Transcript NF3.02_NA_role_in_safetyy.pot

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
Understand safety and
emergency care skills
within the nurse aide
range of function.
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REQUIREMENT:
Nurse aide students must
hold current certification in
HEALTHCARE PROVIDER
BASIC LIFE SUPPORT and
be assessed for skill
retention prior to clinical!
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PREVENTION
1 POUND
CURE
1 OUNCE
PREVENTION
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The
Bottom
Line
Prevention, Prevention, Prevention,
Prevention, Prevention, Prevention,
Prevention, Prevention, Prevention.
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National Patient Safety Goals
for Long Term Care:
1.
2.
3.
4.
5.
6.
Identify residents correctly
Use medicines safely
Prevent Infection
Check residents medications
Prevent residents from falling
Prevent bed sores
 NPSG impacted greatly by Nurse Aide Work
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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.
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National Patient Safety Goals for Long Term Care:
Identify residents
correctly NPSG.01.01.01
 Provide care to right
resident
 Use identification bracelets
 Ask resident to state name
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National Patient Safety Goals for Long Term Care:
Identify residents
correctly NPSG.01.01.01
 Use I.D. systems that involve
photographs
 Realize that care to wrong
resident can threaten life
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National Patient Safety Goals for Long Term Care:
Prevent
Infection NPSG.07.01.01
 Use the hand cleaning guidelines
from the Centers for Disease
Control and Prevention or World
Health Organization.
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National Patient Safety Goals for Long Term Care:
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.
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• Age related factors
• Awareness of
surroundings
• Decreased Vision
• Hearing Impaired
• Decreased ability to
smell
• Decreased sensitivity to
touch
Greater
Risk of
Falls
• Immobility
• Medications
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Preventing Falls
Report observations to
supervisor that lead
you to believe a
resident is prone to
falling
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For Your Information
Falls
account for
70%
of accidents in healthcare facilities
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Preventing Falls
Answer call signals promptly
Keep frequently used articles
within reach of resident
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Preventing Falls
Lock brakes on movable
equipment
–wheel chairs
–stretchers and mechanical
lifts
–beds
–commodes
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Preventing Falls
Properly position
residents in:
–bed
–wheel chair
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Preventing Falls
OBSERVE NO LIFT OR
LIMITED LIFT POLICIES
TO PREVENT FALLS AND
INJURY TO RESIDENT
AND NURSE AIDE
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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
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National Patient Safety Goals for Long Term Care:
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.

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Bed sores will be discussed in Indicator 5.02
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GENERAL
SAFETY
RULES
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GENERAL SAFETY RULES
Walk in halls and on stairs never run
Keep to the right-hand side
of the hall
Approach swinging doors
with caution
Use handrails going up and
down stairs
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GENERAL SAFETY RULES
Keep halls and
stairs free of
obstacles
Check labels on all
containers prior to
using contents
Wipe up spilled
liquids immediately
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GENERAL SAFETY RULES
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
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GENERAL SAFETY RULES
TAG and TAKE OUT
OF SERVICE!!!!
Report broken or
malfunctioning
equipment
immediately
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GENERAL SAFETY RULES
Check linen for
personal items
contained in folds
prior to sending to the
laundry
Report unsafe
conditions
immediately
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GENERAL SAFETY RULES
Ask for an explanation
of things you don’t
understand
Elevate side rails for
residents at risk of
falling, per facility
policy
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Decreased
strength
Slower movement
Difficulty
maintaining
balance
Tremors that may
affect balance
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FACTORS THAT INCREASE THE
RESIDENT’S RISK OF INJURY
Age related
27
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FACTORS THAT INCREASE THE
RESIDENT’S RISK OF INJURY
Awareness of
surroundings
Some totally
unaware
unconscious
coma
Some suffer from
dementia
confused
disoriented
28
Difficulty seeing
objects
In danger of
falling or
tripping
Difficulty reading
labels or
containers
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FACTORS THAT INCREASE THE
RESIDENT’S RISK OF INJURY
Decreased vision
29
– May not hear
warning
signals or
alarms
– May not hear
approaching
equipment
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FACTORS THAT INCREASE THE
RESIDENT’S RISK OF INJURY
Hearing impaired
30
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FACTORS THAT INCREASE THE
RESIDENT’S RISK OF INJURY
Smell and touch
Reduced smell
unaware of
smoke or gas
fumes
Decreased
sensitivity to
heat and cold
easily burned
31
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FACTORS THAT INCREASE THE
RESIDENT’S RISK OF INJURY
Inability to
move
independently
Crippling
diseases
Arthritis
Paralysis
32
Affect balance
Reduce awareness
Cause confusion or
disorientation
Cause drowsiness
Affect coordination
Make fearful and
uncooperative
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FACTORS THAT INCREASE THE
RESIDENT’S RISK OF INJURY
Medications can:
33
PREVENTING BURNS
Burns are the
second most
common hazard
to residents
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Preventing Burns
• Check water
temperature in
bath or shower
with bath
thermometer or
with your hand
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Preventing Burns
Water temperature
should be NO
HOTTER than
105
degrees F
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Preventing Burns
• Resident must
verify that the
temperature of
the water is
comfortable or
not.
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This is a
little to
warm!
37
Preventing Burns
• Report areas
where water
temperature
seems too hot
• Monitor
smoking
practices
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Preventing Burns
When bathing the resident or
providing a soak,
RESIDENT TO
1) ASK THE
FEEL THE WATER
VERIFY
2) AND
THAT THE
TEMPERATURE OF THE WATER
IS COMFORTABLE TO THEM
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Preventing Burns
• Provide assistance at
mealtime to prevent
spilling hot liquids
• Use facility equipment
according to written
policies
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Preventing Burns
• Monitor use of
electrical
appliances used by
resident
• Avoid overexposure
to sunlight
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PREVENT
POISONING
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Preventing Poisoning
• Store toxins in locked cabinets
• Store toxins away from resident
areas
• Never leave toxic products where
they might be ingested
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Preventing Poisoning
• Have identifying labels on all
containers
• Never use unlabeled substance
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Preventing Choking
• Encourage residents to
use their dentures when
eating
• Assist to cut food into
small pieces
• Report difficulty in
swallowing
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Prevent Choking
Be certain the
HOB is
elevated before attempting
to feed a resident!
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Preventing Choking
Residents with feeding tubes
usually have the HOB
elevated 30-45 degrees.
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Prevent Choking
Be certain the resident
has swallowed
before continuing to feed.
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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.
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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
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Preventing Spread of Microorganisms
Wash hands
before and
after care
Follow Standard
Precautions and
Transmission
Based Precautions.
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Preventing Other Injuries
• Move equipment around corners
with caution
• Be careful of residents’ feet,
hands, arms, and elbows when
transporting residents in
wheelchairs
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Preventing Other Injuries
• Monitor residents who
wander away
• Follow instructions when
providing care
• Keep bed in lowest position
except when giving bedside
care
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Preventing Other Injuries
• Use night lights in rooms
• Have residents wear
shoes/slippers with nonskid soles
• Check crutches, canes and
walkers for non-skid tips
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Preventing Other Injuries
• Keep call signal within
easy reach
• Report immediately any
observations indicating
resident is a danger to
himself or others.
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BODY
MECHANICS
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For Your Information
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.
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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
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Body Mechanics
• Purpose of Good Body Mechanics
–Maximize strength
–Minimize fatigue
–Avoid muscle strain
and injury
–Assure personal and
resident safety
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Body Mechanics
• Never bend over from waist
to pick up object
• Lift firmly and smoothly
• Keep object close to body
• Keep back straight
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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 muscles
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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
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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
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Body Mechanics
• When reaching for
an object,
evaluate distance
• Face in direction
you are working
to prevent
twisting
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Body Mechanics
• Adjust beds to
waist level when
giving resident
care
• Be sure body is in
good alignment at
all times
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FIRE
SAFETY
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For Your Information
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.
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Fire Safety
Everyone is responsible for
preventing fires
If fire occurs, know what to do
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Fire Safety
• Major fire hazards
–faulty electrical
equipment and wiring
–overloaded electrical
circuits
–plugs not properly
grounded
–clutter - paper/rags
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Fire Safety
• Major fire hazards (continued)
–unsafe practices when
oxygen is in use
–smoking
–spontaneous combustible
materials
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Fire Safety
• Elements necessary to
start fire
–fuel - material that
will burn
–heat - flame or spark
–oxygen
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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 procedures
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Fire Safety
• Fire Safety Activities
– Be aware of all fire
hazards and report
them immediately
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Fire Safety
• Watch for frayed
electrical wires
• Never overload circuits
• Use three-prong
grounded plugs
• Never use extension
cords
• Control clutter
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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
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Fire Safety
• Control smoking practices:
– limit to specific areas
– never allow smoking in
bed
– have large ashtrays
available
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Fire Safety
• Control smoking practices:
– observe use of
matches/lighters
– directly supervise
residents when
smoking, as necessary
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In Event Of Fire
Stay
calm
as you
RACE
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R
A
C
E
Remove residents from
IMMEDIATE DANGER;
otherwise, DEFEND IN PLACE
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R
A
C
E
Activate the ALARM
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R
A
C
E
Confine the fire
Close all windows and
doors
Choke off oxygen
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R
A
C
E
Extinguish if you can
Empty the extinguisher
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Use of Fire Extinguisher
•
•
•
•
•
3.02
Carry upright then PASS
FIRE
Pull the safety pin
Aim at the base of the fire
Squeeze handle down
Spray in a sweeping motion at base
of fire
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Some agencies teach RACE plus
an addition “R”
R
A
C
E
R
Relocate residents per
evacuation policy if
directed to do so.
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R
A
C
E
R2
Remember these
important Guidelines:
G
G
G
G
3.02
Shut off air conditioning
Shut off oxygen
Shut off lights
Never use elevators
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OXYGEN
SAFETY
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Oxygen Precautions
• Oxygen precautions
– Never have open flames
or smoking in area
– Remove flammable
liquids from area
– Do not use electrical
equipment in area
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Oxygen Precautions
• Oxygen precautions
– Post “Oxygen in Use”
sign
– Remove cigarettes and
matches from room
– Use cotton blankets
and clothing
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Oxygen Precautions
DO NOT LET THE
RESIDENTS’ NASAL
CANNULA TOUCH THE
FLOOR. Pathogens on the
floor will contaminate the
cannula.
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DISASTERS /
CATASTROPHES
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Disaster / Catastrophe Types
• Natural origin
–flood
–earthquake
–hurricane/tornado
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Disaster / Catastrophe Types
• Human disasters
–airplane/bus/train
accidents
–explosions
–nuclear waste
accident
–blackouts
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Workplace Violence…
a potential Disaster!
Healthcare is impacted
by verbally and
sometimes physically
abusive patients,
families and visitors.
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 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,
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Workplace Violence… a
potential Disaster!
Stop this PowerPoint and
view the PowerPoint
produced by Vanderbilt
University Medical Center.
Then, return to this
PowerPoint.
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Disaster Plans
Facilities are required
to have disaster plans
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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
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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
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MEDICAL
EMERGENCIES
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The Choking Resident
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The Choking Resident - Cause
Choking occurs when
the throat is blocked
or closed up and air
cannot get to the
airway.
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The Choking Resident
Airway may be blocked by:
–Food or liquids (meat
most common food)
–Blood or mucus
–Foreign objects
including the tongue
–Vomitus
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Treating a Choking Resident
If victim is coughing, do not intervene:
– Stay near
– Encourage coughing - most
effective way to dislodge
obstructions
– Never slap coughing
resident on back: can cause
object to fall lower into
trachea
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Treating a Choking Resident
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.
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Treating a Choking Resident
Tilting head back in
unconscious
person may clear
airway since this pulls
tongue forward
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Training Lab Assignment
Engage in the Skill Acquisition Process for:
SKILL 3.02A
Foreign Body Airway Obstruction
(FBAO) Relief: Conscious Resident
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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
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Heart Attack - Signs and Symptoms
• Fainting
• Sweating
• Nausea
• Shortness of breath
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Accident/Emergency Scene
• If certified in CPR, offer assistance
• Defer to those with more experience
and training
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Accident/Emergency Scene
• Seek assistance
–in facility
• use emergency light
• use call signal
• send another resident
for help
• call for help
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Accident/Emergency Scene
• 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
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Cardiopulmonary Resuscitation
• Agencies providing CPR
curriculum:
–American Heart Association
–American Red Cross
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Cardiopulmonary Resuscitation
• You must be trained to administer
CPR
• Activate the emergency medical
system or your facility’s emergency
plan
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Cardiopulmonary Resuscitation
• CPR must be started immediately to
be effective
• Follow facility policy for Advanced
Care Directive
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Cardiopulmonary Resuscitation
• Methods of administering CPR
–one-person CPR
–two-person CPR
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Convulsive Disorders (Seizures)
• Causes:
–infectious disease
–omitted medication
–head injury
–stroke
–seizure syndrome
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Convulsive Disorders (Seizures)
• Types
–Partial
–General
• Tonic-clonic (grand
mal)
• Absence (petit mal)
–Unclassified
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Convulsive Disorders (Seizures)
Take Action
• Summon help
• Stay with resident
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Convulsive Disorders (Seizures)
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
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Convulsive Disorders (Seizures)
Take Action
• Loosen constricting
clothing (around neck)
• Place pillow under head
and turn face to one side
• Note time and type of
seizure
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Convulsive Disorders (Seizures)
Take Action
• Provide rest for resident after
seizure
–very tired
–may be confused
–often disoriented
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Loss of Consciousness – Fainting
• Caused by temporary
reduction of blood to
brain
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Loss of Consciousness – Fainting
• Early signs and symptoms:
–dizziness
–decreased pulse and BP
–pallor and perspiration
–nausea
–cold skin
–numbness and tingling of extremities
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Loss of Consciousness – Fainting
Take Action
•
•
•
•
•
Summon help
Stay with resident
Have resident sit or lie down
Loosen tight clothing
Position head lower than heart
–sitting - head between legs
–lying down - elevate legs
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Loss of Consciousness – Fainting
Take Action
• Monitor pulse and respirations
• Have resident rest for 5-10
minutes before moving
• Provide blanket if cold
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SHOCK – Causes
• Severe injury
• Excessive loss of body
fluids
• Pain
• Respiratory and/or cardiac
arrest
• Anxiety
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SHOCK – Signs and Symptoms
• Low or falling blood
pressure
• Weak, rapid pulse
• Cold, moist, pale
skin
• Rapid respirations
3.02
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SHOCK – Signs and Symptoms
• Thirst
• Restlessness
• Confusion and
loss of
consciousness
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SHOCK – Take Action
• Summon help
• Stay with resident
• Keep resident lying
down
• Control hemorrhage
• Keep resident warm
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Hemorrhage
•Types
–Internal
–External
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Hemorrhage
• Signs and Symptoms
– Internal
• pain
• shock
• vomiting blood
• loss of
consciousness
– External
• can usually be seen
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Hemorrhage – Take Action
• Internal
–Summon help
–Stay with
resident
–Keep warm,
flat and quiet
until help
arrives
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Hemorrhage – Take Action
• External
–Summon help
–Stay with resident
–Identify location of bleeding
–Apply continuous, direct
pressure over bleeding
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Hemorrhage – Take Action
• 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
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Hemorrhage – Take Action
• External
–keep resident
comfortable,
warm and quiet
until help
arrives
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Reporting Emergencies
• Never panic; remain
calm
–Try few slow deep
breaths
–Observe surroundings
–Assess resources
available
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Reporting Emergencies
• Evaluate situation
–check victim
–determine safety of
environment
• Call or send for help immediately
• Determine treatment priorities
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Reporting Emergencies
• Report emergencies accurately
–If help is not available, contact:
• 911 or emergency number
• Police
• Fire department
• Telephone operator
• Local EMS
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Reporting Emergencies
• Report emergencies accurately
by stating:
–Type of help
–Name
needed
–Location
–Description –Number of people
needing help
of scene
–Information
about injuries
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Reporting Emergencies
• Know your limitations
• Provide care and reassure victims
• Keep bystanders away from victims
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
END 
3.02
Understand safety and emergency
care skills within the nurse aide range
of function.
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