Title: Ralph H. Johnson VA Medical Center Orientation
1Ralph H. Johnson VA Medical Center Orientation
2WELCOME TO THE CHARLESTON VAMC
Dr. Hutchison Chief of Staff
John Barilich Director
3CHARLESTON VAMC MISSION
- MISSION STATEMENT
- The mission of the Ralph H. Johnson Department
of Veteran Affairs Medical Center is to improve
the health of the veteran population by providing
primary, specialty and extended care and related
social support services through an integrated
healthcare delivery system.
4CHARLESTON VAMCVISION
- VISION STATEMENT
- We will be the recognized leader.
- in providing innovative methods for treating
patients and supporting their total health care
needs. - in recognizing and developing employees who
enthusiastically and significantly contribute to
the medical center and community. - in conducting meaningful research which provides
breakthroughs in treatment and prevention of
disease. - in continually improving everything we do in
order to meet the needs of those we serve.
5CHARLESTON VAMCVALUES
- VALUES STATEMENT
- We value and expect
- TRUST
- A high degree of confidence in the honesty,
integrity, reliability and sincere good intent of
those with whom we work, the services that we
provide, and the system that we are a part of.
Trust is the basis for the caregiver-patient
relationship and is fundamental to all that we do
in healthcare.
6CHARLESTON VAMCVALUES
- We value and expect
- RESPECT
- Honoring and holding in high regard the dignity
and work of our patients and their families, our
co-workers, and the system we are a part of. It
means communicating and relating to each other
with understanding, and a sensitivity and concern
for each persons individuality and importance.
7CHARLESTON VAMCVALUES
- We value and expect
- COMMITMENT
- Dedication and a promise to work hard to do all
that we can to provide service to our coworkers
and our patients that is in accordance with the
highest principles and ethics governing the
conduct of the healthcare professions and public
service. It is being bound emotionally and
intellectually to our mission and vision a
pledge to assume personal responsibility for our
individual and collective actions and a
willingness to do and give whatever it takes to
make our vision a reality. It means meeting our
goals through unity of purpose and teamwork.
8CHARLESTON VAMCVALUES
- We value and expect
- COMPASSION
- Empathy and caring in all that we say and do. It
means taking the time and responsibility to
consider workers, our patients and their
families, and all others with whom we are involved
9CHARLESTON VAMCVALUES
- We value and expect
- EXCELLENCE
- Exceptionally good and of the highest quality.
It means being the most competent and the finest
in everything we do, an effort encompassing all
aspects of work and personal relationships. It
means having pride in our accomplishments and a
sense of worth from doing a job the very best
that we can. It means continually improving what
we do. It means demonstrating a willingness to
be innovative and creative in the workplace for
problem solving, management and patient care.
10FACILITY SAFETY SECURITY
- All hospitals strive to provide a safe
environment for patients, visitors and staff and
to safeguard property from damage. The Office of
Public Safety tries to prevent problems from
occurring and is responsible for the parking and
visitor areas, lost and found articles, illegal
drugs, solicitation, etc. Officers wear clearly
defined uniforms for quick identification.
11FACILITY SAFETY SECURITY
- How can YOU help?
- Report all incidents (thefts, accidents,
suspicious persons) immediately by stopping by
the security office, 1st floor, B197, or by
dialing ext. 7251 or 0 for operator. - Report malfunctioning patient care equipment to
Biomedical Engineering for repair or replacement. - Report problems with non-patient equipment (A/C,
heating plumbing, etc.) to Engineering Service. - Report other safety hazards to the Safety
Officer. - Security Issues
- All PERSONNEL are required to wear ID badges at
all times. The badge is returned upon
termination. Some areas require additional
security due to special activities, such as, the
facility computer and communication systems.
Access to these sensitive areas is limited. In
order to protect property from theft or damage,
hazards, such as burned out lights, broken locks,
missing signs, etc., should be reported. Keys
should not be left unattended and computer access
codes should not be shared. -
12FACILITY SAFETY SECURITY
- SERVICES PROVIDED
- Maintain close relations with local police
department. - Patrol indoors and outdoors 24 hours a day.
- Increase patrols after dark, including door
checks. - Personal escorts to and from vehicles for
employees. - Store valuables, property and lost and found
articles. - Register employee vehicles and control parking.
- Investigate injuries, incidents or thefts.
- Help manage emergencies per emergency plans.
- Control identification process.
13Drug-Free Workplace
- Random drug tests can be performed at any time on
patient care or support staff - Drug usage by a VA employee could result in
property damage or destruction, injury, or death - The VA has a goal of being a drug-free workplace,
and the plan includes policies for employee
education
14FIRE SAFETY
- Prevent these three components from coming
together and you prevent a fire. - OXYGEN HEAT FUEL
15FIRE SAFETY
- Remember the RACE procedure when safely and
quickly responding to a fire - Rescue anyone in immediate danger (patients,
staff and visitors). - Alarm by engaging a fire alarm or calling 7911
- Contain by closing doors or covering the fire.
- Evacuate Assist in patient evacuation.
16FIRE SAFETY
- Evacuation..Use the unit concept when
evacuating a hospital. Each evacuation step is a
unit. - Horizontal Relocation Moving patients and staff
during a fire emergency through a fire door to a
safer area on the same floor. Know where the
nearest fire compartment is in your work area.
Look for fire/smoke wall signs above doorways. - Vertical Relocation Moving patients down an
enclosed fire escape stairwell. This method is
used when horizontal relocation is not possible. - NOTE Never turn off the main O2 valve on a
ward. The Charge Nurse/Supervisor in charge is
responsible to do this in the event of fire.
17EQUIPMENT SAFETY
- If patient care equipment malfunctions contact
Biomedical Engineering for repair or replacement. - If theres a problem with non-patient care
electrical equipment, HVAC, plumbing or doors,
contact Engineering Services (24 hours a day),
ext. 7269. - If you find a hazard and dont know what to do,
contact Safety and Security or Risk Manager (QM)
for help, ext. 6331 MED1
18Protect Confidentiality
- Patient records are confidential and accessed on
a need to know basis by members of the Health
care team. - Responsible for safekeeping records and
information pertaining to the patients care and
treatment - Avoid discussion of individual patient care
issues in public areas
19COMPUTER SECURITY
- Safeguarding patient or employee information in
the hospitals automated information system (AIS)
is the duty of everyone. - Responsibilities The Privacy Act of 1974
mandates that sensitive patient or employee
information will be accessed on a need to know
basis. - The facility Information Security Officer is
responsible for oversight of the AIS security
program and training employees who access
sensitive patient information. - All VA employees, contractors and others using
AIS resources are responsible for completing
initial and annual Cyber Security training and
following AIS policies and procedures.
20COMPUTER SECURITY
- Securities DOs and DONTs
- Safeguard assigned access/verify codes.
- Never leave disks containing sensitive
information unsecured. - Use privacy screens to prevent disclosure of
patient data from passers-by. - Safeguard computer printouts.
- Shred sensitive documents after they are no
longer needed. - Take care of equipment by never eating or
drinking at the computer. - Protect disks from magnetic hazards.
- Make certain the anti-virus software in always
present and running on the equipment. - Thumb drives are strictly prohibited from use and
on most computers they are inoperable
21COMPUTER SECURITY
- REMEMBER!!!! Just because you can access patient
information does not mean that you have the
privilege to do so. It is never appropriate to
look at patient or employee information that you
do not have a legitimate need to view. - REPORT ALL SECURITY VIOLATIONS. First, tell
your responsible provider. Then, report to the
Information Security Officer, ext. 7036.
22Cyber Security Privacy Training
- Training for CYBER PRIVACY must be completed on
the following website. - www.ees-learning.net
- Please remember all usernames and passwords!
- This will take approximately 90 min
- You will have to print a certificate with your
name on it for each course and turn in a copy to
education service or your service coordinator
23EMERGENCY PREPAREDNESS
- What is a Disaster? Disasters are emergencies
that result in large-scale severe injuries and
may bring in an unexpected number of patients,
putting strain on a hospitals staff, facility
and other resources. The problems that a
disaster creates require hospitals to do tasks
that are not part of the normal routine and can
cause major disruption in the environment of
care. - What is an Emergency? An emergency is a natural
or man-made event that happens suddenly and can
disrupt a healthcare facilitys ability to
provide care to patients. Emergencies are either
24EMERGENCY PREPAREDNESS
- Internal are those that occur within the building
or on the grounds, and directly and immediately
affect the hospital, staff and its operations,
such as - natural disasters
- large scale power outage
- riots/terrorism/hostage situations
- fires/bomb threats
- transportation accidents
- hazardous materials release
- public health disaster
25EMERGENCY PREPAREDNESS
- External are those that happen outside the
building but affect the facility when many
casualties are brought to be treated, such as - fire, smoke or fumes
- loss of environmental support services
- loss of medical gases
- explosion
- acts of terrorism
- hazardous material release
- mass casualties
26EMERGENCY PREPAREDNESSPLANS/DRILLS
- All people in the hospital have a role in the
Emergency Preparedness Plan. The Emergency
Preparedness Committee is responsible for proper
organization and implementation of training,
drills and procedures involving disaster
planning, but each service has its own policies
and procedures, as well as a set of duties to
perform. - Drills are held to
- Prepare all personnel by educating all
participants - Provide an opportunity to practice assigned
duties in a real emergency - Allow for continuous improvement
- Evaluate effectiveness and outcomes to a changing
environment or emergency type.
27EMERGENCY PREPAREDNESS
- What is your responsibility?
- Know the plan (See CPM 138-16)
- Know your duties
- Know your priorities
- Know where to report
- Know to whom you report
- Know location of supplies
- Take part in training and drills
- Ask questions
28EMERGENCY PREPAREDNESS
- What to do in a typical emergency procedure?
- Activate the Fan Out (normal duty hours) or the
Call Back (off hours) system. - Notify key personnel of the emergency.
- Listen for announcements/updates over the
intercom system and media - Employees report to assigned stations and await
special assignments. - Every department has a copy of its emergency plan
and respond accordingly
29EMERGENCY PREPAREDNESSPLAN EXAMPLE
- Medical Center Director
- establishes a command post
- Surgical/Nursing Service/Primary Care Services
- setup triage areas of casualties.
- Engineering Service
- provides hand held 2-way radios, emergency
electrical power, repairs, and maintains
operational level of fuel, tools and spare parts. - Materials Management
- provides supplies/equipment.
- Patient Care Staff
- prepares for alternate patient care sites and
duties. - Police and Security Service
- provides traffic control.
30EMERGENCY PREPAREDNESS
- When the emergency or disaster is over
- Personnel will be notified via the Fan Out/Call
Back systems and via overhead pages.
31Violence in the Workplace Prevention
Appropriate Response
- Julian Libet, Ph.D.
- Chairman, VBPC
- Associate Manager, Mental Health Service
32Violence What Do We Mean?
- Physical violence against patients, staff,
students, visitors, or VA property - Credible threats of harm against patients, staff,
students, visitors, or VA property - Repeated disruptive or larcenous behavior that
undermines safe and quality patient care - The RHJ VA Medical Center has a 0 tolerance for
this kind of behavior
33Violence What To Do - 1?
- Report the Incident of Disruptive Behavior to
prevent its recurrence - If an emergency
- Call x7911
- If not an emergency
- Call the VA Police Service x7251 or x7354
- Tell us
- What, where, when it happened
- Names SSNs of involved parties
- Whether anyone was injured or traumatized
- Document the incident in CPRS using the PN
Template - Disruptive Behavior Incident
34Violence What To Do - 2?
- Position yourself for an avenue of escape
- Remain quiet, centered, unruffled!, but show
concern about for the patient - If possible, describe the disruptive behavior to
the patient request that it cease - If possible, inform the patient of the potential
consequences of the disruptive behavior - If necessary, excuse yourself, call the VA Police
either discontinue the visit or request the
Police to stand by
35Violence What Not To Do?
- Do Not
- Invade the patients personal space
- Become louder, faster, co-escalate, challenge,
make demands, or use You messages - Take it personally
- Acting out is a response to the provocation, your
own sensitive buttons, your feelings of anger,
outrage, or an inclination to twist the Golden
Rule
36Violence What We Will Do- 1
- The VA Police will issue a warning to the patient
either verbally, face-to-face, or via certified
letter refer to the Violent Behavior Prevention
Committee (VBPC) if indicated - The VBPC will
- Conduct a thorough violent behavior threat
assessment - Direct fact-finding from meeting with providers
- Delineation of operative static and dynamic risk
factors
37Violence What We Will Do- 2
- The VBPC may
- Place a Category 1 National Behavioral Flag in
CPRS indicating - Status of the patient (including notification of
the VA Police for scheduled visits) - Triggers or sensitive buttons for the patient
- Recommended actions / precautions on patient
visits - Currently we have about 75 patients flagged at
the Charleston VAMC (25 generated locally)
38Violence What We Will Do- 3
- The VBPC may
- Draft and co-present an individualized
Behavioral Health Care Agreement with clear
expectations (and consequences) with due
process rights incorporated - All BHCAs will be placed in CPRS under an
identical PN Title - Recommend (as a last resort) to the Medical
Center Director the total barring of the patient
from the Medical Center for not less than 1 year - Currently we have 10 patients barred from the
Charleston VA Medical Center allied CBOCs
39Violence What To Do for Prevention
- Listen to the patient. Be attentive to the
patients needs and satisfaction early relieve
(at least empathize with) patients frustrations - Set clear boundaries and mutual roles
responsibilities early - Make your expectations match the attention span,
ability, motivation level of the patient and ?
for understanding - Sometimes insufficiently managed clinical issues
such as - Narcotics Abuse
- Non-adherence to the Treatment Plan
- Access Issues
- lead to escalation set limits or Heath Care
Agreements (contracts) early
40Questions / Concerns Down the Road
- Contact
- Julian Libet, Ph.D.
- Chairman, VBPC
- x7133 or Pager 220-6994
- Roger Summerlin
- Chief of VA Police
- x7251, x7373, 7354
41 Infection Control Program
- The Infection Control Program is a Center wide
discipline that develops effective measures to
prevent, identify and control infections acquired
in the Medical Center or brought into the Medical
Center from the community.
42 Infection Control Policies/Procedures
- Blood Borne Pathogens Exposure Control Plan
- Isolation Precautions
- Tuberculosis Control Guideline
- Hand Hygiene, just to name a few
- All these policies/guidelines follow the
Occupational Safety and Health Administration
(OSHA) and Center for Disease Control and
Prevention(CDC) mandates that were implemented to
help protect and prevent health care workers and
patients from acquiring infections.
43Who do you call when you have questions about
Infection Control?
- Infection Control Practitioner
- Marietta Hill, RN,BSN,CIC
- Ext. 7469
44What is the single most important means to
prevent the spread of infection?
- Good Hand Hygiene Practices
45When should I wash my hands?
- Before and after patient contact
- After contact with any infectious or potentially
infectious material - After removing gloves or before
- putting on a new pair
- After using the restroom
- Before and after eating
46Hand Hygiene
- Options
- Regular soap and Water
- Antimicrobial hand soap and water
- Alcohol hand gels
- Lotions
47Blood Borne Pathogens
- HIV
- Hepatitis B
- Hepatitis C
- These are the top three of most concern for
healthcare workers - Every direct healthcare worker should be
vaccinated against Hepatitis B!
48If You have possible HIV exposure
- Wash exposed site with water and soap (If eye,
flush with water only) - In this order of preference contact
- Employee Health
- Emergency Department
- Infection Control Physician on call
- Tests for HIV will most likely occur immediately
and 3, 6, and 12 months after exposure.
49Source of exposure
- You dont know if the source of the exposure is
HIV positive. - Testing can ONLY be conducted with the patients
consent. - You may possibly receive antiviral prophylaxis,
depending on the nature of the exposure.
50Your patient receives a positive test result
- Report your patient to infection control. They
will handle the report to DHEC. - If any information is needed from you for the
DHEC report, Infection control will contact you.
51What are Standard Precautions?
- Taking precautions with everyone and treating
each person as potentially infected. Using
barriers i.e., gowns, gloves, mask, face shield
or goggles to reduce the spread of infection. - These things are called
- PPE (Personal Protection Equipment)
52 Standard Precautions
- Treat every person as potentially infectious
- Use thorough hand-washing (best defense) to
prevent the spread of infection - Wear gloves other protective equipment
- Never recap needles! Use Safety devices
- Report any exposures immediately to your
immediate supervisor
53Isolation Precautions
- Lets talk about Precautions taken in addition to
standard Precautions called - Transmission-based Precautions
- CONTACT
- DROPLET
- AIRBORNE
54Contact Isolation
- Used for patients that are infected with
antibiotic resistant organisms such as
(Methicillin Resistant Staph, Aureus (MRSA),
Vancomycin Resistant Enterococi (VRE), or C.
difficile that can be transmitted by direct
contact, or by indirect contact with the surface
of patient care items in the environment. Used in
addition to standard precautions.
55 Isolation
- Contact Precautions
- Private room, if possible
- Cohorting might be necessary
- Gloves Gowns
- Wash hands
- Limit the use of non-critical patient care
equipment to single patient - Clean/Disinfect common equipment used between
patients
56Droplet Isolation
- Used for patients with known or suspected agents
transmitted by large droplet method (gt5microns).
Indications Influenza, meningitis, Meningococcal
pneumonia, and resistant Streptococcus pneumonia
disease. Used in addition to Standard
Precautions.
57Isolation
- Droplet Precautions
- Private room
- Wear surgical mask within 3 feet of patient or
when entering room - Patient transport
- Limit movement of patients to essential purposes
- Place surgical MASK on patient if transport is
necessary - Always notify all staff involved in a a transfer
of the precautions
58Airborne Isolation
- Used for patients with suspected or diagnosed
conditions that are transmitted by the airborne
route such as pulmonary tuberculosis or
meningococcal meningitis.
59Symptoms of TB
- Cough
- Weakness
- Fatigue
- Unexplained weight loss
- Hemoptysis
- Night sweats
- Mention ppd
- (Everyone does have a current PPD, right?)
60Biohazard Waste
61Where Does All The Garbage Go?
-
- Sharps Needles, lancets, surgical staples,
rods, pins, intravenous catheters, protected
sharps, syringes with attached needles, scalpels,
scissors, guide wires, etc - Sharps Container Must be emptied when ¾ full.
They become a danger when overfilled.
62Isolation Room Waste
- Isolation status does not affect Red Bag Waste
Guidelines Regular trash from an isolation room
is still regular trash. - Trash Can
- Liquid Human Waste from reusable containers like
urine, feces, sputum, blood etc. - Toilet
- (Use splash precautions)
63Questions to check out be familiar with
- What kinds of precautions do you practice on your
units? - How is biohazardous waste handled?
- Where is Personal Protective Equipment (PPE)
kept? Do you have everything you need? - How is equipment cleaned
- (I.e., wheelchairs, laryngoscope blades, etc)?
64Questions to look up be familiar with
- How do you give and receive feedback from the
infection control practitioner? - How do you know if items are clean or dirty?
- What actions have you taken to reduce risks for
and/or prevent nosocomial (hospital acquired)
infections?
65 Patient Safety Goal number seven (7) is very
important for infection control
- 7. Reduce the risk of health care acquired
infections - (Nosocomial Infections-Hospital Acquired
Infections) - Number one wayGood Hand Hygiene
PracticesWASH,WASH, and WASH AGAIN!
66 Infection Control Resources
- Infection Control Practitioner
- Marietta Hill,RN,BSN,CIC
- ext. 7469, Pager 383
- Medical Center Epidemiologist
- Preston Church, MD
- ext. 7714, Pager 14342
-
-
67HAZARDOUS MATERIALS
- Substance that may cause physical or health
related problems - Labels are the safe way to identify hazardous
materials - Signs and symbols warning you about hazardous
substances
68HAZARDOUS MATERIALS
- Health hazards
- Labeled as carcinogen, toxic, highly toxic,
corrosive or irritant - Examples include
- mercury in thermometers
- lead in paints
- formaldehyde used in bio-labs
- xylene solvents.
- Physical hazards
- Labeled as corrosive, organic peroxide or
oxidizer - Examples include
- isopropyl alcohol
- flammable acetone
- combustible oxygen.
69HAZARDOUS MATERIALS
- Affects
- Acute or Chronic
- Minor
- Rashes/Coughs
- Serious
- Poisoning
- Birth Defects
- Life Threatening
- Anaphylaxis
70HAZARDOUS MATERIALSExamples
- Substances
- Markers/Correcting Fluids
- Paints and Adhesives
- Mercury
- Cleaners/Solvents
- Waste Products
- Flammable/Compressed Gases
- Radioactive Materials
- Chemotherapy Agents
- Location
- Offices
- Engineering
- Food Service
- Housekeeping
- Central Supply
- Lab/Pathology
- OR
- Pharmacy
- Nuclear Medicine
71HAZARDOUS MATERIALS
- Exposure what to do?
- Each area of the hospital is required to have
Material Safety Data Sheets (MSDS) for each
hazardous material it uses, provided by the
company that ships the material. - If exposed, follow the steps on the MSDS
- Use personal protective equipment
- Dont eat, drink or smoke in any hazardous
materials work area - Wash your hands after working with these
substances, even if wearing gloves.
72Latex Allergies
- Reaction to proteins which coat natural rubber
latex - Increased risk to those who have frequent
exposure to latex materials - Examples
- medical gloves
- cuffed enema/enterolysis catheters
- wound drains
- anesthesia masks
- electrode pads
- crutch pads
- bandages
- wheelchair tires
- drug vial stoppers
73Latex AllergiesReactions
- Symptoms can be minor, severe or life threatening
- Examples
- hives or rash on the skin exposed to the latex
- itchy, watery or swollen eyes
- runny nose and sneezing
- asthma symptoms and respiratory distress
- swelling of areas exposed to the latex
74Latex AllergiesReactions
- What to do?...... If you are sensitive to latex
- avoid natural latex products, this facility can
provide you with non-latex gloves. Please
request - Clearly identify yourself to other staff as being
latex sensitive - Be prepared for extreme reactions by carrying
injectable epinephrine.
75PATIENT SAFETY OVERVIEW
- The goal of the Patient Safety Improvement
Program is to create a Culture of Safety and
awareness of patient safety issues for all VA
Employees, Patients and their Families . - We cant solve problems by using the same kind
of thinking we used to create them - ALBERT EINSTEIN
762007 PATIENT SAFETY GOALS
NEW
-
- Goal 1- Improve the accuracy of patient
identification. - Goal 2- Improve the effectiveness of
communication among caregivers. - Goal 3- Improve the safety of using medications
- Goal 7- Reduce the risk of health
care-associated infections - Goal 8- Accurately and completely reconcile
medications across the continuum of care. - Goal 9- Reduce the risk of patient harm
resulting from falls. - Goal 13- Encourage patients active involvement
in their own care as a patient safety
strategy. - Goal 15- The organization identifies safety risks
inherent in its patient population. - See Hand Out for 2007Goals
772007 PATIENT SAFETY GOALS
OVERVIEW
-
- Goal 1-Improve the accuracy of patient
identification. - Goal 2- Improve the effectiveness of
communication
among caregivers. - Goal 8-Accurately and completely reconcile
medications across the continuum of care.
782007 PATIENT SAFETY GOALS
- Goal 1
- Improve the accuracy of patient identification
79PATIENT IDENTIFICATION
- Must use 2 patient identifiers (full name full
Social Security number) whenever you - Give meds (BCMA scanning counts) or blood
- Draw blood
- Obtain other specimens
- Provide treatments/ procedures
- Example. When you draw blood, you ask the
patient to state his name SS no. - (If pt. cannot speak/ is confused, check arm
band). Then you compare those 2 pieces of info
with those on the lab order. - Remember both steps.ask/ check then compare.
80PATIENT ID ( Procedures)
- TIME OUT MARKING THE SITE
- Time out is conducted prior to starting all
procedures (including bedside and clinic
procedures) to make sure you have the correct
patient, correct site and correct side is marked - Surgical sites-all surgical sites must be marked
(Limited exceptions ) - Bedside procedures-sites must be marked unless
you are never leaving the bedside prior to the
procedure
81PATIENT ID ( Procedures)
Example of a Template to Document these ELEMENTS
822007 PATIENT SAFETY GOALS
- Goal 2
- Improve the effectiveness of communication among
caregivers.
83Standardize the way we hand off communication
to the next caregiver.
STANDARIZED COMMUNICATION
- All patient care hand-offs are guided by the
acronym, P-A-S-S and will include the following
minimal information, as appropriate - P Patient (Name and identifiers, such as age,
sex, location) - A Assessment (i.e. diagnosis, pertinent vital
signs, mental status, DNR status, recent
procedure, current clinical status) - S - Safety (i.e. isolation, fall/ elopement risk,
restraints, critical lab values) - S - Special needs (i.e. equipment, oxygen, needed
follow-up or action items for next episode of
care). - When you hand-off.remember to P-A-S-S!
- (e.g. nursing shift changes, report to
covering MDs, lunch breaks)
842007 PATIENT SAFETY GOALS
- Goal 8
- Accurately and completely reconcile medications
across the continuum of care.
85MEDication RECONciliation
- Must get a complete, accurate list of the
patients current (e.g. HOME) medications
including any OTC/ herbals meds. - WHEN ?
- upon admission to the hospital
- in the outpatient clinics, Urgent Care, and in
most cases before an O/P procedure, if
medications are going to be given or changed. - Documenting the accurate list is the MD/
providers responsibility.
86MEDication RECONciliation
EXAMPLE
- Active Op Meds W/Sig
- Medicine/Supplies
Qty Last Filled - --------------------------------------------------
------------------------ - 1) CLOTRIMAZOLE 1 TOP CREAM APPLY THIN
FILM 15 AUG 01, 2005 - TOPICALLY TWICE A DAY FOR FUNGAL INFECTION
- 2) LORAZEPAM 1MG TAB TAKE ONE-HALF TABLET BY
MOUTH 60 JUN 24, 2006 - EVERY MORNING AND TAKE ONE-HALF TABLET
- 3) BENZTROPINE MESYLATE 1MG TAB TAKE ONE TABLET
BY 60 JUL 01, 2006 - MOUTH TWICE A DAY FOR AKATHISIA
- 4) QUETIAPINE FUMARATE 200MG TAB TAKE THREE
AND 105 JUN 24, 2006 - ONE-HALF TABLETS BY MOUTH AT BEDTIME MAY CAUSE
- 5) RISPERIDONE 4MG TAB TAKE ONE-HALF TABLET BY
MOUTH 15 JUN 14, 2006 - AT BEDTIME FOR MOOD
- 6) SERTRALINE HCL 100MG TAB TAKE ONE TABLET BY
MOUTH 30 JUL 01, 2006 - EVERY DAY TAKE AT THE SAME TIME EACH DAY.FOR
- The following corrections are made to the above
active medication list - Meds/OTCs patient is taking that are not
on the above list -
87MEDication RECONciliation
STEP 2
- The pharmacist will compare the current list of
meds with - Meds ordered on admission
- Meds ordered on transfer to another unit
- Meds ordered at discharge
- to make sure there are no duplications,
interactions, omissions, incorrect doses ordered.
88MEDication RECONciliation
Additional Info
- When the patient transfers to another setting, or
is discharged, the accurate list of medications
is communicated to the next provider of care. - The patient is also given a list of the
medications. - At hospital discharge, this is done via the
Discharge Instructions
89PATIENT SAFETY REPORTING
- Report any and all Adverse Events/Close
Calls/Near Misses/Sentinel Events or other
Patient Safety Concerns using one of the
following the following - Patient Safety Hotline _at_ 6331
- Patient Safety Manager _at_ 7220
- Risk Manager _at_ 7717
90PATIENT SAFETY REPORTING
- We Value Your Concerns and Need Your Help to
Improve Safety
91Blood Transfusions
- MD Consent required
- Screens
- Crossmatch
- Blood By Products (FFP, Plasma, Platelets, Cryo)
- COS may authorize in situations where patient or
surrogate can not sign - MD Order required (CPRS Clinician Menu)
- Premedication if desired
- Number of Units
- Crossmatch
- Screening
- Transfusion
92Blood Transfusions
- Emergent Situations
- Requires COS Approval
- MD requestor initiates statement to release
uncrossmatched blood - O negative or 0 positive until crossmatch is
available - Blood Procedures (Lab Nursing)
- T-Drive
- Hemolytic Transfusion Reaction CPM T-Drive (LAB)
- Infusion stopped
- Notify Blood Bank
- Return Blood, Tubing
- 2 Large Red tubes
- 2 Large Lavender
- MD Completes Report on Transfusion Reaction
Investigation
93Pharmacy Formulary
- Sharon Castle, Pharm D. BCPS
- Chief, Pharmacy Service
- Please review the computerized patient record
system (CPRS) training - Training is available at www.charleston.va.gov or
educations service has a CD available for
checkout
94On AdmissionOrder Meds Patient Is Currently
Taking
Date last filled
95Medication Order Dialogs Transmit to Pharmacy
Service
Text Orders remain in Notes
96The ExceptionC-II Outpatient Rxs
- Written Rx on Prescription Form 10-2577d
- a CPRS Order Entry
- Rx cannot be dispensed until written Rx
received in Pharmacy Service.
97Inpatient OrdersFirst Dose Now Check Box
Expected First Dose
Give Additional Dose Now Check Box
98Medication Quick Orders Menus
Standard defaulted information.
99Quick OrdersConvenient, but review before
signing.
- Does the order state everything correctly?
- -Dose/Frequency/Indication
- Change if not correct/complete.
- -Discontinues the old order at the same time it
enters a new order.
100Indication for all Medication Orders
101CPRS Consults Tab Non-Formulary Drug Request Menu
102Routed to Responsible Service
103Routed to Responsible Service
104Medication Reconciliation onHospital Discharge
105VISTA Imaging
- VISTA Imaging is an extension of the VA
Computerized Patient Record System (CPRS) that
allows the user to view medical images through
CPRS. - All Providers, Nurses, Residents and Students
have access to VISTA Imaging from the CPRS tool
bar.
106Introduction to Nursing Service Mary Fraggos,
RN, MS, CNAA, CNOR
- Inpatient units include Medical, Surgical, Mental
Health, Nursing Home Care Unit, Medical and
Surgical Intensive Care Units and Urgent Care. - 117 authorized beds operating 96 beds and a 28
bed nursing home care unit - Annual services consist of 4300 inpatient stays
107Some People to Know
- Charleston VAMC
- Director and Associate Directors
108John Barilich Director
Mary Fraggos, RN, MS, CNAA Associate Director for
Nursing and Patient Care Services
Johnetta McKinley Associate Director
Dr. Florence Hutchison Chief of Staff
109Charleston VAMC
110SERVICE CHIEFS
Sheila CrewActing Chief of HR Service
Michael Cortright Chief Information Technology
Jan Basile Chief of Primary Care
111SERVICE CHIEFS
Dr. Warters Chief of Anesthesia
Dr. Merrill Chief of Medicine
Avtar Singh Chief of Lab Service
112SERVICE CHIEFS
Dr. Derya TaggeChief of Surgical Service
Dr. Freedland Chief of Radiology
Dr. Tyor Chief of Neurology
113SERVICE CHIEFS
Carolyn MartelChief of Volunteer Service
Dr. Bernard Williams Chief of Dental
Charles Smoak Business Manager
114SERVICE CHIEFS
Rita Young, PhD Associate Chief of Staff for
Research
Karleen McNealChief of Geriatric Service
Hugh MyrickChief of Mental Health
115SERVICE CHIEFS
Suzanne Anderson Chief of Canteen Service
Milllie SeeseChief of Prosthetic Service
Nancy GannonChief of Nutrition and Food Service
116SERVICE CHIEFS
Tracy McFall, M.D. Chief of Phys /
Rehabilitation
Dr. Preston Church Medical Center Epidemiologist
Chief of Infection Control Service
Dr. Joseph John Associate Chief of Staff for
Education
117SERVICE CHIEFS
Kenneth Turner Chief of Facilities Management
Roger SummerlinChief of Police
Lorenzo Moses Chaplain
118Customer Service
- VHA has both external and internal "customers."
- The primary customers in VHA are considered the
veterans who use our services and by extension,
their families. - Charleston CBOCs
- Goose Creek (GCPCC)
- Beaufort (BPCC)
- Savannah (SPCC)
- Myrtle Beach (MBPCC)
119Customer ServicePatients Rights/Responsibilities
- Staff Courtesy. We will treat you with courtesy
and dignity. - Timeliness. We will provide you with timely
access to health care. - One Provider. One health care team will be in
charge of your care. - Decisions. We will involve you in decisions
about your care. - Physical Comfort. We will strive to meet your
physical comfort needs.
120Customer Service Patients Rights/Responsibilitie
s
- Emotional Needs. We will provide support to meet
your emotional needs. - Coordination of Care. We will take
responsibility for coordinating your care. - Patient Education. We will try to provide
information and education about your health care
that you will understand. - Family Involvement. We will provide the
opportunity to involve your family in your care
when appropriate. - Transition. We will provide smooth transition
between your inpatient and outpatient care.
121Ethics and Patient Abuse
- Ethics Review Committee provides
- An avenue for patient care concerns
- Ethical guidance and review of issues that may
arise in the course of caring for the patient - The patient, family, representative, or
medical/health care staff can request a referral - Referrals can be directed to any member of the
committee or to the chairman - Julian Libet, Ph.D. (extension 7133)
122Patient Abuse/Neglect/Exploitation
- If any abuse, neglect, or exploitation of a
patient is suspected, the attending physician
must be notified immediately. - Please refer to CPM 11-06, Adult/Child Victims
of Alleged Abuse, for criteria for identifying
abuse and for reporting procedures.
123Unique Health Risks
- WWII\Korea
- Cold Injury
- Nuclear Weapons Exposure
- Chemical Warfare Agents
- Cold War
- Nuclear Testing
- Vietnam
- Agent Orange Exposure
- Hepatitis C
124Unique Health Risks
- Gulf Wars
- Exposure to Smoke
- Leishmaniasis
- Parasitic Protozoan Skin Disease
- Immunizations
- Chemical or Biological Agents
- Depleted Uranium (DU)
125Unique Health Risks
- Operation Iraqi Freedom/Operation Enduring
Freedom (OIF/OEF) - Combined penetrating, blunt trauma
- Burn or Blast Injury
- Traumatic Brain/Spinal Cord Injury
- Mental Health Issues
- Vision Loss
- Traumatic Amputation
- Chemical or Biological Agents
- Depleted Uranium (DU)
126EEO
- Equal opportunity in employment to all qualified
persons - Based upon merit and fitness
- Regardless of race, color, religion, sex
(including sexual harassment), age, national
origin, physical or mental disability, reprisal
for participation in past EEO complaint activity,
sexual orientation and status as a parent in
federally conducted and training programs. - No benefit will be denied based on discriminatory
practices.
127Medical Error Disclosure
- Disclosure and reporting are separate
requirements - Adverse events reporting
- Outlined in CPM 00QM-03.
- MED 1 (6331)
- Adverse event should be disclosed to the patient
unless the patient is unable to participate in
the disclosure process - Death
- Incapacitation
- Disclosure made to the patients representative
or designee
128Medical Error Disclosure
- Information communicated should come from those
involved in the adverse event - Include factual information within the medical
record - Information protected
- Privacy Act, Health Insurance Portability and
Accountability Act (HIPPA), 38 U.S.C. Section
7332 - Treatment for substance abuse
- Sickle cell anemia
- HIV)
- Section 5705 No Disclosure
- Information obtained from RCA or peer reviews
- Questions call
- Chief, Health Information Management Service
- Medical Centers Privacy Officer
- Daphne Simons, Privacy Officer 7833
129The Five Rs of Apology
- Recognition
- Keep tabs on how you recognize situations
- Regret
- Id like you to know how very sorry I am
- Responsibility
- I am responsible for your care and this
regrettable outcome. - Remedy
- Two components, educational and financial
- Remain Engaged
130Educational Remedy
- Three Major Questions Patients Want Answered
- What is being done to correct the problem that I
now have? - How will this affect my health in the short and
long term? - Am I going to be responsible for the cost of this
error or complication?
131Ethics Gifts
- Gifts are restricted by value
- Value of no more than 20 per occurrence
- Not to exceed 50 in aggregate value over a given
12 month consecutive period of time from any one
source.
132Compliance and Business Integrity (CBI)
- Veterans Health Administration mandates business
operations and health information practices
comply with applicable standards and ethics
regulations - Achieve the highest levels integrity and are
spontaneously audited (IG) - Requires programs exist at all levels of the
organization -
133Dress Code
- Appropriate Dress
- Clean
- Tidy
- Professional
- Inappropriate
- Sheer or see-through
- Dresses or skirts over 3 above the knee
- Clothing with offensive language or slogans
- Jeans, jogging\sweat suits, warm-ups or underwear
worn as outerwear
134Dress Code
- Employee ID Badges
- Visible
- Worn midway between the waist and shoulder at
all times while on duty. - Free of pins or other piercing items that
obstruct view or may cause damage
135My HealtheVet
- The gateway to veteran health benefits and
services. - Provides access to
- Trusted health information
- Links to Federal and VA Benefits and resources
- Personal Health Journal
- Online VA prescription refill
- WWW.myhealth.va.gov
136VA Library
- Located in Room CC212
- Resources below located
- Charleston VA Web Page
- Select the Library and Clinical References
- Micromedix
- E-Facts online
- PubMed
- Lippincott Healthcare Reference
- Ebsco Comprehensive Hospital Library
- New England Journal of Medicine
137Education Service Contact Info
Phone (843) 789-7238 FAX (843)
789-6112 Joseph F John, Jr., M.D. ACOS/E Brenda
Flannigan-Tyson, RN MSN ANE/E Janice Skipper, RN
MSN Clinical Educator Barbara Knepshield, RN PhD
Clinical Educator Bryan Williams, Affiliation
Coordinator William Kuhn, Education Program
Assistant
138CONGRATULATIONS!!!
- Youve finished Orientation
139RHJ VA MEDICAL CENTERTRAINEE HOSPITAL
ORIENTATION
- Please Print and Sign this page only.
- Statement
- I acknowledge that I have read the RHJ Hospital
Orientation and completely understand the
content. ______________________________ - SIGNATURE OF EMPLOYEE DATE
140THANK YOU for completing AY 08-09 Orientation
- Please complete your test (located in the
checklist), VA Privacy (HIPPA) and Cyber training
and print certificates of training. These items
along with your required forms can be turned into
your service coordinator or VAMC Education
Service. - If you need processing forms or training web
addresses you may access at www_at_charleston.va.gov
You will need to come in hand with the above
items along with photo copies of your BLS if
applicable ACLS and 2 forms of Picture ID. If
you have any questions please contact the VAMC
Education Service at 789-7238.