A nurse is caring for a client who is it at risk for a pressure injury. Which of the following actions should the nurse take?

A) Use hot water so rinse hand sanitizer off:
Using hot water is not recommended when performing hand hygiene with alcohol-based hand sanitizer. Alcohol-based sanitizers do not require rinsing off, as they are designed to evaporate quickly, killing germs as they dry. Rinsing with water, especially hot water, can dilute the sanitizer, reducing its effectiveness. Hands should be left to dry naturally after applying the sanitizer.

B) Dry hands with a reusable towel:
While towels can be used for drying hands after washing with soap and water, they should not be used after alcohol-based hand sanitizers. Alcohol hand sanitizers should be allowed to air dry on the hands. Using a towel could reintroduce contaminants and diminish the effectiveness of the sanitizer. Ideally, hands should be rubbed together until they are dry without the need for any towel.

C) Rub hands together for 20 seconds:
Alcohol-based hand sanitizers are effective in killing germs in a short amount of time—usually within 20 seconds or less. However, the correct technique for using alcohol-based hand sanitizers involves rubbing hands together until they are completely dry, not for a full 20 seconds as one might with handwashing. The important factor is ensuring the sanitizer has covered all surfaces of the hands, including between fingers and around nails, before allowing it to air dry.

D) Rub hand sanitizer around rings on fingers:
Rubbing the hand sanitizer around rings is a necessary step. Jewelry, such as rings, can harbor bacteria or other pathogens, making it essential to ensure the sanitizer comes into contact with areas that are often missed during hand hygiene, like around rings. The nurse should rub the hand sanitizer thoroughly over all surfaces of the hands, including around jewelry, to ensure effective hand hygiene.

A) Notify the facility’s ethics committee:
While it may be relevant to involve an ethics committee in certain complex situations, such as when there are concerns about patient autonomy or ethical decision-making, the refusal of a medication by a client is generally a standard issue that does not immediately require ethics consultation.

B) Return the opened medication in the medication cart:
Returning an opened unit-dose medication to the cart is not appropriate. Once a unit-dose medication is opened, it cannot be reused due to safety concerns (e.g., contamination, dosage errors). The opened medication should be disposed of properly according to the facility's policies for medication handling and disposal.

C) Report the incident to the provider:
The provider should be notified when a client refuses medication, especially if the medication is essential for the client’s treatment or health condition. It is important for the nurse to document the refusal and inform the provider so that appropriate follow-up can be arranged, including possible reassessment of the treatment plan, alternative medications, or further education for the client.

D) Fill out an incident report:
An incident report is typically completed for situations that involve safety issues, errors, or accidents that may affect patient safety or quality of care. While refusal of medication is an important event, it does not generally require an incident report unless it involves an unusual or dangerous situation, such as a medication error or patient harm.