Safety & Fall Prevention

Fall Prevention: The Least-Restrictive Approach

Falls are the leading cause of injury among nursing-home residents, and the exam expects you to prevent them using the least-restrictive methods first. A fall is any unplanned descent to the floor, with or without injury. A high fall-risk resident has a history of falls, weakness, dizziness, confusion, or medications that affect balance.

Core Fall-Prevention Interventions

These are the safe, non-restraint measures the test rewards:

• Keep the call light within reach and answer it promptly — an unanswered call light is a top cause of falls when residents try to get up alone.
• Keep the bed in the lowest position with wheels locked; use a bed/chair alarm if ordered.
• Provide non-skid footwear and ensure eyeglasses and hearing aids are in place.
• Keep walkways clutter-free, floors dry, and adequate lighting on (especially a night light to the bathroom).
• Toilet residents on a schedule so they do not rush unassisted, and use grab bars and proper transfer technique with a gait belt.

Exam trap: applying a vest or wrist restraint "to prevent all falls" is always wrong. Restraints increase injury, agitation, and even strangulation risk, and they violate residents' rights.

Restraints: Last Resort Only

A physical restraint is any device, material, or equipment attached to or near the body that the resident cannot remove and that restricts free movement (vest, wrist ties, lap tray that locks). A chemical restraint is a medication used to control behavior that is not required to treat a medical condition.

Under federal OBRA '87 and Connecticut DPH regulation, a restraint may be applied only when ALL of these are true:

1. There is a physician's order specifying type, reason, and time limit.
2. It is used for a medical/treatment reason (e.g., protecting a healing surgical site) — never for staff convenience or discipline.
3. Least-restrictive alternatives were tried and documented as ineffective.
4. The resident or representative consents.
5. The resident is monitored continuously and the restraint is released regularly (typically at least every 2 hours) for repositioning, toileting, and circulation checks.

Fire Safety: RACE and PASS

Fire is the most-tested emergency on the safety section. Under the Life Safety Code (NFPA 101, 19.7.1.6) that Connecticut facilities follow, nursing homes must conduct fire drills at least quarterly on each shift — that is, one drill per shift per quarter. With three shifts this commonly works out to about one drill per month rotated across the shifts (~12 per year), but the rule is quarterly-per-shift, and drills must be held at unannounced, varying times (not during shift change), so staff practice the response under realistic conditions.

RACE is the response sequence:

• R — Rescue anyone in immediate danger first.
• A — Alarm: pull the fire alarm and call for help.
• C — Confine the fire by closing doors and windows.
• E — Extinguish a small fire (or Evacuate if it is too large).

PASS is how you use a fire extinguisher:

• P — Pull the safety pin.
• A — Aim at the base of the fire.
• S — Squeeze the handle.
• S — Sweep side to side.

Evacuation priority: residents in immediate danger (closest to the fire) are moved first, regardless of whether they walk independently or need a wheelchair. Do not prioritize by mobility level — prioritize by proximity to the hazard.

Oxygen and Equipment Safety

Oxygen supports combustion, so fire risk is high around it:

• Keep oxygen equipment at least 5 feet from open flames and heat sources.
• Post No Smoking signs; no smoking within 10 feet of oxygen.
• Secure tanks upright so they cannot fall and rupture.
• Avoid wool blankets, electric razors, and petroleum products (Vaseline) near oxygen — use water-based lubricants instead.

General equipment safety also matters: report frayed cords, malfunctioning bed rails, and broken call lights immediately, and never use equipment you have not been trained on.

When a Resident Falls

If you find or witness a fall, do not move the resident. Stay with them, call for the nurse, and let the nurse assess for injury (especially head, hip, or spine). Moving an injured resident can worsen a fracture. After the nurse clears the resident, help reposition them, then complete an incident report documenting only the facts you observed. Falls, near-misses, and equipment failures are all reportable events under Connecticut DPH facility policy.

Incident Reports: Facts Only

An incident report (occurrence report) is a factual record of any unexpected event — a fall, injury, or equipment failure. Exam-critical rules:

• Record only what you observed and did, objectively ("Resident found sitting on floor beside bed at 0830").
• Do not write opinions, blame, or guesses about cause.
• Do not reference the incident report in the medical chart — it is a separate risk-management document.
• Report verbally to the nurse first, then complete the written report promptly.

General Environmental Safety

Beyond falls and fire, the exam tests everyday hazard awareness in the long-term care environment:

• Two-identifier check: verify the right resident using name plus a second identifier (date of birth or photo) before any care.
• Bath water: test water temperature (about 105 degrees F / 41 degrees C) to prevent scalds, especially with reduced sensation.
• Wandering/elopement: residents with dementia may try to leave; use wander-guard alarms and report a missing resident immediately.
• Bed positioning: lock wheels, keep the bed low, and use side rails only when ordered — a side rail can itself be a restraint or an entrapment hazard.

These measures, paired with prompt reporting, keep residents safe and keep the CNA squarely within scope.