Long-Term Care Survey Alert

If you haven't taken these measures, your residents could be in harm's way.

A poisoning can be just a hand-reach away for a resident with dementia, so take steps in time to prevent a potentially lethal accident and surefire IJ tag.

Start by doing a careful risk-hazard assessment of each area of the facility through the eyes of an inquisitive resident who might be attracted to colorful or flavored toxic items. In that regard, an arts and crafts room may be an accident waiting to happen if staff don't supervise residents closely and store materials safely out of reach.

Case in point: One elderly resident doing artwork drank a substantial amount of the lead-based pottery glaze, reports Karen Simone, PharmD, DABAT, managing director of the Northern New England Poison Center in Portland, ME.  "The nursing home rushed her to the hospital by ambulance and the hospital had to giver her a chelating agent to help remove the lead from her system," she says.

A resident's bathroom can also harbor potential poisons that staff might not recognize as such. For example, "many of the mouthwash preparations are brightly colored and have a pleasant taste," says Guy Soo Hoo, MD, MPH, in Los Angeles.

Beware: Some mouthwash preparations have as much as 27 percent alcohol by weight and therefore can be quite potent when an adult drinks even four ounces or more, says Soo Hoo. Certain aftershave lotions have even more alcohol than mouthwash preparations, he cautions.

Sometimes an undetected cognitively intact alcoholic resident will drink mouthwash, says Simone. "Facilities should do a good assessment of residents at admission to identify any potential alcohol or substance abuse issues," she advises.

Risk management tip: Facilities can obtain mouthwash without alcohol, adds Simone.

Do a Safety Sweep

Work with the area poison center to identify cleaners that aren't as toxic or corrosive, advises Simone.

Top of the danger list: Drain cleaners used to dissolve hair clogging drain pipes can result in catastrophic injury if swallowed. Facilities that use these cleaners should have strict policies to prevent residents from getting hold of them, warns Simone.

Toilet bowl cleaners that you put in the bowl and swish around are more toxic than the ones that flush into the bowl, she says.

Unlocked cabinets or closets containing cleaning supplies can be a poisoning and serious F tag waiting to happen.

Checking to see that these are locked at all times is everyone's responsibility--not just maintenance and housekeeping, says Roberta Reed, RN, MSN, NHA, a survey expert in Cleveland.

Also, don't use communal bathrooms for storing hygiene or cleaning supplies, suggests Reed.

Poison-Proof Med Carts

"Medication carts can be a source of poisoning if facilities aren't vigilant," warns survey and management expert Eleanor Alvarez, who reports she's seen a resident reach on a med cart and grab whatever was within reach. "All she got was a cup of applesauce, but the hand sanitizer was a couple of inches from her grasp," relays Alvarez, president of LeaderStat in Westerville, OH.

Instruct nurses on the procedure for locking the cart any time they aren't standing at the cart or have it directly within their vision, advises Gross. "Everyone should watch the medication cart to make sure it's attended," she adds. "Also, nurses should never pre-pour medications and leave them on top of the cart."

Editor's note: Read how to define and manage an accidental poisoning in the February 2006 Long-Term Care Survey Alert.