Simple staff checklist aids fire prevention
By Betty T. Dixon, RN, BSN
Home Care Consultant
Medical Management Development and Associates
Savannah, GA
Home care providers should always be concerned with fire prevention. The 1997-98 Comprehensive Accreditation Manual for Home Care (CAMHC) addresses the Joint Commission’s concern for these processes through the Environ mental Safety and Equipment Management (EC) chapter. Home care providers should look at fire prevention as it pertains to their company or organization environment and to the patient environment.
Researchers say the typical home care patient is an elderly woman who lives independently. Women of this era generally did not think about home fire prevention and safety; that was the role of their spouse or male children. Your agency can use this opportunity to provide a valuable service by checking the home and educating all patients about fire prevention.
The Joint Commission defines patient environment as the residential setting in which the patient receives care or service. These home settings usually are not under the organization’s control. However, your organization frequently places medical equipment, such as oxygen, in the patient’s residence. Such equipment must be appropriate to the home setting and maintained in safe, working order.
Standard EC.1.6, CAMHC p. 350, requires your organization to have a plan for fire prevention. Standard EC.1.7, CAMHC p. 351, requires your organization to implement its plan. Count on the JCAHO surveyor asking at least one patient, "Do you know what to do in case there is a fire?" Fortunately, caring for patients and fulfilling these standards can be done in a variety of different ways.
During the initial patient assessment, make sure your staff check the home for fire safety by using this checklist as part of their overall patient safety review assessment:
• Space heaters and halogen bulbs.
It makes sense to give space heaters space. The National Fire Protection Association recommends keeping portable heaters and space heaters at least three feet or one meter away from anything that can burn. Halogen lamps also pose a fire threat. These small, inexpensive bulbs become quite hot and are the cause of many fires. Staff should instruct patients to NEVER place an article of clothing over these bulbs. Halogen lamps and space heaters should be turned off when the room is vacated.
• Frayed cords.
Cords should be inspected, and frayed cords removed or repaired. Several agencies and DME companies reuse expensive pieces of equipment. Their equipment is cleaned and checked prior to another patient’s use. A final check-off, which occurs when the equipment is set up in the home, has been added by many agencies. Agencies should follow the manufacturer’s guidelines for safety and performance to ensure the equipment is working properly before leaving the patient’s home. If there is a problem, the visiting nurse can call the company providing the equipment for further assistance. The faulty equipment should be replaced by the company.
Staff should visually inspect any cords belonging to the patient that are obviously frayed, particularly if they are leaving oxygen in the home. If an electric appliance smokes or has an unusual smell, unplug it immediately, and see that it is serviced before using it again. Make sure neither staff nor patients have overloaded extension cords or run them under rugs.
• Gas stoves.
Ask who will be doing the cooking. Whoever uses the stove should cook carefully. Older patients or patients on medication may forget the stove is on. Staff can recommend that patients use a timer to remind them that the stove is in use. Reminding patients not to store cooking oils directly above the stove is another prevention measure. Several communities have Meals on Wheels, and this might be an alternative for your patient to pursue.
• Open fireplaces.
No piece of equipment brought in the home by an agency should be left near the fireplace, even if the patient gives their word they will not use it. Staff should keep an eye on the fireplace, especially if this is a long-term patient. Well-meaning family members will move items in your absence.
• Oxygen use.
Oxygen should be stored away from electrical outlets and upright if possible. Do not allow smoking or open flames while loading or unloading any oxidizing material to and from the home.
• Smoking.
If the patient is a smoker, this may be the perfect opportunity to discuss smoking cessation programs. Smoking in bed or when the patient is drowsy can be fatal. If patients are not inclined to quit smoking, encourage the use of large, deep, non-tip ashtrays. Soak butts with water before discarding. If the patient is unable, encourage a family member to check under and around cushions and upholstered furniture for smoldering cigarettes prior to going to bed.
• Smoke detectors.
Working smoke detectors can alert patients to a fire in time for escape. Ideally, smoke detectors should be installed on every level of the home, including the basement, and outside each sleeping area. If the patient sleeps with the door closed, one should be inside the sleeping area as well.
Encourage family members to test detectors every month, following the manufacturer’s directions. Replace batteries once a year or whenever a detector chirps to signal low battery power. Agencies could provide the smoke detector, if necessary.
• A fire escape plan.
If a fire breaks out in the home, the patient must get out fast. Staff can prepare the patient and the family by sitting down with them and designing an escape plan. Be sure everyone knows at least two unobstructed ways out, doors and windows. If the patient lives in an apartment building, remind them that the stairs, not the elevators, are part of the plan. Decide on a meeting place outside where everyone will gather after the escape.
During a fire, smoke and poisonous gases rise with the heat. The air is cleaner near the floor. Keep the patient on or close to the floor during escape. The National Fire Protection Association recommends a height no greater than 24 inches, or 60 centimeters, above the floor.
By using these guidelines as a teaching tool in patient homes, agencies can perform a valuable service to their patients and the community.
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