Safety & Fall Prevention

Falls: The Number One Safety Risk in MA Long-Term Care

Falls are the leading cause of injury and injury-related death among adults 65 and older, and LTC residents fall at high rates. The exam expects you to know multifactorial fall prevention — many small interventions, not one magic fix.

Evidence-based fall prevention in MA DPH-regulated facilities includes:

• Call light within reach at all times, and answer it promptly.
• Bed in the lowest position and locked when you leave.
• Non-skid footwear — never bare feet, never socks alone.
• Clear, well-lit pathways; remove clutter, cords, and spills.
• Scheduled (every-2-hour) toileting so residents do not rush to the bathroom alone.
• Eyeglasses, hearing aids, and assistive devices in place and within reach.

Orthostatic (postural) hypotension is a major fall trigger: a drop of ≥20 mmHg systolic or ≥10 mmHg diastolic within 3 minutes of standing. Prevent it by having the resident dangle their legs at the bedside for 1-2 minutes before standing.

What Does NOT Prevent Falls (Exam Traps)

Bed rails and restraints are NOT fall-prevention tools. Full bed rails are linked to entrapment injuries and death, and a restrained resident can still fall — often with more serious injury. Sedating medication increases fall risk. If a question offers "raise all four side rails" or "apply a vest restraint" as a fall fix, it is wrong.

When a resident begins to fall, do not try to hold them upright. Ease them to the floor or onto your body, protecting the head, then call the nurse. Never leave the resident; never move them until assessed.

Restraints: Massachusetts Rules

A physical restraint is any device that restricts free movement and that the resident cannot remove easily. Under OBRA 1987 and 105 CMR 150.007, a restraint may be applied ONLY when:

Restraints can NEVER be used for staff convenience, punishment, or simply because the family requests them. Families may decline a restraint but cannot independently require one. Always try restraint alternatives first: bed/chair alarms, low beds with floor mats, frequent toileting, activity and companionship, and reducing environmental hazards.

Fire Safety: RACE

Massachusetts LTC facilities run regular fire drills, and the exam tests the RACE sequence. When you discover a fire or smell smoke, act in this order:

1. R - Rescue anyone in immediate danger.
2. A - Alarm — pull the alarm and call 911.
3. C - Confine — close doors and windows to slow the fire.
4. E - Extinguish or Evacuate — extinguish only a small, contained fire; otherwise evacuate.

Resident safety is always first. Never use elevators during a fire — use stairs. Know your facility's evacuation routes and your assigned residents.

Using a Fire Extinguisher: PASS

Only attempt to fight a small, contained fire, and keep an exit at your back. The technique is PASS:

• P - Pull the pin.
• A - Aim at the BASE of the fire (the fuel), not the flames.
• S - Squeeze the handle.
• S - Sweep side to side until the fire is out.

If the fire grows or the extinguisher empties, leave immediately and close the door behind you.

Oxygen Safety

Oxygen does not burn by itself, but it supports and intensifies combustion — materials ignite faster and burn hotter in an oxygen-enriched space. When a resident uses oxygen:

• Post "No Smoking / Oxygen in Use" signs and prohibit smoking, candles, and matches.
• Keep oxygen at least 5-10 feet from open flames, sparks, and heat sources.
• Avoid petroleum products (petroleum jelly, oil-based lotions) and aerosol sprays near the face; use water-based lubricant for the nares.
• Avoid wool and synthetic fabrics that build static; never let electrical equipment spark near the tubing.

After a Fall and Incident Reporting

If a resident has fallen, do not rush to lift them. Stay with the resident, call the nurse to assess for injury, and check for pain, bleeding, deformity, or loss of consciousness before any movement. Once the nurse clears the resident, help them up safely. Then complete an incident (occurrence) report with only the objective facts — what you saw, the time, the position you found the resident in, and statements in the resident's own words. Never write opinions or guess the cause. Incident reports are internal risk-management tools, not part of the chart.

A Safe Environment Around the Bed

Most resident time is spent in or near the bed, so environmental safety focuses there:

• Keep the bed in the lowest locked position with the call light, water, glasses, and tissues within reach.
• Lock the wheels on beds, wheelchairs, and stretchers before any transfer.
• Use bed and chair alarms as restraint alternatives for residents who try to rise unassisted.
• Keep floors dry and uncluttered; report burned-out lights and frayed cords.
• For confused residents, consider a low bed with a floor mat rather than full rails.

Verifying the Right Resident and Hot/Cold Safety

Always confirm you have the right resident before care — check the ID band and address the resident by name. Be alert to scald and burn risks: bath water should be about 105°F (40.5°C) and never above roughly 110°F, and food and bath water are tested before contact, especially for residents with diabetes or reduced sensation who may not feel a dangerous temperature. Heat and cold applications are applied only as ordered and are checked frequently for skin damage.

Common mistakes: raising side rails as a fall fix, restraining for convenience, using an elevator during a fire, aiming an extinguisher at the flame tops instead of the base, lifting a fallen resident before the nurse assesses them, and applying petroleum jelly to a resident on oxygen.