE from https:// OR DISTRIBUTION Mennen, F. E., Kim, K., Sang, J., & Trickett, P. K. (2010). Child neglect: www.safekids.org/research-report/safe-storage-safe-dosing-safe Denition and identication of youth’s experiences in ocial -kids-report-nation-safe-medication-march-2012 reports of maltreatment. Child Abuse & Neglect, 34(9), 647–658. Sharek, P., & Classen, D. (2006). e incidence of adverse events and Miller, S. (2012). Concept-based curriculum to transform nursing medical errors in pediatrics. Pediatric Clinics of North America, education.© Jones Retrieved & Bartlett from http://www.mynursingcommunity Learning, LLC 53(6), 1067–1077.© Jones & Bartlett Learning, LLC .com/wp-content/uploads/2012/04/Considering-a-conceptNOT FOR SALE OR DISTRIBUTION Sherwood, G., &NOT Zomorodi, FOR M. SALE (2014). A OR new DISTRIBUTIONmindset for quality -based-curriculum.pdf and safety: e QSEN competencies redening nurses’ roles in Milligan, K. L., Matsui, E., & Sharma, H. (2016). Asthma in urban practice. Journal of Nursing Administration, 44(10), S10–S18. children: Epidemiology, environmental risk factors, and the Starmer, A,. Spector, N., Srivastava, R., West, D., Rosenbluth, G., public health domain. Current Allergy and Asthma Reports, Allen, A., . . . Landrigan, C. (2014). Changes in medical errors © Jones & Bartlett16(4), 33. Learning, LLC © Jonesaer implementation& Bartlett ofLearning, a hando program. LLC New England Journal NOT FORMishamandani, SALE OR S. DISTRIBUTION (2015). Summit addresses safe drinking waterNOT FORof Medicine, SALE 371(19), OR 1803–1812. DISTRIBUTION doi: 10.1056/NEJMsa1405556 from private wells. Environmental Factor. National Institute of Treyster, Z., & Gitterman, B. (2011). Second-hand smoke exposure Environmental Health Sciences. Retrieved from https://www in children: Environmental factors, physiological eects, and .niehs.nih.gov/news/newsletter/2015/12/spotlight-water interventions within pediatrics. Reviews on Environmental National Center for Children in Poverty. (2016). Basic facts about Health, 26(3), 187–195. low-income children. Children© Jones under & 18 Bartlett years, 2014. Learning,Retrieved U.S.LLC Environmental Protection Agency.© (2017).Jones Air pollution:& Bartlett Current Learning, LLC from http://www.nccp.org/publications/pub_1145.htmlNOT FOR SALE OR DISTRIBUTIONand future challenges. Retrieved fromNOT https://www.epa.gov/clean FOR SALE OR DISTRIBUTION National Resources Defense Council. (2015). Water. Retrieved from -air-act-overview/air-pollution-current-and-future-challenges%20 http://www.nrdc.org/water Wasserman, G. A., Liu, X., LoIacono, N. J., Kline, J., Factor-Litvak, P., Nikolas, M. A., Elmore, A. L., Franzen, L., O’Neal, E., Kearney, J. K., & van Geen, A., . . . Graziano, J. H. (2014). A cross-sectional study Plumert, J. M. (2016). Risky bicycling behavior among youth with of well water arsenic and child IQ in Maine schoolchildren. and© without Jones attention-decit & Bartlett hyperactivity Learning, disorder. LLC Journal of Environmental© JonesHealth, 13 ,& 23. Bartlett Learning, LLC ChildNOT Psychology FOR and SALE Psychiatry, OR 57 DISTRIBUTION(2), 141‒148. World Health Organization,NOT FOR Unit SALE of Radiation OR DISTRIBUTIONand Environmental Quality and Safety Education for Nurses (QSEN). (2015). QSEN Health. (2001, July). Protecting children from ultraviolet radia- competencies. Retrieved from http://qsen.org/competencies tion: Fact Sheet No. 261. Retrieved from http://www.who.int.uv /pre-licensure-ksas /resources/fact/en/fs261protectchild.pdf

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