CNA Guide: Key Role in Error Prevention

We are prone to committing mistakes as human beings. As what they say, no one is perfect and no one will ever be. This is a fact we all have to accept and deal with. But when it comes to medical professions, making one simple mistake can be fatal. Dealing with the lives of clients make your role as a health care provider very important. As such, you need to exert more effort and caution when rendering care to your clients.  All nursing assistants do not want to commit an error, but reports show that health care errors made by CNAs are still increasing. Several factors have been attributed to errors made in the health facilities. Thus, the government and relevant organizations have set up standards and policies to be followed in hope that errors will be lessened. But these governing bodies can only do that much. In the actual health facility, committing a mistake can mostly be judged on the one who made the error personally. It must be due to the fact that as a health provider who passed the certification, you are accountable for your actions, including your wrongdoings.

Being a certified nursing assistant makes you vulnerable in making a mistake. The key role here is knowing your responsibilities to your clients, co-workers and institution and practicing within the scope and limitations of your profession. If you are able to do this, then there’s no way you can endanger the lives of your clients. But having the necessary knowledge and skills are not enough. Human factors also influence your work habits that may pave way to not doing the right thing. So make sure to get enough rest, sleep and nutrition before working as to not comprise your client’s care. You should also learn to deal with stress positively, so that you can work at your best. Also, manage your time effectively and efficiently. As a CNA, you have physical and written workloads. Most of the time, you also need to listen to your clients’ concerns and find ways to comfort them. Eventually, all these demands can take a toll on your working habits. So make sure that you are prepared physically, emotionally and intellectually when reporting for duty.

Basic guidelines for preventing errors include:

  • Be competent and stay competent. Update your knowledge and practice with your skills. If you are unsure of what you’re supposed to do, ask your supervisor or someone in position who knows the answer. The keywords here and certainty and valid confidence in what you do.
  • Communicate constantly. Talk to your superiors when you have work-related concerns. Interact with your co-workers because you’re a a team and you might learn a thing or two when dealing with clients. Report changes with your client as soon as you observed them to proper personnel. Make time and listen to your client’s complaints and problems.
  • Be attentive and alert. Identify your client accurately before performing any procedure on them.  Pay attention always to what you are doing. Do not let your mind wander elsewhere when you are on duty. Remember that the client is your priority.

CNA Skills – Care of Nails

Procedure

Key Points

1. Cut the nails then file To prevent nails from being brittle
2. Apply emollient like cold cream To keep nails and cuticles in goof condition
3. Cut the nails short To prevent dirt from accumulating underneath
4. Fingernails may be trim in oval fashion, but filing the nails too far down on the sides is contraindicated To prevent injury to the cuticle and the skin around the nail
5. Toe nails are cut square To prevent ingrown toenails
6. Hangnails are broken pieces of cuticles; they should be removed by cutting. Hangnails can be prevented by pushing the cuticle back gently with a blunt instrument or with a towel after washing the hands
7. Nails should be cleaned with an orange wood stick rather than with a metal instrument

CNA Skills – Colostomy Irrigation

photo by: edu.gdpeds.com

CNA SkillsColostomy Irrigation is the introduction of sterile solution through the artificial abdominal anus

Purpose:
1. To wash out the colon of feces, gas excess mucus, bacteria and any toxic agent that may be present
2. To promote healing of the obstructing lesion by gentle, warm irrigation
3. To give comfort to the patient
4. To teach the patient how to clean the colon
5. To establish good bowel habit

Precautions:
1. Strict aseptic technique should be observed throughout the procedure
2. Dressing should not be done during mealtime (it will destroy patients appetite)
3. Never rub stoma (opening)
4. Never use cotton

Procedure

Key Points

1. Prepare equipment and carry to bedside To save time and motion
2. Screen bed and replace sheet with blanket To insure privacy
3. Explain procedure to patient To gain cooperation
4. Place patient on his back in semi-fowler’s position To make him comfortable and to facilitate drainage
5. Open binder and remove dressings with forceps and place in kidney basin
6. Place rubber sheet cover with one sterile towel at side of patient nearest colostomy opening
7. Put on rubber gloves Complete aseptic technique
8. Hang irrigator can stand not more than 18 inches above the wound. Expel air from tubing
9. Lubricate tube and insert catheter into proximal (upper) loop not more than 7 inches To facilitate insertion of the catheter
10. Turn patient towards affected site. Place emesis basin under the colostomy To empty loop
11. Wipe off catheter, lubricate it and insert into distal (lower) loop
12. Fill irrigator can with the solution and allow it to run smoothly
13. If patient complains of severe cramping and no solution is expelled through rectum, withdraw tube and allow solution to return through colostomy opening
14. Clean stoma and surrounding area with soap and water, dry and apply Benzoin To prevent irritation

After Care:
Patient
1. Dress the colostomy
2. Replace the binder

Equipment
1. Wrap soiled dressing
2. Wash instruments and equipment and sterilize
3. Reset tray and cover

Watch Video:

CNA Skills – Catheterization – Female

CNA Skills – Catheterization (Female) is the introduction of Catheter through the urethra into the bladder for general purpose of withdrawing urine from the bladder.

Purposes:

  1. To get a clean specimen of urine as possible for diagnostic purposes
  2. To remove urine when the patient is unable to void or when it is not desirable for the patient to void
  3. Sometimes, to prevent bedwetting if the patient is incontinent
  4. To insure safety preceding an abdominal operation
  5. To determine whether the failure to void a normal amount is due to inability to expel urine from the bladder (urinary retention) or failure of the kidneys to secrete urine (suppression)
  6. To determine residual urine

Special Considerations:

  1. Catheter should be examined for defects before procedure is started
  2. Tip of catheter must be kept sterile always. Discard if sterility is doubtful
  3. Catheter must be inserted gently without force
  4. Once in place , secure catheter with adhesive tape to avoid slipping back and forth from urethra
  5. Gradual decompression of a distended bladder is safer procedure than a rapid removal of all urine

Procedure

Key Points

1. Explain the necessity for the treatment To gain cooperation of the patient
2. Have patient lie on her back near the side of the bed most convenient for the caregiver
3. Place protector under the buttocks To protect linen
4. Raise the gown of the patient, flex knees, feet flat on the bed, legs well separated
5. Drape the patient properly To avoid unnecessary exposure
6.Give external douche
7. Put a sterile towel under the buttocks
8. Place a tray at the foot of the bed
9. Place a kidney basin at a convenient place
10. Adjust light
11. Put on sterile gloves
12. Holding the sponges with the right hand, moisten them with antiseptics. Strokes should be from the clitoris downwards, removing any secretion from the labia majora, separate and lift upward the labia majora with the thumb and forefinger of the left hand exposing the meatus
13. Lubricate catheter and insert into urethra gently about 1 ½ to 3 inches or until urine begins to flow out
14. If catheterized specimen is desired, keep the outer end of the catheter sterile until after the specimen is collected
15. When flow of urine begins to diminish, withdraw the catheter slowly about ½ inch at a time. Pinch catheter when urine ceases to flow, remove catheter gently and place it in the kidney basin
16. Dry the areas as indicated
17. Measure urine obtained
18. Wrap soiled cotton in paper and place in waste can
19. Rearrange clothing and beddings, leave patient in a comfortable  position
20. Wash all articles used and set catheterization tray for the next use