Transcript Use of Restraints

UNIT 4
CLEAN AND SAFE
ENVIRONMENT
Unit Two Objectives
• Describe safety of the resident
• Identify Situations which require
Emergency Action
• Describe principals of Body Mechanics
• Describe principals of infection control
• Describe standard precautions
• Identify care giver precautions with
infectious diseases
Objectives
• Identify common pathogens and resulting
diseases or conditions.
• Describe pre and post steps for resident
care.
• Discuss admission and transfer policies’
Skills for Unit Two
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Handwashing
Resident Unit order
Unoccupied bed making
Transfer Belt placement
Clear obstructed airway on Conscious
Resident
• Gown, glove and bag linen
Describe Safety of the Resident
• It’s necessary for All staff to be alert to
SAFETY concerns for the resident.
• Adjustments to environment are necessary
for individual needs
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Light
Noise
Air temperature
Type of furniture
Identify residents at risk for
injury
• Those with sensory impairments:
– Vision
– Hearing
– Loss of sensation
• The confused or mentally impaired resident
• The weak or frail resident
• The resident recently admitted to the facility
Hazards to Safety
• Disoriented and new residents are at the
greatest risk
• FALLING IS THE GREATEST THREAT
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Slippery floors
Clutter in the halls
Rearranged furniture
Not using transfer belt
Hazards to Safety
• UNLOCKED CABINETS
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Disinfectants
Cleaning supplies
Medications
Poison
• IMPROPER LIGHTING
Hazards to Safety
• Unsafe equipment
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Resident lifts
Wheelchairs
Bed rails
Restraints
Call lights not working
Shower chairs
Walkers
Canes
Hazards to Safety
• Unsafe personnel
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Poor skill performance
Placing or preparing incorrect meal tray
Wrong medication
Wrong treatment
• Smoking
– Only in allowed designated areas
– Leaving resident unattended
WAYS TO PREVENT INJURY
• Respond to emergency care immediately
• Follow care plans at all times
• Be alert to resident safety at all times.
– Answer call lights as soon as possible
– Many injuries occur in the bathroom: be alert
when toileting residents: do not leave
unattended.
– Use locks on wheelchairs, lifts and beds
More:
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Use safety devices when indicated
Get help when necessary
Report unsafe equipment
Perform skills accurately
Only perform skills you have been taught
Use transfer belts
• Used to support
resident
• Promotes correct body
alignment for the
resident
• Prevents injury such
as shoulder dislocation
• May be part of a
facility uniform policy
• Improves body
mechanics for the
NAR
• Do not use to lift a
resident; only to move
or walk a resident
Know fire safety policies
• Be alert to fire safety violations
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Know smoking rules
Oxygen safety
Electrical equipment
Unsafe wires
Extension cords are not allowed in long term
care facilities
Other safety Rules:
• Sun exposure limitations – due to
medications
• May choke easily
• Maintain your own health
– Follow rules of healthy life style. Accidents
increase when caregiver is ill or emotionally
upset
– Focus on resident may decrease when caregiver
is emotionally upset
Workers must know The Right to
Know Law
• Right to Know law is a Minnesota law
which informs workers when working with
hazardous substances or infectious
substances and control measures necessary
• Provides for availability of infection control
measures as needed
MSDS: Material Safety Data Sheets
• Identify hazardous materials
• Identify health hazards of dangerous
materials
• List guidelines for safe use of hazardous
materials
• Identifies emergency procedure of exposure
occurs
• Know the location of the MSDS in the
building
Use of Physical Restraints
• A physical restraint is any manual method
or physical or mechanical device, material
or equipment attached to or adjacent to the
residents body that the individual cannot
remove easily which restricts freedom of
movement or normal access to one’s own
body.
Examples of Restraints
• Side rails that keep a resident from
voluntary getting out of bed
• Using devices in conjunction with a chair,
such as trays, tables, or belts that a resident
cannot move easily, that prevent a resident
from rising
• Placing a resident in a chair that prevents a
resident from rising
Examples of Restraints
• Placing a chair or bed so close to a wall that
the wall prevents the resident from rising
out of the chair or voluntarily getting out of
bed.
• Hand mitts
• Vests, jackets, wrist restraints
Laws concerning use of restraints
• Federal and state laws and accrediting agency
standards identify limiting use of physical
restraints
• Federal regulatory guidance indicates that the
potential for serious injury is more likely from a
fall from a bed with raised side rails than from a
fall where there are no side rails used
• Side rails potentially increase the likelihood that
the resident will spend more time in bed and fall
when attempting to transfer from the bed
Use of Restraints
• Residents must be assessed for use of
restraint devices
• The individualized assessment by nurses
and other health care team members
indicate purpose of restraint
• Use of physical restraints must be ordered
by the physician
Guidelines for Using Restraints
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enistructions for use must be on care plan
Never use for staff convenience
Use proper size of restraint
Always apply the restraint properly
Monitor resident as indicated in the care
plan
Risks with Restraints
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Falls
Constipation
Pressure sores
Incontinence
Anxiety
Loss of dignity
Dehydration
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Bruises
Helplessness
Death
Climbing over bed
rails
• Becoming caught
between mattress
and side rail
Benefits of Reduced use of Restraints
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Resident is not isolated
Confusion may decrease
Body functions may improve- ability to breathe
Combative behavior may decrease
Falls may decrease
Improved self-esteem
Maintain independence
Use Alternatives Instead of Restraints
• Restraints are only used with
a doctors order and then only
if alternatives have been tried
and documented.
Alternatives to physical restraints
• Care for personal needs
promptly
• Make environmental
changes such as arranging
furniture to prevent falls or
place stop signs or visual
barriers across restricted
doorways
• Maintain safe and calm
surroundings
• Provide companionship
• Encourage group
activities
• Lower the bed
• Mattress on the floor
The residents Unit
• The residents unit is
their personal space or
home. The personal
items they have are
valuable to them.
Treat them with care
and respect. Knock on
residents door before
entering their home!
Keep Room Safe and Clean
• Do not move furniture without notifying
resident
• Be certain call lights work
• Keep call lights within reach
• Rooms must be free from spills; notify
housekeeping/charge nurse for major spills
• Keep bedside stand area neat and clean
Keep Room Safe and Clean
• Keep closets free from clutter to reduce
falling objects
• Keep over bed tables secure so they stay at
placed level
• Always handle resident belongings
carefully and with respect
Situations for Emergency Action
• Understand facility procedures
• Know phone numbers of appropriate contacts
• Know the location of emergency equipment
and supplies
• Remain calm
• Understand proper role of nursing assistant
during emergency response (location of
alarms, extinguishers)
Fire and Major causes
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Improper use of smoking material
Defects in heating systems
Improper trash disposal
Misuse of electrical equipment
Spontaneous combustion
Action to take if fire is discovered
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R = RESCUE AND REMOVE
A = ALERT OTHERS
C = CONFINE FIRE
E = EXTINGUISH OR EVACUATE IF
DIRECTED
• all facilities conduct fire drills monthly.
Know how to use fire
extinguishers
• Most fire extinguishers are the dry chemical
type, suitable for all types of fires. To Use:
• Remember PASS
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P - pull the safety pin
A - Aim the nozzle at the base of the fire
S - squeeze the trigger handle
S - sweep side to side at the base of the fire
Fire Safety
• Know the facility code word for FIRE (code
red, Dr. Blaze, etc)
• When moving an immobile resident to
safety follow facility policy. Which may
include placing residents on a blanket and
pulling them out of danger or removing the
entire bed.
Finding a resident on the floor
• Stay with resident and
call for help
immediately
• DO NOT attempt to
move resident until a
nurse has assessed.
• If a resident is walking
and begins to fall, ease
them to the floor with
a T.B.
• Lean them on your leg
as you kneel to the
floor
• Protect the resident’s
head from hitting the
floor
• Assist nurse as
appropriate
Actions to take if a resident is
choking
• If a resident is coughing, but able to breathe
DO NOT INTERVENE.
• Clutching the neck with one or both hands
is the universal sign for choking.
– Ask the resident, “are you choking?”
– If resident nods yes, begin procedure for
obstructed airway.
Actions to take if finding an
unresponsive resident
• Call the resident by name to determine
unresponsiveness.
• Call for nurse immediately and stay with
resident.
• Assist the nurse as directed.
Seizures
• Seizures are sudden involuntary muscle
contractions, muscle jerks rigidity or blank
stare.
• Persons may be partially conscious or
unconscious.
Seizures
• Responsibilities include:
– Stay calm and look at your watch to time
seizure
– Move obstacles away from resident to avoid
injury
– Call for nurse immediately
– Ease resident to the floor if needed and protect
head
– Gently roll the resident on his/her side to help
keep airway clear
Seizures
• Responsibilities:
– Do not restrain movements
– Stay with the resident until seizure ends
naturally
– Assist nurse as appropriate
Following a Seizure
• Resident may be sleepy or confused for a
few minutes to a few hours
• Be calm and reassuring and find out if there
is any unusual pain
• Protect the person from harm until full
awareness returns
Actions to take for wandering or
lost residents
• Report to nurse immediately.
• Follow facility policies and nurses
instructions.
Actions to take for severe
weather
• Follow facility policies for tornado watches
and warnings.
• Close windows and drapes
• Move resident away from windows
• Protect and reassure residents.
BODY MECHANICS
• PROPER USE OF THE BODY TO MAKE
THE BEST USE OF STRENGTH, AVOID
FATIGUE AND INJURY TO SELF AND
OTHERS…...
Importance of Proper Body
Mechanics
• NAR’s will be moving, lifting, and turning
residents often during a routine day.
• Using proper body mechanics can prevent
injuries, minimize strain and fatigue.
• Using proper body mechanics involves
good posture, balance and the strongest
muscles of the body.
• Using proper body mechanics enhances
safety for residents and workers.
Guidelines for Good Body
Mechanics
• Check the resident’s care plan
– Follow special instructions for moving,
positioning or transferring
– Always explain the process to the resident
Guidelines for Good Body
Mechanics
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Plan what actions to take
Know if the resident can assist
Ask for help if necessary
Keep back straight
Have a wide base of support
Use both hands when lifting and moving
heavy objects
Guidelines for Good Body
Mechanics
• Tighten abdominal muscles upward and
buttock muscles downward before lifting
• Bend at knees and hips while keeping back
straight
• Lift using thigh muscles
• Match movements when working with a
partner
• Use smooth movements instead of quick
motions
Guidelines for Good Body
Mechanics
• Turn your feet; do not twist body
• Do not lift when you can push/pull
• Use lifting aids when appropriate;
mechanical lifts and lift sheets
• When giving bedside care, raise the bed to a
comfortable height to avoid bending at the
waist
Guidelines for Good Body
Mechanics
• Always return the bed to the lowest position
when cares are completed
• Remember to use a transfer belt
• If appropriate or if it is facility policy, wear
a back support belt
Infection Control
Infection control are practices that prevent the
development and spread of disease producing
microorganisms, also called pathogens or
germs
MEDICAL ASEPSIS
• “Free from germs”
• Hand hygiene is the single most important
measure to reduce the spread of infection
• Separation of clean and dirty items
– Linen
– Clothing
– Supplies
Medical Asepsis - Linen
• If linen is contaminated with blood or body fluid,
wear gloves
• Do not let clean or dirty linen touch uniform
• Do NOT SHAKE LINEN
• If clean linen falls to the floor, place it in the
soiled linen hamper
• Dirty linen should never go on the floor, place
directly in the hamper or at the foot of the bed
• Take only the linen you need into the residents
room
Medical Asepsis
• Proper disposal of liquids
– Avoid splashing
– Follow facility policy
• Wear nonsterile gloves when appropriate
– Contact with blood or body fluids
– Follow facility policy
– Change gloves and wash hands, use hand
sanitizer between tasks
Medical Asepsis
• Maintain good health
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Balanced diet
Rest
Exercise
Mental health
Call in if ill
• Know the proper Personal Protective
Equipment (PPE) to use
Medical Asepsis
• Family members who are ill should not visit
loved ones
• Dispose of trash
– In proper containers
– Follow facility policy
• Disinfection of equipment and supplies
Medical Asepsis
• Correct handling of food
• Correctly handle body waste by disposing
of waste according to facility policy and
procedure
• Do not wear artificial nails or extenders
when providing direct resident care
How do the germs get into our
bodies?
• Body openings such as
mouth, nose, eyes,
urinary tract
• Body cuts (broken
skin)
• Tubing such as IV,
catheters, feeding
tubes
The chain of infection:
• The route pathogens
travel to spread
disease is known as
the chain of infection.
• There are six parts to
the chain of infection.
Chain of Infection Includes:
• Pathogen -cause of
infection
• Reservoir - where the
pathogen lives
• Exit point - body
secretions or wounds
• Method of
transmission - hands
or supplies
Chain of Infection
• Entry point - such as
broken skin
• Host - person receives
pathogen and harbors
it. Disease will occur
more often in persons
at risk such as those
who are ill.
Risk Factors for Developing
Infections
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Health of individual
Age of person
Heredity
Pre-existing condition (HIV, Immune
system disorder)
• Strength of pathogen
What germs need to grow:
• Food: found on body, body discharges,
equipment or trash
• Moisture
• Air – some want air, some want no air
• Temperature ( best between 40 to 110
degrees
• Darkness: Direct sunlight can kill some
germs.
STANDARD PRECAUTIONS
• Basic Infection control practices for all
health care facilities in the United States
and any industry which could affect the
health of citizens were developed by the
CDC in Atlanta. The practices are called
Standard Precautions or Universal
precautions and are designed to reduce the
risk of transmission of disease causing
microorganisms.
Use Standard Precautions:
• For anyone receiving care
• Assume that every person is potentially
infected with an organism that could be
transmitted
• If caregiver or receiver has an open area
• To comply with blood borne pathogen
standards
Use Standard Precautions:
• When there is HIV or HBV risk
• When there is exposure or potential exposure to pathogens
– Blood
– Urine
– Stool
– Saliva
– Sputum
– Vaginal secretions
– Mucus and mucous membranes
– Does not include perspiration or sweat
Standard Precautions, Practices,
PPE
• Hand hygiene is a general
term that applies to
washing hands with water
and either plain
soap/detergent containing
antiseptic agent or
thoroughly applying an
alcohol based hand rub
(ABHR)
Standard Precautions/PPE
Hand Hygiene continues to be the primary
means of preventing transmission of infection
Situations Requiring Hand Hygiene
• Beginning work
• Coming in contact with resident’s intact skin
(taking a pulse or BP or lifting a resident)
• Before and after assisting a resident with
toileting
• Before handling food
• After blowing or wiping nose
• After handling soiled or used linens, bedpans or
urinals
Situations Requiring Hand Hygiene
• After personal cares like using the bathroom
or combing your hair
• After handling resident’s belongings
• After removing gloves
• After removing trash
• When hands are visibly dirty
• Gloves or use of baby wipes are not a
substitute for hand hygiene
Antimicrobial soap and water
• Use when:
– Hands are visibly soiled
– After you use the bathroom
– Before and after assisting a resident with
toileting
– Before you eat or prepare food
Alcohol-based hand rub (ABHR)
• 60-95% ethanol or isopropyl alcohol containing
preparations designed for application to the hand
to reduce microorganisms
• Except where situations where hand washing is
specifically required, ABHR’s are appropriate for
cleaning hands
• Refer to facility policy or care plan
Technique for using ABHR
Apply product to palm of one hand and rubbing
hands together, covering all surfaces of the hands
and fingers until the hands are dry
Standard Precautions
• Gown: Wear to
protect skin and
clothing if possibility
of coming in contact
with body fluids.
• Mask, Eye, face
shield: Wear if there is
possibility of contact
with body fluids.
Standard Precautions Include:
• Linen and trash:
Handle, transport and
dispose in a manner
that avoids transfer of
pathogens.
• STOP THE SPREAD
OF INFECTIONS!!
Isolation Precautions
• Precautions used in addition to standard
precautions that are based upon the means
of transmission by interrupting how the
disease is spread.
– AIRBORNE
– CONTACT
– DROPLET
ISOLATION
• Practices used to reduce the spread of
infectious agent and/or minimize the
transmission of infection
– Protects the individual receiving care
– Protects the caregiver
– Protects other residents
Airborne Precautions
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Pathogen is in the air
Pathogen can travel long distances
Pathogen is inhaled
Caregiver must wear a respirator mask
Rooms must have special ventilation
Example: Tuberculosis
Droplet Precautions
• Pathogen is in the air in the form of a large
droplet
• Droplets can only travel several feet
• Spread through coughing, sneezing, talking
or laughing
• Example: Influenza
• A mask must be work with standard
precautions
Contact Precautions
• Pathogen is spread through direct or indirect
contact by touching another person
• It may also be spread by touching
contaminated equipment, linen or body
fluids
• Example: Scabies
• Gloves and gown must be worn with
standard precautions
Isolation Procedures Include:
• Restrict resident to
own room
• Double bag linens and
trash
• Keep equipment in
room (thermometers)
• Special cleaning of
room when resident is
removed from
precautions.
Special Considerations for Residents
• May feel lonely or sad, provide additional
checks or visits
• May question need for isolation
• May feel unclean or untouchable-show
acceptance in providing cares
• Check care plan for special procedures for
removing linens, trash or infectious material
– Identify correct waste containers, biohazard
bag, follow facility policies
Infectious Diseases
• There are many types of disease producing
microorganisms. These are usually
identified by special features such as their
shape and how they grow, multiply and
spread.
Types of Bacterias
• This germ grows in
groups and a culture
sample helps to
determine the best
medicine for
treatment. There are
many antibiotic
medications.
• Strains of
streptococcus - “strep”
which can cause a sore
throat
• Strains of
staphylococcus
“staph” which causes
infections in cuts and
surgery sites
Mycobacterium tuberculosis
• Bacteria which causes TB is transmitted
from the cough or sneeze of an infected
person. Usually attacks the lungs. A
mantoux skin test identifies exposure to the
germ. All health care workers are screened
annually. Residents in facilities are
screened upon admission to the facility.
Fungus
• The most common disease producing
fungus is yeast infections.
– Candida albicans occurs in mouth and vagina
– Tinea capitis “ringworm” occurs on the skin
– Tinea pedis “athletes foot” also occurs on the
skin.
Virus:
• The virus is the smallest microorganism in
the world. The germ needs a host to
multiply. There is no specific medications
for viruses. Medications are usually
developed to control the specific features of
the pathogen. Viruses are able to change
their features.
Examples of viruses:
• Common colds, which
affect the respiratory
system
• Influenza, affects the
respiratory system
with additional
symptoms of
headache, body aches.
Flu shots are given
yearly.
• Herpes Simplex, cold
sore or fever blister on
mouth or lips.
• Herpes zoster
“shingles” which are
blister like sores along
the route of a nerve.
• Hepatitis - a systemic
infection affecting the
liver.
Types of Hepatitis
• Hepatitis “A” reservoir (Where it lives) is
stool or feces. It is spread stool to mouth
route by food or water contaminated by the
virus.
• Hepatitis “B and C” reservoir is blood. It is
spread by direct contact with body fluids.
• Immunizations are available to protect
against exposure to Hepatitis A and B only
Human Immunodeficiency Virus
• HIV
– Immune system is affected
– Spread by contact with HIV infected blood or
body fluid
– May or may not develop into AIDS
– Caregivers must follow infection control
guidelines
Drug Resistant Infections
• Pathogens or germs
can become resistant
to the medications that
were developed to
fight them in people
who got the infection.
• Examples include:
– MRSA - methicillin
resistant staph aureus
– VRE vancomycin
resistant enterocci
• Most people who
develop drug
resistance are people
who with weak
immune systems
Pre-steps for resident cares
• Check your assignment sheet- check care plan or
charge nurse, NOT another nursing assistant
• Wash Hands
• Gather supplies
• Knock on the door
• Identify the resident
• Face the resident and speak clearly
• Explain what you are going to do
• Clarify if needed to confirm resident’s
understanding
Pre -Steps for Skills
• Provide privacy by closing the door and/or pulling
privacy curtain
• Assure resident is in a safe and comfortable
position
• Check own body mechanics and adjust bed height
or other equipment to safely complete procedure
• If gloves and other PPE needed, apply as infection
control policy requires
• Use side rails according to individual care plan
Post-Steps for Skills
• If gloves used, remove gloves per infection
control policy
• Ask resident if there is anything else they
need
• Leave resident in a safe and comfortable
position, with the call light cord in reach
• Open privacy curtain
• Return the bed, chair or other equipment to
safe position
Post- steps for skills
• Apply gloves if needed to dispose, clean or replace
supplies as appropriate
• Remove gloves if worn
• Wash hands
• Report/record procedure and resident observations
STANDARD PRE AND POST STEPS ARE
REQUIRED TO BE PERFORMED
CONSISTENTLY, PRACTICE SO THEY
BECOME A HABIT
Admission and transfers
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Introduce self
Demonstrate equipment (call lite. Bed)
Help resident put personal belongings away
Label personal belongings. Complete inventory
sheet.
• Explain facility dining times, location of
bathroom, location of personal supplies.
• Any other procedures according to job description.
Home Health Aide
Unit Two
Safe and Clean Environment
Unit Two Objectives
• Describe safety in Clients home
• Discuss emergencies in the home
• Describe Homemaking duties
Safety differences in healthcare
facilities vs client home
• Healthcare facilities
are regulated by state
and federal agencies.
They receive routine
inspections.
• Private homes: It’s
owner responsibility
for clean safe
environment.
Safety and Infection Control in
clients home
• Follow agency
policies and
procedures. Use good
body mechanics.
• Report unsafe
situations to
supervisor.
• Identify habits which
may promote the
spread of germs.
– Clients or family not
washing hands.
– Spoiled food
– dirty dishes, clothing,
linen piling up
– Poor cleaning of home
– pet wastes not
contained
Disinfection and sterilization
• Disinfection is the
process which
removes most disease
causing
microorganisms.
– 1:10 bleach water can
be used to clean.
– There are many
commercial
disinfecting products
• Sterilization destroys
all microorganisms.
– Boiling: Clean items
covered with water and
boil for 20 minutes. If
container is covered
boiled water will
remain sterile for 36
hours.
– Baking: wrap items in
clean towel and bake
for one hour at 350.
Describe emergencies
• Emergencies call for immediate action.
They are sudden, unexpected events, which
are often life threatening. Home Health
agencies have emergency procedures which
include a plan for calling emergency
services.
Common home emergencies:
• Poisoning - Any
substance taken into
the body by ingestion,
inhalation, injection or
absorption which
interferes with normal
body function.
• Call 1-800-poison-1
Minnesota poison
control system
Common Home Emergencies
• Burns: Skin-tissue injury from excessive
heat, chemical, electrical, or radioactive
agents.
• Allergic Reactions: Abnormal response to a
substance which normally does not cause a
reaction.
• Respiratory Emergencies: Any situation
which interferes with breathing.
• Falls: Most common injury
Emergencies:
• Stroke: Blood supply to part of the brain is
interrupted.
• Heart attack: Blood supply to part of the
heart is interrupted.
• Diabetic reaction: Physical responses due
to imbalance of food and insulin.
• Seizures: Involuntary muscle twitching
related to brain injury or condition.
Call 911
• Life threatening events such as breathing
problems, severe pain, profuse bleeding,
loss of consciousness and extensive burns
CALL 911.
– Stay calm
– Remove client and family
– Follow directions of 911 operator.
Weather and Fire Emergencies
• Follow agency policy and procedures.
• Know location of smoke alarms and fire
extinguishers.
• Have an evacuation plan for client.
• Know community alarm systems.
• Discuss with supervisor as part of client
care plan.
Home making duties
• Part of the home
health aide job
responsibilities include
combining client
personal care with
housekeeping
tasks.Each clients
home will require
different schedules
and challenges.
Housekeeping duties:
• Light house keeping
includes daily and
weekly tasks to
maintain the
environment for the
client.
– Meal preparation
– surface cleaning
– laundry
• Heavy housekeeping
duties are often
contracted out or done
by family members.
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House painting/repair
shoveling snow
mowing lawn
washing windows
appliance maintenance
Light housekeeping schedules:
• Daily tasks;
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Pick up clutter
empty waste baskets
make beds
wash dishes
clean up spills
pick up toys, clothing,
newspaper
• Weekly tasks:
– Change bed linens
weekly and as needed
– Do laundry weekly and
as needed
– dust and vacuum
– wet mop floors
– remove garbage
– clean bathroom
– water plants
Monthly or Periodic Cleaning
• Remove cob webs
from corners
• vacuum drapes
• Clean cabinets, closets
and drawers
• Hand wash table
ornaments
• Damp wipe light
fixtures