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Title: Mandatory Education and Training MEAT


1
Mandatory Education and TrainingMEAT
  • 2009

2
Tuberculosis (TB)
  • TB is caused by a tiny germ (mycobacterium
    tuberculosis) that is spread through the air when
    people with active disease cough, sneeze, sing or
    laugh. Nearby people may inhale these germs and
    become infected. Clothing, bedding or other
    personal items that a person may touch do not
    spread TB. Common symptoms of TB are
  • Cough that last for more than 3 weeks
  • Coughing up blood
  • Fever
  • Night sweats
  • Unexplained weight loss
  • Chest x-ray showing evidence of TB in lungs.

3
Question 1
  • TB is spread through the air when someone with
    active TB disease coughs, sneezes, sings or
    laughs.
  • A. True
  • B. False

4
TB Airborne Precautions
  • When an inpatient is suspected of having TB
  • They are placed in Airborne Precautions in a
    negative pressure isolation room with the door
    kept closed.
  • Air in room is exhausted to outside and not mixed
    with air in the hospital.
  • In ambulatory care settings, patients should be
    isolated from other patients.
  • All patients should be instructed to cover their
    mouth with a tissue when they cough or sneeze.
  • Patients should not leave their room unless it is
    medically necessary and if this is the case, they
    must wear a surgical mask.
  • Staff must put on a N95 respirator (formally
    called HEPA respirator) before entering a TB
    isolation room.
  • You should be fit tested yearly for N95
    respirator to insure proper fit.

5
Question 2
  • When a patient is suspected of having TB, they
    should be instructed to covering their nose and
    mouth when sneezing or coughing.
  • A. True
  • B. False

6
Question 3
  • You need to wear a N95 respirator when caring for
    a patient in Airborne Precautions.
  • A. True
  • B. False

7
Question 4
  • You need to be fit tested every year to wear a
    N95 respirators.
  • A. True
  • B. False

8
Question 5
  • Patients should wear a surgical mask if they need
    to go outside of the negative pressure room.
  • A. True
  • B. False

9
TB Someone is Diagnosed
  • Patients diagnosed with TB are treated with
    several medications.
  • After taking TB medications for about 2 weeks,
    patients are not considered not to be infectious.
  • 3 Daily Acid Fast Bacilli (AFB) smears should be
    ordered.
  • Airborne precautions can be discontinued after
    all the ABF smears are negative.
  • The patient must take TB medications for at least
    6 months to totally clear the disease.
  • If patients dont take their medication as
    prescribed, the TB germ may become resistant.
  • TB patients are monitored by Public health to
    ensure they take their medications properly.

10
TB Skin Test
  • The Centers for Disease Control and Prevention
    (CDC) recommends that we have a yearly TB skin
    test (PPD) if we have patient contact.
  • If PPD test is positive, employee is infected
    with TB germ.
  • If no symptoms are present, the body was able to
    stop the bacteria from growing and that is called
    latent TB. Persons with latent TB cannot spread
    TB.
  • If you have a positive TB skin test, you will be
    asked if you have any signs and symptoms of TB.
  • People who have latent TB can take TB medications
    to prevent developing TB disease.

11
Corporate Compliance
  • Bay Regional Medical Center (BRMC) and local
    affiliates are committed to conducting business
    in an ethical and legal manner through the
    development of a compliance program. Education
    and training are key elements of this plan. The
    Board of Directors is committed to ensuring that
    all employees, volunteers, physicians,
    contractors and vendors (workforce members)
    associated with BRMC understand the rules that
    govern our actions and the conduct of business.
    General compliance education and training is
    conducted at new employee orientation and at
    least annually thereafter. Periodic compliance
    education will be offered to workforce members.
    Each employee must annually receive between 1-3
    hours of compliance training as outlined in his
    or her Department Compliance Plan. Attending the
    Annual MEAT Training, is part of this annual
    training requirement. Department meetings, and/or
    continuing education sessions fulfill the balance
    of the annual training requirements. Specialized
    compliance training will be provided to
    departments/individuals that work in identified
    risk areas, e.g., coding, billing, laboratory and
    finance. New employees will receive compliance
    and HIPAA training as part of their general
    orientation

12
Question 6
  • All employees are required to receive between 1-3
    hours of compliance training each year.
  • a. True
  • b. False

13
Question 7
  • Specialized training is provided employees in
    high risk areas such as
  • a. Coding
  • b. Billing
  • c. Finance
  • d. All of the above

14
Corporate Compliance
  • Department directors are responsible for ensuring
    that all employees in their department/area
    receive the required annual amount of training. A
    report is submitted annually to the Compliance
    Officer on the percent of compliance with
    orientation, annual and specialized training
    programs.
  • All employees have an obligation to actively
    participate in annual compliance training by
  • Attending staff meetings
  • Reading compliance information distributed by
    your department representative
  • Recognizing potential compliance problems in the
    course of your daily activity
  • Reporting suspected violations
  • Asking questions

15
Question 8
  • Who is responsible for ensuring all department
    employees receive the required amount of
    training?
  • a. Department Director
  • b. Compliance Representative
  • c. Department Supervisor
  • d. Compliance Officer

16
Question 9
  • How can employees actively participate in their
    compliance training?
  • a. Attend staff meetings
  • b. Read information distributed by the
    department compliance representative
  • c. Recognize potential compliance problems
  • d. All of the above

17
Corporate Compliance
  • All employees have an obligation to report
    suspected violations. Any employee can report a
    suspected compliance violation by
  • Contacting your director or supervisor
  • Contacting your department compliance
    representative
  • Contacting the compliance officer
  • Calling the Compliance Hotline (894-3945)
  • Reporting is confidential. Under no circumstances
    will any person, who in good faith reports a
    possible violation, be subject to any form of
    reprisal.
  • Mike Jamrog is BRMCs Corporate Compliance
    Officer and Privacy Officer.

18
Question 10
  • You can be subject to reprisals if you report
    possible compliance violations.
  • a. True
  • b. False

19
Hazard Communication
  • Hazardous chemicals are located in many areas of
    our facilities. As a health care employee, it is
    important that you understand your
    responsibilities when working with hazardous
    chemicals. By doing so, you are protecting our
    patients, yourself, and your fellow employees
    from potential injury.

20
MiOSHAs Hazard Communication Program
  • Often referred to as Right to Know designed to
    protect employees from exposure to hazardous
    chemicals in the workplace.
  • There are 5 main components to the hazard
    communication program
  • - employee education
  • - container labeling
  • - material safety data sheets (MSDS)
  • - inventory list
  • - personal protective equipment (PPE).

21
Question 11
  • The MSDS acronym stands for
  • A. Master Safety Data Sheet
  • B. Material Safety Data Sheet

22
Question 12
  • MiOSHAs hazard communication program is often
    referred to as Right to Know.
  • A. True
  • B. False

23
Question 13
  • There are 5 components to hazard communication
    programs employee education, container
    labeling, material safety data sheets, inventory
    list and person protective equipment.
  • A. True
  • B. False

24
Material Safety Data Sheets (MSDS)
  • Contain pertinent information on hazardous
    substance such as the chemical name, hazardous
    ingredients, precautions for safe use, required
    safety equipment for use, first aide procedures,
    and spill and disposal procedures.
  • Where applicable, MSDSs are located in every
    department.
  • A master MSDS book is kept in Risk Management
    (BRMC East, BRMC West and Bay Special Care
    Hospital).
  • MSDSs specific to your area are kept in your
    department MSDS book and are available 24 hours a
    day/7 days a week.

25
Question 14
  • MSDSs are available 24 hours a day/7 days a week
    in your department.
  • A. True
  • B. False

26
Emergency Preparedness
  • External Disaster Its one or more events that
    occur outside of the hospital and result in a
    large number of casualties coming to the
    Emergency Department. Examples include fire,
    explosion, tornado, transportation accident,
    civil disorders or chemical spills.
  • Internal Disaster Its one or more event within
    the hospital that severely reduce the ability of
    one or more essential services to function
    normally. Examples include internal fire,
    utility disruption, chemical spill or bomb threat.

27
Question 15
  • An external disaster is one or more events that
    occur outside of the hospital and result in a
    large number of casualties coming to the
    Emergency Department.
  • A. True
  • B. False

28
Question 16
  • Examples of an internal disaster would include
    internal fire, utility disruption, chemical spill
    or bomb threat.
  • A. True
  • B. False

29
BRMC Emergency Codes
  • Code Red Fire
  • Code Weather Alert Tornado/Severe Weather Watch
  • Code Weather Tornado/Severe Weather Warning
  • Code Blue Cardiac Arrest Adult
  • Code Blue Pediatric Cardiac Arrest Pediatric
  • Code Triage External Alert Potential External
    Disaster
  • Code Triage External External Disaster
  • Code Triage Internal Internal Disaster
  • Code Yellow Alert Bomb threat has been received
  • Code Yellow Suspicious item has been found
  • Code Pink Infant Abduction
  • Code Purple Pediatric Abduction
  • Code Orange Hazardous Material Response
  • Code Green Biological/Chemical Response
  • Code Silver Hostage Situation
  • Dr. Strong Additional personnel needed
  • Rapid Response Team Multi-disciplinary
    emergency team
  • Stroke Response Team Stroke patient
  • Dr. Heart Acute Myocardial Infarction
  • Condition H Family/Patient initiated Rapid
    Response
  • Code Clear All Clear

30
Your Responsibility During a Code
  • Know your role/responsibility for each code.
  • Participate in all code announcements as if they
    were real.
  • Know your departments initial response
    procedures.
  • Know your departmental evacuation plan.
  • Know the number to call in case of an emergency
    (East West Campus 2-2-2-2-2 or Off Site
    9-1-1

31
Hazard and Vulnerability Analysis (HVA)
  • BRMC is required to complete a Hazard and
    Vulnerability Analysis (HVA) each year. Based on
    our HVA, the following are the tops risks
    identified for our hospital
  • Ice Storm
  • Severe Thunderstorm
  • Blizzard
  • Fire, Internal
  • Flood, Internal

32
Question 17
  • Which one of the following risks has been
    identified as a high risk at Bay Regional Medical
    Center?
  • A. Earthquake
  • B. Hurricane
  • C. Blizzard

33
Prevention of Injuries (Lifting)
  • Keep the load close to your body
  • Keep your head, shoulders and hips in a straight
    line
  • Lift with your legs, not your back
  • Avoid twisting as you lift
  • Get assistance with lifting when needed
  • Always use lifting equipment
  • Never overfill trash/linen bags

34
Question 18
  • When you lift a patient, equipment, trash or a
    heavy object you should
  • A. Keep the load close your body
  • B. Lift with your legs, not your back
  • C. Get assistance with lifting when needed
    and/or use lifting equipment.
  • D. All of the above

35
Slips/Trips/Falls
  • Wipe spills promptly
  • Be observant of wet floors and icy parking lots
  • Wear proper footwear
  • Watch where you walk
  • Report unsafe conditions immediately, i.e.,
    spills, icy sidewalks, etc.

36
Handling of Needles and Sharps
  • Dispose of needles and sharps immediately after
    use in proper sharp containers
  • Use the safety features on sharps correctly to
    eliminate exposures to blood/body fluids
  • Do not recap needles
  • Empty sharp container when ¾ full
  • Do not discard expired medications in the sharp
    containers
  • Wear appropriate personal protective equipment
  • Use caution when placing sharps into sharp
    containers

37
Reporting of Injuries
  • If you are injured while on duty, report the
    injury immediately to your department/manager/supe
    rvisor. All injuries should be reported no
    matter how significant they may seem to you.
  • The Manager/Supervisor, Employee Health Service
    or Human Resources will authorize initial medical
    examination/treatment.
  • Document the injury by completing the employee
    section of the Employee Incident Report form as
    soon as possible or by the end of your shift.
  • Employee Incident Report forms are available
    from your Manager/Supervisor or Employee
    Occupational Health Service.

38
Question 19
  • If you are injured at work, what is the first
    thing you should do?
  • 1. Report the injury immediately to your
    Manager/Supervisor
  • 2. Keep working
  • 3. Go home

39
Reporting Bloodborne Exposures
  • If you have a percutaneous (needle), mucous
    membrane or open wound exposure to blood or body
    fluids from another person, NOTIFY YOUR
    MANAGER/SUPERVISOR IMMEDIATELY.
  • If a small puncture or laceration, milk the wound
    so it bleeds freely then wash with copious
    amounts of soap and water mucous membranes,
    rinse with copious amounts of water eye splash,
    irrigate with copious amounts of water.
  • Advise your Manager or Supervisor of source
    patients name so they can order laboratory
    testing immediately on the patient. If indicated
    by patient history, you can be counseled and
    started on prophylactic treatment.

40
Question 20
  • If you have a percutaneous (needle), mucous
    membrane or open wound exposure to blood or body
    fluids of another person, you should
  • 1. Notify your Manager/Supervisor immediately.
  • 2. Milk the wound so it bleeds freely, then wash
    with large amounts of soap and water, rinse
    mucous membranes with large amounts of water,
    irrigate eye splash with large amount of water.
  • 3. Tell your Manager or Supervisor the name of
    the patient or person you were exposed to so
    their blood can be tested for HIV and Hepatitis.
  • 4. All of the above

41
Bloodborne Pathogens
  • Health care workers could be exposed to
    bloodborne pathogens by accidental needlesticks
    and splashes. The most common bloodborne
    pathogens (BBP) are Hepatitis B Virus (HBV),
    Hepatitis C Virus (HCV) and Human
    Immunodeficiency Virus (HIV). Because BBP can
    cause serious, even fatal diseases, MIOSHA
    (Michigan Occupational Safety and Health
    Administration) has written rules and regulations
    about BBP these rules can be found in Human
    Resources, Infection Control and Employee Health
    Service offices. Along with the MIOSHA rules, Bay
    Regional Medical Center (BRMC) has written an
    Exposure Control Plan for BBP, available on the
    BRMC Intranet (Administrative policy 211).

42
Question 21
  • HIV, Hepatitis B and Hepatitis C are bloodborne
    pathogens.
  • A. True
  • B. False

43
Bloodborne Pathogens (BBP)
  • HIV causes AIDS which disables the bodys immune
    system to fight off infections. HBV and HCV
    infects the liver and may lead to fatal illnesses
    such as liver cancer. These BBP can be found in
    blood, blood products (plasma), semen, vaginal
    secretions, amniotic fluid, fluids surrounding
    the brain, spine, heart, joints, chest, abdomen
    and other fluids containing visible blood. BBP
    are transmitted by
  • needlestick injuries
  • infected body fluids that has contact with breaks
    in the skin (cut, scrapes)
  • splashes in the mouth, nose or eyes from blood or
    body fluids that are infected with BBP
  • sex
  • using dirty drug needles
  • pregnant woman can pass a BBP to her baby
  • Since healthcare workers could be exposed to a
    BBP, they must follow Standard Precautions. This
    means treating all blood and body fluids as if
    they are infected with a BBP and use safer
    practices and sharp devices to protect from
    exposures from occurring.

44
Bloodborne Pathogens (BBP)
  • Personal Protective Equipment (PPE), such as
    gloves, goggles, gowns, and masks are available
    throughout BRMC work sites. PPE should be worn
    any time contact with blood and body fluids is
    possible. PPE should be discarded after removed.
    Other important work practices are hand hygiene
    before and after removing gloves, use safe sharp
    products and devices with safety features when
    ever possible, and use protective resuscitation
    devices when providing rescue breathing. Sharps
    containers are available throughout BRMC. Place
    needles, broken glass or sharp objects into sharp
    containers. Change sharp containers when ¾ full.
    Do not recap needles. Never reach into trash
    containers to retrieve item or compress contents.
    Take special care when handling, collecting or
    transporting blood or other potentially
    infectious materials. These materials must be
    stored in leak-proof containers clearly labeled
    with red or orange biohazard labels to protect
    others from exposures.
  • To clean a blood/body fluid spill, wear gloves,
    use disposable towels and hospital disinfectant
    to wipe spills up. If you have not already
    received Hepatitis B vaccine, consider being
    vaccinated. The series of three injections is
    provided to BRMC employees with no cost.

45
Question 22
  • Gloves, disposable towels and hospital
    disinfectant are all used to clean up a blood
    spill.
  • A. True
  • B. False

46
Bloodborne Pathogens
  • If exposure to blood/body fluid occurs, wash area
    with soap and water and report the incident to
    your supervisor immediately for proper follow-up
    testing and treatment. It is important that we
    know how the incident occurred and what device
    was involved.
  • The Safe Sharp Task Force studies all sharp
    related injuries looking for trends and makes
    recommendations for safer medical devices and
    monitoring of safety devices. In addition to key
    management personnel, the task force members
    include Nursing Practice Council members,
    laboratory and other front line staff that are
    potentially exposed to injuries from sharps.

47
Question 23
  • Exposures to BBP should be reported to your
    supervisor immediately.
  • A. True
  • B. False

48
Question 24
  • BRMC has a Safe Sharps Task Force that includes
    front line staff.
  • A. True
  • B. False

49
Medical Equipment
  • Employees who utilize medical equipment at Bay
    Regional Medical Center related subsidiaries
    play a major role in assuring that medical
    equipment operates correctly and safely. They are
    normally the first to become aware that repairs
    are needed due to breakdown or improper
    operation. They are also instrumental in
    identifying potential problems i.e., exposed
    wires, broken cases, excessive noise or
    vibrations, burning smells, missing safety
    guards, etc.
  • When a piece of medical equipment is found to be
    in need of repair, it is vital that the device be
    tagged defective to prevent further use. The tag
    should include the name and phone number of the
    person reporting, and include a brief description
    of the problem. Then initiate the appropriate
    repair process with the department responsible
    for servicing the equipment.

50
Question 25
  • If you become aware that a piece of equipment is
    in need of repair, you should
  • a. Push it aside and grab another machine.
  • b. Apply defective label with appropriate
    information.
  • c. Make your own repairs with tape, etc.
  • d. Throw it into the dumpster.

51
Question 26
  • Why is it important to tag defective equipment?
  • a. It informs others not to use the equipment
  • b. It describes what needs to be repaired.
  • c. It identifies who can be contacted for more
    information
  • d. All of the above

52
Medical Equipment
  • The Safe Medical Devices Act of 1990 (SMDA) is
    a law requiring a special report if it is
    believed that a piece of equipment may have
    contributed to death, serious illness or serious
    injury of a patient. If this type of event is
    believed to have occurred, ensure the patient has
    received all possible care to minimize injuries.
    When possible, the machine should be left in its
    original condition with settings unchanged. All
    accessories and any packaging available
    (disposable and reusable) should also be saved.
    Contact Risk Management and fill out an
    Improvement Report describing the event.

53
Question 27
  • If a death, serious illness or injury occurs
    involving equipment, you should
  • a. If possible, leave machine and controls in
    original settings.
  • b. Save all accessories (both disposable and
    reusable)
  • c. Contact Risk Management
  • d. All of the above

54
Transmission-Based Precautions
  • To help prevent the spread of certain contagious
    diseases in addition to Standard Precautions,
    BRMC uses Transmission-based precautions. There
    are 3 categories, Airborne Precautions, Droplet
    Precautions and Contact Precautions. When
    patients are in any these precautions, there will
    be a colored sign on their door describing what
    the additional precautions are.

55
Airborne Precautions
  • Airborne Precautions (pink sign) is used for
    patients known or suspected to be infected with
    germs that are spread through the air. Examples
    are tuberculosis (TB), chickenpox, smallpox,
    plague and measles. Patients requiring Airborne
    Precautions will be placed in a negative pressure
    room (rooms 481, 479, 431, 429, 331, 329, 295,
    293 and 217). ED patients are placed in room C or
    G. N95 respirators should be worn by anyone
    entering the room of patients with TB or
    smallpox. Regular surgical masks should be worn
    for patients with chickenpox, plague or measles.
    Only staff who is immune to chickenpox, measles
    or smallpox should enter the room of patients
    suspected or confirmed to have that infection.
    Avoid transporting patients who are in Airborne
    Precautions. If transport is medically necessary,
    patients should wear a surgical mask. Visitors
    should wear the necessary personal protective
    equipment that staff is required to wear when
    visiting patients in Airborne Precautions.
  • These infections also require Contact Precautions

56
Question 28
  • Airborne Precautions require patients to be in a
    negative pressure room.
  • A. True
  • B. False

57
Droplet Precautions
  • Droplet Precautions (orange sign) is used for
    patients known or suspected to be infected by
    germs that travel in the air for a short distance
    (3 feet) such as influenza, bacterial meningitis,
    pertussis, SARS, strept throat, scarlet fever,
    rubella, Haemophilus influenza, and diphtheria.
    Patients in droplet precautions will be placed in
    a private room. Surgical masks should be worn for
    everyone coming within 3 feet of the patient.
    Patients in Droplet Precautions should not go
    outside of their room unless medically necessary
    and if so, they must wear a surgical mask.
    Visitors should wear the necessary personal
    protective equipment that staff is required to
    wear when visiting patients in Droplet
    Precautions.
  • this disease also requires Contact Precautions

58
Contact Precautions
  • Contact Precautions (green sign) is the most
    commonly used precaution at BRMC. Contact
    Precautions is used for patients with MRSA, VRE,
    C. difficle, scabies, lice, shingles, RSV, viral
    meningitis, patients with infectious diarrhea
    (Shigella, Norovirus, Hepatitis A, rotavirus, E.
    coli O157H7) and patients with hemorrhagic
    fevers. Patients should be placed in a private
    room or cohort with a patient who has the same
    organism. Gloves and gowns should be put on
    before entering the room. Gloves should be
    changed and hand hygiene performed after contact
    with infected body substances. If the patient has
    C. difficle, hand hygiene should be performed
    with soap and water. Avoid touching any surface
    that might be contaminated. Remove gloves and
    gown right before leaving the room. Perform hand
    hygiene after removing gloves and gown. Designate
    noncritical equipment for patients in Contact
    Precautions and leave them in the patient room.
    Clean and disinfect this equipment after the
    patient is discharged. If the patient needs to
    leave the room, remind patient to avoid touching
    surfaces or equipment. Visitors of patients in
    Contact Precautions will need to wear gloves and
    gowns if they participate in any patient care
    activities.

59
Question 29
  • If the patient has C.difficile, hands should be
    washed with soap and water.
  • A. True
  • B. False

60
Question 30
  • Contact precautions require staff to wear gloves
    and gowns prior to entering patients room.
  • A. True
  • B. False

61
Transmission-Based Precautions
  • Disposable dishes are NOT required for patients
    in any of the above precautions. No special
    requirements are needed for laundry. Cubical
    curtains do not have to be changed unless they
    are visibly soiled or if the patient had a bad
    case of head lice. No special terminal cleaning
    of the walls is required.

62
Question 31
  • Disposable dishes are not required for any
    patient in precautions.
  • A. True
  • B. False

63
Security
  • Bay Regional Medical Center related
    subsidiaries do not tolerate any verbal or
    physical aggression directed toward any employee
    intentional or unintentional. Security and/or
    Risk Management review all Security and
    Improvement Reports and staff will be encouraged
    to pursue criminal charges if applicable. If
    someone demonstrates aggressive behavior
  • BRMC East Campus - Contact Security in the event
    the behavior is directed at the employee or
    another person or property and is escalating. If
    STAT (emergency), dial 2-2-2-2-2. With the
    help of Security, assist in bringing the
    situation under control. If Security was not
    contacted to bring the situation under control,
    Security will need to be contacted to document
    same. A Dr. Strong will be called to request
    additional manpower in the event Security cannot
    control the situation.
  • West Campus - Contact police via 9-1-1
    (remember to dial 9 before dialing
    9-1-1)After the situation is resolved, contact
    Security at Ext. 43762 and report behavior
    encountered

64
Question 32
  • To contact Security in an Emergency Situation at
    the East Campus, dial
  • 1. 0
  • 2. 2-2-2-2-2
  • 3. 43762

65
Security (Lost Found)
  • Checking a patients area thoroughly before being
    discharged or transferred will help reduce the
    number of lost and found problems. Upon
    notification of a patients loss of personal
    belongings, a thorough search of the area where
    the loss occurred must be made by personnel. If
    you do not find the item, contact Security. They
    will complete the necessary lost report.
    Security will investigate and be responsible for
    determining if reimbursement is needed. Do not
    tell the patient that they will automatically be
    reimbursed. If an item is found, attempt to
    identify the owner. You will need to contact
    Security to either pick up the item or drop the
    item off in Security. Include the identity of the
    patient and location found if known. Please do
    not leave the article in the department where it
    was found.

66
Question 33
  • Checking a patients area thoroughly before
    discharge or transfer will help reduce the number
    of lost and found problems.
  • A. True
  • B. False

67
Life Safety
  • Fires that occur in the healthcare setting
    require rapid, efficient response by healthcare
    staff to limit physical damage and reduce the
    risk of injuries or fatalities. Health care
    fires present a unique challenge to responding
    staff because many of our patients are unable to
    ambulate on their own, and rely on us to rescue
    them from the fire. To help protect our
    patients, visitors and yourself, think of the
    acronym R-A-C-E if you discover a fire.

68
Life Safety
  • R rescue anyone in immediate danger or relocate
    people from harm.
  • A activate the pull station alarm and dial
    2-2-2-2-2 at Bay Regional Medical Center East
    and West Campus. If you are at one of the
    entities, dial 9-1-1 and give the exact
    location. (Remember to dial 9 before you dial
    9-1-1 if applicable)
  • C - confine or contain the fire by closing the
    doors to rooms and corridors. Employees working
    in outside buildings need to close doors on the
    way out of the building.
  • E - extinguish if fire is small, evacuate the
    danger area if needed.

69
Question 34
  • RACE is used to describe actions to take if you
    discover a fire.
  • A. True
  • B. False

70
Life Safety
  • Be sure you know the locations of all fire
    extinguishers, fire alarm pull stations, and fire
    exits in your department. If you need to use a
    fire extinguisher, think of the acronym
    P-A-S-S
  • P pull the pin
  • A aim the nozzle
  • S squeeze the handle
  • S - sweep back and forth at the base of the fire

71
Question 35
  • To use a fire extinguisher, you should
  • A. First make sure you have had your annual
    training.
  • B. Pull the pin, aim the nozzle, squeeze the
    handles and sweep back and forth at the base of
    the fire.
  • C. Only fire fighters can use extinguishers.
  • D. Roll it on the floor for 10 seconds to mix up
    the solution inside.

72
Life Safety
  • The life safety components of a building provide
    a fire safe environment of care for patients,
    visitors and staff. This includes not only the
    fire alarm systems but also how we react to a
    Code Red condition. The components of a fire
    alarm system include detectors, pull stations,
    sprinkler systems, chimes and strobes, fire
    dampers in ductwork and fire doors. During a Code
    Red drill it is important to observe the system
    components in your area for proper operation.
    Please report any problems on observation reports
    to Security.

73
Utilities
  • There are a number of critical utility systems
    present within the health system including
    electrical, heating/cooling, plumbing, boiler and
    steam, ventilation, medical gas, communication
    and transport systems. To report a utility
    outage, contact Facilities at Ext. 43755.

74
Question 36
  • To report a utility outage, Facilities management
    should be contacted at Ext. 43755.
  • A. True
  • B. False

75
Utilities
  • There are a number of different types of
    ventilation systems within the hospital and other
    health system sites depending upon the type of
    room usage. Ventilation systems bring in varying
    amounts of outdoor air, filter and condition it.
    Many areas have systems which exhaust the air
    outside without re-circulating it. These areas
    include bathrooms, isolation rooms, Lab,
    Pharmacy, Dietary and some utility room hood
    systems. Temperatures are controlled by
    thermostats throughout the building. Most
    thermostats control more than one room. For
    patient care areas, thermostat settings should be
    at 72-75 degrees. This is the comfort level of
    most patients.

76
Question 37
  • Exhaust fan systems are found in
  • A. Bathrooms
  • B. Lab, Pharmacy, Dietary hoods, and utility
    room hoods
  • C. Isolation Rooms
  • D. All of the above

77
Utilities
  • Care should be taken to avoid spreading harmful
    odors and fumes into the wrong ventilation
    system. If a new chemical is being used by a
    vendor or your department or operation, the MSDS
    should be reviewed for ventilation related
    concerns. The Facilities Management Department
    should be contacted when you have concerns over
    the warnings that are present on the MSDS.
    Ventilation system vapors can spread to other
    areas within the hospital and within other BRMC
    buildings. If a chemical spill occurs, Facilities
    Management should be notified to secure
    ventilation systems, to avoid the fumes from
    spreading to other areas.

78
Utilities
  • Another common contaminant is diesel fumes. At
    the Main Campus diesel fumes are generated at the
    old ED entrance, new ED entrance and the
    Receiving Dock. At the West Campus they usually
    originate during emergency generator operation.
    Any odors should be reported to Facilities
    Management immediately.

79
Question 38
  • Sources of diesel fume contamination at the East
    Campus include
  • A. Receiving Dock, Old ED Entrance, and new ED
    Entrance
  • B. Monitor Sugar

C. I-75
80
Ergonomics Working Safely
  • Ergonomics is the Science of fitting the task to
    the worker. Ergonomics helps reduce the
    incidence of Musculoskeletal Disorders (MSDs).
    MSDs are injuries, usually associated with
    overuse, that result in damage to the muscles,
    nerves, ligaments, joints, tendons or spinal
    discs. Some examples you may have heard of
    include carpal tunnel syndrome tendentious low
    back pain rotator cuff syndrome sciatica
    trigger finger.
  • Some common signs and symptoms of MSDs are
  • Pain
  • Stiffness
  • Numbness
  • Decreased range of motion
  • Tingling
  • Decreased grip strength
  • Burning
  • Cramping
  • Loss of muscle function

81
Question 39
  • Which of the following is not a symptom of a MSD?
  • a. Pain
  • b. Numbness
  • c. Burning
  • d. Hair loss

82
Ergonomics
  • MSDs are usually a result of overuse both at
    home and at work. You can help reduce your risk
    of developing MSDs by taking some simple steps
    to change the way you do things at home as well
    as in the workplace. Everyone is at risk for
    MSDs.
  • 1. Avoid heavy lifting and use correct body
    mechanics.
  • 2. Make sure your workstation is adjusted
    correctly for you. (Ask your supervisor if you
    are not sure)
  • 3. Take a break from sustained postures at least
    every 15 minutes
  • 4. Report symptoms early
  • 5. Always use available lifting equipment to
    reduce manual lifting and handling tasks.

83
Question 40
  • What can YOU do to reduce the risk of developing
    a MSD?
  • a. Report symptoms early
  • b. Avoid heavy lifting and use good body
    mechanics
  • c. Using lifting and handling equipment whenever
    possible.
  • d. All of the above

84
Question 41
  • What professions are at risk for MSDs?
  • a. Nurse
  • b. Therapist
  • c. Department Secretary
  • d. All the above

85
Ergonomics
  • If MSD symptoms are not reported early, lasting
    problems or even permanent disability may result.
    If you experience any of these symptoms and you
    feel them during or after performing your work
    activities, you should report to your supervisor
    or manager immediately. If they are not
    available, report to Occupational Health (Ext.
    43159).

86
Service Recovery
  • Service Recovery is the process of regaining
    customer confidence after a service failure. The
    best way to accomplish this is by following the
    H.E.A.R.T. approach. You can do this by
  • Hear Listen attentively. Most people just want
    to be heard.
  • Empathize Use statements such as I can see why
    you feel that way or I see what you mean.
  • Apologize I am sorry this happened to you.
    Do not become defensive or blame others.
  • Respond Take ownership. Try to resolve the
    issue yourself or involve others who can help.
    Assure the person that you will follow up on the
    problem quickly. If possible. Follow up with
    them.
  • Thank Thank you for sharing your concern so
    that we can continually improve our services.

87
Question 42
  • In Service Recovery, what does H.E.A.R.T. stand
    for?
  • a. Harass, engage, acknowledge, rehearse and
    trick
  • b. Help, empower, apologize, respond and thank
  • c. Heckle, explore, analyze, repair and think
  • d. Hear, empathize, apologize, respond and thank.

88
Patient Safety
  • Bay Regional Medical Centers Patient Safety Plan
    was developed by the Patient Safety Committee to
    improve patient safety and reduce risk to our
    patients. We use a coordinated and collaborative
    approach to establish mechanisms that respond to
    occurrences, provide ongoing proactive reduction
    in medication errors, and integrate safety
    priorities into all processes, functions and
    services of Bay Regional Medical Center.
  • Errors or occurrences usually occur because the
    system or process is too complicated, not because
    of personal skill. All staff, including
    physicians and volunteers are required to report
    actual or potential safety problems to their
    manager or supervisor or any member of the
    Patient Safety Committee. Problems may be
    identified as near misses, medication errors,
    adverse drug reactions, transfusion reactions,
    hazardous conditions, sentinel events or any
    other identified problem that could affect
    patient safety. The Patient Safety Committee
    will analyze the data and make recommended
    changes to the system so errors will be
    eliminated.

89
Question 43
  • Errors usually occur because of
  • a. Lack of skill on the part of the caregiver
  • b. The system is too complicated
  • c. The caregiver does not care and is a sloppy
    employee.

90
Question 44
  • Who is responsible to ensure that our patients
    are safe?
  • a. Nurses
  • b. Physicians
  • c. Environment Services Staff
  • d. All of the above

91
Patient Safety
  • Proactive Risk Assessment The Patient Safety
    Committee conducts a proactive risk assessment on
    a high-risk process every year. Failure Mode and
    Effect Analysis (FMEA) is the method used to
    evaluate this high-risk process. The 2008 risk
    assessment was Pneumonia and Influenza Vaccine.
  • Sentinel Event A sentinel event is any process
    variation that resulted or could have resulted in
    a serious adverse patient outcome including a
    patient death. A sentinel event needs to be
    reported to Risk Management immediately.

92
Question 45
  • What process does the Patient Safety Committee
    use to assess one high risk process every year?
  • a. Plan, Do, Check, Act (PDCA)
  • b. Failure Mode and Effect Analysis (FMEA)

93
Patient Safety
  • Reporting Errors What do you do if your know of
    an actual error or potential error? If it was an
    actual error, first, support the patients
    clinical condition. Second, contact the
    patients physician. Preserve any information
    related to the error and report the error to your
    manager or supervisor. If you are uncomfortable
    reporting the error to your supervisor, you may
    report the error via the Hot Line. If you
    chose to report via our Hot Line, you need to
    leave enough information so the Patient Safety
    Committee can investigate if a process needs to
    be changed.
  • Disclosure If an error occurs, and patient harm
    results, it is required that the patient be
    informed of the error and the outcome of the
    error. The physician or his or her designee is
    required to inform the patient.
  • Non-punitive Environment We encourage all staff
    to report all errors and potential errors. We do
    this so we can get the information we need to
    determine if a process needs to be altered. Bay
    Regional Medical Center has adopted a
    non-punitive policy in that if an individual
    makes an error, they will not receive discipline.

94
Patient Safety Goals
  • JCAHO National Patient Safety Goals for 2009
  • 1. Improve the accuracy of patient
    identification.
  • 2. Improve the effectiveness of communication
    among caregivers.
  • 3. Improve the safety of using medications.
  • 4. Reduce the risk of health care acquired
    infections.
  • 5. Accurately and completely reconcile
    medications across the continuum of care.
  • 6. Reduce the potential of patient harm
    resulting from falls.
  • 7. Encourage patients active involvement in
    their own care as a patient safety strategy.
  • 8. The organization identifies safety risks
    inherent in its population.
  • 9. Improve recognition and response to changes
    in a patients condition.

95
Question 46
  • How many Joint Commission National Patient Safety
    Goals exists?
  • a. 7
  • b. 8
  • c. 9

96
Age Specific Guidelines
  • Age-related stages describe key conflict or core
    problems from which after successful completion
    or mastery of one problem, the individual moves
    on to the next problem. No core problem is ever
    really completely solved. With each new
    situation the core problem demands another
    resolution and thus is the development of the
    person. How we treat each person takes into
    account the development or stage of the person we
    are treating. This assists the caregiver in
    providing treatment that is age appropriate.
    Each age group also has specific risks one should
    be aware of.
  • Newborn Birth to discharge from the hospital.

97
Age Specific Guidelines
  • Infants any child up to 1 year. The infant is
    in the Trust vs. Mistrust stage. Mistrust
    evolves from inconsistent care and unmet needs.
    Infants are totally dependent on daily care. They
    need their basic needs met. These include
    sleeping, feeding, sucking, bathing, cleanliness,
    and affection. Infants have rapid physical
    growth.
  • Safety risks include water safety,
    childproofing, and motor vehicle injury
    prevention.
  • Toddler- 1-3 years old. Toddlers are in the
    stage of Autonomy vs. Shame Doubt. In this
    stage it is important to ensure safety by keeping
    the side rails up. Toddlers are fearful
    therefore speak in a soothing tone, cuddle an
    upset toddler, encourage parents to stay with
    toddlers and assist with care. Explain procedures
    to parents and the toddler in simple terms. Let
    the toddler touch equipment and try the procedure
    on a doll or stuffed animal. Have parents
    demonstrate procedures to show understanding.
    Remember that toddlers are afraid of strangers.
    The toddler is more fearful than the preschooler.
  • Safety risks include injury
    prevention, water safety, playground safety,
    stranger safety, motor vehicle injury prevention,
    violent behavior and firearm safety as well as
    the risk for abuse.

98
Age Specific Guidelines
  • The Preschooler 3-6 years old. Preschoolers
    are in the Initiative vs. Guilt stage. In this
    stage it is important to explain procedures and
    objects in ways that the child can understand.
    Avoid words that are scary. Reassure the child
    that the procedure is not a punishment. Show the
    child how the equipment is used by using visual
    aids. Allow the child to assist with the
    equipment. Give the child the chance to express
    feelings and ask questions through talk and play.
    The child may want a security item such as a
    blanket or doll.
  • Safety risks include same as toddler.
  • School age 6-12 years old. School age children
    are in the Industry vs. Inferiority stage. In
    this stage growth is slower until they have a
    spurt usually at puberty. Procedures and
    treatments need to be explained in advance.
    Utilize correct terminology as well as visual
    aids. Allow the school age child to help as much
    as possible. Privacy is very important to these
    children. School age children are ready to learn
    about health and safety, this includes education
    on alcohol, tobacco, and drugs. Praise positive
    behavior as it helps build their self-esteem.
    Friends are important so allow time to interact
    with their friends.
  • Safety risks include alcohol and
    substance abuse, diet and nutrition abuse, injury
    prevention, motor vehicle injury prevention,
    violent behavior and firearms safety. Also
    depression/suicide and violence and abuse.

99
Question 47
  • The School Age Child needs positive behavior
    praised to help self-esteem.
  • a. True
  • b. False

100
Question 48
  • The toddler is often more fearful than the
    preschooler.
  • a. True
  • b. False

101
Age Specific Guidelines
  • Adolescents age 13-17 years old. Adolescents
    are in the Identity vs. Role diffusion stage of
    development. They are focusing on developing an
    identity thus they have emotional swings
  • and face peer pressure. Adolescents are
    very concerned about body image and are
    self-conscious. They should have the same sex
    caregiver. Adolescents can be taught by
    utilizing correct terminology and visual aids.
    Adolescents need to be involved in their care and
    decision-making regarding their care. Teaching
    is important at this stage. Adolescents are
    ready to learn about nutrition, safety, and
    health risks such as sexually transmitted
    diseases, alcohol, and drugs.
  • Safety risks infectious
    disease prevention/STDs, alcohol/substance abuse,
    tobacco, diet/nutrition, eating disorders, injury
    prevention motor vehicle injury prevention,
    violent behavior/firearms safety, depression,
    domestic violence/abuse, parenting and sexual
    activity safety.

102
Question 49
  • The Adolescent stage has many emotional swings.
  • a. True
  • b. False

103
Age Specific Guidelines
  • Young Adults- 18-30 years. The stage this group
    is working on is Intimacy vs. Isolation. Young
    adults are very dedicated to education and
    occupation. Encourage young adults to talk about
    their feelings and concerns and how illness or
    injury may affect their plans, family, and
    finances. Young adults have strong ties. Involve
    the young adult and their family in decision
    making and education. Young adults may deny or
    mask symptoms so assess their readiness to learn.
  • Safety risks injury, family
    violence/abuse, conception counseling,
    alcohol/substance abuse, tobacco, diet nutrition,
    obesity, infectious diseases/STDs, water safety,
    motor vehicle injury prevention, violent
    behavior/firearms and depression/suicide.

104
Age Specific Guidelines
  • Middle Adults 30-64 years old. Generativy vs.
    Stagnation is the stage these adults are
    experiencing. Middle-age adults begin to
    experience physical changes, such as decreased
    endurance. Assistance with care may be
    necessary. Illness interferes with plans.
    Chronic illnesses begin to develop. Middle-age
    adults are interested in learning and are
    independent so encourage self care as much as
    possible. Teach middle age adults about healthy
    lifestyles such as stress and weight management.
    Involve the middle age adult and their close
    family in decisions about care.
  • Safety risks cancer screening,
    cholesterol, hypertension, diabetes screening,
    infectious diseases, sensory screening (ears
    eyes) family violence/abuse, water safety alcohol
    and substance abuse, conception, menopause
    management, osteoporosis diet nutrition, obesity,
    motor vehicle injury prevention, violent
    behavior/firearms, and depression/suicide.

105
Age Specific Guidelines
  • Geriatric age 65 and older. Integrity vs.
    Despair is the stage these adults are
    experiencing. Geriatrics adults begin to
    experience changes in skin, muscles, and sensory
    abilities. They are at a higher risk for
    infection. Geriatrics may have reduced attention
    spans, and may make decisions slowly as well as
    need more time to learn. Speak clearly and avoid
    background noise when talking. Use larger print
    and ensure enough light. Give information in
    short segments and repeat as needed. Do not rush!
    Encourage the patient and his/her family to take
    an active role in their care. Give geriatrics
    time to reminisce. Safety is a concern in this
    age group therefore keep areas clear to avoid
    falls.
  • Safety is a concern in this age
    group, therefore, keep areas clear to avoid
    falls. Cancer screening, cholesterol,
    hypertension, diabetes screening, infectious
    diseases, sensory screening (ears eyes) family
    violence/abuse, water safety, alcohol and
    substance abuse, conception, menopause
    management, osteoporosis diet nutrition, obesity,
    motor vehicle injury prevention, violent
    behavior/firearms, and depression/suicide.

106
Hand Hygiene
  • Hand hygiene is the 1 way to prevent infections
    yet several studies showed that healthcare
    workers are only 40 compliant with hand hygiene.
    With the use of alcohol-based hand rubs, it is
    easier to comply with hand hygiene requirements.
    Compared to soap and water hand washing,
    alcohol-based hand rubs have the following
    advantages
  • takes less time (about a fourth of the time less)
  • is more accessible than sinks
  • causes less skin irritation and dryness
  • are more effective in reducing bacteria and
    viruses on hands

107
Question 50
  • Why should you perform hand hygiene?
  • a. It is the 1 way to prevent infections
  • b. To remove germs from your hands
  • c. All the above

108
Hand Hygiene
  • When washing hands with soap and water, wet
    hands, then apply soap (one pump is all you
    need), rub hands vigorously for at least 15
    seconds, covering all surfaces of the hands,
    rinse and dry with a disposable paper towel. You
    should use the paper towel to turn off the
    faucet. Hands should be washed with soap and
    water when
  • they are visibly dirty or soiled
  • the patient you care for has diarrhea (especially
    caused by C. difficle)
  • before you eat
  • after using the restroom

109
Question 51
  • When should you wash your hands with soap and
    water?
  • a. When your hands are visibly dirty
  • b. When caring for a patient with C. Difficle
  • c. After using the restroom
  • d. All the above

110
Hand Hygiene
  • To perform hand hygiene with an alcohol-based
    hand rub, apply product to one hand (using only
    one pump) and rub hands together, covering all
    surfaces of hands and fingers, until hands are
    DRY. Hands need to be dry before touching any
    electrical or oxygen device. Hands should be
    decontaminated when
  • right before entering a patients room
  • before donning sterile gloves to insert an
    invasive device or change a dressing
  • after contact with a patients skin (when taking
    a pulse or blood pressure and when lifting a
    patient)
  • after removing gloves
  • after touching surfaces in patients room
  • when leaving a patients room
  • Also, you can not wear artificial fingernails or
    extenders and you can not have your fingernail
    tips be more than ¼ inch long. Studies have
    shown false nails as a source of infections.

111
Question 52
  • When should you perform hand hygiene with an
    alcohol-based hand rub?
  • a. After removing your gloves
  • b. Upon entering a patients room
  • c. After taking a blood pressure
  • d. All of the above

112
MRI
  • MRIs are safe machines, as long as you follow
    certain rules and dont bring metal into the
    room. EVERYONE who could potentially access the
    MRI area needs to be informed of the potential
    dangers. Every death and most severe injuries
    reported to the FDA by MRI users were due to not
    following established safety procedures and/or
    adequate screening of patients.
  • Magnetic Resonance Imaging uses a magnet up to
    30,000 times stronger than the earths magnetic
    field. The magnetic field generated by the MRI
    magnet is incredibly powerful. You cannot see
    the magnetic field, you cannot feel it, and you
    wont detect it until a MAGNETIC metal is ripped
    out of your hands. NOTE not all metals are
    magnetic. Aluminum, for instance, isnt
    magnetic. Many alloys of stainless steel are
    safe in the MRI environment, but a number of
    other stainless steel alloys are very magnetic
    and, therefore, dangerous.

113
Question 53
  • You cannot see the magnetic field, you cannot
    feel it, and you wont detect it until a MAGNETIC
    metal is ripped out of your hands.
  • a. True
  • b. False

114
MRI
  • Strong magnetic fields used by MRI scanners may
    cause injury or death. Large MAGNETIC objects
    are potentially deadly. A gurney from the floor
    could easily pin a MRI tech against the magnet.
    Even small objects (pins, earrings, paper clips,
    etc). can seriously injure patients or staff. A
    bobby pin can be accelerated to over 35 miles per
    hour before it reaches the center of the magnet.
    TAKE HOME DO NOT BRING ANY METAL INTO AN MRI
    ROOM EVER. Only MRI staff should make that
    decision.
  • Specifically, to be SAFE, anyone wanting to enter
    the magnet room should
  • Screening All personnel must be screened.
  • Absolutely No pacemakers or non-removable
    electronic devices. The magnet will make them
    malfunction.
  • Ferromagnetic Equipment Not permitted in the
    magnet room.
  • Empty pockets and remove jewelry.

115
Question 54
  • Even small objects (pins, earrings, paper clips,
    etc.) can seriously injure patients or staff.
  • a. True
  • b. False

116
Question 55
  • No pacemakers or electronic devices are allowed
    to enter the magnetic room.
  • a. True
  • b. False

117
MRI
  • Code Procedures
  • The MRI staff will activate the hospital CODE
    BLUE procedure.
  • The MRI staff will remove the patient from the
    magnet room.
  • The code response team should not enter the
    magnet room.
  • Suffocation Danger
  • The MRI magnet contains about 75 gallons of
    liquid helium. If the magnet ruptures, the
    liquid helium will turn to vapor and displace
    oxygen. If the container ruptures (as happened
    at St. Marys in 1989), the room can be flooded
    with very cold Helium vapor. Breathing the
    sub-zero vapor can freeze the lungs, cause severe
    skin frostbite, and if the staff does not
    evacuate quickly, cause asphyxiation.

118
MRI
  • If you hear the magnet ROARING or if you walk
    into the magnet area and begin talking like
    Donald Duck
  • Drop to your hands and knees
  • Waste no time
  • Crawl quickly outside
  • Take everyone in the area with you!
  • MRI has a set of potential dangers of which
    everyone must be made aware. By following these
    guidelines, we can assure the safety of staff and
    patients when in the MRI suite.

119
False Claims Act
  • The Federal False Claims Act, as amended in 1986,
    prohibits fraud and abuse of any federally funded
    contract or program, excluding income tax fraud.
    Liability is imposed on any person or entity who
  • makes a false or fraudulent claim to the federal
    government for payment to which they are not
    entitled
  • makes a false record or statement to get a false
    or fraudulent claim paid by the government
  • conspires to have a false or fraudulent claim
    paid by the government
  • withholds government property with the intent to
    defraud the government or to willfully conceal it
    from the government
  • makes or delivers a false or fraudulent receipt
    for government property
  • buys government property from someone
    unauthorized to sell the property or,
  • makes a false statement to avoid or deceive an
    obligation to pay money or property to the
    government.

120
False Claims Act
  • The Act applies to all types of government
    claims, but the top two areas where most qui tam
    cases occur are in the health care and defense
    industries. Qui tam is short for a Latin phrase
    meaning he who sues on his own behalf as well as
    for the King. The Act allows a private citizen
    who has knowledge of fraudulent activity to file
    a qui tam lawsuit on behalf of the government,
    and to share in the proceeds if the lawsuit is
    successful.
  • There are a variety of types of fraud prohibited
    by the False Claims Act. Most important to
    healthcare are Medicaid and Medicare violations.
    Any violation of Medicare laws or the Medicare
    Fraud and Abuse Statue are also violations of the
    False Claims Act. For example, inappropriate
    billing for services that were never provided,
    making misrepresentations about the type of
    services provided, or providing substandard
    medical care are all violations of the Act.

121
Question 56
  • The Federal False Claims Act allows a private
    citizen to file a qui Tam lawsuit on behalf of
    the government.
  • a. True
  • b. False

122
False Claims Act
  • The Act was also modified to add protection
    against retaliation for any person who blows the
    whistle against fraudulent activity.
    Specif
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