Safety, Infection Control, and Emergency Response
Safety
Safety as a system
Safety questions ask you to prevent harm before it happens. Falls are the most common safety event, so every resident is treated as a fall risk until assessed. Know the basics: call light within reach, bed in the lowest position, wheels locked, non-skid footwear, clear path, adequate lighting, and a toileting schedule. Scheduled toileting prevents more falls than restraints do.
Restraints
Physical and chemical restraints require a physician's order, must be the least restrictive option, and require monitoring and release. Never tie a resident, never use a sheet as a restraint, and never use bed rails as a restraint. Try alternatives first: company, activity, repositioning, toileting, and a calmer environment.
Fire and oxygen
Use RACE: Rescue, Alarm, Contain, Extinguish or Evacuate. Use PASS for a fire extinguisher: Pull, Aim, Squeeze, Sweep. With oxygen in use, there is no smoking, no petroleum products, and no sparks.
Reporting
Incident reports contain facts only: what happened, when, who was present, what you did, and who you notified. Notify the nurse immediately. Never blame, speculate, or alter the medical record.
Traps
A common distractor is applying a restraint because a resident wanders, or documenting a fall and telling the nurse at the end of the shift. Both are wrong. Another trap is ignoring a new symptom such as dizziness or sudden weakness.
Rule of thumb
Any change in condition means stop, assist the resident to a safe position, stay with them, and report immediately.
Infection Control and Emergency Response
Hand hygiene and PPE
Hand hygiene is the single most effective way to prevent infection. Wash with soap and water when hands are visibly soiled, after using the restroom, and after caring for a resident with C. difficile. Otherwise use alcohol-based rub. Gloves never replace hand hygiene; clean your hands before and after gloves.
Standard precautions apply to every resident: gloves for blood and body fluids, and gown, mask, and eye protection when a splash is likely. Transmission-based precautions add contact precautions (MRSA, C. diff, scabies), droplet precautions (influenza), and airborne precautions with an N95 respirator (tuberculosis, measles).
PPE order: gown, mask, goggles, then gloves. Remove gloves first, then goggles, gown, and mask, with hand hygiene after.
Never recap a used needle. Report any exposure immediately.
Emergency response
- Unresponsive: call for help, check breathing, and begin CPR per your training; for an adult, compressions are 100 to 120 per minute.
- Choking: encourage coughing; if the airway is blocked, give back blows and abdominal thrusts.
- Seizure: protect from injury, do not restrain, time it, and turn the resident on their side afterward.
- Suspected stroke: note the time symptoms began and call for help.
- Severe bleeding: apply direct pressure.
Traps
Watch for answers that use gloves instead of hand hygiene, carry PPE from one room to the next, or put an object in a seizing resident's mouth. All are wrong.
Rule of thumb
Your safety comes first. Call for help and use PPE before you touch anything.