Nursing Assistant

1. Nursing Assistant Safe Environment

2. 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

3. Role (cont) • Keep resident comfortable & calm • Evacuate resident to safety according to plans • Send family or visitors to the facility designated area

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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?

18. 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

19. 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

20. 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

21. 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

22. PASS for fire emergencies • P – Pull extinguisher pin • A – Aim • S – Squeeze • S – Sweep low

23. Fire emergencies • Make sure that residents are not placed by fire emergency doors • Swing shut automatically • Know & follow facility’s specific policy & procedure

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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)

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. Implications • Psychological • Explain to resident & family reason for protective devices • Resident may struggle against devices – reassure & support resident & family

39. Bioterrorism • Possible terrorist acts • Biological • Bacteria or viruses • Toxins • Chemical • Explosions • Nuclear blast • Radiation

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