As a Registered Nurse that works in a nearby nursing home, fire safety is one element of nursing home safety that all employees, and residents, should always be cognizant about. Because of the frail condition of elderly patients, particular aspects of this process may need to be adapted from what you may be accustomed to doing in other workplaces.

Firstly, an effective orientation period, for all new employees of your nursing home facility, is absolutely critical. Whether the new employee be a physician, an administrative assistant, or a janitor, safety is something that everyone should be ever-vigilant about, at all times. This orientation period will offer all new employees an opportunity to become familiar, and indoctrinated, with regards to the established procedures of the facility. They will have the opportunity to ask questions, and have all their concerns addressed, regarding safety policies, as well as, general organizational policies.

Secondly, all employees should take as many proactive measures as they possibly can in order to ensure that your nursing home's organizational policies are enacted and adhered to, at all times. In the event that a fire ever really did occur, it certainly will bring peace of mind knowing that an evacuation can effectively be executed with open spaces that are free of clutter, as well as fire exits that are clearly marked.

This step is intertwined with the first step simply because the information you instill in your employees, at their initial orientation session, will, or should, be carried with them throughout the tenure of their employment at your nursing home facility. As they are given a tour of your building, you must ensure that they know the location of all fire alarms, exits, and extinguishers, in the event that they ever really had to use them.

Knowing the telephone number for reporting fires, as well as, the fire drill and evacuation plan of your agency, is also imperative, and should be reviewed during your orientation session.

Thirdly, your patients are ultimately residents, and paying customers, and should be treated with upmost respect and kindness. On the same token, you can't always expect that they will keep their living environments in perfect condition. Where they leave off, nurses' aides, and registered nurses, should take it upon themselves to ensure that their living conditions are always maneuvarable and clutter-free.

Fourthly, all employees should know the priority of actions to take in the event of a fire. Whether in a hospital, a nursing home, or any other assisted living center, the mnemonic "RACE" has become universally accepted because its simplicity in recalling the immediate priority of actions to take. You may introduce your new employees to this mnemonic during their orientation session, as well as, you may also hang a poster in the hallway for them to recall in passing.

R - Rescue: Remove all clients from the vicinity of a fire.
A - Alarm: Activate the fire alarm; report a fire before attempting to extinguish it.
C - Confine: Close doors and windows when a fire is detected.
E - Extinguish - Extinguish the fire, using the appropriate fire extinguisher. (Mneumonic extracted from Box 16-1, Saunders, p.178)

Fifthly, you must remember that, in the event of a fire, several steps or actions may overlap dependent upon the situation. A general rule, however, is that your elevator should never be used if a fire were to occur. On top of that, these residents may certainly be ordered oxygen therapy that will need to be turned off, if they are in the vicinity of the fire.

Sixthly, you must remember that your compassion, and calmness, under a difficult situation, will be reflected in your face and accompanying mannerisms. With that said, in order to satisfy the above mnemonic, you will encounter residents of varying physical conditions and capabilities that will need to be rescued.

If a client is on life support, you should maintain their respiratory status manually with an ambu-bag until the client is moved away from the threat of the fire and can be placed back on life support. Your facility's registered nurses can direct ambulatory residents to walk by themselves to a safe area, or, in certain situations, they may also be able to assist moving other clients in wheelchairs.

Lastly, it is up to all employees to ensure safety is maintained during every step of the fire evacuation process. If a bedridden resident has to be moved from the scene of a fire by stretcher, appropriate trasfer techniques need to be used. This adherence to safety should be maintained at all times, regardless of the task your employees are performing.

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Risk Management in Health Care Institutions: A Strategic Approach
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