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OCCUPATIONAL SAFETY AND HEALTH
Instructions on labor protection when working with those provided by the psycho-neurological boarding school. Full document
Occupational Safety and Health / Standard instructions for labor protection Safe Operation Safety requirements In order to prevent the infliction of physical and moral injuries to personnel and those provided, the personnel must: 1. Upon receipt of those provided, check and seize items that can injure a person or damage the boarding school (cutting, stabbing, flammable substances, blunt objects, electrical appliances, poisonous substances, spoiled food, ropes, etc.). 2. Personnel at work should use only overalls, tuck long hair, remove earrings. Exit of personnel in overalls outside the boarding school is prohibited. 3. All items with which the persons provided can injure the staff, themselves or other persons provided (shovels, mops, spoons, plates, bindings, sharp objects, etc.) after use under the supervision of the personnel must be kept locked and locked. It is forbidden to give sharp objects into the hands of patients. 4. When changing duty, the nurse on duty (nurse), orderlies and orderlies should be assigned to posts and familiarized with the characteristics of the condition and behavior of patients in order to prevent cases of aggression and auto-aggression of patients. 5. Avoid individual contacts with patients. Staying alone indoors:
6. In order to prevent attacks, fights or other excesses between the provided, the latter must be under constant supervision of the medical staff. 7. Only staff on duty should be in the boarding school. Off-duty personnel are not allowed to enter the department. It is forbidden to take the keys to the office premises home, they must be stored in a specially designated place. Carriage keys must be carried with you at all times. 8. Nurses are appointed to the post and are replaced from the post by the nurse on duty, they are strictly prohibited from leaving the post without permission and sleeping on the post. 9. Employees who are seen drinking alcohol on the territory of the APNI, or who come to work in a state of intoxication, are not allowed to continue working, about which an appropriate act is drawn up and transferred to the administration. 10. In case of illness, an employee is not allowed to work and is sent to a medical institution (polyclinic, emergency room of a city hospital) for further treatment. 11. In case of excitement provided, the staff helps each other, and if the measures taken are unsuccessful, they ensure their own safety and the safety of others and call the police squad. 12. In dealing with those provided, the staff shows due patience and self-control, caution, thoughtfulness and gentleness. Establishes contact with the provided and even, calm, sensitive and, at the same time, fair and strict attitude, the same to all provided. Unacceptable: a dry official attitude, obscene language addressed to patients or bringing them too close to oneself, as well as notification of affairs in a boarding school. Rudeness and harshness should be excluded. You can not raise your voice, rude shouting or intimidation of those provided is unacceptable. Loud negotiations in the entire department, quarrels between staff in the presence of patients are unacceptable. 13. Any manifestation of malice, hostility and even aggression on the part of the person being provided should be regarded as a manifestation of a disease state and should not cause a negative or fearful attitude towards him among the staff. 14. Service personnel should always remember the enormous significance of the word when caring for the mentally ill. You can’t laugh at them, make fun of them, because a mentally ill person sometimes does not even understand a friendly joke, but takes all the words in the literal sense, every carelessly spoken word remains in his mind for a long time. 15. In relation to those provided with a dreary mood, indifferent, uncommunicative, absorbed in their experiences (i.e. depressive), one needs to show more attention, gentleness, warmth, sensitivity, because all this, despite the apparent absence of an external reaction, finds a response in his inner emotional experiences. 16. Talking to the beneficiaries is simple: the way we talk in our daily lives. You should not talk to them about personal troubles or grief. You can not discuss the affairs of the department, your grievances against the staff, administration. You cannot seek sympathy from them or turn them against anyone. 17. You should never shy away from talking with the provided. You need to patiently listen to them (even delusional claims, without assenting, but not ridiculing either). At the same time, it is not necessary to maintain the excitement, talkativeness, obsession, verbosity of manic patients; in these cases, it is necessary, under some pretext, to evade prolonged listening. 18. One must be careful with patients suffering from delusional ideas of persecution, because no arguments convince them, and an attempt to prove the patient wrong will only aggravate the situation. 19. You can not enter into a conflict, refute the judgments of patients, prove your case with a sick, irritable, rude voice. In these cases, you need to remain calm, try to switch the patient's attention to something else, distract him or simply shut up, offering to clarify controversial issues with the doctor. 20. In the event of a quarrel or fight between those provided, if possible, you need to separate them, and then report to the nurse on duty, and she to the doctor. In this case, one cannot take sides from those who quarrel. 21. Particular attention should be paid to patients with epilepsy due to their characteristic features - extreme pettiness, accuracy, slowness, malice, which sharply increase when the promise given to them is not fulfilled. 22. It is strictly forbidden to leave in the office provided alone without staff, to show them the medical history, observation diary and other documents. 23. Even with calm secured, one should not show carelessness and weaken vigilance, because at any moment they can become excited and commit dangerous acts. 24. You can not divide the provided into favorites and enemies. 25. When visiting those provided by relatives, there should be no outsiders and provided persons in the visiting room. Information about a visited patient can only be given by a nurse on duty, and in case of claims or complaints from relatives, they must be sent to a doctor or a representative of the administration. It is forbidden to receive any gifts or offerings from relatives. In relationships with relatives, you need to show calmness, tact, goodwill, firmness in matters of care and treatment. 26. Walking is allowed only by a doctor. The medical staff ensures that those provided do not bring objects with which they can injure or injure themselves or others. Those provided are taken out for walks according to the list and also accepted according to the list after the walk, examining them so that they cannot carry rubbish or dangerous objects in their pockets. The walking yard is carefully checked for the absence of dangerous objects before the exit provided. 27. If it is necessary to keep an excited patient in bed, the patient is placed on the bed (with a mattress) on his back, his legs should be straightened on both sides. One or two people stand on both sides of the bed (sometimes more if necessary), two of them hold the patient's hands, fixing the shoulders and forearms, and two hold the legs, fixing the thigh and lower leg. When two nurses are enough to hold, then one holds her hands (having previously crossed them so that the left lay on the right), and the other holds her legs. If the patient, during arousal, tries to hit or hit his head, or bite others, then in addition to fixing his arms and legs, a third person holds his head with a towel, pressing it tightly against the pillow. While holding, it is impossible to intentionally hurt the patient, put pressure on the stomach and chest. In the event that a highly excited patient does not allow approaching him, threatening with any object, he should be approached from behind, holding a blanket unfolded and raised up in front of him, which is quickly thrown over the patient. The patient loses orientation and at this moment he is put to bed and kept according to the rules described above. Arms and legs are fixed with bandages (bandages), which must be sewn from a soft fabric 5-7 cm wide. The bandages are applied to the wrist and ankle joints, but without a tightening loop (for a maximum of 1 hour). The bindings are tightened so that a finger passes between the arm (leg) of the patient and viscous. Having fixed the binding on the legs (arms) of the patient, fix it to the bed net. After fixing the patient, the staff should not leave him unattended: it is necessary to ensure that he does not untie himself, or does not tighten the binding so that the limbs turn blue or turn pale, or use the binding for suicide. 28. When transferring an excited patient from one room to another, the following rules must be observed: a) if the patient is led by one person, then he should approach the patient from behind, take his hands crosswise and walk next to him, with the resistance of the patient, the crossed arms should be raised, thereby weakening the movements of the patient’s shoulders and head; b) if the patient is led by two people (with strong excitement), then each of them takes one arm of the patient and holds it in the wrist and above the elbow joint, the patient's hands are taken to the sides. 29. Measures of physical constraint and isolation are applied only in those cases and forms, and for the period of time when it is impossible to prevent the patient's actions that pose an immediate danger to him or other persons by other methods (by decision of the doctor or nurse on duty), and are carried out under constant supervision of the medical staff. About the forms and time of application of measures of physical constraint and isolation, an appropriate entry is made in the medical documentation (the journal of the transfer of duties by the guard nurses and in the medical history - by the doctor). 30. The performance of household work by the provided is allowed with the permission of a doctor and only under the supervision of an employee of the boarding school or an occupational therapy instructor. 31. In their actions, the staff is based on Art. 5, 7, 11, 12, 13, 16, 28, 30, 33, 34, 37, 39, 41, 43, 44, 46, 47, 50 of the Law of the Russian Federation "On psychiatric care and guarantees of the rights of citizens in its provision". Base:
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