Nursing Assistant Safe Environment. Role of CNA in Emergency, Disaster, & Fire Situations Be...
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Transcript of Nursing Assistant Safe Environment. Role of CNA in Emergency, Disaster, & Fire Situations Be...
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
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