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Pediatric Environmental Home Assessment

 

Nursing Care Plan - Part 3 - Home Safety

 

Pediatric Environment Home Assessment

(PEHA)

________

 

Start Training

 

Training Scenario

 

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Forms

Survey - Part 1

Survey - Part 2

Nursing Care Plan - Part 1

Nursing Care Plan - Part 2

Nursing Care Plan - Part 3

 

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Instructions:  This page represents the third part of the Pediatric Environmental Home Assessment - Nursing Care Plan.  It is designed to help you create a list of actions that need to be taken to address any health hazards that you identified in the Survey. Please complete the form, including the section requesting some limited information about yourself, then click on .  You will get a webpage confirming your form submission.  Please click only once for each form.  If you want to change your information, resubmit it and explain the changes in the Notes Box.  You do not need to complete the forms in the order listed.

 

You have completed the exercise.  Thank you!  The website will send an email to NCHH's Judith Agyeman at jagyeman@nchh.org with your information.  She will review it and get back to you within ten business days if she has any questions.  Please feel free to contact her directly.  If there are questions, it will be helpful if you have saved the form submission as described above. 

 

Hints:

  1. If you are impatient and want to see how you did, click here to download a completed form that we think best matches the scenario. 

  2. If you want to know why an issue is important, click on the Section heading or the text in the left column to get more information. 

  3. If you have problems with the form, contact Susan Aceti at saceti@nchh.org.

We are constantly learning from your feedback.  Please use the "Notes" box in each section to help us understand how to do better and to identify environmental health problems we may have missed.  You are always welcome to send us an email.   

 

 

 

 
Information on Person Submitting Form

 

Name:            

Organization:   

Email:          

Have You Attended Essentials for Healthy Homes Practitioner Course?  

                   If so, what date:    

Did you complete Part 1 & 2 of Survey and Part 1 & 2 of Nursing Care Plan?   

             If yes, provide the date you completed Part 1 of the Survey:  

If you are a nurse, which description fits best?  

             If yes, do want continuing education credits? 

             If yes, do you want an incentive?   

             If you want an incentive, pick one.  

Home Safety

CONCERN

NURSE TO DO

FAMILY TO DO

Renovation / remodeling

   See “Age of Home” above.

   Review items in “Family To Do” column with family.

   See “Age of Home” above.

   If the home was built pre-1978 and there is a child less than six years old:

o     get a lead paint inspection or risk assessment.

o     repair any lead hazards based on state and local regulations and requirements.  Consult with state CLPPP.

   If the home was built pre-1978 and there is no child less than six years old:

o     consult with the CLPPP at your state and local departments of health about lead-safe renovation.

o     Change behaviors, such as modifying dust generating techniques and containing the work area.

 

Will do actions listed above except: 

Will advise family as listed above except: 

Stairs, walls, railings, porches, lighting

   If family owns home, then counsel to change behaviors, such as making minor repairs to fix loose railings.

   If family rents home, then counsel them to talk with their landlord.

   Review items in “Family To Do” column with family.

   If homeowner, then make necessary repairs.

   If renter, then talk with your landlord about needed repairs.  Consider calling the local board of health for possible code violations.

 

 

Will do actions listed above except: 

Will advise family as listed above except: 

Poison control

   Provide national poison control number 800-222-1222 to family. 

   Review items in “Family To Do” column with family.

   Post the national poison control number 800-222-1222 near telephone.
 

Will do actions listed above except: 

Will advise family as listed above except: 

Family fire escape plan

   Counsel to change behaviors, such as develop a family safety plan.

    Get more fire safety information at www.usa.safekids.org

   Review items in “Family To Do” column with family.

   Develop a family safety plan.

   Need to know two ways out of the house.

   Need to have a place to meet after you are outside the house.

   Teach children the family safety plan for escaping your home in a fire and practice it

 

Will do actions listed above except: 

Will advise family as listed above except: 

Electrical appliances

   Counsel to change behavior. 

   Review items in “Family To Do” column with family.

   Do not use electrical appliances near water.

 

Will do actions listed above except: 

Will advise family as listed above except: 

Matches and lighters

   Counsel to change behavior. 

   Review items in “Family To Do” column with family.

   Do not store matches and lighters where children can reach them.

 

Will do actions listed above except: 

Will advise family as listed above except: 

Exterior environment

   If abundant trash and debris, counsel family about waste management.

    If waste containment is the problem, counsel family to talk with landlord.

   See “Infestations” above.

   If the home was built pre-1978, contact the childhood lead poisoning prevention program (CLPPP) at your state and local departments of health for information about chipping, peeling paint.  See “Age of Home” above.

   Review items in “Family To Do” column with family.

   See “Infestations” above.

   See “Age of Home” above.

 

 

Will do actions listed above except: 

Will advise family as listed above except: 

Child Safety

Hot liquids / cleaning supplies / medicines

   Counsel to change behaviors. 

   Review items in “Family To Do” column with family.

   Do not have hot liquids, cleaning supplies, or medicines within a child’s reach.

 

Will do actions listed above except: 

Will advise family as listed above except: 

Lead testing for children less than 6 years old

   If the home was built pre-1978, counsel the family to have the child’s blood tested for lead.

   See “Age of Home” above.

    Review items in “Family To Do” column with family.

 

    Contact the childhood lead poisoning prevention program (CLPPP) at your state and local departments of health about lead testing resources.

    See “Age of Home” above.

 

Will do actions listed above except: 

Will advise family as listed above except: 

Child watched by an adult while in tub

   Counsel to change behavior. 

   Educate family about importance of not leaving children unattended in the tub.

■    Review items in “Family To Do” column with family.

    Do not leave children unattended in the tub.

 

Will do actions listed above except: 

Will advise family as listed above except: 

Hot water temperature

   Educate family about dangers of scalding.

    Review items in “Family To Do” column with family.

     Set hot water temperature to <120 F

 

Will do actions listed above except: 

Will advise family as listed above except: 

Toddler gates

   Counsel family to install non-accordion toddler gates at the top and bottom of stairways.

   Review items in “Family To Do” column with family.

    Contact local injury prevention program to determine whether there are toddler gate resources available.

   Install non-accordion toddler gates at the top and bottom of stairways.

 

Will do actions listed above except: 

Will advise family as listed above except: 

Crib mattress

   Counsel family that crib mattress should fit snugly next to the crib so that there is no gap.

   If two adult fingers can be placed between the mattress and the crib, then counsel the family to immediately replace the mattress.

   Review items in “Family To Do” column with family.

    Put your baby to sleep in a crib with a firm, flat mattress and no soft bedding underneath.

   Ensure that your crib mattress fits snugly next to the crib so that there is no gap.

 

Will do actions listed above except: 

Will advise family as listed above except: 

Window guards

   Counsel family about window safety.

    Contact local injury prevention program to determine whether there are window guard resources available.

   Review items in “Family To Do” column with family.

   Contact local injury prevention program to determine whether there are window guard resources available.

   Install window guards.

 

Will do actions listed above except: 

Will advise family as listed above except: 

Window blind cords

   Counsel family to keep window blind cords out of children’s reach and to purchase childproofing items for cord safety.

■    Review items in “Family To Do” column with family.

   Keep window blind cords out of children’s reach

   Purchase childproofing items for cord safety.

 

Will do actions listed above except: 

Will advise family as listed above except: 

 

 


 

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Phone: 410.992.0712 • Fax: 443.539.4150