Spring 2023 MHolley
Professionalism Exam 4 ~ Ch 39, 96-100
Chapter 39 ~ Emergency Preparedness
» SAFETY & PREPAREDNESS:
o Safety in the HCF extends to pts, employees, students, & visitors.
o The goal is to px accidents & to be prepared for emergencies.
o Safety committee is responsible for disaster plans, safety policies & procedures, procedures for handling
hazardous substances, & information sheets regarding these substances.
» PT SAFETY:
o A pt. has the right to expect that a HCF will protect against injury & disease.
o Facility Safety Measures:
General emergency preparedness
Plans for specific emergencies.
Plans for evacuation.
Policies for resuscitation
Accurate admin. of meds & txs
Most HCFs require all staff to attend regular training sessions regarding safety.
o Topics include:
Fire safety
Handling of hazardous materials
Code or disaster procedures
» MEASURES THAT HELP PX ACCIDENTS:
o Double-lock medicine carts & medicine rooms.
o Ensure all meds are kept out of the reach of children.
o Get adequate assistance to move & walk pts.
o Use a transfer belt when necessary.
o Provide adequate lighting including night light.
o Check the temp. of liquids or solutions prior to use.
o Always use two means to identify each pt. before performing any procedure or giving medication.
o Conduct & document fall risk assessment.
o Place the pt.’s necessary items within reach.
o Especially considering the left-handed pt.
o Know how to call codes in your facility.
o Know the location of fire extinguishers.
o Keep up to date on CPR.
» MATERIAL SAFETY DATA SHEET (MSDS):
o Each facility must have an MSDS describing any substance considered hazardous.
o It gives information on the protective equipment required, safe handling information, & first-aid interventions for
accidental exposure.
o The information helps staff provide appropriate tx & to take necessary precautions when exposed to contaminated
individuals in an ED or ambulance.
» EMPLOYEE SAFETY:
o OSHA requires a job safety analysis (JSA) for each position.
o Employee right-to-know laws.
Employees have the right to be aware of all dangers associated with hazardous substances or harmful physical
or infectious agents they might encounter in the workplace.
» SAFETY TIPS FOR HAZARDOUS SUBSTANCES:
o Have the phone number of the local Poison Control Center readily available.
o Read labels carefully & note emergency information. Follow instructions for use, storage, & disposal. Never use
any unlabeled substance.
o Never store hazardous materials in alternative containers. Don use or store gasoline or turpentine indoors or use
hairspray or other aerosol products around an open flame, eyeglasses, or contact lenses.
o Avoid breathing mists or vapors; follow radiation prevention guidelines closely. Use protective equipment as
recommended.
o If any hazardous substance is spilled, consult facility or home care agency procedures for the safe & approved
method of cleanup.
o Always wear gloves & carefully wash hands when cleaning up spills. Any major spills must be cleaned up by
specially trained personnel.
» EMERGENCY PREPAREDNESS:
o Nurse’s call light & intercom: Check pts frequently if they are sedated or physically unable to use the call light. A
tap bell may be used in certain situations.
o Emergency signal: In most facilities, the call signal in the pt.’s bathroom causes an additional buzzer to sound at a
central station. Many home care pts can activate an alert system.
o Emergency resuscitation: In the hospital & in a skilled nrsg facility (SNF), each area generally has a crash cart
stocked with emergency meds & equipment. Know the procedure for CPR.
» FALL-RISK EVALUATION:
o Pts are evaluated on a regular basis for the risk of falling.
o Hendrich Fall Risk Tool may be used.
o The pt. is scored on each risk factor in the Fall Risk questionnaire.
o If a factor is absent, the score for that factor is 0.
o If the total score is 5 or greater, the pt. has a high risk of falling.
o The pt. at risk for falling is often identified by:
1
,Spring 2023 MHolley
A special yellow wristband
Yellow slipper-socks
A “falling star” sign outside the room.
» What care should be taken for a pt. with fall risk? Ensure the call signal is easily reachable.
» STAFF NOTIFICATION WHEN TELEPHONE SERVICE IS DISRUPTED:
o Amateur radio ham operators, television, or radio broadcasts
o Runners (people who transport messages on foot)
o Computers (email), pagers
o Contacts outside the affected area
o Portable or handheld radios
o Police
» PERSONAL EMERGENCY PREPAREDNESS:
o Plan for prolonged power outages.
o Keep a first-aid kit stocked & on hand. Carry an emergency kit, an emergency hammer, & a charged cell phone in
your car.
o Store 1 gallon of water per person in the household per day, & adequate food supplies to last 4 days.
o Store prescriptions, glasses, dentures, hearing aids, & other essential items in a secure & accessible area.
o Identify safe areas in the home.
» CONSIDERATIONS AFFECTING PT & EMPLOYEE SAFETY:
o Weapons, narcotics, & other contraband: If the nurse suspects that a pt. or visitor has a weapon, the nurse should
report it to the supervisor & security department immediately.
o Flowers & gifts: Flowers & other gifts can pose a threat to certain pts.
o Workplace violence: If a pt. or visitor becomes threatening, the nurse must protect other pts & self by speaking
calmly, moving those threatened to a safer area, & notifying the supervisor or the security staff immediately.
» INTERNAL VS EXTERNAL DISASTERS:
o Internal disaster
The facility itself is in danger or damaged &/or function is impaired. An internal disaster may be caused by a fire,
an explosion, terrorist activity, radiation, a biologic spill, or a storm.
o External disaster
Occurs outside the facility & has an impact on normal operations.
» DISASTER PLAN:
o A facility’s disaster plan describes actions to take in a disaster.
o HCFs are required to have regular, periodic fire & disaster drills to allow their staff to practice emergency skills.
o These disasters may include: tornadoes, blizzards, hurricanes, earthquakes, avalanches, floods, or mudslides.
» BOMB THREAT:
o In case of a bomb threat, notify the supervisor & security personnel, & protect pts.
o In case of threat over the phone, check the “caller ID” to determine the origin of the call, ask questions & write
down the caller’s answers, & listen to other cues & note what is heard.
o A search will be conducted by the police bomb squad.
o The nurse must report anything unusual & follow the professionals’ instructions.
o Stay away from windows or other large glass objects during the search.
o Don’t use elevators until the situation is cleared.
o Carefully document the incident after the danger has passed.
» IMPLEMENTING THE DISASTER PLAN:
o A disaster plan describes duties & responsibilities of staff in a disaster.
o It identifies the location of the command center, which provides overall direction of the facility’s activities.
» EMERGENCY TRIAGE:
o Triage
Process of sorting & classifying injured persons to determine priority of needs.
o Simple triage & rapid tx (START) system:
Identifies people who are going to die quickly if they don’t receive immediate medical care.
» T/F: A nurse may be required to assist a triage. - TRUE
» PT EVACUATION:
o A disaster medical assistance team (DMAT) provides assistance & support in many environments, both inside &
outside HCFs.
o The extent of the emergency will affect the decision to evacuate a portion or the entire facility.
» INFANT/CHILD ABDUCTION:
o Give a full description of the child & the suspect, including what they were wearing.
o Tell parents to stay with their children in their rooms.
o Move the parents of the abducted child to a private area.
o Be prepared with the following information for law enforcement personnel:
Infant footprints, full written description, photos, blood samples, condition of the child, any special health
problems of the child such as diabetes or seizures
» RACE:
o RACE is an acronym on the general order of procedures for a fire:
R—Rescue: Remove pts from the general area.
A—Alarm/Alert: Sound alarm.
C—Confine: Contain fire.
E—Extinguish the fire.
» PASS:
o If you must put out a fire, remember the letters PASS:
2
, Spring 2023 MHolley
P—Pull the pin.
A—Aim at the base of the fire, near the edge.
S—Squeeze the handles together.
S—Sweep across the base of the fire, with a back-&-forth motion.
» FIRE PX: CONSTANT ALERTNESS:
o Enforce “no smoking” regulations; be sure no smoking occurs near oxygen use or storage.
o Inspect the home care pt.’s home for potential fire hazards.
o Make sure all equipment is operating properly; practice electrical safety; make sure fire alarms, fire doors, &
emergency stairs are clearly marked & unobstructed; & never prop open a fire door.
o Make sure all hallways are clear. Regularly practice procedures to follow in case of a fire.
» What care should be taken to ensure fire safety at the HCF? Ensure no smoking occurs near oxygen use.
» FIRE EXTINGUISHERS & THEIR USES:
o Type A contains water under pressure used for burning paper, wood, cloth.
o Type B contains carbon dioxide used for fires caused by gasoline, oil, paint, grease, & other flammable liquids,
chemicals, gases, anesthetics.
o Type C contains dry chemicals used to put out electrical fires.
o Type ABC contains graphite used to put out any type of fire.
Chapter 96 ~ Extended Care
∆ HOUSING OPTIONS:
¤ Assisted living.
¤ Senior & other special housing programs
¤ Continuing Care Retirement Community (CCRC)
¤ Intermediate care facilities
¤ Extended-care facilities
¤ Extended-Care Facilities
∆ EXTENDED-CARE FACILITIES (ECFS):
¤ “Extend” or continue care started in the hospital.
Subacute-care or transitional facilities
Medically complex care facilities
Short-term rehab units
Long-term care (LTC) facilities or skilled nrsg facilities (SNF) (“nrsg homes”)
∆ LONG-TERM CARE FACILITIES:
¤ The skilled nrsg facility (SNF)
24-hour care & must have a licensed nurse (LPN, LVN, or RN) on duty 24 hours a day
Rehab services, special diets, & access to pharmacy, x-ray, & laboratory services
The primary care or “medical oversight” is often provided by an advance practice nurse.
Physicians are on call.
¤ The intermediate care facility (ICF)
Provide fewer services & less extensive care than the SNF.
Provide room, board, & some nrsg care
A licensed nurse is not required to be on duty 24 hours a day.
A nurse is usually required to be on call.
∆ COMPONENTS OF LTC FACILITIES:
¤ Meal programs, activities, & services
¤ Skin & wound care
¤ The ombudsperson, payment for long-term care
¤ The quality improvement organization
¤ The case manager or care manager
¤ Specialized communities
¤ Respite care & daycare programs
¤ Services provided to the community by long-term care facilities & volunteers.
∆ T/F: TheSNF is the only facility not licensed by the state, commonwealth, or province. ~ FALSE
∆ SERVICES PROVIDED IN TRANSITIONAL FACILITIES:
¤ Intravenous (IV) therapy
¤ Cardiac monitoring
¤ Ventilator &/or tracheostomy care
¤ Tube feedings
¤ Dialysis
¤ Colostomy/ileostomy care
¤ Mgmt. of severe wounds
∆ OTHER EXTENDED CARE OPTIONS:
¤ Independent living options
¤ The continuing care retirement community
¤ Senior & other special housing programs
Congregate housing
Board-&-care home
Supervised group home
Hospice care or end-of-life care
¤ Assisted living.
∆ SPECIAL SERVICES PROVIDED BY LTCS:
¤ Snack bar
¤ Gift shop
3
Professionalism Exam 4 ~ Ch 39, 96-100
Chapter 39 ~ Emergency Preparedness
» SAFETY & PREPAREDNESS:
o Safety in the HCF extends to pts, employees, students, & visitors.
o The goal is to px accidents & to be prepared for emergencies.
o Safety committee is responsible for disaster plans, safety policies & procedures, procedures for handling
hazardous substances, & information sheets regarding these substances.
» PT SAFETY:
o A pt. has the right to expect that a HCF will protect against injury & disease.
o Facility Safety Measures:
General emergency preparedness
Plans for specific emergencies.
Plans for evacuation.
Policies for resuscitation
Accurate admin. of meds & txs
Most HCFs require all staff to attend regular training sessions regarding safety.
o Topics include:
Fire safety
Handling of hazardous materials
Code or disaster procedures
» MEASURES THAT HELP PX ACCIDENTS:
o Double-lock medicine carts & medicine rooms.
o Ensure all meds are kept out of the reach of children.
o Get adequate assistance to move & walk pts.
o Use a transfer belt when necessary.
o Provide adequate lighting including night light.
o Check the temp. of liquids or solutions prior to use.
o Always use two means to identify each pt. before performing any procedure or giving medication.
o Conduct & document fall risk assessment.
o Place the pt.’s necessary items within reach.
o Especially considering the left-handed pt.
o Know how to call codes in your facility.
o Know the location of fire extinguishers.
o Keep up to date on CPR.
» MATERIAL SAFETY DATA SHEET (MSDS):
o Each facility must have an MSDS describing any substance considered hazardous.
o It gives information on the protective equipment required, safe handling information, & first-aid interventions for
accidental exposure.
o The information helps staff provide appropriate tx & to take necessary precautions when exposed to contaminated
individuals in an ED or ambulance.
» EMPLOYEE SAFETY:
o OSHA requires a job safety analysis (JSA) for each position.
o Employee right-to-know laws.
Employees have the right to be aware of all dangers associated with hazardous substances or harmful physical
or infectious agents they might encounter in the workplace.
» SAFETY TIPS FOR HAZARDOUS SUBSTANCES:
o Have the phone number of the local Poison Control Center readily available.
o Read labels carefully & note emergency information. Follow instructions for use, storage, & disposal. Never use
any unlabeled substance.
o Never store hazardous materials in alternative containers. Don use or store gasoline or turpentine indoors or use
hairspray or other aerosol products around an open flame, eyeglasses, or contact lenses.
o Avoid breathing mists or vapors; follow radiation prevention guidelines closely. Use protective equipment as
recommended.
o If any hazardous substance is spilled, consult facility or home care agency procedures for the safe & approved
method of cleanup.
o Always wear gloves & carefully wash hands when cleaning up spills. Any major spills must be cleaned up by
specially trained personnel.
» EMERGENCY PREPAREDNESS:
o Nurse’s call light & intercom: Check pts frequently if they are sedated or physically unable to use the call light. A
tap bell may be used in certain situations.
o Emergency signal: In most facilities, the call signal in the pt.’s bathroom causes an additional buzzer to sound at a
central station. Many home care pts can activate an alert system.
o Emergency resuscitation: In the hospital & in a skilled nrsg facility (SNF), each area generally has a crash cart
stocked with emergency meds & equipment. Know the procedure for CPR.
» FALL-RISK EVALUATION:
o Pts are evaluated on a regular basis for the risk of falling.
o Hendrich Fall Risk Tool may be used.
o The pt. is scored on each risk factor in the Fall Risk questionnaire.
o If a factor is absent, the score for that factor is 0.
o If the total score is 5 or greater, the pt. has a high risk of falling.
o The pt. at risk for falling is often identified by:
1
,Spring 2023 MHolley
A special yellow wristband
Yellow slipper-socks
A “falling star” sign outside the room.
» What care should be taken for a pt. with fall risk? Ensure the call signal is easily reachable.
» STAFF NOTIFICATION WHEN TELEPHONE SERVICE IS DISRUPTED:
o Amateur radio ham operators, television, or radio broadcasts
o Runners (people who transport messages on foot)
o Computers (email), pagers
o Contacts outside the affected area
o Portable or handheld radios
o Police
» PERSONAL EMERGENCY PREPAREDNESS:
o Plan for prolonged power outages.
o Keep a first-aid kit stocked & on hand. Carry an emergency kit, an emergency hammer, & a charged cell phone in
your car.
o Store 1 gallon of water per person in the household per day, & adequate food supplies to last 4 days.
o Store prescriptions, glasses, dentures, hearing aids, & other essential items in a secure & accessible area.
o Identify safe areas in the home.
» CONSIDERATIONS AFFECTING PT & EMPLOYEE SAFETY:
o Weapons, narcotics, & other contraband: If the nurse suspects that a pt. or visitor has a weapon, the nurse should
report it to the supervisor & security department immediately.
o Flowers & gifts: Flowers & other gifts can pose a threat to certain pts.
o Workplace violence: If a pt. or visitor becomes threatening, the nurse must protect other pts & self by speaking
calmly, moving those threatened to a safer area, & notifying the supervisor or the security staff immediately.
» INTERNAL VS EXTERNAL DISASTERS:
o Internal disaster
The facility itself is in danger or damaged &/or function is impaired. An internal disaster may be caused by a fire,
an explosion, terrorist activity, radiation, a biologic spill, or a storm.
o External disaster
Occurs outside the facility & has an impact on normal operations.
» DISASTER PLAN:
o A facility’s disaster plan describes actions to take in a disaster.
o HCFs are required to have regular, periodic fire & disaster drills to allow their staff to practice emergency skills.
o These disasters may include: tornadoes, blizzards, hurricanes, earthquakes, avalanches, floods, or mudslides.
» BOMB THREAT:
o In case of a bomb threat, notify the supervisor & security personnel, & protect pts.
o In case of threat over the phone, check the “caller ID” to determine the origin of the call, ask questions & write
down the caller’s answers, & listen to other cues & note what is heard.
o A search will be conducted by the police bomb squad.
o The nurse must report anything unusual & follow the professionals’ instructions.
o Stay away from windows or other large glass objects during the search.
o Don’t use elevators until the situation is cleared.
o Carefully document the incident after the danger has passed.
» IMPLEMENTING THE DISASTER PLAN:
o A disaster plan describes duties & responsibilities of staff in a disaster.
o It identifies the location of the command center, which provides overall direction of the facility’s activities.
» EMERGENCY TRIAGE:
o Triage
Process of sorting & classifying injured persons to determine priority of needs.
o Simple triage & rapid tx (START) system:
Identifies people who are going to die quickly if they don’t receive immediate medical care.
» T/F: A nurse may be required to assist a triage. - TRUE
» PT EVACUATION:
o A disaster medical assistance team (DMAT) provides assistance & support in many environments, both inside &
outside HCFs.
o The extent of the emergency will affect the decision to evacuate a portion or the entire facility.
» INFANT/CHILD ABDUCTION:
o Give a full description of the child & the suspect, including what they were wearing.
o Tell parents to stay with their children in their rooms.
o Move the parents of the abducted child to a private area.
o Be prepared with the following information for law enforcement personnel:
Infant footprints, full written description, photos, blood samples, condition of the child, any special health
problems of the child such as diabetes or seizures
» RACE:
o RACE is an acronym on the general order of procedures for a fire:
R—Rescue: Remove pts from the general area.
A—Alarm/Alert: Sound alarm.
C—Confine: Contain fire.
E—Extinguish the fire.
» PASS:
o If you must put out a fire, remember the letters PASS:
2
, Spring 2023 MHolley
P—Pull the pin.
A—Aim at the base of the fire, near the edge.
S—Squeeze the handles together.
S—Sweep across the base of the fire, with a back-&-forth motion.
» FIRE PX: CONSTANT ALERTNESS:
o Enforce “no smoking” regulations; be sure no smoking occurs near oxygen use or storage.
o Inspect the home care pt.’s home for potential fire hazards.
o Make sure all equipment is operating properly; practice electrical safety; make sure fire alarms, fire doors, &
emergency stairs are clearly marked & unobstructed; & never prop open a fire door.
o Make sure all hallways are clear. Regularly practice procedures to follow in case of a fire.
» What care should be taken to ensure fire safety at the HCF? Ensure no smoking occurs near oxygen use.
» FIRE EXTINGUISHERS & THEIR USES:
o Type A contains water under pressure used for burning paper, wood, cloth.
o Type B contains carbon dioxide used for fires caused by gasoline, oil, paint, grease, & other flammable liquids,
chemicals, gases, anesthetics.
o Type C contains dry chemicals used to put out electrical fires.
o Type ABC contains graphite used to put out any type of fire.
Chapter 96 ~ Extended Care
∆ HOUSING OPTIONS:
¤ Assisted living.
¤ Senior & other special housing programs
¤ Continuing Care Retirement Community (CCRC)
¤ Intermediate care facilities
¤ Extended-care facilities
¤ Extended-Care Facilities
∆ EXTENDED-CARE FACILITIES (ECFS):
¤ “Extend” or continue care started in the hospital.
Subacute-care or transitional facilities
Medically complex care facilities
Short-term rehab units
Long-term care (LTC) facilities or skilled nrsg facilities (SNF) (“nrsg homes”)
∆ LONG-TERM CARE FACILITIES:
¤ The skilled nrsg facility (SNF)
24-hour care & must have a licensed nurse (LPN, LVN, or RN) on duty 24 hours a day
Rehab services, special diets, & access to pharmacy, x-ray, & laboratory services
The primary care or “medical oversight” is often provided by an advance practice nurse.
Physicians are on call.
¤ The intermediate care facility (ICF)
Provide fewer services & less extensive care than the SNF.
Provide room, board, & some nrsg care
A licensed nurse is not required to be on duty 24 hours a day.
A nurse is usually required to be on call.
∆ COMPONENTS OF LTC FACILITIES:
¤ Meal programs, activities, & services
¤ Skin & wound care
¤ The ombudsperson, payment for long-term care
¤ The quality improvement organization
¤ The case manager or care manager
¤ Specialized communities
¤ Respite care & daycare programs
¤ Services provided to the community by long-term care facilities & volunteers.
∆ T/F: TheSNF is the only facility not licensed by the state, commonwealth, or province. ~ FALSE
∆ SERVICES PROVIDED IN TRANSITIONAL FACILITIES:
¤ Intravenous (IV) therapy
¤ Cardiac monitoring
¤ Ventilator &/or tracheostomy care
¤ Tube feedings
¤ Dialysis
¤ Colostomy/ileostomy care
¤ Mgmt. of severe wounds
∆ OTHER EXTENDED CARE OPTIONS:
¤ Independent living options
¤ The continuing care retirement community
¤ Senior & other special housing programs
Congregate housing
Board-&-care home
Supervised group home
Hospice care or end-of-life care
¤ Assisted living.
∆ SPECIAL SERVICES PROVIDED BY LTCS:
¤ Snack bar
¤ Gift shop
3
