Nursing Assistant

Safe Environment

Role of CNA in Emergency, Disaster, & Fire Situations Be prepared

– Know emergency codes (STAT)– Fire & disaster plans– Location of fire exits/extinguishers

Remain calm Call for assistance, don’t act beyond level of

knowledge Move residents in immediate danger Remain with resident

Role (cont)

Keep resident comfortable & calm Evacuate resident to safety according to

plans Send family or visitors to the facility

designated area

Ways to help others remain calm

Stay calm yourself, use a calm voice Project confidence Know & use facility emergency plans Stay with resident, keep them

comfortable & quiet Move or direct families to the

designated areas or safe places

Common Emergency Codes

Types– Fire – code red or doctor red– Cardiac arrest – code blue, code 99– Resident safety issue – manpower or a

special alarm sound– Disaster code – disaster level 3

Emergency Call System

Telephone numbers– Numbers within the facility– EMS – licensed nurse dials 911

Remain call, don’t shout fire or arrest STAT – respond at once

General rules for providing a safe environment Use good body mechanics Know policy & procedures regarding safety

laws on use of equipment & handling hazardous materials (OSHA & MSDS)

What are hazardous materials? Wipe up spills immediately, identify wet floors

with signs Walk, never run in halls, watch at intersections Tag & report broken equipment

General rules (cont)

Report unsafe conditions Use 3-pronged plugs on electrical equipment Refuse to do any task you do not know how

to do Watch linens & garbage for safety hazards

(sharps) Report if sharps container is over half full

In case of personal injury

Report injury immediately to supervisor Fill out incident or accident report Seek medical help as necessary Resident safety is an important quality

assurance issue

General measures to provide safe environment Check wrist bands or name tags before

performing any task Use side rails when appropriate Have resident use handrails or assistive devices

when unstable Non-skid footwear when ambulatory Call signal within reach at all times & resident

aware of how to use Lock wheels on bed/wheelchair/gurney Answer call lights promptly

General measures (cont)

Use night lights to help ensure good lighting & reduce obstacle hazards

Keep be in lowest position except when working with the resident

Check bed/chair alarms ensuring working condition

2 top safety issues

FALLS (70% of all accidents)– Proper position in bed/wheelchair &

readjust every 2 hours– Soft protective devices as ordered– SIDE RAILS – watch for arms/legs/tubing.

Make sure they are locked in up position– Brakes on while transferring resident– Comfort items (water, call light, urinal)

within easy reach

Safety Issues

Falls (cont)– Answer call lights promptly– Areas should have good lighting & be free of clutter– Foot latches on beds & foot supports of w/c out of way

to prevent tripping or hitting legs– Wipe up spills promptly– Meet needs quickly (water, elimination)– Use appropriate assistive devices as directed by

licensed nurse– Be aware of resident’s location at all times– More likely to occur when attention is elsewhere

Safety issues

Assistive devices used to reduce falls & maintain safe mobility– Assessed for need by licensed nurse, PT,

or rehab team (imput from CNA)– Types of devices

• Cane – single tip, tri tip, quad cane• Use on strong side• Check rubber tip & appropriate height

Safety issues

Assistive devices (cont)– Walker – provides stability & support

• Pick-up, front-wheeled, four-wheeled• Check rubber tips & height• Give instruction on correct use

– Wheelchair – provides mobility• Different types• Removable arm rests & foot rests• Brake locks on when transferring resident

Safety issues

BURNS – 2nd most common hazard– Types & causes

• Steam or water burns – bathing, hot drinks• Flames – smoking• Chemical – cleaners like peri-wash• Thermal – heating pads, sunburn

– Prevention of burns – best approach• Check water temp, report if too hot• Monitor smoking, hot drinks, & risk for spills• Know how to use equipment like K-pads & hot packs• Protect from sunburn with hat, sunscreen, brief exposure• Know policy & procedure of fire response• Follow directions on use of chemical cleaners

Safety issues

Intervention of burns (initial first aid)– First degree burns –

• Ice & cold water only for discomfort– Never use butter, shortening, etc

– Causes burn to be worse

– Deeper or large burns – immediate attention• Notify licensed nurse immediately• Describe cause of burn if possible

Who is at high risk for accidents?

Fire

Major causes– Smoking is number one cause– Sparks from faulty electrical equipment– Heating systems– Spontaneous ignition– Improper disposal of trash– 3 things needed to start a fire

• Fuel • Flame• Oxygen

Fire can cause both burns & suffocation

Fire prevention

Electrical– Report frayed electrical cords, smoke, or

burning smells– Don’t use too many electrical devices on

one wall socket– Use 3-pronged GROUNDED plugs

Fire prevention

Smoking– Empty waste paper into proper containers– Supervise residents who smoke if their

condition is confusion, lethargic, or weak– Be sure materials in ashtrays are

completely extinguished before throwing away. Always use ashtrays when smoking

– Smoking allowed in designated areas only

RACE – for fire emergencies

R – Remove resident from fire & close the room door

A – Activate the fire alarm system C – Contain the fire E – Extinguish if possible

PASS for fire emergencies

P – Pull extinguisher pin A – Aim S – Squeeze S – Sweep low

Fire emergencies

Make sure that residents are not placed by fire emergency doors– Swing shut automatically

Know & follow facility’s specific policy & procedure

Safety rules for Oxygen use

Oxygen therapy– Abbreviated as O2– Colorless, odorless, tasteless– Essential for respiration– Some residents need supplemental O2– Supplied in portable tanks or through wall outlets– Increases the risk of fire because it supports

combustion & is one of the 3 elements needed for fire

Safety precautions for oxygen “No smoking, Oxygen in use” sign on door & over

bed Smoking is NEVER allowed near oxygen by

ANYONE! Keep tubing open & free of kinks Check electrical equipment use (electric razors,

fans, radios) No flammable liquids (alcohol, nail polish remover,

petroleum based – vaseline, chapstick) Watch for static when combing hair, using WOOL

blankets, or nylon in clothing

Types of oxygen equipment

Green metal portable tanks– Under pressure & must be handled

carefully to prevent dropping & possible explosion when in storage

– Must be secured to wall– On movable stands & strapped in place

Wall outlets – use wall mount flow meter & plastic tubing

Types of oxygen equipment

Portable tanks – Large ones covered with plastic casing & small

ones that resident can carry or hang on assistive devices

– Must be kept upright & not dropped

Equipment used to deliver oxygen– Nasal cannula– Face mask– concentrators

Nursing care for oxygen Dr’s order needed (considered med) Make sure resident wears mask or cannula

– If oxygen needs to be turned off, MUST have an order– When not in use, needs to be turned off (very

expensive & a fire hazard) Follow facility procedures for filling oxygen tanks,

turning tanks off & on, set-up of oxygen Oxygen is very drying

– Check nose & cleanse– Maintain water level in humidifier to reduce dryness

Nursing care for oxygen

Check for redness over ears & on face where tubing rests – report if present

May turn tank on & off, but may NOT adjust oxygen to a lighter flow (med administration, not in your scope of practice)

Postural supports

Used to prevent resident from harming self or others

Used to prevent– Falling out of bed/chair– Crawling over side rails or end of bed– Interfering with therapy by removing tubing

or dressings– Hurting themselves or others

Postural supports

Types– Soft protective device – serves as a reminder to

resident of safety issues (waist device)– Postural supports – devices to help to keep the resident

in the correct postural position when up in a chair (posey vest)

– Restraints – control behavior & are used only in extreme measures like limb devices. Side rails can be considered a restraint

Infringe on resident’s rights to freedom of movement & may be considered “false imprisonment” if used inappropriately

Alternative to device use

Place resident where there is constant supervision

Make sure comfort needs are met (water, toilet, reposition) so that there is a reduced risk of attempting to do unassisted & agitation is reduced

Devices are used as a last resort & NEVER for convenience or as a punishment

Types of protective devices Vest or jacket device – has opening in front, watch

for choking & cutting into resident Wrist or ankle device – soft limb device restricts limb

movement Hand mitt device – prevents scratching & removal of

tubes & dressings Waist device – soft cloth or metal bars that remind

the resident that they need assistance before walking or standing to reduce falls

Pelvic support – keeps resident from sliding down in w/c, wide in front/narrow in back. Watch genitalia

Regulations regarding postural supports Approach in calm manner to reduce

anxiety & agitation during application Explain in non-threatening manner –

“safety” & “soft protective” Use only on resident in bed or chair with

wheels in case of emergency Place resident in good body alignment Pad bony prominences

Regulations

Use quick release bow-tie knots to secure device to bed frame or chair so that you can untie quickly in an emergency

Tie securely, but allow two-finger slack for movement between support & skin

Check circulation, sensation, & movement (CMS) every two hours

Tie support to bed frame NOT side rails Remove support & reposition every 2 hours,

do ROM to joint

Regulations

Offer fluids, bedpan, urinal on a frequent, regular basis. Have call light within reach

Apply vest device with open area of vest in FRONT to prevent choking

Document type of device, reason for applying, time on & off, CMS, effectiveness, & nursing care required

Legal & Psychological implications of postural devices Legal –

– Must have a dr’s order stating reason for use, type of device, & for how long

– Must have informed consent– Cannot restrain unnecessarily or for staff

convenience– Unnecessary restraint can equal false

imprisonment

Implications

Psychological – Explain to resident & family reason for

protective devices– Resident may struggle against devices –

reassure & support resident & family

Bioterrorism

Possible terrorist acts– Biological

• Bacteria or viruses• Toxins

– Chemical– Explosions– Nuclear blast– Radiation

Homeland security advisory system Green – low condition Blue – guarded condition Yellow – elevated condition Orange – high condition Red – severe condition