This in-service was developed to ensure that all staff heighten their awareness for safety, will be competent to handle any unexpected situations, to inform the office of incidents and to give the office feedback for the organization to improve the safety and well being of its clients and employees.

COMPETENT CARE

• First and foremost in providing a safe environment for you and your client is that you know how to provide the client's care competently.
• You will be afforded the opportunity to train on all of the equipment and care of each client that you are assigned to.
• All nurses must be competent in the use and maintenance of all necessary equipment and in emergency protocols for each client.
• This includes but is not limited to being able to recognize an emergency, give emergency medications if ordered, replace a trach tube, trouble shoot a ventilator, administer oxygen, change ventilator circuits, use suction machines and feeding pumps depending on the needs of each client and initiating an emergency transfer.
• It is your responsibility to communicate to our office if you feel that you need further training in order to provide quality nursing care for your client.

EMERGENCY PREPARATION

• Caregivers must be familiar with the escape route from the home
• How to contact the family and the emergency responders
• How to access all the emergency equipment such as 02, ambu bag, emergency bag, back up vent and flashlight
• Ensure that all equipment is fully charged daily in preparation for any emergency. Back up battery sources are only good if they are charged.
• Encourage clients to maintain their home and to change batteries on smoke detectors semi-annually.
• Review fire emergency plan regularly with client and update as needed.
• To assess for any safety hazards or risks and to intervene to rectify these hazards. To bring any identified safety risks to the attention of your supervisor if assistance is needed in correcting the safety risk.

A DAILY ROUTINE

• First - observe exits and alternative routes of escape, ensure they have a clear pathway
• Second - Locate safety equipment and supplies
• A communication line is available at all times, phone is working and available.
• spare trach tube
• oxygen tanks and delivery system, ensure they are accessible, filled and operational
• ambu bag and suction machine with catheters
• travel bag and any other safety equipment such as the location of the fire extinguisher.
• Emergency drugs and medications are present, accessible and not expired.
• Third - Ensure that all equipment is charged and operational, even if not routinely used.

TEACHING SAFETY TO CLIENTS

• Nurses discovering safety hazards should instruct client/caregiver and make suggestions on preventing & reducing risks
• Client education regarding environmental hazards and risks will be documented in the client record including:
• What was taught
• The client's level of understanding
• The client's response to teaching.
• Clients that are actively involved in their own care and safety are less likely to have a poor outcome.
• Involve your clients using education, collaborative planning and communication.
• Instruct them to call the office if they have an unresolved issue with safety or quality of care.

INJURY PREVENTION

Body Mechanics means the proper use of muscles to move and lift objects and maintain correct posture. It is a way of using your body so that the work is performed by several groups of muscles with the strongest ones being used. The way we use our bodies to walk, sit, stand, lift, push and pull is very important. It is important in every part of our day and most especially when working with clients. The body is like a finely tuned machine. When used correctly, it performs very well. When misused, it performs poorly and eventually breaks down.

Lower back injuries are the leading cause of work-related injuries for home care workers. Using correct body mechanics helps prevent injury and helps to keep both the caregiver and the patient safe. The key to safety is prevention - knowing what things can go wrong and taking steps to avoid them.

The purpose of this learning module is to review basic body mechanics and provide information to the caregiver on preventing injury.

BENEFITS OF GOOD BODY MECHANICS:

• Correct muscle groups are used for the task being performed
• Muscle fatigue, strain and bodily injury are reduced
• Personal safety is maintained
• Tasks are performed efficiently
• Patient anxiety and fears about moving are reduced
• Position changes are made smoothly without injury to the client
• Fewer injuries to client skin occur due to friction and/or shearing of tissues

STEPS TO GOOD BODY MECHANICS

The first step toward good body mechanics is correct posture or alignment. Alignment is the correct positioning to keep the spine straight and to avoid any twisting, straining, pressure or discomfort. You can sit, stand and lift in certain ways that improve your body alignment. Proper alignment helps promote balance, conserve energy, prevent muscle strain and maintain the natural curves of the spine. Like a car out of alignment wears out tires unevenly and becomes difficult to steer, our bodies have similar responses to improper alignment. When improper alignment occurs body parts get pulled out of place resulting in pain and injury. When Standing

• Head erect
• Shoulders back and at ease
• Chest up and forward
• Arms at sides
• Feet parallel to each other; one slightly forward
• Do not lock knees
• To turn your body, start with your feet and let your upper body follow, rather than turning from the waist

When Sitting

• Head erect
• Shoulders back and at ease
• Chest up and forward
• Hips bent at right angles
• Knees slightly above your hips
• Weight supported by thighs
• Sit back in chair
• Rest both feet on the floor
• Turn your entire body when needed, not just chest and shoulders

When Lifting

• To lift an object, squat, or bend knees, take hold of the item and straighten up.
• Divide weight of object between both hands.
• Leg or thigh muscles must be used for lifting objects. Your leg muscles are stronger and better equipped for lifting
• Maintain a wide base of support by keeping your feet apart. Secure firm footing before lifting.
• Bend at the knees and hips
• Keep back straight when lifting.
• Lift straight upward in a smooth motion. Avoid jerking motions
• Keep the person or object close to you your body so you don't have to lean or reach
• Ask for assistance with heavy objects.
• When a mechanical lift is in the home, it MUST be used for every transfer and/or movement of client per AHHC policy.
• When transferring equipment in/out of the home, do not overload yourself and make several trips if needed.
• Do not overload wheelchairs with client equipment.
• Ask for assistance when transferring client and equipment.

GENERAL CONSIDERATIONS FOR PERFORMING PHYSICAL TASKS

• It is easier to pull, push, or roll an object than it is to lift it
• Ask for help and wait until you have help before moving a heavy patient or object
• Movements should be smooth and coordinated rather than jerky
• Less energy or force is required to keep an object moving than it is to start and stop it
• Use the arm and leg muscles as much as possible, the back muscles as little as possible.
• Keep the work as close as possible to your body. It puts less strain on your back, legs, and arms.
• Rock backward or forward on your feet to use your body weight as a pushing or pulling force
• Keep the work at a comfortable height to avoid excessive bending at the waist
• Keep your body in good physical condition to reduce the chance of injury

By using good body mechanics, you keep yourself safe and are better able to provide safety for others. You should also help your clients use good body mechanics to prevent injury or strain. Promoting and assisting with proper body alignment is a very important part of your job.

A person who spends most of the time in bed or in a chair may slump to the side from time to time. Providing pillows, rolled towels or other devices to maintain alignment and support for the person are key factors in preventing injury, pain and skin breakdown.

Each home situation presents unique challenges for positioning and transferring clients. To ensure that you don't injure yourself or the client, it is essential that you apply safety principals and use good body mechanics with each position change. Assess the situation before attempting a transfer. It is important that you know the person's level of mobility, independence and ability to help with a transfer before attempting to move them. If you have concerns about being able to safely move a client by yourself, discuss this with your nursing supervisor so that additional help can be obtained. In some cases family members can be trained to assist you properly. Do not take any chances that could result in injury to yourself or the client.

PREVENTION OF BURNS AND SKIN REACTIONS

• Avoid skin contact with all chemicals and/or contaminants.
• Handle chemicals cautiously.
• Never spray chemicals towards face or another person.
• If cleaning compounds produce fumes, use only in well ventilated areas.
• Mix only those chemicals together for which specific instructions have been written, to avoid making a dangerous combination.
• Wash promptly if any chemical comes in contact with skin.
• Test the temperature of water before submerging body parts into a tub of hot water.

PREVENTION OF INFECTIONS

• Always adhere to CDC protocols for hand hygiene
• Always adhere to Standard Precautions.
• Always wear gloves when there is a potential for exposure to secretions.
• Use sharps containers appropriately.
• Never recap needles, properly use safety needles and needleless systems.
• Never eat, drink, smoke, apply cosmetics or handle contact lenses while in work areas.
• Instruct client or caregivers on infection control protocols
• Standard precautions, proper hand hygiene
• Wearing gloves is a good way of preventing infection for every procedure. Combine with proper hand hygiene before & after each procedure.
• Wear gloves while handling and disposing of body fluids.
• Instruct on proper nutrition.
• Use non-literary aids for those with literacy deficits.
• Instruct on Neutropenic precautions (applicable to clients with low white blood counts, on chemotherapy).
• Instructions should include other family members such as younger siblings, grandparents, etc.
• Wash hands after personal hygiene, touching pets, eating, coughing or sneezing.

RISK OF FIRE:

• Assess premises for the presence of smoke detectors, fire extinguisher, fire escape, blocked exits, limited exits & and the presence of an escape plan.
• Assess equipment for proper function, frayed electrical cords, and overloaded electrical outlets.
• Instruct client on oxygen precautions, if applicable
• Keep oxygen stored properly away from sunlight and heat sources.
• Keep oxygen away from open flames, stoves, space heaters.
• No smoking, turn off oxygen when lighting candles.
• Mark the outside of the house with “oxygen in use” signs.
• Have smoke alarms installed.
• Instruct on fire safety, review emergency fire plan regularly
• Clear pathways, and keep exits cleared of obstacles.
• Provide smokers with large, deep ashtrays.
• Give space heaters space; keep away from curtains and flammable objects.
• Instruct on “Stop, drop and roll.”
• Plan and practice your escape from fire. Plan your escape around your abilities.
• Know your local emergency number, post numbers near phone.

PREVENTION OF LATEX ALLERGIES

Latex products are made from natural rubber, and sensitivity can develop after repeated exposure. Limiting exposure to latex can help prevent allergic reactions for both home healthcare workers and their clients.

LATEX EXPOSURE REACTIONS

Three types of reactions can occur when using latex products:

• Irritant Contact Dermatitis - This is the most common negative reaction to latex. Symptoms include dry, itchy, irritated skin—most often on the hands.
• Allergic Contact Dermatitis (delayed hypersensitivity) - This skin reaction looks like the rash from contact with poison ivy and usually shows up 24–96 hours after contact.
• Latex Allergy (immediate hypersensitivity) - This type of reaction usually happens within minutes of exposure, but symptoms can also show up a few hours later. Symptoms of a mild reaction are skin redness, hives, or itching. Symptoms of more serious reactions might include runny nose, sneezing, itchy eyes, scratchy throat, wheezing, coughing, or difficulty with breathing. Rarely, shock may occur, but a life-threatening reaction is seldom the first sign of sensitivity. A latex-exposed worker developing any serious allergic reactions should be taken to a doctor immediately.

HOW TO PREVENT LATEX ALLERGIES

• Ask for reduced-protein, powder-free gloves, if your employer supplies latex gloves.
• Avoid oil-based creams or lotions when using latex gloves. They may cause the gloves to break down.
• Wash hands with a mild soap and dry hands completely after using gloves.
• Recognize symptoms of latex allergy (rash; hives; flushing; itching; nasal, eye, and sinus irritation; asthma; and shock).
• Avoid direct contact with latex gloves and other latex-containing products if you develop symptoms of latex allergy, until you can see a doctor.

IF YOU ARE DIAGNOSED WITH LATEX ALLERGY

• Avoid touching, using, or being near latex-containing products.
• Avoid areas where latex is likely to be inhaled (for example, where powdered latex gloves are being used).
• Inform your employer and your personal healthcare professionals that you have latex allergy.
• Wear a medical alert bracelet.
• Follow your doctor’s recommendations about latex allergy.
• Before receiving any shots (such as a flu shot), be sure the person giving it uses a latex-free vial stopper.
• Before undergoing a medical procedure or surgery, consult the specialist who will perform the procedure about any modifications that may be needed.