Unit 8
A number of environmental nursing home risks can pose dangers to the health and safety of both residents and staff members. In order to reduce the occurrence of environmental nursing home risks, state and federal nursing home laws require that facilities provide safe, comfortable, and sanitary environments. Facilities must pass annual safety inspections that are aimed at decreasing environmental nursing home risks and increasing overall resident quality of life.
Situations or conditions of the body that can influence safety is the following:
Confusion or forgetfulness
Impaired mobility
Sensory impairment
Vision
Hearing
Diminished sense of touch and temperature
Diminished sense of smell and taste
Side effects from medications
Falls, typical incidents among older adults in the nursing home, are associated with debility, functional impairment, and mortality. Falls resulting in injury and medical complication have proven to be costly, and once the elderly fall, they develop a fear of falling again. This fear reduces movement adding the risk of developing a co-morbid condition such as pressure injury, pneumonia, and depression related to feelings of isolation. Falls thus affect the quality of life among older adults.
Safety precautions to prevent falls should include:
Clothing - trip hazard,
Resident room - lighting, space an organization
Personal items in reach
Answer call light promptly
Provide clear walking path
Adequate light
Clear of spills
Electrical devices properly used
Use bed rails properly and as care planned - most all LTC do not use bedrails due to injuries and restraints.
No throw rugs.
Use brakes on chairs/beds/lifts
In hallways - handrails and corners
Encourage handrails to be used
Keep hallways free from clutter
Toileting- assist resident - keep close by if care planned
Report hazards promptly
After a fall- never help a resident up before a nurse can properly assess them for injuries!
Safety precautions to prevent burns
Provide mealtime assistance
Water temperature
Never change the water temperature while it is flowing over the resident! Always remove the water, wait for the temperature to adjust and test it on yourself before placing it back on the resident
Monitor residents while bathing
Monitor residents’ activity when they are cooking.
Assist with smoking
Heat/Cold pads- watch for redness every 5 minutes. Should not be left on for more than 20 minutes. 20 minutes on 20 minutes off.
Safety to prevent electrical injury
Lock Out/Tag Out is a common practice in most nursing homes. They should be providing a box full of lock-out devices that can be used to cover outlets, light switches, or plugs to prevent their use in case they prove to be disfunctional or at risk for short circuiting or causing a fire. A "tag" is then filled out to report the disfunctional device to maintenance for repair. Only maintenance is allowed to remove these devices, so if the CNA comes across a locked out device they should not remove them and use the equipment anyway. If a CNA notices that an electronic device is smoking, sparking, or otherwise malfunctioning, they should themselves report it to the nurse and then lock the item out using the lock out/tag out method.
Report malfunctioning equipment
Most facilities do not allow heat-causing devices, extension cords, electric blankets, or electric heating pads
Follow facility policy for electrical safety.
Safety precautions for chemicals
Assume that an unlabeled bottle or container contains harmful materials. Do not use.
Labels should include instructions
Lock up harmful substances
MSDS- Materials Safety Data Sheets- this is a three ring binder filled with a page for every single chemical found in the building. On these sheets safety information including what to do in case of ingestion, skin contact, or spills can be found. Everything from hand soap, lotion, and nail polish remover to caustic cleaning agents, laundry detergent, and bleach should be included in the MSDS book. Keep this in mind when admitting residents and doing inventories on their belongings as their possessions must also be included.
Safety precautions for choking
Present food and liquids to resident as care planned (thickened liquids? mechanical soft?)
Observe for choking
There should always be a staff member present in the dining room during meals
Know how and when to perform abdominal thrusts
Safety precautions for O2
Post signs for rooms where oxygen is in use
Limit situations that might start a fire
No smoking or open flame
Check with nurse before using any electrical equipment
Remove oxygen before using an electric razor or hair dryer
Follow facility policies and care plan
Observe O2 flow rate
Secure O2 tanks properly- use dolly for transporting
Safety precautions when a fire is discovered
Most people think the danger from fire is the flames, however, it is the smoke that can travel quickly to areas far from the fire. It is important to realize that people living in nursing homes may not be able to evacuate because of mobility or other disabilities. Proper planning, training, and practice of all staff are essential in order to provide for the safety of residents. It is important for staff to know that patient safety is their number one priority.
Follow facility’s emergency plan.
Rescue, Alert, Confine or Contain, Extinguish or Evacuate R.A.CE.
Pull pin, Aim toward the base of the flame, Squeeze the handle, Sweep spray from extinguisher from side to side. P.A.S.S.
Evacuation
Every facility should have written fire procedures that are understood and practiced by all staff. Staff should be responsible for knowing and carrying out their part of the plan. That includes doctors, nursing staff, kitchen staff, maintenance, volunteers, and others.
Response procedures should be practiced regularly
There should be a clear "code word" agreed upon beforehand for the facility to alert other staff in case of fire.
Use resident beds and wheelchairs
Follow facility policy for evacuation
Safety measures for tornado
You should be trained on your facility's plan. All nursing care communities should have written procedure and do drills frequently throughout the year. Know your part to getting residents to safety! Have a weather radio or TV on to keep informed.
Safety emergency plan
Flood, chemical spill, violence, prolonged power outage, and prolonged disruption of water supply. Know your facilities emergency plans BEFORE an emergency occurs!
Elopement
In nursing homes and other long-term care facilities, an elopement is a form of unsupervised wandering that leads to the resident leaving the facility. This endangers the resident immediately and can result in serious injury, or even death, depending on circumstances such as the location of the facility, the time of year, how long it takes staff to recognize the resident is missing, and how long it takes to find the resident.
Most facilities use a keypad to secure exits. Confused residents usually never think to enter a combination on a keypad and the doors will set off an alarm if they are opened without the proper combination. In addition, residents with confusion and are mobile enough to make it out the door on their own are usually fashioned with a wander guard, which is a bracelet that will set off an alarm if they near an exit or if the door opens while they are in the vicinity. If the elopement alarm goes off it is imperative that a staff person responds immediately.
Remember to use validation therapy when approaching a resident that has eloped. Staff should ensure that they are viewed as a friendly presence there to help, not a hysterical stranger trying to force them back into the building. If they trust the staff member then they will allow them to walk with them until they can be creatively persuaded to return to the facility.