GENERAL SAXFETY PROCEDURES

Goals
1. After reading this chapter, you will have the information needed to:
2. Use proper body mechanics and lifting technique to protect your body from injury on the job.
3. Describe the safe use of equipment with moving parts.
4. Be aware of factors that place those in your care at risk for injury.
5. Take measures to prevent common accidents (such as falls, electrical shocks, burns and poisoning) from occurring.
6. Ensure that proper follow-up takes place if an incident does occur.
7. Understand the hazards associated with restraint use, and describe alternatives to restraint use.
8. Describe the conditions that must be met before a restraint is applied, and describe actions you must take to keep a
person who is restrained safe.
9. Describe preparation and completion steps that are performed before and after every procedure to protect yourself and
the people in your care.

PROTECTING YOUR BODY FROM INJURY

As a nurse assistant, you lift and move people and things all day long. This can place a great deal of strain on your muscles
and joints, causing pain and injury. Today, many employers have “no lift” or “safe patient handling” programs, per
Occupational Safety and Health Administration (OSHA) recommendations. These programs seek to limit on-the-job injuries
by providing equipment (such as mechanical lifts and powered standing-assist devices), training and resources (such as
additional staffing) to make lifting and repositioning people easier and safer for the health care worker. Always follow your
employer’s policies and the person’s care plan when you are determining how to assist a person with moving, and use the
equipment that is available to you. Ask for help from co-workers when you need it. And learn and practice good body
mechanics and lifting technique.

Practicing Good Body Mechanics

When you practice good body mechanics, you use your body in a safe and efficient way to accomplish tasks such as lifting,
pushing and pulling. Good body mechanics are all about alignment, balance and coordination.
Alignment is good posture. If you have ever driven a car that is out of alignment, you know that it’s hard to steer, the tires
wear down unevenly and it’s unsafe. Human bodies that are out of alignment have similar problems. Body parts get pulled
out of shape, which leads to discomfort and injury. Holding your body in alignment reduces strain on your joints and
muscles.

 Standing. To practice good alignment while standing, keep your knees slightly bent and stand with your feet shoulder-
width apart. Put your weight evenly on both legs. Keep your shoulders straight and centered over your hips, your
stomach muscles tightened and buttocks tucked under, your head up and your chin level.
 Sitting. To practice good alignment while sitting, sit with your knees level with your hips, your back straight, your
stomach muscles tightened, and your shoulders straight and centered above your hips.

Balance is stability achieved through the even distribution of weight. Having a wide base of support and keeping the heaviest
part of your body (your center of gravity) close to your base of support helps you to stay balanced. When you are standing,
your feet and legs are your base of support, and your torso is your center of gravity. Therefore, spreading your legs apart
and bending your knees to bring your torso lower helps you to remain stable on your feet.

Coordination is the use of direction and force for purposeful action. For example, when you are moving a person up in
bed, you will place one of your feet in front of the other. Shifting your weight from your back foot toward your front foot
gives you additional power and helps you to move the person toward the head of the bed. Coordination also means working
with someone, rather than against them. For example, when you are repositioning a person, encourage the person to help
you as much as possible. Similarly, if you are working with another nurse assistant to reposition a person, you will want to
use good communication to make sure you are both performing the same movements at the same time. This will give you
twice the power and make the move easier.

Lifting Safely

As a nurse assistant, you will be required to lift people and equipment frequently. If you don’t use proper technique when
lifting, you put yourself at risk for injuring your back. Back injuries can be painful and difficult to treat. They can prevent
you from participating in activities that you enjoy, and they may even end your career in health care.
Proper lifting technique involves using the powerful muscles of your legs and buttocks to drive yourself, and whatever you
are lifting, upward. To practice proper lifting technique:
1. Plan your lift, and get help if you need it.
2. Stand close to the person or object you are lifting. Avoid leaning over or reaching.
3. Place your feet about 12 inches apart, with one foot slightly in front of the other. This position provides a broad base of
support and helps you maintain your balance.
4. Avoid bending over at the waist. Instead, bend your knees and keep your back straight. Keeping the person or object
close to your body, tighten your stomach muscles and drive yourself upward, using the muscles of your legs and
buttocks.
5. To turn, pivot with your feet. Avoid twisting your body at the waist when your arms are loaded.

USING EQUIPMENT SAFELY

As a nurse assistant, you use equipment that makes your job easier and helps to ensure the safety of the people in your care.
But because most equipment has moving parts, you can cause serious injuries if you do not use it properly. Before using
any piece of equipment, be sure you understand how it works. Read the user’s manual and follow instructions exactly.
(Instructions for use may also be located on a sticker or label attached to the equipment.)
Before using the equipment with a person in your care, practice using the equipment by yourself. If you are not completely
confident about using the equipment, ask the nurse for help rather than risk injuring yourself or the person in your care.

Equipment with Wheels

Many pieces of equipment that you will use in the health care setting, such as beds, shower chairs and wheelchairs, have
wheels. The brakes provided on equipment with wheels prevent the equipment from rolling. Imagine how unsafe and
difficult it would be to help someone into a piece of equipment that kept moving. Before using a piece of equipment that
has wheels, try out the brakes. Make sure you know how they work and that they work properly. If they do not work
properly, do not use the equipment. Report the equipment problem to the nurse.

Side Rails

Beds used in health care facilities may be equipped with side rails that can be raised to prevent the person from falling out
of bed. Some people may also use raised side rails as an assistive device for repositioning themselves in bed. Today, use of
side rails is becoming less common, because side rails are considered a form of restraint (you will learn more about restraints
later in this chapter). In addition, side rails can cause serious injury. A confused person may try to climb over the side rail
and fall. Entrapment is also a concern when side rails are in use, especially with older people who are confused or
disoriented. In entrapment, the person’s head or another body part gets trapped between, under, or on the side rails, or
between the mattress and the side rail. This can lead to suffocation (an inability to breathe), serious injuries and death. The
person’s care plan will state whether the side rails are to be lowered or raised when the person is in bed. Always follow the
person’s care plan! If side rails are in use for a person in your care, make sure that the side rails have been installed properly,
and check the bed frame, side rails and mattress to find areas where a person may become entrapped.

KEEPING THE PEOPLE IN YOUR CARE SAFE

The key to safety is prevention, or trying to keep things from going wrong by considering the things that can go wrong and
taking steps to avoid them. By using common sense and your knowledge of the person in your care, you can think about
things that might go wrong and take steps to prevent them from happening.
Risk Factors for Injury

Many of the people in your care will have one or more risk factors that put them at increased risk for injury. Understanding
each person’s risk factors for injury will allow you to take steps to prevent injuries from occurring.

 Sensory impairment. Our five senses—sight, smell, touch, hearing and taste—give us information about our
environment and help to keep us safe. Think about how often you rely on your senses to maintain your own safety. For
example, you read a label on a bottle to determine what is inside, and you look both ways before you cross the street.
You listen for alarms and other sounds that alert you to danger. A food’s odor or taste might tell you that the food is
spoiled. You test the water in the shower before stepping in to see if it is too hot, or not hot enough. A person with
sensory impairment (for example, as a result of a stroke, complications of diabetes or advanced age) is at increased risk
for injuries because the sensory impairment affects his ability to detect potential dangers in the environment.
 Confusion and disorientation. A person who is confused (for example, as a result of dementia, medication effects or
being in an unfamiliar place) is not able to make good, safe choices. The person might try to stand up when it is not safe
for her to do so. She might drink or eat something poisonous because she confuses it for something that is safe to drink
or eat. She might go outside without first putting on a coat to offer protection from bad weather.
 Poor mobility. A person who is physically weak, unsteady on her feet, or paralyzed is more likely to trip or fall.
Disorders such as Parkinson’s disease or a stroke can cause a person to shuffle, which increases the risk for tripping. A
person who is weak (for example, due to illness or advanced age) will tire easily when moving, which can cause her to
fall.

Preventing Common Injuries

As a nurse assistant, there are many things you can do to prevent the people in your care from being accidentally injured.
Let’s take a closer look at common accidents that might occur.

Falls
Falls happen to all human beings. As people age, factors such as declining eyesight, decreased strength and increased
difficulty moving can increase a person’s risk for falling. Certain disorders (such as Parkinson’s disease) and the effects of
medications can also increase a person’s risk for falling. Falls can cause serious, even fatal injuries. Because falls can have
such serious consequences, prevention is key.
The nurse is responsible for assessing the person to evaluate the person’s risk for falling when the person is admitted to the
facility, and periodically thereafter. Many facilities use a fall risk assessment form, which assigns a numerical value to risk
factors the person has for falling. Strategies for addressing and minimizing the risk factors are then written into the person’s
care plan. If the person is at high risk for falling, a symbol (such as a falling leaf or a falling star) may be placed next to the
person’s room number or above the bed to alert all staff, even those who do not have access to the person’s care plan, to the
person’s risk for falling.
You can use your specific knowledge of each person in your care to help prevent falls. The key to managing and preventing
falls is to realize that a fall is nothing more than the result of a motivated behavior. In other words, if the person does not
get up, she won’t fall down! The key then is to work to find out what the person wants to do and then help her to do it safely.
Use your knowledge of the person to think about why she might try to get up without help, or what might cause her to fall.
Then think about ways you can meet the person’s need and reduce or eliminate the risk for falling. For example:

 You know that Mrs. Williams will try to get up to get a book or magazine or other item that she needs, rather than ask
for help. To help reduce Mrs. Williams’ risk of falling, you can make sure the items she might want are within easy
reach. This can be accomplished by moving the table closer to Mrs. Williams, rearranging the items on the table so that
what she needs is within easy reach, or providing her with a grabber she can use to reach the items.
 Lately, Mr. McDaniels has been complaining of feeling dizzy whenever he sits up. To help reduce his risk of falling,
you can make sure the nurse knows about the dizziness, so that the cause can be determined and addressed. Details
about the person’s dizziness—such as the level (mild to severe), the length of time it lasts (from a few seconds to 5
minutes or more), and what the person was doing when the dizziness occurred (for example, moving his head, trying to
sit up or stand)—are also helpful to report.
 Mrs. Jones has dementia. You know that because of her memory loss, she has trouble understanding her environment.
You also know from talking to Mrs. Jones that she had dogs as pets up until she came to live at the nursing home.
Lately, Mrs. Jones has been trying to get up in the middle of the night unassisted to “take the dog out.” To help reduce
Mrs. Jones’ risk for falling, you could look at pictures of her dogs with her before she goes to bed to bring back good
memories, and reassure her that her dogs are being well taken care of. This might help her to feel calm and contented,
and reduce her tendency to get up in the middle of the night to take care of the dog.
 Mrs. Lukins is a very private person. You know that she is embarrassed to ask for help using the bathroom. You make
it a point to check on Mrs. Lukins frequently and ask her if you can help her to the bathroom.

In each of these examples, your knowledge of the person as an individual gives you information you can use to help lower
the person’s risk for falling.

Electrical shocks

As you go about your daily routine, you will use many pieces of electrical equipment, from grooming appliances (hairdryers,
curling irons, electric shavers) to furniture (adjustable beds, lamps). Always inspect electrical devices before you use them
to make sure that they are in good working order and that cords are intact. A piece of equipment that is not working properly
or that has a frayed cord can give the person (or you) an electrical shock. Always follow the manufacturer’s directions for
using the piece of equipment, and avoid getting the equipment near water.
Shocks can also occur at electrical outlets. Use care when inserting and removing plugs, and advise those in your care to do
the same. Use plastic outlet covers to prevent children or confused adults from sticking their fingers or other objects into
the outlet. Avoid overloading outlets. Use a surge protector if it is necessary to plug more than two items into a standard
outlet. Avoid using extension cords, except on a temporary basis.

Burns

A person can easily be burned if the water used for bathing is too hot. Turn hot water on last and off first, and check the
temperature of the water coming out of the faucets. You can test the temperature of the water using your wrist, but remember
that a person with impaired sensation may not be able to tell if the water coming out of the faucet is too hot. Teach people
with impaired sensation to use a thermometer to measure the temperature of the water before getting in the bathtub or
shower. The temperature of hot tap water should be less than 115°F. If water seems too hot, report this concern immediately
to the nurse.

Foods and beverages that are too hot can also cause burns. If food is steaming or a plate is too hot to touch, wait until the
food stops steaming or the plate has cooled a little before serving the meal. Also make sure hot beverages have cooled a bit
before serving them. If a person has trouble keeping a fi rm grip on the cup, spills can occur, leading to burns. Serving the
beverage in a cup with handles and a lid can help the person hold the cup more securely.
Some people may use heating pads to promote comfort. Place the heating pad in its cloth cover or wrap a towel around it
before placing it against the person’s skin. Set the temperature according to the person’s care plan, and avoid leaving the
heating pad in place for longer than 20 minutes. Check the skin underneath the pad every 5 minutes for excessive redness
or blisters. Do not allow the person to lie on top of the heating pad, because this increases the likelihood of burns.

Poisoning

A poison is any substance that causes injury, illness or death if it enters the body. Cleaning supplies, fluids used for car and
home maintenance, and certain plants can all cause poisoning if a person swallows them. Poisoning can also occur if a
person takes the wrong medication, or too much of it. To reduce the risk for accidental poisoning, make sure all containers
are clearly and accurately labeled. Store all medicines, cleaning materials and other potentially poisonous substances in
locked cabinets and closets.

Reporting Incidents

An incident is something unusual that happens to a person receiving care, a staff member or a visitor to the facility and has
the potential to cause harm. You must verbally report all incidents, even those that do not result in injury, to the nurse. In
addition, you must complete a written incident report, per your employer’s policy.
When reporting an incident and completing an incident report, it is important to provide facts, not opinions. The goal is not
to assign blame. It is to provide a factual account of what happened so that appropriate steps can be taken to prevent a
similar incident from happening in the future. Report the incident and complete the incident report promptly, while the
details of what happened are still fresh in your mind.

A complete incident report contains answers to the following questions:

 Who was the person involved in the incident? Was the person confused before or after the incident?
 Was the person alone?
 What happened to the person? Was the person injured? If so, describe the injury.
 What caused the incident? (For example, was water on the floor?) Remember to state only facts, not opinions.
 Where did the incident happen?
 When did the incident happen (time, date)?
 Who gave assistance or first aid?
 What kind of assistance or fiRst aid was given?
 Were there witnesses to the incident? If so, who?
 Did the person receive medical treatment? Also include other information that would be a useful part of the record or
that is required by your employer.

A WORD ABOUT RESTRAINT

A restraint is any device that inhibits a person’s freedom of movement. Restraints can be physical or chemical. A physical
restraint is attached on or near a person’s body to limit the person’s freedom of movement or ability to reach part of her
body. Examples of physical restraints include wrist restraints, mitt restraints, jacket restraints and vest restraints. Devices
such as side rails and lap trays can also be considered physical restraints, if the person is not able to move them out of the
way independently. Chemical restraints are medications used to subdue a person, so that the person is unable to function
normally.
In the past, it was thought that restraints helped to keep people safe by preventing them from getting up without assistance
and falling or wandering away from the facility. However, now we know that restraints can cause very serious
complications, and even death. In addition, the use of restraints can rob a person of his or her dignity. As a result, restraint
use is decreasing in all health care settings. Today, many health care facilities, especially nursing homes, strive to be restraint
free. The Omnibus Budget Reconciliation Act (OBRA) states that people receiving care in nursing homes and in their own
homes have the right to be free of restraints, and establishes strict guidelines for their use.

Restraints must never be used as a convenience for the nursing staff, or to punish or discipline a person. As a nurse assistant,
you must seek ways to keep the people in your care safe without using restraints. Providing company and distraction is one
way to do this. Involve the person in meaningful activities, such as exercise, games, hobbies or musical entertainment.
Activities provide gentle physical and mental stimulation, help the person feel useful and improve the person’s self-esteem.
Ask family members or volunteers to sit with the person, or bring the person to the nurse’s station with you while your
complete paperwork. Check in on the person very frequently, and offer a snack or beverage, or assistance using the
bathroom. Getting to know the person as an individual will help you think of creative ways to keep the person safe without
using restraints.

In some very specific situations and health care settings, it may be necessary to apply a restraint. For example, it may be
necessary to apply a wrist restraint to a hospitalized person who is confused and keeps removing a medical device that is
essential to his care, such as an intravenous (IV) line. If restraints are in use in the facility where you work and applying
them is part of your job description, your employer will teach you how to properly apply the types of restraints that are in
use in the facility. If you are asked to apply a restraint, make sure that the conditions listed in Box 7-4 have been met first.
Make sure you understand exactly how to use the restraint, and use the right size for the person’s height and weight. Follow
your employer’s procedure and the manufacturer’s instructions for securing the restraint. After the restraint is applied, you
must help keep the person safe.