3.02 na role in safety

Understand safety and

emergency care skills

within the nurse aide

range of function.

Unit A

Nurse Aide Workplace Fundamentals

Essential Standard NA3.00

Understand infection control, safety and emergency skills within the nurse aide scope of practice.

Indicator 3.02

Understand nurse aide’s safety and emergency care skills within the nurse aide range of function

3.02 Nursing Fundamentals 7243 1

Nurse aide students must

hold current certification in

HEALTHCARE PROVIDER

BASIC LIFE SUPPORT and

be assessed for skill

retention prior to clinical!

REQUIREMENT:


1 OUNCE

PREVENTION

1 POUND

CURE

PR

EV

EN

TIO

N


The Bottom Line

Prevention, Prevention, Prevention,

Prevention, Prevention, Prevention,

Prevention, Prevention, Prevention.


National Patient Safety Goals

for Long Term Care:

1. Identify residents correctly

2. Use medicines safely

3. Prevent Infection

4. Check residents medications

5. Prevent residents from falling

6. Prevent bed sores

NPSG impacted greatly by Nurse Aide Work


National Patient Safety Goals for Long Term Care:

Identify residents

correctly NPSG.01.01.01

Use at least two ways to

identify residents. For example, use

the resident’s name and date of birth or last four

digits of SS number.



Identify residents


Provide care to right

resident

Use identification bracelets

Ask resident to state name3.02 Nursing Fundamentals 7243 7


Identify residents


Use I.D. systems that involve

photographs

Realize that care to wrong

resident can threaten life



Prevent

Infection NPSG.07.01.01

Use the hand cleaning guidelines

from the Centers for Disease

Control and Prevention or World

Health Organization.



Prevent residents from

falling NPSG.09.02.01

Find out which residents are

most likely to fall. For example, is the

resident taking any medications that might make

them weak, dizzy, or sleepy? Take action to prevent

falls for these residents.


Greater

Risk of

Falls

• Age related factors

• Awareness of

surroundings

• Decreased Vision

• Hearing Impaired

• Decreased ability to

smell

• Decreased sensitivity to

touch

• Immobility

• Medications


Report observations to supervisor that lead you to believe a resident is prone to falling

Preventing Falls


Falls account for 70%of accidents in healthcare facilities

For Your Information


Answer call signals promptly

Keep frequently used articles

within reach of resident

Preventing Falls


Lock brakes on movable equipment

–wheel chairs

–stretchers and mechanical lifts

–beds

–commodes

Preventing Falls


Properly position

residents in:

–bed

–wheel chair

Preventing Falls


OBSERVE NO LIFT OR

LIMITED LIFT POLICIES

TO PREVENT FALLS AND

INJURY TO RESIDENT

AND NURSE AIDE

Preventing Falls


Report any facility structure hazard

immediately that could lead to falls

– frayed carpeting

– loose or broken side rails

– lights that don’t work

Preventing Falls



Prevent

bed sores NPSG.14.01.01

Find out which residents are most

likely to have bed sores. Take

action to prevent bed sores in

these residents. Bed sores will be discussed in Indicator 5.02


GENERAL

SAFETY

RULES3.02 Nursing Fundamentals 7243 20

GENERAL SAFETY RULES

Walk in halls and on stairs -never runKeep to the right-hand side of the hallApproach swinging doors with cautionUse handrails going up and down stairs3.02 Nursing Fundamentals 7243 21


Keep halls and

stairs free of

obstacles

Check labels on all

containers prior to

using contents

Wipe up spilled

liquids immediately3.02 Nursing Fundamentals 7243 22


Pick up litter and place it in

the proper container

Follow instructions of your

supervisor for resident care

Report injuries promptly

Never use damaged or frayed

electrical cords



TAG and TAKE OUT

OF SERVICE!!!!

Report broken or

malfunctioning

equipment

immediately



Check linen for

personal items

contained in folds

prior to sending to the

laundry

Report unsafe

conditions

immediately



Ask for an explanation

of things you don’t

understand

Elevate side rails for

residents at risk of

falling, per facility

policy


FA

CT

OR

S T

HA

T IN

CR

EA

SE

TH

E

RE

SID

EN

T’S

RIS

K O

F IN

JU

RY

Age related

Decreased

strength

Slower movement

Difficulty

maintaining

balance

Tremors that may

affect balance


FA

CT

OR

S T

HA

T IN

CR

EA

SE

TH

E

RE

SID

EN

T’S

RIS

K O

F IN

JU

RY

Awareness of surroundings

Some totally unaware

unconscious

coma

Some suffer from dementia

confused

disoriented3.02 Nursing Fundamentals 7243 28

FA

CT

OR

S T

HA

T IN

CR

EA

SE

TH

E

RE

SID

EN

T’S

RIS

K O

F IN

JU

RY

Decreased vision

Difficulty seeing

objects

In danger of

falling or

tripping

Difficulty reading

labels or

containers


FA

CT

OR

S T

HA

T IN

CR

EA

SE

TH

E

RE

SID

EN

T’S

RIS

K O

F IN

JU

RY

Hearing impaired

– May not hear

warning

signals or

alarms

– May not hear

approaching

equipment


FA

CT

OR

S T

HA

T IN

CR

EA

SE

TH

E

RE

SID

EN

T’S

RIS

K O

F IN

JU

RY

Smell and touch

Reduced smell unaware of smoke or gas fumes

Decreased sensitivity to heat and coldeasily burned


FA

CT

OR

S T

HA

T IN

CR

EA

SE

TH

E

RE

SID

EN

T’S

RIS

K O

F IN

JU

RY

Inability to move independently

Crippling diseases

Arthritis

Paralysis


FA

CT

OR

S T

HA

T IN

CR

EA

SE

TH

E

RE

SID

EN

T’S

RIS

K O

F IN

JU

RY

Medications can:

Affect balance

Reduce awareness

Cause confusion or disorientation

Cause drowsiness

Affect coordination

Make fearful and uncooperative


PREVENTING BURNS

Burns are the

second most

common hazard

to residents


Preventing Burns

• Check water

temperature in

bath or shower

with bath

thermometer or

with your hand


Preventing Burns

Water temperature

should be NO

HOTTER than

105

degrees F


Preventing Burns

• Resident must

verify that the

temperature of

the water is

comfortable or

not.

This is a

little to

warm!


Preventing Burns

• Report areas

where water

temperature

seems too hot

• Monitor

smoking

practices


Preventing Burns

When bathing the resident or

providing a soak,

1) ASK THE RESIDENT TO

FEEL THE WATER

2) AND VERIFY THAT THE

TEMPERATURE OF THE WATER

IS COMFORTABLE TO THEM


Preventing Burns

• Provide assistance at

mealtime to prevent

spilling hot liquids

• Use facility equipment

according to written

policies


Preventing Burns

• Monitor use of

electrical

appliances used by

resident

• Avoid overexposure

to sunlight



PREVENT

POISONING

Preventing Poisoning

• Store toxins in locked cabinets

• Store toxins away from resident

areas

• Never leave toxic products where

they might be ingested


Preventing Poisoning

• Have identifying labels on all

containers

• Never use unlabeled substance


Preventing Choking

• Encourage residents to

use their dentures when

eating

• Assist to cut food into

small pieces

• Report difficulty in

swallowing


Be certain the HOB is

elevated before attempting

to feed a resident!

Prevent Choking


Preventing Choking

Residents with feeding tubes

usually have the HOB

elevated 30-45 degrees.


Be certain the resident

has swallowed before continuing to feed.

Prevent Choking


Preventing Choking

Residents with feeding tubes

should never have the bed flat

for extended periods of time.

Follow instructions regarding

residents’ position to prevent

residents from aspirating.


Preventing Suffocation

• Never leave unattended in

bathtub

• Immediately transport from

areas where smoke or gas

fumes are noticed

• Properly apply and check

vest and safety belt

restraints


Preventing Spread of Microorganisms

Follow Standard

Precautions and

Transmission

Based Precautions.

Wash hands

before and

after care


Preventing Other Injuries

• Move equipment around corners

with caution

• Be careful of residents’ feet,

hands, arms, and elbows when

transporting residents in

wheelchairs



• Monitor residents who

wander away

• Follow instructions when

providing care

• Keep bed in lowest position

except when giving bedside

care



• Use night lights in rooms

• Have residents wear

shoes/slippers with non-

skid soles

• Check crutches, canes and

walkers for non-skid tips



• Keep call signal within

easy reach

• Report immediately any

observations indicating

resident is a danger to

himself or others.


BODY

MECHANICS3.02 Nursing Fundamentals 7243 56


There is intentional repeat of some HSII course

content in Nursing Fundamentals.

Academic and skill competence must be

maintained at a very high level for direct

resident care.

Repeating course content distributes learning

over time and increases long term memory.


Body Mechanics

• Body mechanics: the coordination of body alignment, balance and movement

• Job requirements for nurse aides include lifting, moving and transferring resident and lifting, moving and carrying objects


Body Mechanics

• Purpose of Good Body Mechanics

–Maximize strength

–Minimize fatigue

–Avoid muscle strain

and injury

–Assure personal and

resident safety


Body Mechanics

• Never bend over from waist to pick up object

• Lift firmly and smoothly

• Keep object close to body

• Keep back straight


Body Mechanics

• Bend at hips and knees

and get close to object

prior to lifting

• Grip objects firmly with

both hands

• Lift by pushing up with

strong leg muscles3.02 Nursing Fundamentals 7243 61

Body Mechanics

• Get help if object or

resident appears too heavy

• Keep feet apart to provide

wide base of support

• Pivot or turn with feet


Body Mechanics

• Use short steps to turn

• Turn entire body without

twisting back and neck

• Pull or push when

possible instead of lifting

• Use body weight to help

push or pull


Body Mechanics

• When reaching for an object, evaluate distance

• Face in direction you are working to prevent twisting


Body Mechanics

• Adjust beds to waist level when giving resident care

• Be sure body is in good alignment at all times


FIRE

SAFETY3.02 Nursing Fundamentals 7243 66


There is intentional repeat of some HSII course

content in Nursing Fundamentals.

Academic and skill competence must be

maintained at a very high level for direct

resident care.

Repeating course content distributes learning

over time and increases long term memory.


Fire Safety

Everyone is responsible for

preventing fires

If fire occurs, know what to do


Fire Safety

• Major fire hazards

–faulty electrical

equipment and wiring

–overloaded electrical

circuits

–plugs not properly

grounded

–clutter - paper/rags3.02 Nursing Fundamentals 7243 69

Fire Safety

• Major fire hazards (continued)

–unsafe practices when

oxygen is in use

–smoking

–spontaneous combustible

materials


Fire Safety

• Elements necessary to

start fire

–fuel - material that

will burn

–heat - flame or spark

–oxygen


Fire Safety

• Fire safety activities

– Locate and learn

• escape routes and fire escapes

• use of all fire control equipment

–fire doors

–sprinkler system controls

–fire extinguishers

• fire drill procedures3.02 Nursing Fundamentals 7243 72

Fire Safety

• Fire Safety Activities

– Be aware of all fire

hazards and report

them immediately


Fire Safety

• Watch for frayed electrical wires

• Never overload circuits

• Use three-prong grounded plugs

• Never use extension cords

• Control clutter


Fire Safety

• Dispose of rags properly

• Empty ashtrays in metal containers

• Empty wastebaskets in proper receptacles

• Report odors of smoke or burning

• Keep fire exits clear


Fire Safety

• Control smoking practices:

– limit to specific areas

– never allow smoking in

bed

– have large ashtrays

available


Fire Safety

• Control smoking practices:

– observe use of

matches/lighters

– directly supervise

residents when

smoking, as necessary


In Event Of Fire

Stay calm as you

RACE3.02 Nursing Fundamentals 7243 78

R A C E

Remove residents from

IMMEDIATE DANGER;

otherwise, DEFEND IN PLACE


R A C E

Activate the ALARM


R A C E

Confine the fire

Close all windows and doors

Choke off oxygen


R A C E

Extinguish if you can

Empty the extinguisher3.02 Nursing Fundamentals 7243 82

Use of Fire Extinguisher

• Carry upright then PASS

• Pull the safety pin

• Aim at the base of the fire

• Squeeze handle down

• Spray in a sweeping motion at base

of fire

FIRE


R A C E R

Relocate residents per

evacuation policy if

directed to do so.

Some agencies teach RACE plus an addition “R”


R A C E R2

Remember these

important Guidelines:G Shut off air conditioning

G Shut off oxygen

G Shut off lights

G Never use elevators3.02 Nursing Fundamentals 7243 85

OXYGEN

SAFETY3.02 Nursing Fundamentals 7243 86

Oxygen Precautions

• Oxygen precautions

– Never have open flames or smoking in area

– Remove flammable liquids from area

– Do not use electrical equipment in area


Oxygen Precautions

• Oxygen precautions

– Post “Oxygen in Use”

sign

– Remove cigarettes and

matches from room

– Use cotton blankets

and clothing


Oxygen Precautions

DO NOT LET THE

RESIDENTS’ NASAL

CANNULA TOUCH THE

FLOOR. Pathogens on the

floor will contaminate the

cannula.3.02 Nursing Fundamentals 7243 89

DISASTERS /

CATASTROPHES


Disaster / Catastrophe Types

• Natural origin

–flood

–earthquake

–hurricane/tornado


Disaster / Catastrophe Types

• Human disasters

–airplane/bus/train

accidents

–explosions

–nuclear waste

accident

–blackouts


Workplace Violence… a potential Disaster!


Healthcare is impactedby verbally and sometimes physicallyabusive patients, families and visitors.


Verbal abuse often goes unreported and is thought to be “just part of the job”.

70% of Nurses are assaulted on duty during their career.

The majority of healthcare worker violence takes place on evening and night shifts.

OSHA [1996]. Guidelines for preventing workplace violence

for health care and social service workers. Washington, DC: U.S. Department of Labor,

Workplace Violence… a

potential Disaster!


Stop this PowerPoint and view the PowerPoint produced by Vanderbilt

University Medical Center.

Then, return to this PowerPoint.

Disaster Plans

Facilities are required to have disaster plans


Disaster Plans

• Responsibilities in a disaster

– Remove residents from immediate danger

– Report to facility and follow directions for your role

– Know your facility’s disaster plan

– Assist with evacuation


Disaster Plans

–Help remove and secure equipment, supplies, and records

–Think before you act; don’t waste time

–Remain calm

–Carry out responsibilities in confident manner


MEDICAL

EMERGENCIES


The Choking Resident


The Choking Resident - Cause

Choking occurs when

the throat is blocked

or closed up and air

cannot get to the

airway.


The Choking Resident

Airway may be blocked by:

–Food or liquids (meat

most common food)

–Blood or mucus

–Foreign objects

including the tongue

–Vomitus


Treating a Choking Resident

– Stay near

– Encourage coughing - most effective way to dislodge obstructions

– Never slap coughing resident on back: can cause object to fall lower into trachea

If victim is coughing, do not intervene:



Signs of severe foreign body airway obstruction

–Unable to speak

–No air movement

–Grasping throat -distress signal

Abdominal thrusts, chest thrusts and back blows are effective for relieving severe foreign body airway obstruction.



Tilting head back in

unconsciousperson may clear

airway since this pulls

tongue forward



SKILL 3.02AForeign Body Airway Obstruction

(FBAO) Relief: Conscious Resident

Training Lab AssignmentEngage in the Skill Acquisition Process for:

Heart Attack - Signs and Symptoms

• Chest discomfort

–pressure, fullness, squeezing, or pain

–in center of chest behind breastbone or spread to either shoulder, neck, jaw, or arm

–usually lasts longer than a few minutes – comes and goes


Heart Attack - Signs and Symptoms

• Fainting

• Sweating

• Nausea

• Shortness of breath


Accident/Emergency Scene

• If certified in CPR, offer assistance

• Defer to those with more experience

and training



• Seek assistance

–in facility

• use emergency light

• use call signal

• send another resident

for help

• call for help



• Seek assistance –at home or at accident scene

• dial 911 operator or emergency number

• give location

• give phone number

• relate type of emergency

• give number of people needing help

• relate requested information


Cardiopulmonary Resuscitation

• Agencies providing CPR

curriculum:

–American Heart Association

–American Red Cross



• You must be trained to administer

CPR

• Activate the emergency medical

system or your facility’s emergency

plan



• CPR must be started immediately to

be effective

• Follow facility policy for Advanced

Care Directive



• Methods of administering CPR

–one-person CPR

–two-person CPR


Convulsive Disorders (Seizures)

• Causes:

–infectious disease

–omitted medication

–head injury

–stroke

–seizure syndrome



• Types

–Partial

–General

• Tonic-clonic (grand mal)

• Absence (petit mal)

–Unclassified



Take Action

• Summon help

• Stay with resident



Take Action

• Protect from injury

–lower to floor if appropriate

–move objects away that might

cause injury

• Do not restrain or put any object

into mouth



Take Action

• Loosen constricting

clothing (around neck)

• Place pillow under head

and turn face to one side

• Note time and type of

seizure



Take Action

• Provide rest for resident after

seizure

–very tired

–may be confused

–often disoriented


Loss of Consciousness – Fainting

• Caused by temporary

reduction of blood to

brain



• Early signs and symptoms:

–dizziness

–decreased pulse and BP

–pallor and perspiration

–nausea

–cold skin

–numbness and tingling of extremities



Take Action

• Summon help


• Have resident sit or lie down

• Loosen tight clothing

• Position head lower than heart

–sitting - head between legs

–lying down - elevate legs



Take Action

• Monitor pulse and respirations

• Have resident rest for 5-10

minutes before moving

• Provide blanket if cold


SHOCK – Causes

• Severe injury

• Excessive loss of body

fluids

• Pain

• Respiratory and/or cardiac

arrest

• Anxiety


• Low or falling blood pressure

• Weak, rapid pulse

• Cold, moist, pale skin

• Rapid respirations


SHOCK – Signs and Symptoms

SHOCK – Signs and Symptoms

• Thirst

• Restlessness

• Confusion and loss of consciousness


SHOCK – Take Action

• Summon help


• Keep resident lying

down

• Control hemorrhage

• Keep resident warm


Hemorrhage

•Types

–Internal

–External


Hemorrhage

• Signs and Symptoms– Internal

• pain• shock• vomiting blood• loss of

consciousness– External

• can usually be seen


Hemorrhage – Take Action

• Internal

–Summon help

–Stay with

resident

–Keep warm,

flat and quiet

until help

arrives



• External

–Summon help

–Stay with resident

–Identify location of bleeding

–Apply continuous, direct

pressure over bleeding



• External

–If bleeding not controlled, apply

pressure over artery above

bleeding site

–If no pain or broken bones,

elevate wounded area above heart

while maintaining pressure



• External

–keep resident

comfortable,

warm and quiet

until help

arrives


Reporting Emergencies

• Never panic; remain

calm

–Try few slow deep

breaths

–Observe surroundings

–Assess resources

available



• Evaluate situation

–check victim

–determine safety of

environment

• Call or send for help immediately

• Determine treatment priorities



• Report emergencies accurately

–If help is not available, contact:

• 911 or emergency number

• Police

• Fire department

• Telephone operator

• Local EMS



–Name

–Location

–Descriptionof scene

–Information about injuries

–Type of help needed

–Number of people needing help

• Report emergencies accurately

by stating:



• Know your limitations

• Provide care and reassure victims

• Keep bystanders away from victims


Understand safety and emergency

care skills within the nurse aide range

of function.

141

END

3.02

3.02 Nursing Fundamentals 7243

Education

3.02 na role in safety