3.3 Safety, Fall Prevention & Emergencies

A Safe Environment Is the SRNA's First Duty

Safety is woven through every task an SRNA performs, and falls are the leading cause of injury in Kentucky long-term care facilities. A safe environment starts with simple, constant habits: keep the call light within reach at all times, keep the bed in the lowest position and locked, keep the floor clutter-free and dry, provide non-slip footwear, ensure adequate lighting, and lock the wheelchair brakes before any transfer. Report environmental hazards you cannot fix yourself — a frayed electrical cord, for example, is a fire and shock hazard: remove the item from use, tell the nurse and maintenance, and document it. A key scope-of-practice rule: the SRNA never adjusts a resident's oxygen flow rate — only the nurse or respiratory therapist changes it.

Fall Risk and Prevention

Residents at high fall risk include those who are confused, weak, taking many medications, incontinent (rushing to the bathroom), or newly admitted. When a care plan flags fall risk, the SRNA implements the core bundle:

• Bed in the lowest position, locked, with side rails only as directed by the care plan.
• Call light within reach and prompt response to every call.
• Non-slip footwear and clothing that does not drag.
• Frequent rounding (typically every 2 hours) to offer toileting, water, and repositioning.
• Clear pathways, good lighting, and mobility aids (walker/cane) within reach.

If a resident does fall, do not rush to lift them. Stay with the resident, call for help without leaving them alone, and do not move them until the nurse has assessed for injury — moving someone with a possible fracture or head injury can cause serious harm. If a resident begins to fall while you are walking with them, do not try to hold them upright; using the gait belt, bend your knees, slide one foot back, and ease them down to the floor, protecting the head. Then call the nurse.

Restraints: Last Resort, Strict Rules

A physical restraint is any device that restricts freedom of movement (vest, wrist restraints, a lap tray the resident cannot remove, or side rails used to keep someone in bed). Under OBRA and Kentucky CHFS regulations, restraints are a last resort. They require a physician's written order stating the reason, type, and time limit; they may be used only after less-restrictive alternatives have failed; and the least restrictive device must be used for the shortest time. A restrained resident must be monitored continuously, and the restraint released with repositioning, circulation, and skin checks at least every 2 hours. Ties must use a quick-release (slip) knot secured to the movable bed frame, never the side rail. Restraint alternatives — the preferred approach — include frequent toileting, bed/chair alarms, low beds with floor mats, keeping the resident near the nurses' station, comfort measures, and diversional activities.

Choking and the Heimlich Maneuver

The universal sign of choking is hands clutched to the throat and an inability to speak, cough, or breathe. For a conscious adult with a complete airway obstruction, call for help and immediately perform abdominal thrusts (the Heimlich maneuver) — stand behind the resident, place a fist thumb-side-in above the navel, and give quick inward-and-upward thrusts until the object clears or the resident becomes unresponsive. If the resident can still cough forcefully (partial obstruction), encourage coughing and do not interfere.

Basic Emergency Response

The SRNA's role in an emergency is to recognize it, call for help, protect the resident, and start basic care — never to diagnose. Learn these responses:

Remember that a valid DNR (Do Not Resuscitate) order in the resident's chart, verified by the nurse, determines whether CPR is started — the SRNA does not make that decision.

Fire Safety: RACE and PASS

Two acronyms are heavily tested. RACE is the fire-response sequence: Rescue anyone in immediate danger, Alarm (pull the alarm and call 911), Contain/Confine the fire by closing doors and windows, and Extinguish a small fire or Evacuate. To use a fire extinguisher, follow PASS: Pull the pin, Aim at the base of the fire, Squeeze the handle, and Sweep side to side.

Incident Reporting

Any fall, injury, error, or unusual event requires an incident report documenting the facts only — what you observed, when, and what you did — without opinions or blame. Timely, factual reporting protects the resident, meets Kentucky regulatory requirements, and helps the team prevent the next event.