5.4 Pre- and Post-Procedural Steps

Each time a nursing assistant provides personal cares, there are routine steps that should be performed before and after the interaction, regardless of the skills provided. Having a list of routine steps ensures the following:

• Important aspects of care won’t be overlooked.
• Dignity for the client and respect for their preferences are provided.
• Risk for transmission of pathogens is reduced.
• Safety is provided.
• Necessary equipment and supplies are present.

Before providing care to a resident, follow the SKWIPE acronym:

• Supplies: Many supplies are kept in the resident’s room, but ask yourself if anything is needed that is not available in the room. Being prepared prevents disruption of the procedure and possible delays that can result in discomfort for the resident.
• Knock: Always knock before entering a room, even if the door is open. Knocking maintains dignity for the client and shows respect for their privacy.
• Wash: Always perform hand hygiene when entering the resident’s room to reduce the risk of transmitting pathogens from other residents, equipment, or environmental surfaces.
• Introduce and Identify: Introduce yourself to the resident with your name and your title or position at the facility. Identify the client following facility policy. For example, properly identifying a client in a hospital setting may include asking them their name and date or birth and checking their medical ID band. However, in a long-term care setting, some residents may have cognitive or sensory deficits and may not correctly state their own name, so asking their name is not always a safe manner to identify them. Instead, identification in long-term care settings is typically performed by using a photograph in the medical record or by asking another experienced staff member to confirm identification.
• Privacy: Provide privacy by closing the door and pulling the privacy curtain to ensure dignity when providing personal care.
• Explain: Explain what care you will be providing so the resident can ask questions or decline care if it is not desired at that time.

After providing care to a resident, but before leaving the room, follow the CLOWD acronym:

• Comfort: Ask if the resident is comfortable and if they need anything else such as tissues, water, TV remote, etc.
• Light, Lock, and Low: Place the resident’s call light within reach so they can call for staff when they need assistance. Check the brakes on the bed to ensure they are locked, and the bed won’t move. Place the bed in the lowest position. These and other measures such as ensuring bed and/or chair alarms are in place and turned on are vital for ensuring patient safety. If a resident decides to self-transfer out of bed instead of requesting assistance, locking and lowering the bed will reduce the risk of injury because it is lower to the floor and won’t move suddenly out from underneath them.
• Open: Open the door and privacy curtain. For safety reasons, residents must be within staff eyesight when they are alone in their rooms, unless they are physically able to move independently.
• Wash: Perform hand hygiene before leaving the room to reduce the risk of transmitting pathogens to another resident, equipment, or environmental surfaces.
• Document: Ask yourself if you provided any cares that should be documented in the medical record or if you need to report anything to the nurse or other staff member. Routine cares (i.e., those cares provided to every resident every day) are not necessarily documented unless they are declined or something out of the ordinary occurred or was observed. Follow agency policy regarding documentation.