MODULE 2

SAFETY AND MOBILITY

Healthcare College

Chapter 22: Safety, pp. 382

Chapter 23: Preventing Infection, pp. 420

Chapter 25: Body Mechanics, pp. 491

Chapter 26: Exercise and Activity, pp. 533

Sorrentino, S. A., Wilk, M. J., & Remmert, L. N. (2018).

Mosby's Canadian textbook for the support worker (4th ed.).

Toronto, Ontario: Elsevier Canada.

Occupational Health and Safety Legislation (OH&S)

◦ Federal and provincial laws designed to protect employees from injuries and accidents in workplace; these laws outline the rights and responsibilities of employers, supervisors, and workers.

Having written policies that promote safety Training and educating you about these policies Creating a health and safety committee Responding to reports of workplace hazards Warning you about safety hazards and correcting

these hazards, whenever possible Reporting all accidents promptly to OH&S Making sure that all necessary equipment is

available (including personal protective equipment PPE such as gloves and masks) and all is kept in good working order.

Following all safety policies and procedures

Using all recommended protective equipment and clothing

Reporting all safety hazards and concerns immediately to your supervisor

Completing an incident report. This is a report submitted to our employer whenever an accident, error, or unexpected problems arises in the workplace.

Image credit: http://jobsresumes.org/7-sample-incident-report-form/

According to OH&S legislation, you have the right to refuse to do unsafe work. This applies whether you are working in a facility or in community setting.

However, you cannot refuse to work if:▪ The danger is a normal part of the job

▪ Your refusal would endanger the client

For example, you could not refuse to provide care to a client with a communicable disease because you are afraid of getting the disease.

However, you could refuse to provide care to a client with a communicable disease if protective gloves, masks, and gowns are not available.

Confirming Client/Patient Identity Prior to Treatment or Care

“RIGHT CARE TO RIGHT CLIENT”

Ways for correct patient identification:1. When asking resident’s name, let the client verbalize

his/her name.2. Matching resident’s name and room number, bed

number.3. Matching resident’s picture in care plan or Kardex to

actual resident 4. Matching resident’s name with ID bracelet5. Be aware of “name alert” – most residents may have

same surname or even complete name at times.6. Follow institution policy for patient identification.

Impaired awareness of the surroundings

Vision impairment

Hearing impairment

Reduced sense of smell and touch

Decreased mobility (paralysis, balance, etc.)

Medication side effects

Age

Weaker muscles Slower, less steady movements Slowed reaction time Balance problems Reduced sensitivity to heat Decreased vision Hearing problems Dulled sense of smell, taste and touch Memory problems Joint pain and stiffness Low blood pressure

History of falls (recurrent falls) Foot problems Ill-fitting shoes Elimination problems – incontinence Dizziness and light headedness Depression Poor judgement or dementia Unfamiliar surroundings Treatment equipment (IV lines, catheter, etc.) Improper use of wheelchairs, walkers, canes,

and crutches

Preventing Falls1. Never leave infants and young children unsupervised.2. Secure child in a high chair or infant seat.3. Do not use baby walkers; they have caused many serious falls and

injuries.4. Use of safety gates.5. Always keep one hand on a child when on a scale, change table or

other furniture.6. Keep crib rails up at all times, frequently check.7. Make sure nothing on the crib that the baby can stand.8. Do not let children under 6 years old to sleep on top of a bunk bed.9. Keep children away from windows. Keep in mind that window screens

are not strong to prevent falls.10. Do not let children run with objects in their hand or mouth.11. Make sure all furniture are secured on the wall such as dressers and

drawers.

Preventing Choking

1. Always supervise children when eating.2. Always hold feeding bottles when feeding infants.3. Remove all small objects such as coins, pins marbles, etc.4. Do not allow children to blow balloons using their mouth, use a

balloon pump when necessary.5. Keep all plastic bags away from children.6. Do not let children use necklace, strings, cords. Remove bibs before

placing infant in crib.7. Position infants on their back for sleep.8. Remove pillows, stuffed toys or other items that may cover an

infants face while sleeping.9. Always keep bathroom doors locked, this prevents children enter

the bathroom without supervision.10. Always keep buckets, sinks, and basin empty when not in use.11. Do not leave children or infants unattended in a vehicle.

Preventing Falls1. Clean up water and other spills immediately.2. Report throw rugs and small mats that are not secured.3. Report loose floorboards and tiles, or bumpy rugs and

carpet.4. Keep high traffic areas (hallways) free from cords and

wires.5. Keep the floor and stairways free of clutter.6. Ensure proper lighting, esp. near stairway and bathroom.7. Keep a clear path from bedroom to bathroom.8. Do not rearrange the client’s furniture.9. Use non slip rubber mats in bath tubs and showers.10.Make sure client’s footwear and clothing fit properly.

Preventing Falls – cont’d▪ Ensure mobility aids (walkers, cane, etc.) are in good working

condition. Make sure the client uses these devices correctly.▪ Make sure wheelchair breaks are working properly, keep it

locked when not moving. Report broken breaks immediately.▪ Encourage the client to wear their glasses and hearing aids.▪ Check the client often, especially those with risk factors.▪ Use electronic warning devices properly when needed (refer to

facility policies before using).▪ Respond to all alarms (call bell) accordingly.▪ Place call bell within client’s reach.▪ Offer assistance often to clients who need help with elimination.▪ Keep beds in the lowest position, except when giving bedside

care.▪ Never leave the client alone when the bed is raised.▪ Use bedrails strictly according to care plan and institution policy.

Preventing Falls – cont’d▪ Use floor cushions beside the bed for those clients with

high risk for fall.

▪ Lock the wheels on bed legs when giving bedside care and transferring the client.

▪ In facilities, be cautious when turning on corners of hallways; it may cause collision and falls.

▪ In both facilities and home, perform a safety check of the room after the visitors leave.

• Safety barriers are used to prevent wandering. (Follow care plan and institution policy)

Image credit: http://www.posey.com/sites/default/files/8210-2_door_guard_stop_920x920.jpg

• Encourage clients to use hand rails and grab bars.

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Use floor cushions beside the bed for those clients with high risk for fall.

Image credit: http://www.posey.com/sites/default/files/6027_beveled_floor_cushion_920x920_0.jpg

Roll guards can prevent a client from rolling out of bed (use per care plan and institution policy)

Image credit: http://www.posey.com/sites/default/files/5700-3_roll_guards_brushed_polyCVR_920x920.jpg

❖ Moving a client from one place to another when the client can bear their own body weight.

Transfer Sheet

In medicine, in particular, in emergency medicine, the log roll or logrolling is a maneuver used to move a patient without flexing the spinal column.

Patient's legs are stretched, the head is held, to immobilize the neck. To minimize the amount of lateral spinal displacement the arms must be stretched along the sides, with palms resting on the thighs.

After that the patient is carefully rolled in the desired direction without twisting or bending the body.

To move the patient as a whole unit, not in sections.

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Safety Measures to Prevent Burns/Scalds

1. Educate client about the dangers of wearing loose clothing while cooking.

2. In facilities, ensure that clients only smoke in designated smoking areas.

3. Supervise clients who smoke and who cannot protect themselves.

4. Follow safety guidelines when applying heat or cold.

5. When feeding client, always test the temperature of the food or drink. Testing by using separate spoon and touching it to your lower arm. Use separate clean spoon to feed client.

6. Always test the water temperature when giving bath.

7. Assist clients with eating and drinking, as needed. Spilled hot foods and fluids can cause burns, which can be minor or severe.

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Superficial Burn

Partial-Thickness Burn

Full-Thickness Burn

Follow your institution/agency policy, report to nurse or supervisor for any client injury.

Immediately cool the injured area to reduce pain, swelling, blistering, and tissue damage. Immerse the area of the burn in a sink of cool water, run cool water over it, or cover it with a clean and wet cool cloth.

Once pain is reduced, gently pat the skin dry and cover it with a dry, lint free, clean cloth or gauze. Secure it with tape as necessary.

Do not apply oil, butter, salve, or ointments on a burn.

For more serious burns, seek medical attention as necessary (Activate EMS system, usually calling 911)

Suffocation occurs when breathing stops due to lack of oxygen.

Brain damage or death may occur within 3 to 4 minutes, depending on how long the person has been deprived of oxygen.

Common causes of suffocation:1. Choking2. Drowning3. Gas inhalation4. Strangulation5. Electrical shock

When feeding clients, do not rush them. Cut food into small, bite-sized pieces for those who cannot do for themselves.

Report any sign of dysphagia (difficulty in swallowing), report to nurse or supervisor.

Follow care plan for client’s diet restrictions (regular, minced, soft, pureed diet) and/or fluid restriction (thickened or thin fluids).

Make sure client’s dentures fit properly, report any loose fitting or loose teeth/tooth.

Follow institution policy for clients with feeding tubes. Open windows or doors if you notice gas odors. Report

immediately or call 911 if the odor is strong. Assist client to move out of the area if necessary.

Always follow correct client positioning when feeding (High-Fowlers position/sitting upright). Keep client in upright position 30 minutes after feeding/meals.

Use bed rails properly, as per institution policy.

A restraint is any device, garment, barrier, furniture, or medication that limits or restricts the freedom of movement or access to one’s own body.

Personal support workers never decide if restraints are to be used, restraints require a physician’s order after consultation with the client’s family.

Always follow institution/agency policy regarding use of restraints.

RESTRAINTS

1. PHYSICAL RESTRAINTS❖ Garments or devices used to restrict movement.

❖ Examples: mitt restraint, wheelchair seatbelt,

Types of Restraints

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https://www.mobilityworks.com/blog/images/wheelchair-securement.jpg

2. ENVIRONMENTAL RESTRAINTS

❖Barriers, furniture, or devices near the body that are not directly attached to client’s body.

❖Examples: geriatric chair, chair placed closed to the wall so the client cannot move, bed rails, locked rooms (seclusion areas).

Types of Restraints

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3. CHEMICAL RESTRAINTS

❖Medications used only to control behavior or movement, they are not otherwise required for the client’s medical condition.

❖Examples: anti-anxiety medications

❖ If needed for client’s agitation, anxiety, aggressions; only a physician or nurse can administer chemical restraints.

Types of Restraints

Under our Canadian Charter of Rights and Freedoms, threatening a client while applying a restraint is considered an assault, and using a restraint on a client without doctor’s orders is considered a battery.

Fires are a constant danger in homes and facilities. Unsafe smoking, cooking accidents, faulty electrical equipment and wiring, and heating equipment are major causes.

The entire healthcare team must be vigilant to prevent fires.

PREVENTING FIRES

1. Smoke only on designated areas. Do not smoke in the client’s home.

2. Supervise clients who smoke, provide ashtrays as necessary. Ensure all ashes and cigarettes are put out before emptying. Empty ashtrays in designated metal waste bin.

3. Check smoking areas for dropped cigarettes and ashes.4. Do not allow client to smoke in bed.5. Do not light matches or lighters or smoke around flammable

materials. (Be aware of client who uses oxygen)6. Keep space heaters away from blanket, curtains or drapes.7. Do not run electrical cords under carpet.8. Remove all electrical equipment from outlet when not in use.9. Keep flammable liquid (alcohol etc.) away from fireplaces,

radiators, and heaters.10. Follow safety measures for clients who uses oxygen.

The acronym R-A-C-E will help you remember what to do if you discover a fire in a home or a facility.

R – Rescue: Rescue people in immediate danger. Move them to a safe place.

A – Alarm: Sound the nearest fire alarm. Notify the switchboard operator, or call 911 if in any client’s home.

C – Confine/Contain: Close doors and windows to confine the fire.

E – Extinguish or Evacuate: Use a fire extinguisher on a small fire that has not spread to a larger area. If unable to extinguish, evacuation will be necessary.

Image credit: http://www.metrolifesafety.com/uploads/7/1/7/2/71723847/__7371968_orig.jpg

Harmful substances◦ Medications and vitamins◦ Household cleaners◦ Personal care products◦ Houseplants◦ Insecticides◦ Alcohol, tobacco products

What to do if you suspect poisoning◦ Contact the Emergency Medical Service or 911◦ Gather any empty pill bottles for evidence◦ Stay with your client. ◦ Remain calm.

Contact the emergency medical services (EMS) for your area by dialing 9-1-1 on the telephone…

Gather any empty pill bottles or other evidence of poisoning to determine what has been ingested and how much.

Stay with your client. Be sure to remain calm.

Inspecting equipment before use

Know the electrical equipment being used

Look for warning signs of faulty equipment

WHMIS– is a national system that provides safety information about hazardous materials. It includes labeling, material safety data sheets (MSDS), and employee education.

1. Labels– WHMIS labels provide the essential

information needed to safely handle a controlled product.

Product information – the brand, code, or chemical name of the product.

Supplier information – the name and address of the supplier

2. Material Safety Data Sheets (MSDS)

– these provide detailed information about each

hazardous material. They are obtained from

suppliers or developed by employers

3. Worker education

– employers must provide WHMIS education to

employees who work with controlled products.

Important safety device

Keep within client’s reach

Place on the client’s strong side

Remind client to use it when help is needed

Answer call bells promptly

ASEPSIS– is the practice of reducing or eliminating potential

pathogens (bacteria, viruses, fungi, and parasites).

A. Medical Asepsis

– the goal is to exclude all pathogenic micro-organisms through medical aseptic technique

B. Surgical Asepsis

– aims to exclude all micro-organisms and their spores through surgical aseptic technique

(sterilization)

Hand washing

Donning and Doffing Gloves (clean and sterile gloves)

Putting Mask and Gown

Correct procedure on Personal Protective Equipment (PPE)

◦ Handwashing / Hand Hygiene

M – Mask

G – Goggles/ Eye Shield

G – Gown

G - Gloves

G – GlovesG – Gown Handwashing/

Hand Hygiene

G – Goggles/Eye ShieldM – Mask Handwashing/

Hand Hygiene

Reasons why good body mechanics are important

Comfort and safety measures when lifting/ moving/ transferring a person

Demonstrate good body mechanics and apply appropriate comfort and safety measure when:▪ raising a person’s head and shoulders

▪ moving a person up in bed

▪ moving a person up in bed with a lift sheet

❖moving a person to the side of the bed

❖turning a person

❖logroll

❖sitting/ dangling a person at the side of the

bed

❖transferring a person

❖applying a walking/ transfer belt

❖transferring a person to a wheelchair, chair or

commode

❖using a mechanical lift

❖moving a person using a transfer board

❖ Changing the position of the client but not changing

their location.

Turning a client/ Log-roll Technique

❖ MECHANCAL LIFT : Moving a client who is unable to weight bear from one place to ❖ another using a mechanical device with two staff assisting.

General comfort and safety measures when positioning a person

Demonstrate the following positions using appropriate comfort and safety measures:

◦ Fowler’s

◦ supine

◦ prone

◦ lateral

◦ Sims’

◦ chair positioning

It is a semi-sitting position– either high-Fowler’s or low-Fowler’s positions, depending on how high the head of the bed is up. To place a client in high-Fowler’s position, raise the head of the bed to an angle of 45 to 60 degrees. To place a client in a low-Fowler’s position, raise the head of the bed to an angle of 15 to 30 degrees.

It is a back-lying position used for sleeping and resting. To place a client in a supine position:◦ Make sure the bed is flat. Lower the head of the bed, if necessary.

◦ Place a small pillow under the head and shoulders.

◦ Place the person’s arms along the person’s sides, palms facing down.

◦ Place a small pillow under his or her arms and hands.

◦ Place a small pillows or rolled towels under the lower back, thighs, and ankles if your supervisor tells you to do so.

It is a side-lying position. The client can lie on one side or the other. To place a client in the lateral position:◦ Make sure the bed is flat. Lower the head of the bed, of necessary.

◦ Position the client onto his or her side.

◦ Bend the upper leg at the knee. Position the upper leg in front of the lower leg.

◦ Place a small pillow under the head and neck.

◦ Place small pillows under the upper leg and thigh.

◦ Place small pillows under the upper hand and arm.

◦ Position a small pillow against the client’s back.

It is a left side-lying position in which the right leg is sharply flexed so that it is not resting on the left leg. The left arm is positioned along he client’s back. This position, in which the client is lying partly on the abdomen, is used for administering enemas and other procedures.

It is a front-lying position on the abdomen, with the head tuned to one side. Many clients, including clients with limited range of motion in their necks, cannot tolerate the prone position. It is usually used, if at all, for a short period of time.

Clients in chairs or wheelchairs must hold the upper body and head erect to avoid poor alignment. Some require postural supports if they cannot keep the upper body erect, as supports help maintain good alignment.

Helping a person to walk ( without a walking aid )

Assisting a falling person

Types of walking aids

General safety and comfort measures when using walking aids

Demonstrate the correct procedure for using◦ crutches

◦ canes

◦ walkers

◦ braces

General safety and comfort measures

Demonstrate the correct procedure for assisting a person to use a wheelchair

Supportive, assistive and prosthetic

Types of devices◦ hearing aids

◦ glasses

◦ dentures

◦ other ( braces, rigid splints, etc. )

Care and maintenance of prosthetic devices

Types of bed rest

Bed rest – some activities of daily living (ADLs) are allowed – such as self-feeding, oral hygiene, bathing, shaving, and hair care

Strict bed rest – everything is done for the client. No ADLs are allowed, except use of the bed pan/urinal, if client is continent

Bed rest with commode privileges – the client can use the bedside commode for elimination needs

Bed rest with bathroom privileges (bed rest with BRP) – the client can use the bathroom for elimination needs.

Purposes

To reduce physical activity

To reduce pain

To encourage rest

To regain strength

To promote healing

COMPLICATIONS

• Contractures– occur in the musculo-skeletal system. It is a lack of joint mobility caused by the abnormal shortening of a muscle. The contracted muscle is fixed into position, is deformed, and cannot stretch. Common sites are the fingers, wrists, elbows, toes, ankles, knees, and hips. Contractures can also occur in the neck and spine. The person with a contracture is permanently deformed and disabled.

COMPLICATIONS

• Atrophy– also occur in the musculo-skeletal system. It is the decrease in size or the wasting away of tissue. Muscle atrophy is a decrease in size or a wasting away of muscle. These complications from lack of activity must be prevented to maintain normal body movement.

COMPLICATIONS

• Orthostatic hypotension– (or postural hypotension) occur in the cardiovascular system. It is a drop in (hypo) blood pressure when the client stands up (ortho and static). When he or she moves from lying or sitting to a standing position, the blood pressure drops, and the client experiences dizziness, weakness, and spots before the eyes, followed by syncope (fainting), which is a brief loss of consciousness.

Definition– moving a joint to the extent possible without causing pain is the range of motion (ROM) of that joint. Range-of-motion exercises involve exercising the joints through their complete range of motion. Clients who need these exercises usually do them twice a day.

Types◦ Active ROM—exercises are done by the client independently◦ Passive ROM—exercises involve having another person move the joints of the

client through their range of motion.◦ Active-assistive ROM—exercises are done by the client with some help from

another person.

Rules for performing ROM exercise

ROM techniques for child clients

Demonstrate the correct procedure for assisting with the following ROM exercises:◦ neck◦ shoulder◦ elbow◦ wrist◦ thumb◦ fingers◦ hip◦ knee◦ ankle◦ foot◦ toes

Helpful online links:

https://www.youtube.com/watch?v=LvRP3c5n3P8

https://www.youtube.com/watch?v=zCVu_1d9AJ8

https://www.youtube.com/watch?v=oq6zaq1GCjg

https://www.youtube.com/watch?v=HWHhxnuwjAQ

https://www.youtube.com/watch?v=Ao8V0M99bK8