Module 4A-D Prevention and Management of Catastrophe and Unusual Occurrences

Emergency Preparedness

General Safety Rules

  • Be Prepared:

    • Know emergency codes specific to the facility.

    • Understand fire and disaster plans.

    • Identify the location of fire exits, extinguishers, and alarms.

  • Remain Calm:

  • Emergency Call System:

    • Utilize telephone numbers designated for internal use within the facility.

    • Licensed nurses are responsible for activating the EMS (Emergency Medical System) by dialing 911.

  • Avoid Causing Panic:

    • Do not shout phrases like "fire" or "cardiac arrest".

  • STAT:

    • Indicates the need for an immediate response.

  • RACE and PASS:

    • Follow the facility's policy regarding RACE (Remove, Alarm, Contain, Extinguish) and PASS (Pull, Aim, Squeeze, Sweep) procedures.

  • Scope of Knowledge:

    • Do not act beyond your level of knowledge or training.

  • Resident Safety:

    • Move residents if they are in immediate danger.

    • Remain with the resident.

    • Ensure the resident is comfortable and calm.

    • Evacuate residents to safety according to the facility's fire and disaster plans.

    • Direct family members or visitors to the designated area within the facility.

  • Communication and Confidence:

    • Stay calm and use a calm voice.

    • Project confidence.

  • Facility Emergency Codes and Plans:

    • Know and use facility emergency codes and plans.

  • Fire Safety:

    • Close fire doors.

Emergency Codes

  • Facility-Specific Codes:

    • Each facility may have different codes.

  • Resident Safety Issues:

    • Examples include manpower shortages or specific alarm sounds.

  • Disaster Codes:

    • Example: Disaster Level Three.

    • Codes may differ for internal versus external disasters.

  • Emergency Colors and Meanings:

    • Code Red – fire.

    • Code Blue – adult medical emergency (cardiac/pulmonary).

    • Code Yellow – bomb threat.

    • Code Gray – combative person.

    • Code Silver – person with weapon or hostage.

    • Code Orange – hazardous waste spill or release.

General Safety Rules

  • Body Mechanics:

    • Use proper body mechanic principles.

  • Ergonomics:

    • Use ergonomics.

  • OSHA Safety Laws:

    • Know the policy and procedures regarding OSHA safety laws on the use of equipment and handling hazardous materials, including Material Safety Data Sheets (MSDS).

  • Spills:

    • Wipe up spills immediately and identify wet floors with appropriate signs.

  • Walking:

    • Walk, never run in halls, and watch carefully at intersections.

  • Containers:

    • Only use contents of containers if they have proper labels/dates, and you know how to use them correctly.

  • Equipment:

    • Tag and report broken equipment.

  • Unsafe Situations:

    • Report unsafe situations.

  • Electrical Equipment:

    • Use 3-pronged plugs on electrical equipment.

  • Task Competency:

    • Refuse to do any task that you do not know how to do.

  • Equipment Operation:

    • Know the proper operation of equipment.

  • Safety Hazards:

    • Watch linen and garbage cans for safety hazards (sharps).

  • Sharps Containers:

    • Report if sharps container is over half full.

  • Personal Injury Procedure:

    • Report the injury immediately to the supervisor.

    • Fill out an incident report/unusual occurrence form as per facility policy and procedure.

    • Seek medical help as necessary.

  • Quality Assurance:

    • Resident and staff safety is an important quality assurance issue.

Patient Safety

  • National Patient Safety Goals:

    • Know the National Patient Safety Goals.

  • Identification:

    • Check wrist bands/name tags before performing any task on a resident.

  • Side Rails:

    • Use side rails when appropriate and know facility policy and procedure on side rails.

  • Assistive Devices and Support:

    • Have the resident use handrails/appropriate assistive device when unstable.

  • Footwear:

    • Have residents wear non-skid footwear when ambulatory.

  • Call Signal:

    • Place the call signal light within the reach of the resident and instruct them on correct use.

  • Mobility Equipment:

    • Lock wheels on bed/gurney/wheelchair when transferring the resident.

  • Call Lights:

    • Answer call lights promptly.

  • Lighting:

    • Use night-lights to help ensure good lighting and reduce obstacle hazards.

  • Bed Position:

    • Keep the bed in the lowest position except when tending to the resident.

  • Alarms:

    • Check bed/chair alarms ensuring working condition.

  • Environment:

    • Keep the environment clutter-free.

Falls

  • Statistics:

    • Falls are 70% of all resident-related accidents.

    • Most falls occur during 4:00 pm and 8:00 pm and during shift changes.

  • Prevention:

    • Proper position in bed/wheelchair and readjust every two hours.

    • Soft protective devices as ordered and necessary.

    • Side rails as necessary and use caution when raising and lowering.

    • Watch for arms/legs & tubing.

    • Make sure the rails are locked in the up position.

    • Brakes should be on when transferring resident to or from wheelchair/bed/gurney.

    • Comfort items (water, call bell, urinal, etc.) should be easy for resident to reach.

    • Answer call lights promptly.

    • Areas should have good lighting and be free of clutter.

    • Check to ensure foot latches on beds and foot supports on the wheelchair are out of the way to prevent tripping or hitting staff or resident’s legs.

    • Wipe up spills promptly.

    • Meet the comfort needs of the resident promptly (water and elimination.)

    • Fall precautions; identify at-risk patients who are taking medications that cause the patient to be weak, dizzy, or sleepy.

    • Check residents for weakness, dizziness, and ambulation/transfer hazards.

    • Use the appropriate assistive device as directed by the licensed nurse and ask for help if in doubt.

    • Be aware of resident’s location at all times.

  • Assistive Devices:

    • Assessed for need by the licensed nurse, physical therapy (PT), or rehab aid with input from the Nurse Assistant.

    • Cane:

      • Types of canes include single tip, tri-tip, and quad cane.

      • Use on the strong side.

      • Check the rubber tip and height appropriate for the resident.

    • Walker: Provides stability and support.

      • Types of walkers include pick-up, front-wheeled, and four-wheeled rolling.

      • Some might have seats.

      • Check rubber tips and height appropriate for resident.

      • Give instruction on the correct use.

    • Gait belt:

      • if facility permits.

    • Wheelchair: Provides mobility for the non-ambulatory resident.

      • Different types.

      • Remember removable arm rests and foot rests.

      • Check that the brakes are locked when transferring the resident.

    • Mobility alarm:

      • Used to warn staff and resident of a fall hazard.

      • Used in bed or in chair.

      • Make sure it is in place and all parts are connected.

      • Respond immediately to the alarm and check the resident.

Burns

  • Statistics:

    • Burns are the second most common hazard for residents and often can be prevented

  • Types/Causes:

    • Steam or water burns from bath temperature or hot drinks.

    • Flame from smoking.

    • Chemical burns: cleaners like periwash.

    • Thermal burns: heating pads, sunburn.

  • Prevention and Interventions

    • Prevention (best approach)

      • Check the water temperature and report if it is too hot.

      • Monitor smoking.

      • Monitor hot drinks and risk for spills.

      • Be familiar with the use of equipment such as heating pads and hot packs and know the policy and procedure.

      • Protect resident from sunburn with a hat, sunscreen, and brief exposure.

      • Know the policy and procedure on fire response.

      • Follow directions on the use of chemical cleansers.

    • Intervention (initial first aid)

      • First-degree burns – ice and cold water only for discomfort.

        • Never use butter, shortening, etc., it may cause the burn to become worse.

      • Deeper or large burns require immediate medical attention.

        • Notify licensed nurse immediately.

        • Describe the cause of burn, if possible (e.g., flame, chemical, etc.)

Fire and Procedures

  • Major Causes of Fire

    • Smoking is the number one cause of fire.

    • Sparks from faulty electrical equipment.

    • Heating systems (fireplaces, butane/propane heaters, or electrical heaters).

    • Spontaneous ignition, chemical reaction leading to heat and fire.

    • Improper disposal of rubbish, including disposed of cigarettes, cigars, matches with flammable materials.

  • Elements Needed to Start a Fire

    • Fuel.

    • Flame.

    • Oxygen.

  • Fire Prevention

    • Electrical:

      • Report frayed electrical cords, smoke, or burning smells.

      • Refrain from using too many electrical devices on one wall socket.

      • Use 3-pronged grounded plugs.

    • Smoking Fire Hazard Prevention:

      • Empty waste paper into proper containers.

      • Supervise residents who smoke if they are confused, lethargic, or weak.

      • Be sure materials in ash trays are completely extinguished before throwing them away.

      • Always use ashtrays when smoking.

      • Smoking is allowed in designated areas only.

  • Role of the Nurse Assistant During Fire Emergencies

    • R.A.C.E.

      • R-remove the resident from the fire area and close the room door.

      • A-activate the fire alarm system.

      • C-contain the fire.

      • E-extinguish if possible.

    • P.A.S.S.

      • P-Pull safety pin.

      • A-Aim at base of fire.

      • S-Squeeze.

      • S-Sweep low.

    • Be sure residents are not placed near automatic fire doors.

    • Know and follow the facility’s specific policy and procedure related to fires and fire prevention.

Oxygen Therapy

  • Basics:

    • Oxygen is abbreviated O_2 and measured in liters per minute (L/min).

    • A colorless, odorless, tasteless gas is essential for respiration (breathing).

    • Some residents need supplemental oxygen to assist them in breathing.

    • Oxygen is supplied in portable tanks, through wall outlets, or concentrators.

  • Fire Risk:

    • Oxygen increases the risk of fire since it supports combustion and is one of the three elements needed for fire.

  • Safety Precautions:

    • Place a “no smoking, oxygen in use” sign on the door of resident’s room as well as over their bed.

    • Smoking is never allowed near the oxygen by anyone, including the resident or visitor.

    • Keep oxygen tubing open and free of kinks.

    • Check electrical equipment use in presence of oxygen (electric razors, fans, and radios). Electrical items must be turned off before unplugging.

    • No flammable liquids, such as alcohol, nail polish remover, or petroleum based products (Chap Stick, Vaseline).

    • Watch for static when combing resident’s hair, using wool blankets, or nylon materials in clothing, etc.

  • Types of Oxygen Equipment

    • Green metal portable tanks: (E tank/ H tank)

      • Under pressure and must be handled carefully to prevent dropping and possible explosion when in storage.

      • Must be secured to the wall.

      • Must be on a movable stand and strapped in place.

    • Portable tanks

      • Large ones are covered with plastic casing, and small ones that the resident can carry or hang on an assistive device when moving.

      • Must be kept upright and not dropped.

    • Wall outlets use wall mount flow meter and plastic tubing.

    • Resident equipment used to deliver the flow of oxygen:

      • Nasal cannula.

      • Face mask.

      • Concentrators.

  • Nursing Care

    • A physician’s order is needed for oxygen because it is considered a medication.

    • Make sure the resident wears a mask/cannula at all times.

      • If oxygen needs to be turned off, there needs to be an order stating that the resident may have it off at certain times.

      • When the oxygen is not in use for a short period of time, then the oxygen needs to be turned off, as it is very expensive and poses a fire hazard.

    • The Nurse Assistant must follow the policy and procedure for their facility in filling the oxygen tanks, turning the tanks on and off, as well as the setup.

    • Oxygen is very drying to the nasal passages

      • Check resident’s nose and cleanse.

      • Maintain the water level in the humidifier to reduce dryness.

    • Check for redness and discomfort over the ears where the tubing rests and on the face when wearing the mask.

    • If redness or discomfort is noted, report it to the licensed nurse.

    • The Nurse Assistant may turn the tank on and off but may not adjust the oxygen flow rate, as that is considered administration of medication and is not within their scope of practice.

Postural Supports/Protective Devices/Restraints

  • Description and Purpose:

    • Used to prevent the resident from harming themself or others.

    • Used to prevent the resident from:

      • Falling out of bed/chair.

      • Crawling over side rails or the end of the bed.

      • Interfering with therapy by removing tubing or dressings.

      • Hurting themselves or others.

  • Description of Terms

    • Soft protective device – a device that serves as a reminder to the resident of safety issues, like a waist device or Posey (also called safety device reminders-SDR).

    • Postural supports – are devices that help keep the resident in the correct posture position when in a chair, like a jacket or vest.

    • Restraints:

      • Control behavior and are used only in extreme measures like limb devices.

      • Side rails can be considered a restraint if all four side rails are up.

      • Infringe on the resident’s right to freedom of movement as it holds back or limits a resident’s movements and may be considered “false imprisonment” when inappropriately used.

  • Alternatives to the Use of Devices

    • Place the resident where they can have constant supervision.

    • Make sure the resident’s comfort needs are met like water, toilet, reposition, etc., so there is a reduced risk of them attempting to meet needs unassisted and agitation is reduced. Check for pain or discomfort.

    • Devices are used as a last resort and never for nursing convenience or as punishment.

  • Types of Protective Devices and Postural Supports

    • Vest or jacket device – has an opening in the front, watch for choking and cutting into the resident.

    • Wrist or ankle device – this soft limb device restricts limb movement.

    • Hand mitt device – this device helps to prevent scratching and removal of tubes and dressings.

    • Waist device – this can be a soft cloth that may be self-releasing to remind the resident that they need assistance before walking or standing to reduce falls.

    • Pelvic support – this keeps the resident from sliding down in the wheelchair and is wide in the front and narrow in the back. Be careful not to injure genitalia.

  • Regulations Regarding the Nurse Assistant’s Role

    • The use of postural supports concerns resident rights, and improper application can be dangerous.

    • Approach the resident in a calm manner to reduce anxiety and agitation during application.

    • Explain to the resident and their family in a non-threatening manner by using terms like “safety” and “soft protective”.

    • Use only on a resident in a bed or chair that has wheels in case of an emergency.

    • Place resident in a good body alignment and position.

    • Pad bony prominences.

    • Use a “quick-release” bow-tie knot to secure postural support to the bed frame or chair to ensure easy removal in an emergency.

    • Tie securely but allow some slack for movement – two-finger check between support and skin.

    • Check circulation, sensation, and movement (CSM) every two hours.

    • Tie support to the bed frame that moves with the resident, not the side rail.

    • Remove the support, reposition the resident, and do ROM to the joints every two hours for at least ten minutes or more frequently per facility policy.

    • Offer fluids, bedpan, or urinal on a frequent, regular basis.

    • Have the call bell within reach.

    • Apply the vest device with the open area of the vest in the front to prevent choking or use according to the manufacturer’s instructions.

    • Document the type of device, reason for the device, time on and off, CSMs, effectiveness, and nursing care that is needed.

Legal and Psychological Implications of Postural Supports

  • Legal Implications

    • Must have a doctor’s order to use protective devices, including the stated reason for use, type of device, and for how long.

    • Must have informed consent.

    • Resident rights require that the resident not be restrained unnecessarily or for the convenience of the staff.

    • Unnecessary restraint of a resident could constitute false imprisonment. Ask nurse for explanation of needs if in doubt.

  • Psychological Implications

    • Explain to the resident and the family the reason for using protective devices.

    • The resident is usually aware of restricted movement and may struggle against the supports. Reassure and support the resident and the family.

Terrorism

  • Define terrorism.

  • Possible Terrorism Acts

    • Biological threat:

      • Bacteria – Anthrax.

      • Viruses – Smallpox.

      • Toxins – Ricin.

    • Chemical threat

    • Explosions

    • Nuclear blast

    • Radiation threat

  • Possible Types of Bioterrorism Threats

    • Explosion

    • Chemical/Biological Attack

    • Nuclear/Radiological Attack

  • National Terrorism Advisory System (NTAS)

    • Replaces the Homeland Security Advisory System (HSAS) that was color-coded.

      • Imminent Threat

      • Elevated Threat Alert

      • Sunset Provision – expires after a specific time period.