153. CCA Study Notes: Safety, Fall Prevention, and Call Bell Use

The Big Picture

Safety starts with noticing hazards and following the safety measures already in place for each client. A support worker has responsibilities for client safety, co-worker safety, and personal safety.

Falls deserve special attention because they are a common cause of accidental injury. Children and older people face the greatest risk, and some clients need closer supervision because of their condition or situation.

A call bell is a safety device that lets a client in a facility notify staff when assistance is needed. Keeping it within reach and responding promptly helps the client get help before trying to manage alone.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

Jump to:

Course Notes: Key Ideas You Need to Know

Safety in Home and Facility Settings

Support workers need to recognize common safety hazards and report lapses in safety measures immediately to the proper authority, usually the supervisor.

As a support worker, you are responsible for your clients’ safety, your co-workers’ safety, and your own safety.

Safety measures apply in both community and facility settings. Employers have safety policies to protect clients and staff.

In community settings, case managers may check a client’s home for safety hazards during the assessment phase. Hazards they identify are corrected by the case manager, other professionals, or the client’s family.

Individual client care plans contain the safety measures needed for that client. Follow both the safety policies and the care plan. Avoidable accidents can happen when workers fail to follow them.

Why Fall Prevention Matters

Falls are the most common cause of accidental injuries across settings. Children and older people have the greatest risk.

You should always supervise all clients. Give particular attention to clients with greater risk for fall-related injuries.

Clients who need particular attention include:

• children
• clients in wheelchairs
• clients with a history of injury
• sedated clients
• older clients
• clients with cognitive impairment

Clients with conditions that affect thinking, remembering, communicating, or concentrating also have increased fall risk. The examples given include brain injuries, mental health disorders, dementia, and other conditions that cause confusion or disorientation.

Effects of Falls in Older People

Falls can cause death, serious injury, and changes in quality of life.

After a fall, an older person may become afraid of falling again and stop leaving the house. This can contribute to isolation, anxiety, depression, and increased dependence on others.

Among Canadian older persons:

• falls are the leading cause of injury-related hospitalization
• between 20 and 30% fall each year
• falls can contribute to fear, loss of autonomy ⓘ, isolation, confusion, immobilization, and depression
• the associated financial cost is estimated at $2 billion annually
• this cost is 3.7 times greater than the cost for younger adults

Fall Prevention Programs in Facilities

Many facilities use fall prevention programs with several strategies.

Assessing and Identifying Risk

Clients are assessed for fall risk. Clients at high risk receive extra supervision and assistance.

Facilities may identify clients at increased risk with:

• colour-coded bracelets
• signs
• stickers
• tags

These identifiers might appear on the client’s chart, at the nurses’ station ⓘ, or, in some agencies, above the bed. Wherever these identifiers are used, they should be placed in a way that respects the client’s right to privacy.

Staff who care for clients at risk for falls receive current information and training. This includes safe client movement, proper equipment use, and ways to avoid injuring themselves.

Places and Times With Greater Fall Risk

Most falls occur in bedrooms, bathrooms, and on stairs. These areas need particular attention.

Clients sometimes fall when they rush to the bathroom or commode without help. Remind clients to ask for assistance.

Most falls in facilities occur during the evening between 1800 hours, 6:00 p.m., and 2100 hours, 9:00 p.m. Keep hallways well lit and free of clutter or obstacles.

Falls are also more likely during shift changes. Some agencies use overlapping shifts so staff remain available to check clients while other staff listen to the shift report.

Always follow the client’s care plan for specific fall-prevention measures.

Making the Environment Safer

Several simple environmental measures help reduce fall hazards.

Floors, Stairs, and Walkways

• Report unsecured throw rugs and small mats.
• Keep throw rugs and mats away from high-traffic areas and the tops of stairs.
• Report loose floorboards and tiles.
• Report frayed, torn, or uneven rugs and carpets.
• Keep telephone and electrical cords out of traffic areas.
• Keep floors and stairways free of clutter.
• Never leave items on stairs.
• Use only nonglare, nonslip floor wax.
• Clean up water and other spills immediately.

Lighting and Clear Paths

• Provide proper lighting, especially near stairs and bathrooms.
• Offer to replace burned-out light bulbs.
• Turn on hall night lights, especially near the bathroom.
• Keep a clear path between the bedroom and bathroom.
• Do not rearrange the client’s furniture.
• Use nonslip rubber bath mats or nonslip strips in tubs and showers.

Clothing, Footwear, and Mobility Aids

Mobility means the ability to move around.

Make sure clothing and footwear fit properly.

• Shoes and slippers must have nonskid soles.
• Avoid long shoelaces.
• Clothing should not hang loosely or drag on the floor.
• Belts must be tied or secured in place.
• Make sure crutches, canes, and walkers have nonskid tips.
• Make sure the client uses these devices correctly.

Encourage clients to use glasses or hearing aids as needed. Clients should not wear reading glasses while walking. Store these devices safely when they are not being used.

The Client’s Right to Live at Risk

A client has the right to live with some risk of injury.

For example, a client might understand that scatter rugs present a possible hazard but still choose to keep them. The client’s understanding of the risk does not automatically remove the client’s right to make that choice.

Wheelchair Safety

Check wheelchair brakes and make sure they lock and unlock.

• Remind the client to keep the brakes locked when the wheelchair is not moving.
• Lock both brakes before transferring the client to or from the wheelchair.
• Do not allow the client to stand on the footrests.
• Make sure the front wheels point forward for balance and stability.
• Remove armrests and footrests, if they are removable, during transfers to or from the wheelchair.

Positioning, Observation, and Alarms

Position the client properly in bed, a chair, or a wheelchair. Use pillows, wedge pads, or seats when directed by the care plan.

Check clients often, especially clients with fall risk factors.

Some clients use weight-sensitive electronic alarms on beds or wheelchairs. These alarms detect movement or loss of weight from the surface.

Respond to all alarms at once.

Hip or coccyx protectors can reduce the risk of injury if a fall occurs. They do not replace frequent monitoring.

Toileting and Fall Prevention

Clients sometimes attempt to reach the bathroom without assistance. This increases the importance of prompt help.

• Ask clients to call for assistance before getting out of bed or a chair or before walking when help is needed.
• Help clients to the bathroom as soon as they request assistance.
• Offer a bedpan, urinal, or commode regularly when appropriate for clients who need help with elimination.
• Keep a bedpan or urinal within easy reach of clients who can use it without assistance.

Beds, Bed Rails, and Fall Prevention

Keep beds in the lowest position except while giving bedside care.

Never leave a client alone when the bed is raised.

Bed rails are the metal or plastic sides of a hospital bed used to prevent a client from falling out of bed.

Use bed rails strictly according to the care plan. One client’s care plan may direct staff to leave the rails down, while another client’s plan may direct staff to raise them.

Know the employer’s rules for bed rail use. Bed rails can become unsafe when used incorrectly.

Floor cushions can provide a softer landing area if a client falls from bed. The bed should still remain at its lowest level.

Roll guards can help prevent a client from rolling out of bed.

Other Safety Measures in Facilities and Homes

Encourage clients who are unsteady while walking to use available handrails and grab bars.

Lock the wheels on bed legs when giving bedside care and when transferring a client.

In facilities, use care when:

• turning corners
• entering corridor intersections
• going through doors

A person approaching from another direction could be injured in a collision.

After visitors leave, complete a safety check of the room in both home and facility settings. Visitors might have:

• lowered a bed rail
• moved the call bell
• moved a walker out of reach
• brought an item that might harm the client

During the night, facility staff are responsible for checking all clients at hourly intervals, or more often.

Understanding the Call Bell

A call bell is a safety device used in facilities that lets a client tell staff that assistance is needed.

Call systems differ between facilities. Become familiar with the system used in each workplace.

A system may use a button attached by a cord to a bed or chair. Pressing the button might:

• sound a signal at the nurses’ station
• turn on a light above the client’s door
• turn on a light at the nurses’ station

Some systems connect to an intercom. Others connect directly to cordless phones carried by staff.

Protect Confidentiality When Answering Calls

An intercom or staff phone allows a worker to speak with the client who called.

People nearby may hear the conversation. Protect the client’s right to confidentiality when speaking through an intercom or phone.

Clients Who Need Different Call Methods

A client with limited hand mobility may need a special call bell that activates when tapped with a hand or fist.

Clients learn how to use the call bell when admitted to a facility.

Some clients, including clients who are confused or in a coma, cannot use a call bell. For these clients:

• check the care plan carefully for special communication methods
• check on the client often
• make sure the client’s needs are met

Call Bell Rules You Must Follow

Whenever you finish a procedure and leave the client’s room:

• Keep the call bell within the client’s reach.
• Keep it within reach in the room, bathroom, and shower or tub room.
• Keep it within reach even when the client cannot use it, because visitors or staff might need to call for help.
• Place it on the client’s unaffected side.
• Remind the client to use it when help is needed.
• For a client at risk for falls, ask the client to call for assistance before getting out of bed or a chair or before walking.
• Answer call bells promptly.

A prompt response is especially important when a client needs the bathroom. Prompt help can protect the client’s dignity and help prevent infection, skin breakdown, pressure ulcers, and falls.

Leaving a client without a call bell is regarded as emotional abuse. The client may also consider it negligence ⓘ or punishment.

Calling for Help in Home Care

Some home care clients cannot move out of bed or leave a particular part of the home. They need another way to get someone’s attention.

Possible calling devices include:

• tap bells
• dinner bells
• baby monitors
• a small container with a few coins that makes noise when shaken
• children’s toys with bells, horns, or whistles

Whatever device the client chooses, keep it within easy reach.

Fall Prevention for Infants and Children

Falls are the leading cause of injuries in children.

Accidental injuries are the leading cause of death among Canadian children.

Infants can roll off beds or change tables, and babies and children may fall from highchairs, infant seats, or stairs.

Older children often fall while running or playing. Tired children may pay less attention to hazards and may react more slowly.

Supervision and High Surfaces

• Do not leave infants or young children unsupervised.
• Never leave them unattended in highchairs or on tables, couches, beds, or other high surfaces.
• Keep one hand on a child lying on a scale, bed, change table, or other piece of furniture.
• Keep one hand on a baby during diaper changes.
• Gather supplies before changing or bathing an infant and keep the supplies within easy reach.

Highchairs, Infant Seats, and Baby Walkers

When securing a child in a highchair or infant seat:

• use both waist and crotch straps
• lock the highchair tray after securing the child
• keep highchairs away from stoves, tables, and counters

A child could push against nearby surfaces and cause the chair to fall backward.

Do not use baby walkers. They have caused many serious falls and injuries.

Stairs, Cribs, and Bunk Beds

• Use safety gates at both the top and bottom of stairs.
• Make sure a child cannot become caught in the gate slats.
• Keep crib rails up and locked.
• Check children in cribs frequently.
• Keep objects out of the crib that a baby might stand on to climb over the railing.
• Do not let children under 6 years of age sleep or play on the top bed of a bunk bed.

Windows, Running, and Furniture

Keep children away from windows. Do not allow them to sit on windowsills or lean on windows.

Window screens are not strong enough to prevent a fall. Keep furniture away from windows so children cannot climb on it to reach the window.

Do not allow children to run with objects in their hands or mouths, such as bottles, soothers ⓘ, or sticks.

Take measures to prevent furniture such as TVs, bookcases, dressers, and tables from falling on children. Heavy furniture should be anchored to the wall.