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Student Orientation 2010

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Title: Student Orientation 2010


1
Student Orientation 2010
ABOVE ALL ELSE, WE ARE COMMITTED TO THE CARE AND
IMPROVEMENT OF HUMAN LIFE. IN RECOGNITION OF THIS
COMMITMENT, WE STRIVE TO DELIVER HIGH QUALITY,
COST EFFECTIVE HEALTHCARE TO THE Communities WE
SERVE.
2
A TRADITION OF CARINGWe believe the following
value statements are essential and timeless
  • We recognize and affirm the unique and intrinsic
    worth of each individual.
  • We treat all those we serve with compassion
    and kindness.
  • We act with absolute honesty, integrity and
    fairness in the way we conduct our business and
    the way we live our lives.
  • We trust our colleagues as valuable members or
    our healthcare team and pledge to treat one
    another with loyalty, respect, and dignity.

3
Care Values
  • Redmond Regional Medical Center has a set of
    organizational values that express to everyone
    who enters our facility what we stand for as a
    leading health care provider.
  • These values are
  • Customer .... Always First
  • Actions .. Speak Louder Than Words
  • Respect .... The Golden Rule
  • Excellence ... Is Our Standard
  •  These values are basic elements of our strategy
    to exceed customer expectations in providing
    service to our patients and other guests.

4
Ethics and Compliance
  • Redmond and HCA have a comprehensive,
    values-based Ethics and Compliance Program, which
    is a vital part of the way we conduct ourselves.
    Because the Program rests on our Mission and
    Values, it has easily become incorporated into
    our daily activities and supports our tradition
    of caring for our patients, our communities,
    and our colleagues. We strive to deliver
    healthcare compassionately and to act with
    absolute integrity in the way we do our work and
    the way we live our lives. All work must be done
    in an ethical and legal manner. It is your
    responsibility and your obligation to follow the
    code of conduct and maintain the highest
    standards of ethics and compliance.

5
Ethics and Compliance
  • If you have questions or encounter any situation
    which you believe violates the provisions of the
    code of conduct or the corporate integrity
    agreement, you should immediately consult your
    supervisor, another member of the management
    team, the Human Resources Director (Patsy Adams
    ext 3023), the Ethics and Compliance Officer
    (Deborah Branton ext 3036), or the HCA Ethics
    Line (1-800-455-1996).
  • Each employee and volunteer is required to attend
    two hours of initial code of conduct training and
    a one hour annual refresher training session.
    Leaders and individuals in key jobs have
    additional annual education requirements.

6
Georgia False Claims Laws
  • There is a federal False Claims Act, and there
    are also Georgia laws that address fraud and
    abuse in the Georgia Medicaid program.
  • Any person or entity that knowingly submits a
    false or fraudulent claim for payment of funds is
    liable for significant penalties and fines.
  • The False Claims Act has a qui tam or
    whistleblower provision. This allows a private
    person with knowledge of a false claim to bring a
    civil action on behalf of the US Government. If
    the claim is successful, the whistleblower may be
    awarded a percentage of the funds recovered.
  • For additional information please see the Georgia
    False Claims Statutes Policy.

7
EMTALA
  • The Emergency Medical Treatment and Active Labor
    Act is commonly known as the Patient Anti-Dumping
    Statute.
  • This statute requires Medicare hospitals to
    provide emergency services to all patients,
    whether or not the patient can pay.

8
EMTALA
  • When a patient comes to the emergency department,
    the hospital must screen for a medical emergency.
  • If an emergency medical condition is found, the
    hospital must provide stabilizing treatment.
  • Patients with emergency medical conditions may
    not be transferred out of the hospital for
    economic reasons.

9
Medical Ethics End of Life Care
  • Palliative Care
  • The goal of palliative care is not to cure the
    patient. The goal is to provide comfort.
  • Understand the importance of addressing all of
    the patients comfort needs near the end of life.
    This includes psychosocial, spiritual, and
    physical needs.
  • Stay up-to-date on the legality and ethics of
    using high-dose opiates for physical pain.

10
Medical Ethics End of Life Care
  • End-of-Life Decisions
  • Patients have the right to refuse life-sustaining
    treatment.
  • Respect this right and this decision.
  • Withdrawing Life-Sustaining Treatment
  • Withdrawing and withholding life-sustaining
    treatment are ethically and legally equivalent.
    Both are ethical and legal when the patient has
    given informed consent.

11
Sexual Harassment
  • You should promptly report the incident to your
    supervisor, who will investigate the matter and
    take appropriate action, including reporting it
    to the Human Resources Department.
  • If you believe it would be inappropriate to
    discuss the matter with your supervisor, you may
    bypass your supervisor and report it directly to
    the Human Resources Department, which will
    undertake an investigation.
  • Or you may call the Ethics Line at
    1/800-455-1996. The complaint will be kept
    confidential to the maximum extent possible.

12
SERVICE EXCELLENCE
  • Redmonds Service Standards are ways for you to
    fulfill the CARE values. By practicing these,
    you will be better able to meet and exceed the
    needs of all of our customers.
  • Display a service attitude that is courteous and
    caring.
  • Anticipate the wants and needs of the people we
    serve.
  • Present a professional image.
  • Maintain a safe and clean environment
  • Use good elevator manners. 

13
SERVICE EXCELLENCE
  • Positively represent Redmond Regional Medical
    Center in the workplace and the community.
  • Listen to one another and to the people we serve,
    then respond promptly and reliably.
  • Keep the people we serve informed about their
    care and treatment.
  • Respect the privacy and confidentiality of the
    people we serve.
  • Strive to master the skills needed to do your
    best for the people we serve.
  • Utilize communication tools to assist us in
    responding to our guests.

14
What is teamwork?
  • A cooperative effort by members of a group or
    team trying to achieve a common goal
  • The concept of people working together

15
To make teamwork happen
  • Communication is a necessity
  • Must have interaction with others even when
    things arent going as planned
  • Get Feedback from other associates and managers
  • Share the responsibility

16
Skills for teamwork
  • Listening
  • Questioning
  • Respecting and supporting ideas
  • Helping
  • Sharing
  • Participation

17
Why will Teamwork work for you?
  • Increases productivity and output.
  • Boosts morale.
  • Increases customer satisfaction.
  • Actively involves everyone.

18
Benefits of Team Work
  • You have more minds working on a project
  • You can improve product quality
  • You are able to improve associate morale
  • You can improve productivity
  • You have more cross functional skills

19
HCA Mission and Values Statement
  • We trust our colleagues as valuable members of
    our healthcare team and pledge to treat one
    another with loyalty, respect and dignity.

20
What Can You Do To Prevent Sharps Injuries?
  • Be Prepared
  • Complete your Hepatitis B vaccine series and
    titer in Employee Health Services free of charge.
  • Organize your work area with appropriate sharps
    disposal containers within reach.
  • Receive training on how to use sharps safety
    devices.
  • Wear gloves if you expect to come in contact with
    blood or body fluids.

21
What Can You Do To Prevent Sharps Injuries?
  • Be Aware
  • Keep the exposed sharp in view.
  • Be aware of people around you. Stop if you feel
    rushed or distracted.
  • Focus on your task.
  • Avoid hand-passing sharps and use verbal alerts
    when moving sharps.
  • Watch for sharps in linen, beds, on the floor, or
    in waste containers.

22
What Can You Do To Prevent Sharps Injuries?
  • Follow Policies
  • Dont recap needles.
  • Never use needles with the needleless IV system.
  • Be responsible for every device you use.
  • If you identify a sharps without a safety device,
    discuss this with your supervisor and/or Employee
    Health Services.

23
What Can You Do To Prevent Sharps Injuries?
  • Dispose of Sharps with Care
  • Dont remove contaminated sharps with your hands
    unless medically required (i.e. caps off used
    needles, scalpel blades). If necessary, use a
    mechanical device or forceps.
  • Always activate safety devices immediately after
    using a sharp. Never remove safety devices.
    Keep your hands behind the needle at all times.

24
  • Disposal of Sharps With Care
  • Place all used sharps in biohazard containers,
    see policy IC-45.
  • Securely close biohazard containers when ¾ full
    and notify Environmental Services to change the
    sharps container.
  • Do Not overfill sharps containers.
  • Do Not reach by hand into containers where sharps
    are placed.

25
Additional Sharps Injury Prevention for the OR
  • Use a neutral zone when passing sharps
    instruments. Pass sharps on a tray, not directly
    to another individual. Use verbal alerts when
    moving sharps.
  • When suturing, use blunt sutures for muscle and
    fascia.
  • Stay focused on your task. Stop if you feel
    rushed or distracted.
  • Use mechanical devices such as tongs to handle
    contaminated reusable sharps. Do Not use your
    hands.

26
Prevent Bloodborne Pathogen Exposures
  • Use appropriate barriers such as gloves, eye
    protection, or gowns when contact with blood is
    expected.
  • Wash your hands with soap and warm running water
    as quickly as possible after contact with blood
    or potentially infectious materials.
  • Dont eat, drink, smoke, apply cosmetics or lip
    balm, or handle contact lenses in area with
    possible exposure to bloodborne pathogens.
  • Do not store food in refrigerators, freezers,
    cabinets, shelves, or on countertops where blood
    or other body fluids are present.

27
Bloodborne Pathogen Exposure
  • Report to Employee Health Services or the E.R.
    immediately after a Bloodborne Pathogen Exposure.
    If you go the E.R., then follow-up with Employee
    Health Services as soon as the office opens.
  • Following a bloodborne pathogen exposure, the
    risk of infection may vary with factors such as
    these
  • the pathogen involved
  • the type of exposure
  • the amount of blood involved in the exposure
  • the amount of virus in the patients blood at the
    time of exposure
  • The following factors were associated with an
    increased risk of HIV seroconversion
  • deep injury (deep puncture wound)
  • visible blood on source patient device causing
    injury
  • procedure involving needle placed in a vein or
    artery of source patient
  • endstage AIDS in source patient

28
Needle Stick/Sharps Injury What is the risk of
infection after exposure?
  • HBV
  • Healthcare personnel who have received hepatitis
    B vaccine and developed immunity to the virus are
    at virtually no risk for infection.
  • For a susceptible person, the risk from an
    exposure can range from 6 30 and depends on
    the status of the source individual.

29
Needle Stick/Sharps Injury What is the risk of
infection after exposure?
  • HCV
  • The average risk for infection after a
    needlestick exposure to HCV infected blood is
    approximately 1.8.
  • There is a small risk associated with exposure to
    the eye, mucous membranes, or nonintact skin.

30
Needle Stick/Sharps Injury What is the risk of
infection after exposure?
  • HIV
  • The average risk of infection after a needlestick
    exposure is 0.3 (or about 1 in 300).
  • The risk after exposure of the eye, nose, or
    mouth is about 0.1 (1 in 1,000).
  • The risk after exposure to nonintact skin is less
    than 0.1.

31
Needle Stick/Sharps Injury Treatment For The
Exposure
  • HBV
  • Hepatitis B vaccine for all healthcare personnel
    who have a reasonable chance of exposure to blood
    or body fluids.
  • Hepatitis B immune globulin (HBIG) alone or in
    combination with vaccine (if not previously
    vaccinated or no immunity developed after
    vaccination).

32
Needle Stick/Sharps Injury Treatment For The
Exposure
  • HCV
  • There is no vaccine against hepatitis C and no
    treatment after exposure that will prevent
    infection.
  • Following recommended control practices to
    prevent percutaneous injuries is imperative.

33
Needle Stick/Sharps Injury Treatment For The
Exposure
  • HIV
  • There is no vaccine against HIV.
  • Postexposure prophylaxis (PEP) with retroviral
    drugs is recommended for certain occupational
    exposures that pose a risk of transmission of
    HIV.
  • PEP is not recommended for exposures with low
    risk for transmission of HIV.
  • PEP should be started as soon as possible after
    exposure, preferably within 2 hours.

34
Latex Allergies
  • Latex allergies pose a serious problem for
    nurses, other health care workers, and for 1 to
    6 of the general population. Anaphylactic
    reactions to latex can be fatal. Health care
    workers exposure to latex has increased
    dramatically since universal precautions against
    blood borne pathogens were mandated in 1987.
    Latex can trigger three types of reactions
    irritant contact dermatitis, allergic contact
    dermatitis, and immediate hypersensitivity. Many
    medical devices contain latex that might trigger
    serious systemic reactions by cutaneous (skin)
    exposure, (i.e. ECG electrodes, masks, bandages,
    catheters, gloves, and tape.) There are some
    diagnostic tests to determine if a person has an
    allergy to latex. If a patient tells you they are
    allergic to latex, notify Materials Management
    and they will provide a cart with latex-free
    products. Need more information? Contact the
    Nursing House Supervisor at ext. 3037. For
    associates with latex allergies, contact
    Employee Health Services ext. 4968.

35
Ergonomic Safety
  • Ergonomic Safety is adapting the equipment,
    procedures and work areas to fit the person in
    order to help prevent injuries and improve
    efficiency. Musculoskeletal disorders (MSDs)
    affect muscles, nerves, tendons, ligaments,
    joints or spinal discs. Injuries can include
    strains, sprains, and repetitive motion
    injuries.
  • Signs and symptoms pain, tingling, numbness,
    swelling, stiffness, burning sensation, etc. May
    experience decreased gripping strength, range of
    motion, muscle function, or inability to do
    everyday tasks. Risk factors repetition,
    forceful exertions, awkward postures, contact
    stress, and vibration. Common MSDs Carpal tunnel
    syndrome, rotator cuff syndrome, trigger finger,
    tendonitis, herniated spinal disc, and back pain.

36
Ergonomic Safety
  • Apply these tips to your job Adjust chair height
    and backrest (feet should be flat on the floor,
    knees level with hips, and lower back supported).
    Sit an arm's length away from the computer
    screen. Keep wrists straight and elbows at right
    angles. Alternate tasks. Use proper body
    mechanics when lifting, transferring, etc. Avoid
    reaching and stretching overhead.
  •  You may recommend ways to reduce the chance of
    developing musculoskeletal disorders to your
    supervisor. Your work space may be evaluated for
    ergonomic safety by notifying Paula Dunwoody at
    ext. 4968. Your departmental safety
    representative may assist with body mechanic
    in-services. Report signs, symptoms, illnesses
    ,and injuries to your supervisor, complete an
    occurrence report, and obtain medical treatment
    in Employee Health Services.

37
12 Principles of Ergonomics
  • Keep everything in easy reach
  • Work at proper heights
  • Reduce excessive forces
  • Work in good postures
  • Reduce excessive repetition
  • Minimize fatigue
  • Minimize direct pressure
  • Provide adjustability and change of position
  • Provide clearance and access
  • Maintain a comfortable environment
  • Enhance clarity and understanding
  • Improve work organization

38
ErgonomicsThe Do Nots
  • Upper Extremity
  • Shoulder
  • Reaching over 90 degrees (vertical flexion)
  • External rotation of greater than 45 degrees
  • Elbow
  • Avoid static hold time of flexion
  • Lower Extremity
  • Sitting position
  • The hip, knee, and ankle should be placed at 90
    degrees
  • Body positions to avoid
  • Deep knee bends
  • Constant standing in hip and knee extension
  • Walking with feet externally rotated

39
Ergonomics
  • Self Care
  • Ice THEN heat
  • Stretch regularly
  • Use good posture
  • Exercise!!!!!
  • Work smart
  • Play smart

40
Ergonomic Tips
  • The best way to avoid the discomfort of MSDs is
  • Change body positions frequently/Set up work
    stations to fit your body/Stretch every 45
    minutes to an hour/Perform stretches that are
    designed to decrease discomfort for job specific
    tasks
  • Decrease Fatigue
  • Warm-up exercises
  • Interrupt sustained postures
  • Proper ergonomics
  • Appropriate work methods
  • Limited overtime
  • Increase Recovery
  • Physical fitness
  • Proper nutrition
  • Good sleeping postures
  • Ice after activities
  • Avoid smoking
  • Alternative job placement

41
Performance Improvement Continual Quality
Improvement
  • What is PI?
  • PI is a work philosophy that encourages every
    employee to find new and better ways of doing
    things. All accredited healthcare organizations
    are required to have an improvement program.
    Redmond is accredited by The Joint Commission.

42
Performance Improvement Continual Quality
Improvement
  • Excellent organizations make sustained and
    continuous efforts to improve their care and
    services. Healthcare, our business, is
    constantly changing what made us successful last
    year may no longer be appropriate. Even if we
    think today's solution is perfect, tomorrow will
    teach us that it wasn't perfect it was just the
    best that we could do at the time 
  • Even though a process may appear to work most of
    the time, we are challenged to look at the
    process and ask ourselves, "Is there a better way
    to do this?" or "Why are we doing this? Because
    we live in a rapidly changing environment that is
    fast-paced and stressful, change brings many
    opportunities to improve our care and services.

43
Performance Improvement Continual Quality
Improvement
  • Key Points to Remember
  • Customers come first.
  • Every employee is important.
  • Communication is essential.
  • Tasks (processes) are streamlined whenever
    possible.
  • Ongoing improvement is crucial.
  • Improvement should be maintained.

We want to improve everything we do! We owe this
to our ultimate customer the patient.
44
Performance Improvement Continual Quality
Improvement What does this mean to me?
  • Management provides support and guidance, and
    they bear ultimate responsibility, but the best
    improvement ideas come from people who work
    providing care and services for our customers.
    Continually improving ones own performance and
    their own job processes are essential for
    producing great patient outcomes. Within your
    department, you have the responsibility to think
    about your daily work life to determine if
    there are processes that can be improved. At the
    department level, the organization has determined
    that the Pillars of Excellence should be
    continually improved. There are five pillars
    Service, Quality, People, Growth, and Finance.

45
Performance Improvement Continual Quality
Improvement What does this mean to me?
  • You can make suggestions for improvement to your
    supervisor by expressing the idea and asking if
    an improvement team could be organized to work on
    the project. There is also an Improvement
    Suggestion Form in your departments PI Manual
    (or posted on your departments Communication
    Center) you can fill out the form and turn in to
    your supervisor. If the idea only relates to
    your job, your supervisor may ask you to just do
    it. You may be asked to serve on an improvement
    team or lead an improvement project you should
    accept this as an honor.

46
2010 National Patient Safety Goals for Hospitals
  • The purpose of the National Patient Safety Goals
    is to improve patient safety.
  • The Goals focus on problems in health care safety
    and how to solve them.

47
2010 National Patient Safety Goals for Hospitals
  • Improve the accuracy of patient identification
  • Use at least two ways to identify patients. For
    example, use the patients name and hospital
    account number. This is done to make sure that
    each patient gets the medicine and treatment
    meant for them.

48
2010 National Patient Safety Goals for Hospitals
  • Improve the effectiveness of communication among
    caregivers
  • Provide timely reporting of critical tests and
    critical results
  • Read back and verify spoken or phone orders to
    the person who gave the order.
  • Create a list of abbreviations and symbols that
    are not to be used.
  • Quickly get important test results to the right
    staff person.
  • Create steps for staff to follow when sending
    patients to the next caregiver. The steps should
    help staff tell about the patients care. Make
    sure there is time to ask and answer questions.

49
2010 National Patient Safety Goals for Hospitals
  • Improve the safety of using medications
  • Create a list of medicines with names that look
    alike or sound alike. Update the list every year.
  • Label all medicines that are not already labeled.
    For example, medicines in syringes, cups and
    basins.
  • Take extra care with patients who take medicines
    to thin their blood.

50
2010 National Patient Safety Goals for Hospitals
  • Reduce the risk of health care-associated
    infections
  • Use the hand cleaning guidelines from the Centers
    for Disease Control and Prevention.
  • Report death or injury to patients from
    infections that happen in hospitals.
  • Use proven guidelines to prevent infections that
    are difficult to treat, such as
    multidrug-resistant organism infections.
  • Use proven guidelines to prevent infection of the
    blood, these infections may be associated with
    central lines.
  • Use safe practices to treat the part of the body
    where surgery was done.

51
2010 National Patient Safety Goals for Hospitals
  • Accurately and completely reconcile medications
    across the continuum of care
  • Find out what medicines each patient is taking.
    Make sure that it is OK for the patient to take
    any new medicines with their current medicines.
  • Provide a list of the patients medicines to
    their next caregiver or to their regular doctor
    before the patient goes home.
  • Provide a list of the patients medicines to the
    patient and their family before they go home.
    Explain the list.
  • Some patients may get medicine in small amounts
    or for a short time. Make sure that it is OK for
    those patients to take those medicines with their
    current medicines.

52
2010 National Patient Safety Goals for Hospitals
  • Reduce the risk of patient harm resulting from
    falls
  • Find out which patients are most likely to fall.
    For example, is the patient taking any medicines
    that might make them weak, dizzy or sleepy? Take
    action to prevent falls for these patients.

53
2010 National Patient Safety Goals for Hospitals
  • Prevent health care-associated pressure ulcers
  • Initiate prevention methods to reduce occurrences
    of pressure ulcers.
  • Identify patient safety risks
  • Find out which patients are most likely to commit
    suicide.

54
2010 National Patient Safety Goals for Hospitals
  • Establish a universal protocol for preventing
    wrong site, wrong procedure, and wrong person
    surgery
  • Conduct a pre-procedure verification process.
    Create steps for staff to follow so that all
    documents needed for surgery are on hand before
    surgery starts.
  • Mark the part of the body where the surgery will
    be done. Involve the patient in doing this.
  • Conduce a time-out prior to beginning procedure.

55
Patient rights
  • We believe that most patients want to understand
    and participate in their care. Therefore, it is
    important that each patient understand his or her
    rights and responsibilities while at Redmond. It
    is also necessary as healthcare workers that we
    understand patient rights and responsibilities to
    ensure that quality care is provided.
  • How are patients informed of their rights?
  • Upon admission, each patient is given a handbook,
    which includes a list of patient rights and
    responsibilities. This patient bill of rights
    tells a patient and his or her family what they
    can expect of caregivers and what
    caregivers expect of them.

56
Patient rights
  • What is your role in patient rights?
  • Everyone is involved in protecting the rights of
    patients, not just those involved in direct
    patient care. For example, the right to
    confidentiality means not telling your friends
    and/or relatives when someone you know has been a
    patient. Also, you provide privacy for patients
    by making sure you always knock before entering a
    patients room or any room where a patient might
    be having a procedure.
  • Patients have a right to a secure environment,
    which means you should know how to respond during
    a disaster or fire in the building.Patients are
    informed of their right to establish advance
    directives.
  • Patients also have a right to file a grievance.
    You can assist with the investigation and
    response by contacting Risk Management at ext.
    3950 or Administration at ext. 4100 should you
    have a question.

57
Patient rights
  • Where can you find a list of patient rights?
  • In facility Policy RI-04 Rights and
    Responsibilities of Patients, the Patient
    Handbook , posted beside the elevator in the
    front lobby and at outpatient services and on
    Redmonds Intranet site.

58
Patient rights
  • Access the Ethics Committee and the Ethic
    Resolution Process. Phone 802-3037.
  • Access the grievance process. Express complaints
    or concerns regarding care or services, including
    discharge.  
  • Facility contact 706-802-3950
  • Independent Agency
  • Office of Regulatory Health
  • 2 Peachtree Street N.W., Suite 200
  • Atlanta, Georgia 30329
  • Telephone 1-404- 657-5726
  •  Peer Review Organizations
  • Georgia Medical Foundation Medicare
  • 57 Executive Park South, Suite 200
  • Atlanta, Georgia 30329
  • Telephones 1-800-282-2614
  • 1-404-982-0411
  •  

Humana Military Healthcare Services, Inc
Champus 931 South Semoran Blvd. Suite
218 Winter Park, Florida 32702 Telephone
1-800-658-1405  
59
Pain Management
  • Four major goals of pain management
  • Reduce the incidence and severity of patients'
    acute postoperative or posttraumatic pain.
  • Educate patients about the need to communicate
    unrelieved pain so they can receive prompt
    evaluation and effective treatment.
  • Enhance patient comfort and satisfaction.
  • Contribute to fewer postoperative complications
    and, in some cases, shorter stays after surgical
    procedures.
  • The importance of effective pain management
    increases beyond patient satisfaction when
    additional benefits for the patient are realized,
    e.g., earlier mobilization, shortened hospital
    stay, and reduced costs.

60
Sentinel events
  • A sentinel event is an event which results in
    unanticipated death or major permanent loss of
    function, not related to the natural course of
    the patients illness or underlying condition.
    Also, suicide infant abduction or discharge to
    the wrong family rape hemolytic transfusion
    reaction involving administration of blood or
    blood products having a major blood group
    incompatibility a health-care associated
    infection and surgery on the wrong patient or
    wrong body part are all sentinel events. Please
    secure all information and items related to the
    event. If you have any questions, contact Risk
    Management at ext. 3950.

61
Reportable Events
  • State (Georgia) Reportable Events
  • The following type events should be reported to
    the State of Georgia Office of Regulatory
    Services
  • 1. Any unanticipated patient death not related to
    the natural course of the patients illness or
    underlying condition
  • 2. Any surgery on the wrong patient or the wrong
    body part of the patient
  • 3. Any rape of a patient which occurs in the
    hospital.
  • Redmond Regional Medical Centers employees and
    the medical staff should report to the
    appropriate department leader and Risk Management
    at 3950or Regulatroy Compliance at 3038 in the
    event that any of the above situations occur to a
    patient at Redmond. A multidisciplinary group
    will review the situation, complete the State
    forms, and provide them to the Office of
    Regulatory Services within 24 hours of knowledge
    that the event meets one of the State
    definitions.

62
Suspected Impairment of Licensed Independent
Practitioner
  • Redmond Regional Medical Center makes every
    effort to ensure that licensed independent
    practitioners providing care to our patients are
    competent and able to carry out their patient
    care responsibilities free of any impairment(s)
    that adversely affect their judgment or clinical
    performance. A licensed independent practitioner
    (LIP) is defined as any individual permitted by
    law and the hospital to provide care, treatment,
    and services without direction or supervision.

63
Identification of an Impaired LIP
  • An impaired LIP is defined as one who is unable
    to provide care, treatment, or services with
    reasonable skill and safety to patients because
    of a physical or mental illness, including
    deterioration through the aging process or loss
    of motor skill or excessive use or abuse of drugs
    including alcohol.

64
Signs and Symptoms of Impairment
  • Signs and symptoms of potential impairment
    include, but are not limited to
  • Personality changes/mood swings
  • Loss of efficiency and reliability
  • Increasing personal and professional isolation
  • Inappropriate anger, resentments
  • Abusive language, demeaning others
  • Physical deterioration
  • Memory loss
  • Increase in tardiness, absenteeism, illness
  • Lack of empathy towards others

65
Reporting a LIP Suspected of Impairment
  • If any individual in the hospital has a
    reasonable suspicion that a LIP may be impaired
    and this impairment may adversely affect patient
    care and safety, take immediate action by
    notifying your supervisor and following the
    appropriate Chain of Command listed in policy LD
    05.

66
ADVANCED DIRECTIVES
  • Advance Directives include Living Will and
    Durable Power of Attorney (DPOA) for Health Care.
  • Living Will only applies to terminal conditions.
  • DPOA for Health Care allows a person to name an
    agent to speak on the persons behalf, when the
    person cannot speak for their self.
  • Inside the hospital, the attending physician must
    be present when the patient names an agent. An
    agent can speak for the patient concerning any
    condition.
  • Patients should be asked at the time of admission
    if they have an advance directive.
  • Patients should initial and date a copy of the
    directive(s) and the hospital staff should place
    it inside the current medical record.
  • Social Services can assist by answering general
    questions and provide blank forms.

67
Environment of care
  • EMERGENCY PREPAREDNESS CODES
  • Code RedFire RACE Rescue/Activate/Contain/Ext
    inguish
  • Code GrayBomb ThreatNotify Switchboard
  • Code BlueAdult Cardiopulmonary Arrest
  • Code Blue PEDS Pediatric Cardiopulmonary Arrest
  • Code Pink Pediatirc Abduction
  • Code White Adult Patient Elopement
  • Code YellowTraumaEmergency Room SupportDo not
    call ER
  • Code Green Hostage Situation
  • Code OrangeHazardous Material Event

68
Environment of care
  • EMERGENCY PREPAREDNESS CODES
  • Code TriageCommunity Disaster
  • Standby An event has occurred in the community
  • Activate Begin Disaster Plan
  • Stand-down Return to normal operations
  • Code 900Show of ForceAll Males Respond
  • Code 1000Visitor Needs AssistanceStay with
    person Notify switchboard

69
Environment of care
  • Tornado Warning
  • Tornado warnings will no longer be announced as a
    Code Black. Instead a more recognizable
    announcement will be made so that both staff and
    visitors will be aware of the severe weather
    potential.
  • The announcement will be, Attention, attention,
    attention. Floyd County is currently under a
    tornado warning.

70
Environment of care
  • CONTACTS
  • Extension 4000 Emergency line to Operator/PBX
  • Labor Pool LocationClassroom C (Ext. 2273)
  • Facility Privacy Officer Pam Watkins
  • Facility Information Systems Officer Brad
    Treglown
  • Quality Director Barbara Garner
  • Risk Management Kathy Shapiro
  • Facility Safety Officer Clay Callaway
  • Infection Prevention Director Terri Aaron
  • Ethics and Compliance Officer Deborah Branton
  • Service Excellence Administrator Missy Ragland

71
Emergency Preparedness
  • Designed to provide a safe environment for all
  • Drills are used to improve effectiveness
  • Resource guides and manuals are available to
    assist you
  • Dont wait for an emergency to learn what you
    should to
  • RRMC utilizes an all hazards approach

72
When you hear a code--
  • Do not call PBX!
  • They do not know what you are supposed to do
    they know what they are to do!
  • Call your supervisor or leader

73
Mass Casualty Event
  • Code Triage
  • Standby An event has occurred facility must
    decide if we can meet demands or utilize extra
    resources
  • Develop a plan with the department
  • Call your immediate family
  • Activate Initiate the disaster plan activate
    your department response
  • Stand-down Begin recovery and return to normal
    operations
  • Know your role!

74
Code Orange
  • Hazardous Material Event
  • Haz Mat Team will respond
  • If they walk in dont touch them take them
    back out the way they came in
  • Stay uphill and upwind!
  • Decon is in ED or outside
  • Dont forget your PPEs

75
Code Blue Code Blue PALS
  • Code Blue
  • Adult cardiac or respiratory event
  • Dont forget the Rapid Response Team (Call for
    the Rapid Response team when you feel a patients
    clinical status is in decline.)
  • Know how to call a code and where your supplies
    are
  • Code Blue PALS
  • Pediatric cardiac or respiratory event
  • ED Nurse will respond to assist with running the
    code

76
Code 900
  • You are in a situation in which you are
    threatened verbally or physically
  • All males respond
  • Crisis Prevention Intervention (CPI) training is
    available
  • DO NOT USE THIS CODE FOR LIFTING HELP!!

77
Code 1000
  • Visitor or family member is ill or injured
  • Stay with person and have someone call ext. 4000
    to report the incident
  • ED Nurse and House Supervisor will respond
  • Call 4911 ONLY if packaging is required

78
Tornado Warning
  • A Tornado has been reported in our area
  • Close patient doors
  • Get everyone out of halls and away from glass
  • Discourage visitors from leaving
  • Turn beds to inside walls
  • Clear area of anything that can become a
    projectile
  • Instruct family members ambulatory patients to
    go into the bathrooms and cover themselves

79
Code Green
  • Hostage situation is occurring
  • Lock down your area
  • Do not try to negotiate
  • Police should be alerted to enter in an area
    distant from the hostage situation

80
Code Grey
  • There has been a bomb threat
  • If you get it, notify the switchboard
  • Look for packages or people that should not be in
    your area
  • Only if there is a legitimate reason would we
    evacuate
  • Take direction from Incident Command or law
    enforcement
  • Leave lights alone!

81
Code Pink
  • Pediatric Abduction
  • Can be a patient or visitor
  • Patient Care Coordinator
  • Call ext. 4000
  • Give gender and age
  • Building must be locked down
  • Each department has a response
  • PBX will announce -Code Pink b or g and age
  • Try to detain but do not put yourself in harms
    way
  • Get a good description of person, vehicle, tag,
    etc.
  • Make sure unoccupied rooms and areas are checked.

82
Code White
  • Patient Elopement
  • Patient Care Coordinator
  • Call ext. 4000
  • Give gender and age and clothing description
  • Building must be locked down
  • Each department has a response
  • PBX will announce -Code White m or f and age
  • Make sure unoccupied rooms and areas are checked

83
Code Yellow - Trauma
  • Trauma patient is coming or has arrived
  • ED needs
  • Lab
  • Radiology
  • General notice for House Supervisor
  • Dont go unless you are assigned
  • Dont call the ED to find out what it is!

84
Severe Weather
  • Each leader will review staffing and supplies for
    the anticipated period.
  • It is your responsibility to get here!
  • We will provide housing
  • We can provide child care
  • If you have a special needs situation, we need to
    know before hand
  • Transportation may be provided

85
Evacuation
  • Move from unsafe to safe area
  • Ambulatory first
  • Sickest last
  • Horizontal Evacuation
  • Room to Room, Wing to Wing
  • Vertical Evacuation
  • Floor to floor
  • Full Scale
  • Triage and transport area will be established
  • Make sure you account for all patients

86
Pandemic Influenza
  • A pandemic is an infectious event that has a
    global impact (such as those in 1918, 1958
    1968)
  • The impact on society will be huge!
  • Respiratory Hygiene/Cough Etiquette
  • Learn it, live it, teach it!
  • All staff must either get an flu vaccine or wear
    a mask in designated areas while at work
  • For more information, visit www.pandemicflu.gov

87
Prepare Your Family
  • Have a plan for your family
  • Rewiew your Personal Preparedness Planning Kit
  • Make sure you have a plan for pets
  • You will be required to work
  • If you have special needs, let us know
  • Special needs adult or children and no other
    adult to care for them
  • Military obligations
  • DMAT, other volunteer organization

88
Do Not UseAbbreviations, Acronyms, and Symbols
Abbreviation Preferred Term
U Unit
IU International Unit
Q.D. Q.O.D. daily every other day
Trailing zero (X.0 mg) Lack of leading zero (.X mg) X mg 0.X mg
MS, MS04, MgSO4 morphine sulfate or magnesium sulfate
µg Mcg
T.I.W. 3 times weekly
c.c. Ml
ii, etc. (apothecary symbols) 2 or two
89
Environment of Care
  • Defective Equipment
  •  Defective equipment should be reported to
    BIOMEDICAL Services via Meditech or at Ext. 4962
    if equipment removal constitutes an emergency.
    Equipment will be tagged. Tag will say danger
    defective equipment.
  • Security Related Incidents
  • Any incident requiring Security assistance (i.e.
    theft or suspicious activity), contact security
    by dialing 0 and asking PBX to page a member of
    Security.
  • Please refer to the Environment of Care section
    of the policy manual for in-depth information on
    these topics.

90
Bio-terrorism Update
  • Healthcare facilities may be the initial site of
    recognition and response to bio-terrorism events.
    All patients in healthcare facilities, including
    symptomatic patients with suspected or confirmed
    bio-terrorism-related illnesses should be managed
    utilizing Standard Precautions. For certain
    diseases or syndromes (smallpox and pneumonic
    plague), additional precautions may be needed to
    reduce the likelihood for transmission. For more
    in-depth information on this topic, please refer
    to the
  • Bio-Terrorism Readiness Plan policy.
  • A quick reference guide is posted in the
    Emergency Department
  • For further information visit www.ready.gov

91
What is HIPAA?
  • The Health Insurance Portability and
    Accountability Act deals with patient privacy and
    security of information and systems. HIPAA was
    developed to protect health insurance
    coverage, improve access to healthcare, reduce
    fraud and abuse, and in general improve the
    quality of healthcare. The privacy section will
    govern the use and disclosure of individually
    identifiable health information and patient
    rights in regard to their protected health
    information (PHI). The security section will
    ensure that we protect confidentiality,
    availability, and integrity of individually
    identifiable information. HIPAA is a federally
    mandated law. Compliance is mandatory. The law
    has both civil and criminal penalties for
    non-compliance.

92
HIPAAs TOP TEN
  • Properly dispose of PHI (Privileged Health
    Information) in shred boxes, not trash cans.
  • Access, use or disclose only the minimum
    necessary amount of PHI to accomplish a task.
  • Take reasonable measures to prevent unauthorized
    access to PHI - conceal, turn over, or secure
    PHI that is not needed for immediate use turn
    off computer screens or use screen savers when
    you leave your work area NEVER share
    computer passwords with others.
  • Close patient doors and pull curtains when
    discussing and administering procedures.
  • Immediately report improper disclosures of PHI,
    whether accidental or otherwise, to your
    Facility Privacy Official Pam Watkins 3095.

93
HIPAAs TOP TEN
  • When PHI is discussed within the workplace, lower
    your voice or move to a private area if others
    might overhear you.
  • NEVER discuss any information relating to any
    patient outside of the workplace, including
    elevators and hallways, for any reason.
  • Respond to patient questions, concerns and
    complaints about privacy and security of their
    PHI respectfully and as quickly as possible. All
    concerns and complaints should be reported to the
    Facility Privacy Official immediately.
  • If you have any questions or are ever in doubt
    about what to do, ask your Facility Privacy
    Official.
  • But in emergencies, always put patient care ahead
    of all else even HIPAA.

94
Protecting Patient Privacy
  • All health care personnel must obtain permission
    from the patient prior to discussing any health
    care issues in front of a patients visitors.

95
Organ Donation
  • Timely referrals of potential organ donors
  • Healthcare professionals are required to identify
    and refer all deaths and imminent deaths (brain
    deaths) to the Donation Referral Line at (800)
    882-7177. Timely referrals preserve the option
    of donation for families of medically suitable
    patients.

96
INFECTION PREVENTION
  • Our goal is to identify and reduce risks of
    healthcare associated infections in patients,
    visitors, and healthcare workers.
  • Hand washing is the single most effective way to
    prevent the spread of infection. Routine hand
    washing involves a rigorous rubbing together of
    well lathered hands for 15-20 seconds followed by
    a thorough rinsing under running water. Must use
    soap and water if hands are visibly soiled.
  • Hand hygiene with an alcohol based product is
    acceptable as long as the hands are not visibly
    soiled. (Always wash hands with soap and water
    if the patient you are caring for has C.
    Difficile).
  • IC Champions monitor hand washing in our
    facility. The use of gloves does not eliminate
    the need for good hand washing.

97
Hand Hygiene
  • Wash hands at least in the following situations
  • Before donning sterile gloves when inserting a
    central intravascular catheter
  • Before inserting indwelling urinary catheters,
    peripheral vascular catheters, or other invasive
    devices that do not require a surgical procedure
  • After contact with a patients intact skin (e.g.
    when taking a pulse or blood pressure, and
    lifting a patient)
  • After contact with body fluids or excretions,
    mucous membranes, non-intact skin, and wound
    dressings
  • If moving from a contaminated body site to a
    clean body site during patient care
  • After contact with inanimate objects (including
    medical equipment) in the immediate vicinity of
    the patient
  • After removing gloves
  • Before eating and after using the restroom

98
Hand hygiene compliance
sm
  • A comprehensive hand hygiene program involving
    the patient.
  • Signs have been placed in patient rooms Its OK
    to Ask. Patients have a right to ask if you
    washed your hands before you take care of them
  • Goal for Hand Hygiene is 100

99
Artificial Nails
  • Direct patient care givers can not wear
    artificial nails. Also some departments such as
    OR, can not wear them.
  • Nail polish may be worn in most departments as
    long as it is not chipped. Check with your
    leader if you have questions about whether you
    can wear polish in your department.

100
Ways Redmond Staff Help Prevent Surgical Site
Infections
  • All healthcare workers wash hands before and
    after contact with pt
  • Appropriate skin prep
  • Clip hair instead of shaving hair
  • Antibiotic are given in timely manner for
    appropriate duration
  • Surgical team wears mask, cap, gown, and gloves
    during surgery
  • Monitor for signs and symptoms of infection
  • Control of blood sugar
  • Surgical hand scrubs before procedure

101
Ways Redmond Staff Help Prevent Blood Stream
Infections
  • Wash hands prior to inserting line
  • Wash hands prior to touching line or giving
    medication through line
  • Follow bundle best practices for line insertion
  • Special skin prep, wear gown, mask, gloves and
    cap when inserting line, remove line when no
    longer needed, choose safe site for insertion,
    evaluate necessity of line daily.

102
Ways Redmond Staff Help Prevent the Transmission
of Multidrug resistant organisms like MRSA, VRE,
C Difficile
  • Hand washing before and after contact
  • Use contact precautions when caring for patient
    with history of these conditions (wear gown and
    gloves on entry to room)
  • Special room assignments
  • Screen patients at high risk when they are
    admitted
  • Patient Education
  • Carefully clean hospital equipment

103
Ways Redmond Staff Help Prevent Urinary Tract
Infections caused by a Foley Catheter
  • Hand washing prior to inserting foley catheter
  • Catheters are inserted only when necessary and
    removed when no longer needed
  • Only properly trained staff insert catheters
  • Sterile technique used while inserted foley
  • Skin prep prior to insertion
  • The foley bag is kept below the level of the
    bladder to prevent urine back flow
  • The foley bag is emptied regularly

104
Ways Redmond Staff Help Prevent Ventilator
Associated Pneumonia
  • Hand hygiene prior to care
  • Follow the bundle best practices
  • Head of bed up 30 degrees unless contraindicated
  • Evaluate daily need of ventilator
  • Peptic Ulcer Disease Prophylaxis
  • Deep Venous Thrombosis Prophylaxis
  • Mouth care every two hours

105
Personal Protective Equipment
  • Personal Protective Equipment (PPE) is provided
    at no cost to the associate
  • Worn when there is a chance of contact with blood
    or other potentially infectious body material
    (OPIM).
  • PPEs include, but are not limited to gloves,
    gowns, goggles, pocket masks, and shoe coverings.
    PPEs are available in each department.
  • Wear gloves when it can be reasonably anticipated
    that there may be hand contact with blood or OPIM
    and when handling and touching contaminated items
    or surfaces. Replace them if torn or punctured or
    if their ability to function as a barrier is
    compromised.
  • Gloves must be removed before leaving the room.
    Hands must be washed after glove removal.

106
Personal Protective Equipment
  • Wear appropriate face and eye protection when
    splashes, sprays, splatters, or droplets of blood
    or OPIM may pose a hazard to the eye, nose, or
    mouth.
  • Remove immediately, or as soon as feasible, any
    garment contaminated by blood or OPIM.
  • PPEs may be disposed of in the regular trash
    unless contaminated with blood or other OPIM, if
    contaminated they must be disposed of in red
    biohazard bags.
  • Each department has a list of tasks and what PPE
    is recommended or mandatory to wear while
    performing those tasks. Ask your leader about
    this list.

107
Standard Precautions
  • Standard Precautions apply to all blood or body
    fluid which is considered potentially infectious.
    Very important to wear appropriate PPE when
    dealing with blood or body fluids.
  • By using standard precautions you will
    substantially reduce your risk of infection with
    a blood borne pathogen.
  • In addition to standard precautions, there are
    three types of transmission based precautions
    (isolation precautions) used for patients with
    documented or suspected transmissible pathogens
    that require more than standard precautions.

108
Isolation Precautions
  • Contact (wear gown, gloves, sometimes mask)
  • Add sign Wash hands with soap and water if
    patient has C difficile
  • Airborne (wear N 95 mask)
  • Droplet (wear regular mask)

109
Contact Precautions
  • Used in addition to standard precautions
  • Bacteria transmitted by direct patient contact or
    by indirect contact by touching environmental
    surfaces.
  • Isolation gowns and gloves must be worn and
    sometimes a mask.
  • Private room for patient or placed with patient
    with the same bacteria.
  • Patients should wear an isolation gown and wash
    hands before leaving the room.
  • Environmental services should be notified on
    patient discharge to terminal clean room.

110
Airborne Precautions
  • Used in addition to standard precautions for
    illnesses transmitted by airborne droplets.
  • Patient is placed in a negative air flow room.
  • If patient must leave room, they are given a mask
    to wear.
  • Staff must be fit tested for an N 95 mask before
    entering this type of isolation room. Staff
    members who have not been fit tested may not go
    in this room.
  • Visitors are taught by the nurse how to wear the
    mask.
  • Persons not immune to measles or varicella
    (chicken pox or disseminated varicella) should
    not enter the room of patients with these
    illnesses.

111
Droplet Precautions
  • Used in addition to standard precautions for
    illnesses transmitted by large droplets.
  • A regular mask is worn in this room.
  • Patient must be placed in a private room.
  • If the patient needs to leave the room, they are
    given a mask to wear.
  • For patients with suspected H1N1, wear N 95 mask
    for aerosol generating activities (enhanced
    droplet precautions)

112
Examples of Multi Drug Resistant Organisms
(MDROs)
  • 2. Clostridium Difficile
  • Causes severe diarrhea
  • Can be spread by contact with patient or
    environment
  • Contact precautions upon entry to room
  • Good hand washing with soap and water
  • 3. VRE
  • High risk patients are screened on admission
  • Most patients are colonized with VRE which means
    it is colonized (not bothering them)
  • Contact precautions upon entry to room
  • 1. Methicillin-Resistant StaphAureus (MRSA)
  • Staph aureus are bacteria commonly found on the
    skin of healthy people.
  • MRSA can be present without causing disease.
    When there is no associated disease, we call
    their presence colonization. If MRSA is causing
    disease such as fever or pneumonia, we call it
    infection.
  • MRSA is spread by contact (direct contact with
    the pt or indirect contact with their
    environment) thus contact precautions are
    implemented (gown and gloves)
  • Good hand washing is the best prevention for the
    spread of MRSA.

113
For all MDROs
  • Use disposable equipment, such a B/P cuffs as
    much as possible.
  • Any equipment taken in to the room must be
    disinfected prior to removing it from the room.
  • Education is given to patient/visitors by the
    nurse. The visitor may decide for themselves
    whether or not to wear a gown or gloves.
  • If the visitor will be visiting other patients
    during this visit, they must wear a gown and
    gloves
  • Notify receiving department that the patient is
    on contact precautions .
  • If possible, schedule procedures when there are
    fewer patients in the area.
  • The patient should wear an isolation gown and
    wash hands prior to transport.
  • Have the area where the patient has been
    terminally cleaned by Environmental Services

114
Screening for MRSA
  • Patients who already have MRSA on admission to
    our facility have Community Acquired MRSA. This
    is different from MRSA acquired in a healthcare
    setting.
  • Usually it is a skin infection or MRSA
    coloniza
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