3.3 Safety & Fall Prevention

Fall Prevention

Falls are the most common cause of injury in nursing facilities, so fall prevention is a high-yield safety topic on both the written and skills tests. Residents at highest risk include those who are confused or disoriented, weak or unsteady, taking sedatives or blood-pressure medications, incontinent (and rushing to the toilet), or who have a history of previous falls — the single strongest predictor of a future fall.

Key CNA fall-prevention measures:

• Keep the bed in the lowest position with wheels locked when not giving care.
• Keep the call light within the resident's reach and answer it promptly — many falls happen when residents try to get up unassisted.
• Keep the floor dry and free of clutter, cords, and equipment; clean spills immediately.
• Make sure the resident wears non-skid footwear and properly fitting clothing that does not drag.
• Provide adequate lighting, especially a night-light for trips to the bathroom.
• Lock wheelchair brakes and bed wheels before every transfer, and use a gait belt for ambulation and transfers.

If a resident begins to fall while you are assisting, do not try to stop the fall by yanking them upright — this can injure you both. Instead, widen your stance, ease the resident gently to the floor while protecting the head (often by guiding them down the front of your body), then stay with them and call for the nurse.

Restraints — A Last Resort

A restraint is any device, equipment, or method that restricts a resident's freedom of movement or normal access to their own body and that the resident cannot remove easily. Restraints can be physical (vests, belts, mitts, side rails used to confine) or chemical (medications used to control behavior). They carry serious risks including pressure injuries, loss of muscle tone, incontinence, agitation, strangulation, and death.

Federal OBRA rules and CMS guidance — which Minnesota facilities must follow — require:

• Restraints are always a last resort, used only after less restrictive alternatives have failed and only to treat a documented medical symptom.
• They require a physician's order specifying the type and time limit, and may never be applied for staff convenience or as punishment.
• The least restrictive device is used for the shortest time possible.
• A restrained resident is visually checked at least every 15 minutes, and is released, repositioned, toileted, exercised (range of motion), and offered fluids at least every 2 hours.
• Use a quick-release (slip) knot, never a hard knot, and tie the restraint to the movable part of the bed frame, never to the side rail (which moves up and down and could tighten the restraint).

Restraint Alternatives (try these first)

• Answer call lights quickly and check on residents often
• Offer scheduled toileting, food, and fluids to reduce restlessness
• Use bed/chair alarms and keep the bed low
• Provide activities, familiar objects, and companionship
• Remove tripping hazards and improve lighting

Fire Safety: RACE and PASS

Fire safety is one of the most reliably tested safety topics — memorize both acronyms exactly. The order is fixed, and questions often ask what you do first.

RACE — what to do when a fire is discovered

PASS — how to use a fire extinguisher

The golden rule: protecting life always comes before fighting the fire, so Rescue is always step one. Know the location of your unit's fire alarms, extinguishers, and exits before an emergency happens. During an evacuation, follow the facility plan and never use elevators.

Oxygen, Scald, and Burn Safety

Many residents receive oxygen therapy, and oxygen supports combustion — it makes any fire ignite faster and burn hotter. When a resident is on oxygen:

• Post "No Smoking / Oxygen in Use" signs and prohibit smoking in the room.
• Keep oxygen away from open flames, candles, matches, lighters, and electrical sparks (including some electric razors and battery toys).
• Avoid flammable products near the flow, such as petroleum jelly, aerosol sprays, nail polish remover, and alcohol-based items; use water-based lubricant on the lips and nose instead.
• Do not adjust the liter flow rate — that is the nurse's responsibility; the CNA reports if the tubing is kinked, the cannula is off, or the resident is short of breath.

Preventing Scalds and Burns

• Check bath and shower water temperature before the resident enters — generally no hotter than about 105°F (41°C); test it on your inner wrist.
• Check the temperature of hot foods and beverages before serving.
• Be especially careful with residents who have reduced sensation, confusion, diabetes, or paralysis, because they may not feel a burn until tissue is damaged.