Nursing Assistant
Safe Environment
Role of CNA in Emergency,
Disaster, & Fire Situations
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Be prepared
– Know emergency codes (STAT)
– Fire & disaster plans
– Location of fire exits/extinguishers
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Remain calm
 Call for assistance, don’t act beyond level of
knowledge
 Move residents in immediate danger
 Remain with resident
Role (cont)
Keep resident comfortable & calm
 Evacuate resident to safety according to
plans
 Send family or visitors to the facility
designated area
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Ways to help others remain calm
Stay calm yourself, use a calm voice
 Project confidence
 Know & use facility emergency plans
 Stay with resident, keep them
comfortable & quiet
 Move or direct families to the
designated areas or safe places
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Common Emergency Codes
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Types
– Fire – code red or doctor red
– Cardiac arrest – code blue, code 99
– Resident safety issue – manpower or a
special alarm sound
– Disaster code – disaster level 3
Emergency Call System
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Telephone numbers
– Numbers within the facility
– EMS – licensed nurse dials 911
Remain call, don’t shout fire or arrest
 STAT – respond at once
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General rules for providing a safe
environment
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Use good body mechanics
Know policy & procedures regarding safety
laws on use of equipment & handling
hazardous materials (OSHA & MSDS)
What are hazardous materials?
Wipe up spills immediately, identify wet floors
with signs
Walk, never run in halls, watch at
intersections
Tag & report broken equipment
General rules (cont)
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Report unsafe conditions
Use 3-pronged plugs on electrical equipment
Refuse to do any task you do not know how
to do
Watch linens & garbage for safety hazards
(sharps)
Report if sharps container is over half full
In case of personal injury
Report injury immediately to supervisor
 Fill out incident or accident report
 Seek medical help as necessary
 Resident safety is an important quality
assurance issue
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General measures to provide safe
environment
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Check wrist bands or name tags before
performing any task
Use side rails when appropriate
Have resident use handrails or assistive
devices when unstable
Non-skid footwear when ambulatory
Call signal within reach at all times & resident
aware of how to use
Lock wheels on bed/wheelchair/gurney
Answer call lights promptly
General measures (cont)
Use night lights to help ensure good
lighting & reduce obstacle hazards
 Keep be in lowest position except when
working with the resident
 Check bed/chair alarms ensuring
working condition
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2 top safety issues
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FALLS (70% of all accidents)
– Proper position in bed/wheelchair &
readjust every 2 hours
– Soft protective devices as ordered
– SIDE RAILS – watch for arms/legs/tubing.
Make sure they are locked in up position
– Brakes on while transferring resident
– Comfort items (water, call light, urinal)
within easy reach
Safety Issues
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Falls (cont)
– Answer call lights promptly
– Areas should have good lighting & be free of
clutter
– Foot latches on beds & foot supports of w/c out of
way to prevent tripping or hitting legs
– Wipe up spills promptly
– Meet needs quickly (water, elimination)
– Use appropriate assistive devices as directed by
licensed nurse
– Be aware of resident’s location at all times
– More likely to occur when attention is elsewhere
Safety issues
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Assistive devices used to reduce falls &
maintain safe mobility
– Assessed for need by licensed nurse, PT,
or rehab team (imput from CNA)
– Types of devices
• Cane – single tip, tri tip, quad cane
• Use on strong side
• Check rubber tip & appropriate height
Safety issues
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Assistive devices (cont)
– Walker – provides stability & support
• Pick-up, front-wheeled, four-wheeled
• Check rubber tips & height
• Give instruction on correct use
– Wheelchair – provides mobility
• Different types
• Removable arm rests & foot rests
• Brake locks on when transferring resident
Safety issues
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BURNS – 2nd most common hazard
– Types & causes
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Steam or water burns – bathing, hot drinks
Flames – smoking
Chemical – cleaners like peri-wash
Thermal – heating pads, sunburn
– Prevention of burns – best approach
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Check water temp, report if too hot
Monitor smoking, hot drinks, & risk for spills
Know how to use equipment like K-pads & hot packs
Protect from sunburn with hat, sunscreen, brief exposure
Know policy & procedure of fire response
Follow directions on use of chemical cleaners
Safety issues
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Intervention of burns (initial first aid)
– First degree burns –
• Ice & cold water only for discomfort
– Never use butter, shortening, etc
– Causes burn to be worse
– Deeper or large burns – immediate attention
• Notify licensed nurse immediately
• Describe cause of burn if possible
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Who is at high risk for accidents?
Fire
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Major causes
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Smoking is number one cause
Sparks from faulty electrical equipment
Heating systems
Spontaneous ignition
Improper disposal of trash
3 things needed to start a fire
• Fuel
• Flame
• Oxygen
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Fire can cause both burns & suffocation
Fire prevention
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Electrical
– Report frayed electrical cords, smoke, or
burning smells
– Don’t use too many electrical devices on
one wall socket
– Use 3-pronged GROUNDED plugs
Fire prevention
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Smoking
– Empty waste paper into proper containers
– Supervise residents who smoke if their
condition is confusion, lethargic, or weak
– Be sure materials in ashtrays are
completely extinguished before throwing
away. Always use ashtrays when smoking
– Smoking allowed in designated areas only
RACE – for fire emergencies
R – Remove resident from fire & close
the room door
 A – Activate the fire alarm system
 C – Contain the fire
 E – Extinguish if possible
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PASS for fire emergencies
P – Pull extinguisher pin
 A – Aim
 S – Squeeze
 S – Sweep low
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Fire emergencies
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Make sure that residents are not placed
by fire emergency doors
– Swing shut automatically
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Know & follow facility’s specific policy &
procedure
Safety rules for Oxygen use
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Oxygen therapy
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Abbreviated as O2
Colorless, odorless, tasteless
Essential for respiration
Some residents need supplemental O2
Supplied in portable tanks or through wall outlets
Increases the risk of fire because it supports
combustion & is one of the 3 elements needed for
fire
Safety precautions for oxygen
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“No smoking, Oxygen in use” sign on door &
over bed
Smoking is NEVER allowed near oxygen by
ANYONE!
Keep tubing open & free of kinks
Check electrical equipment use (electric
razors, fans, radios)
No flammable liquids (alcohol, nail polish
remover, petroleum based – vaseline,
chapstick)
Watch for static when combing hair, using
WOOL blankets, or nylon in clothing
Types of oxygen equipment
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Green metal portable tanks
– Under pressure & must be handled
carefully to prevent dropping & possible
explosion when in storage
– Must be secured to wall
– On movable stands & strapped in place
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Wall outlets – use wall mount flow meter
& plastic tubing
Types of oxygen equipment
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Portable tanks
– Large ones covered with plastic casing & small
ones that resident can carry or hang on assistive
devices
– Must be kept upright & not dropped
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Equipment used to deliver oxygen
– Nasal cannula
– Face mask
– concentrators
Nursing care for oxygen
Dr’s order needed (considered med)
 Make sure resident wears mask or cannula
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– If oxygen needs to be turned off, MUST have an
order
– When not in use, needs to be turned off (very
expensive & a fire hazard)
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Follow facility procedures for filling oxygen
tanks, turning tanks off & on, set-up of oxygen
 Oxygen is very drying
– Check nose & cleanse
– Maintain water level in humidifier to reduce
dryness
Nursing care for oxygen
Check for redness over ears & on face
where tubing rests – report if present
 May turn tank on & off, but may NOT
adjust oxygen to a lighter flow (med
administration, not in your scope of
practice)
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Postural supports
Used to prevent resident from harming
self or others
 Used to prevent
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– Falling out of bed/chair
– Crawling over side rails or end of bed
– Interfering with therapy by removing tubing
or dressings
– Hurting themselves or others
Postural supports
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Types
– Soft protective device – serves as a reminder to
resident of safety issues (waist device)
– Postural supports – devices to help to keep the
resident in the correct postural position when up in
a chair (posey vest)
– Restraints – control behavior & are used only in
extreme measures like limb devices. Side rails
can be considered a restraint
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Infringe on resident’s rights to freedom of
movement & may be considered “false
imprisonment” if used inappropriately
Alternative to device use
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Place resident where there is constant
supervision
 Make sure comfort needs are met (water,
toilet, reposition) so that there is a reduced
risk of attempting to do unassisted & agitation
is reduced
 Devices are used as a last resort & NEVER
for convenience or as a punishment
Types of protective devices
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Vest or jacket device – has opening in front,
watch for choking & cutting into resident
Wrist or ankle device – soft limb device
restricts limb movement
Hand mitt device – prevents scratching &
removal of tubes & dressings
Waist device – soft cloth or metal bars that
remind the resident that they need assistance
before walking or standing to reduce falls
Pelvic support – keeps resident from sliding
down in w/c, wide in front/narrow in back.
Watch genitalia
Regulations regarding postural
supports
Approach in calm manner to reduce
anxiety & agitation during application
 Explain in non-threatening manner –
“safety” & “soft protective”
 Use only on resident in bed or chair with
wheels in case of emergency
 Place resident in good body alignment
 Pad bony prominences
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Regulations
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Use quick release bow-tie knots to secure
device to bed frame or chair so that you can
untie quickly in an emergency
Tie securely, but allow two-finger slack for
movement between support & skin
Check circulation, sensation, & movement
(CMS) every two hours
Tie support to bed frame NOT side rails
Remove support & reposition every 2 hours,
do ROM to joint
Regulations
Offer fluids, bedpan, urinal on a
frequent, regular basis. Have call light
within reach
 Apply vest device with open area of vest
in FRONT to prevent choking
 Document type of device, reason for
applying, time on & off, CMS,
effectiveness, & nursing care required
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Legal & Psychological
implications of postural devices
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Legal –
– Must have a dr’s order stating reason for
use, type of device, & for how long
– Must have informed consent
– Cannot restrain unnecessarily or for staff
convenience
– Unnecessary restraint can equal false
imprisonment
Implications
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Psychological
– Explain to resident & family reason for
protective devices
– Resident may struggle against devices –
reassure & support resident & family
Bioterrorism
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Possible terrorist acts
– Biological
• Bacteria or viruses
• Toxins
– Chemical
– Explosions
– Nuclear blast
– Radiation
Homeland security advisory
system
Green – low condition
 Blue – guarded condition
 Yellow – elevated condition
 Orange – high condition
 Red – severe condition
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