Environmental and CNA Safety p. 218

MOD D

Environmental Safety• Encompasses the entire facility: pt rooms, hallways, all departments

• Includes:

• temperature

• air circulation

• light

• Cleanliness

• noise control

• walls/ceilings/floors

• plumbing

• electricity

• equipment

• furniture

Patient Environment• Private rooms: only 1 bed

• Semi-private rooms: 2 beds

• Wards: more than 2 beds

• Basic patient unit/ what’s in a patient’s room

• Hospital bed w/ rails

• Bedside table for: wash basin, emesis basin, bedpan, urinal, soap, towels, toothbrush etc. –what goes

where?

• Chair

• Reading lamp

• Waste basket

• Overbed table

• Signal cord (call bell)

Hospital Beds p.219• Electric or manual (see Figures 14-3 and 14-4)

• Can be raised up high (to save your back during care), need to go back into lowest position before leaving the

room

• Have wheels – ALWAYS have the wheels of the bed locked unless you move the bed

• Head of bed (HOB) can be elevated

• Legs can be elevated

• Side rails: protect pt from falling, but can be considered restraints – check your facilities' policies!

Usually, the 2 top rails by the head are up; all 4 rails are considered a restraint and need to be ordered

by MD

• Provide handle for pt to turn, reposition, get in and out of bed; Provide a feeling of security

• Reduce risk of falling out during transport

• Access to bed/TV controls sometimes in side rails

• Risks: strangulation, suffocation, death, injury, skin tears, bruises, feeling trapped, loss of independence

• Always: check if secure, down only when bed is in lowest position, do not attach any restraints or pt tubes (IV, catheters,

feeding tubes etc) to rails

Temp, Air, Light, Cleanliness, Noise Reduction• Best temperature is between 71-81 F, but think of pt preference and facility policy

• Use screens or curtains to shield pt from drafts

• Often pt rooms have their own AC and can be adjusted individually

• Lights: usually there are several lights, one directly overhead, one reading, one night light

• Indirect light is better to prevent glare

• Consider pt preferences especially at night, but you always have to have enough light to perform your tasks

safely

• Cleanliness: make sure clean and soiled items are separated in pt room: ex. Toothbrush not in same

drawer as bed pan!

• Keep trans can lids closed, bio-hazard waste only goes into red bags, bag soiled items in a plastic bag and

discard

• Keep work area neat, return equipment to where it belongs, check room before leaving

• Things on pt’s bedside table: fresh water/ice pitcher, cups, tissues, straws – all within reach!

• Noise: speak quietly, report squeaky equipment, no banging on things, TV is for pt-not for you

Safety Measures p.222• EVERYONE is responsible for safety – that means YOU!

• Incident – an accident that occurs in a health care facility; any unexpected event that interrupts

normal procedures

• Incident report – Report filled out by the nurse after collecting information from everyone

involved, use only objective findings!!! see figure 14-7 p. 223

• Prevention is key!

• Know your job and follow all safety policies and procedures

• Maintain a safe environment

• Know your patients and use safety measures accordingly – consider

• Confused pt who climbs out of bed – side rails up?

• Dementia patient – his razor open on the bedside table?

• 3 year old – flowers in the room?

Environmental Safety Conditions

• Prevention is key

• Keep all carts, WC, equipment on one side of the hallway

• Report anything not working/functioning right, ex:

• Burned out light bulbs, non-working light switches or electrical outlets

• Any leaks

• Plumbing issues, ex. Faucets not running properly, water too hot or not warm enough, backed up

bathrooms - water temperature should not exceed 120F; most people feel comfortable between 95-

105F

• Loose or missing floor or ceiling tiles

• Windows: do not open/close, cracks, broken

• Temperature not controllable

Equipment

• Concurrent cleaning – daily cleaning of equipment

• Spills must be mopped up immediately to avoid falls – that’s you!

• Report broken/non-functioning equipment, ex:

• Lost screws, frayed straps, loose wheels, broken control knobs, non-working latches, wobbly side rails,

faulty brakes, frayed electrical cords

• If call light is mal-functioning

• Dispose of sharps properly – in puncture proof sharps container! Do not re-cap, bend or break off

needles

• Broken glass: use gloves, use forceps, use brush/broom/dustpan – NEVER your hands

• Know your contaminants

• Mechanical lifts: always inspect before use: legs open/close, raises/lowers, straps/chains, sling, leaking

hydraulic fluid?

• Proper storage for equipment, don’t block anything, don’t store boxes on the floor

Fire Safety p. 226

• Heat + Fuel + Oxygen = Fire

• Know and practice fire and evacuation plans for your facility:

• Fire drills

• Know where things are: Fire alarms, Extinguishers, Sprinklers, Fire doors, Fire escapes

• Look for possible fire hazards and report immediately

• Fire Hazards examples:

• Frayed electrical cords

• Overloaded circuits – extension cables etc

• Ungrounded plugs

• Accumulated clutter

• Improper oxygen therapy, oxygen tank storage

• Uncontrolled smoking

• Matches, lighters with unauthorized people

Fire Prevention

• Check cords for fraying, don’t overload circuits, only use grounded plugs

• Remove clutter, use proper waste receptacles

• Report smoke and/or burning smell

• Keep fire exits clear

• Know and practice fire drill safety

• Do not let visitors give cigarettes to patients!

• Smoking: is not permitted in the facilities for anyone; smoking facilities are usually outside the

building, away somewhere. MD needs to clear pts for smoking and to go to the smoking facility.

Pts can not have any smoking related articles (lighter, cigarettes, candles etc) in their rooms.

They are kept at the nurse’s station and available to the patient during the smoking cession only.

RACE and PASS p. 227-228

• Figure 14-13!!!

• R= Remove pt; move pt to safety

• A= Alarm; use intercom/emergency signal, phone, fire alarm – follow policy

• C= Contain fire; close windows/doors; check doors for temperature before opening them

• E= Extinguish or evacuate area

Keep calm, shut off AC and other electric equipment, shut off O2, use stairs, close all doors, remove

anything that could burn from hallway

• How to use a fire extinguisher:

• P= Pull the pin

• A= Aim the nozzle at the BASE of the fire

• S= Squeeze the handle

• S= Sweep back and forth along base

Oxygen Precautions p.227

• Oxygen is highly flammable! O2 is considered a medication and needs to be prescribed by a MD

• Do not adjust the amount of O2 given, that’s the nurse’s job (medication)

• No smoking or any open flame in the same area; avoid sparks

• No flammable liquids like nail polish, aftershave, hair spray, oils, alcohol

• No electrical equipment while on O2 like hair dryers, razors, heating pads, radios

• Post a sign that O2 is in use

• Use cotton blankets/gowns

• Store O2 bottles upright, use the correct adaptors and plugs

• Report a leaking O2 cylinder ASAP, do NOT move it, it may become a projectile; remove pt

from room and report

Other Emergencies

• Disasters, Tornadoes, Hurricanes, Floods, Earthquakes

• Each facility has procedures in place for the most likely emergencies, know them

• Tornadoes:

• Follow instructions

• Pt’s brought to lowest level of building or safe-zone

• Away from windows

Workplace violence p. 229

• Any physical assault, threatening behavior or verbal abuse in or around the workplace

• Can be committed by strangers, patients, coworkers, personal acquaintances (anyone)

• Causes in health care facilities may include prevalence of weapons, mentally ill pts, drug/alcohol abuse

pts, distraught family members, poor lit parking lots, failure to report suspicious individuals etc

• Violence prevention p. 230!!

• Follow facility policies and procedures

• Don’t prop open doors that should be locked, don’t disable alarms

• Don’t share security codes, keep keys save

• Report assaults or threats STAT to the nurse

• Avoid wearing: scarves, necklaces, earrings, hair long etc

• Don’t bring valuables or lots of cash to work

• Use buddy system, or have security bring you to your care if no-one else is leaving, especially at night

• Keep an exit open, remember stay between aggressive pt and door

Dealing with a Violent Individual p. 231• Stay calm, don’t raise your voice

• Speak slowly, softly, clearly

• Call for help if possible

• Move away from anything that could be used as a weapon

• Check your body language

• Don’t stand right in front of person, keep 3-6 feet distance

• Position yourself so exit is accessible

• Avoid sudden movements

• Listen

• Avoid arguing

• Ask the person to leave

• Ask questions to regain control

• Avoid challenging, bargaining or making promises you can’t keep

• Don’t touch

• If he/she is holding a weapon, ask her/him to put it down, away from you. Do not grab for the weapon!

CNA Safety p. 230

• Ergonomics – adapting environment and using equipment and techniques to prevent injury

• Risk factors for injury:

• Performing same motion over 2-4 hours

• Fixed/awkward posture for more than 2-4 hrs

• Forceful hand exertions for more than 2-4 hrs

• Unassisted heavy lifting for more than 2-4 hrs

• Ergonomic techniques to prevent injury:

• Use correct body mechanics

• Raise beds to comfortable working heights

• Use mechanical lifts if necessary

• Use back supports if required or preferred

• Get help!

• Use a cart to move heavy equipment

8 Commandments for lifting p. 232

1. Plan your lift, test the load

2. Ask for help

3. Get firm footing

4. Bend your knees

5. Tighten your abdominal muscles

6. Lift with your legs

7. Keep load close to your body

8. Keep your back upright

Figure 14-17 !!!!!

Work Environment Hazards p. 232

• OSHA: Occupational Safety and Health Administration: employee safety; Employer has to

• have MSDS for each hazard at the workplace and tell employees where they are

• inform employees what kinds of hazards there are in the workplace and where they are

• Inform employees how to read and understand chemical labels and hazard signs

• Inform employees what type of PPE has to be worn

• Inform employees on how to manage spills/where clean up equipment is

Health care facilities have to keep all chemicals in locked cupboards

• MSDS: Material Safety Data Sheets: provide information about hazards like chemicals, ex:

• What precautions to take

• Safe use

• Clean up and disposal

• First aid measures

Homework

Read Unit 14 in Textbook

Read p. 87 in workbook: Unit Summary, Nursing Assistant Alert,

Workbook p. 87: Completion questions 1-24