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System Wide Orientation and Training

Self- Study Packet

Please read this packet in its entirety.

If you have any questions, please feel free to contact

Human Resources

910-892-1000 ext 4123

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Harnett Health’s Mission

Harnett Health is dedicated to providing quality and personalized

care with respect and compassion. We are committed to making

a difference throughout our communities with service excellence.

Harnett Health’s Vision

Harnett Health will be a top tier healthcare system providing

nationally-recognized quality primary and secondary care.

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overview

Purpose

The purpose of the Hospital Wide Orientation and Training self-study

packet is to educate employees, contractors, students, volunteers and

vendors with the general functioning of the organization.

Objectives

At the conclusion of the Hospital Wide Orientation, participants will be

able to:

Describe the Mission, Vision and Values of Harnett Health System

Discuss Risk Management issues directly related to the hospitals

Discuss Fire and Electrical Safety as related to the hospitals

Describe MRI Safety

Discuss the Hospital’s Corporate Compliance Program

Understand the Hospital’s position on confidentiality and each

employee’s role to ensure patient confidentiality

Describe corporate image

Define the hospital’s position on unproductive work environments

Describe the Hospital’s Quality Performance Improvement plan

Discuss Employee Health and Infection Control issues as related to

the hospitals

Discuss proper body mechanics as related to their specific job duties

SAFETY

Harnett Health System is committed to the safety of all patients, visitors, guests and employees.

The Hospital Incident Command System (HICS) is activated by the Emergency Incident Commander

or designee in the event of an emergency outside the normal realm of hospital function. This

could include a fire, weather related incidents and internal/external disasters.

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The General and Departmental safety policies are in the first section of the safety manual. All

employees need to be aware of and follow these policies. Violation of any safety policy will result

in disciplinary action by your manager.

CALL

For Medical (Rapid Response, Code Blue, Code Assist, etc.) and security emergencies call ext 5555

and notify the operator of the code to be paged and location of the code.

Code Red-----------Fire

Code Blue----------Cardiac/Respiratory Arrest

Code Pink----------Infant/Pediatric Abduction

These are the only “color” alerts we have. The rest are Plain English. (Facility Alert, Security Alert,

and Medical Alert)

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Event

Recommend Plain

Language Alternate

Code Sample Scripting

Evacuation / Relocation

Facility Alert + Evacuation/Relocation + Descriptor + Location

None Overhead: Facility Alert + Immediate

Evacuation + Betsy Johnson Hospital - 4th

Floor.

Fire / Smoke Alarm Facility Alert + Fire/Smoke Alarm + Descriptor + Location

Code Red Overhead: Facility Alert + Fire Alert (or Fire Confirmed) + Central Harnett Hospital + 2East. Use RACE procedures.

Hazardous / Materials Spill

Facility Alert + Hazardous Spill + Descriptor + Location

None Overhead: Facility Alert + Hazardous Materials Spill + Betsy Johnson Hospital + Laboratory. Use RAFT procedures. (consider to not overhead page unless spill is significant requiring evacuation)

Mass Casualty Facility Alert + Mass Casualty + Descriptor (may have levels) + Location

None Overhead: Facility Alert + Mass Casualty + Level 3 + Emergency Department.

Medical Decontamination

Facility Alert + Medical Decontamination + Descriptor (biological, chemical, radiological, or unknown) + Location

None Overhead: Facility Alert + Medical Decontamination + Chemical (and/or Biological and/or Radiation) + Betsy Johnson Hospital + Emergency Department. (Consider not to overhead page)

Surge Capacity Facility Alert + Surge Capacity + Descriptor (may have levels) + Location

None Overhead: Facility Alert + Surge + Red + Central Harnett Hospital. (Consider not to overhead page)

Utility / Technology Interruption

Facility Alert + Type of Service Interruption + Descriptor + Location

None Overhead: Facility Alert + IS Network Downtime + Implement downtime procedures for patient charting. (Consider to not overhead page)

Weather Facility Alert + (Instruction) + Weather + Descriptor (National Weather Service Statement)+ Location

None Overhead: Facility Alert + Seek Safety Immediately. Move away from windows to interior portions of the building. The National Weather Service has issued a Tornado Warning for the local area in effect until (time).

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Event Recommend Plain Language

Alternate Code

Sample Scripting

Missing Infant / Child <18 yrs.

Security Alert + Missing Person + Descriptor (Infant/Child) + Location

Code Pink Overhead Page: Security Alert + Code Pink + STOP , SECURE, SEARCH for an approximate 25 year old white female wearing dark blue scrubs, possibly carrying a one day old baby girl. If you see this person please alert the nearest hospital staff member and call the hospital emergency security number at 5555. The woman was last seen leaving the Betsy Johnson Hospital back elevators.

Decisionally Impaired Missing Person >18 yrs

Security Alert + Missing Person + Descriptor (Adult) + Location

None Overhead: Security Alert + Missing Person + STOP, SECURE, SEARCH for a 65 year old female wearing a hospital gown. If you see this person, alert the nearest hospital staff member and call the hospital emergency security number 5555 + Last seen on the

2nd

floor of Central Harnett Hospital. Armed Intruder / Shooter/ Hostage Situation / Threat of Violence

Security Alert + (Instruction) + Descriptor + (Type of Threat) + Location

None Overhead: Security Alert + Seek Safety Immediately. RUN HIDE FIGHT + Armed Intruder + Betsy Johnson Hospital ED. Overhead: Security Alert + Hostage Situation + Cancer Center.

Bomb Threat / Suspicious Package

Security Alert + (Type of Threat) + Descriptor + Location

None Overhead: Security Alert + For your safety, maintain possession of all your personal belongings. Report suspicious packages, bags, or boxes or persons to the nearest staff member call the hospital emergency security number (insert number) + Betsy Johnson Hospital + Critical Care Unit.

Combative Patient / Person

Security Alert + Location + Security Assistance Requested

None Overhead: Security Alert + 3rd

Floor Room 332 Betsy Johnson Hospital + Security Assistance Requested.

Civil Disturbance

Security Alert + Civil Disturbance + Descriptor +Location

None Overhead: Security Alert + Civil Disturbance + Due

to the security risk, avoid entering the + 3rd

Floor Betsy Johnson Hospital.

Controlled Access

Security Alert + Controlled Access + Descriptor +Location

None Overhead: Security Alert + Controlled Access + Implement controlled access procedures + Central Harnett Hospital

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Event Recommend Plain Language

Alternate Code Sample Scripting

Medical Emergency or Incident

Medical Alert + (Type of Emergency-Incident) + Descriptor + Location

*Code Blue is the only accepted color code for medical alerts

Overhead: Medical Alert + Code Blue + Unit 4300 Room 10

Stroke Medical Alert + Stroke + Descriptor + Location

None Overhead: Medical Alert + Stroke – ED – 15 minutes

STEMI Medical Alert + STEMI + Descriptor + Location

None Overhead: Medical Alert + STEMI – ED – 15 minutes

Rapid

Response Medical Alert +Rapid Response+ Descriptor + Location

None Overhead: Medical Alert + Rapid

Response – 3rd

Floor – Room 306

Medical

Assistance (Code Assist)

Medical Alert + Medical Assistance + Descriptor + Location

None Overhead: Medical Alert + Medical Assistance needed - Lobby

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RISK MANAGMENT

Sentinel Events

A sentient event is an unexpected occurrence not primarily related to the natural course of the

patient’s illness or underlying condition involving death or serious physical or psychological injury,

or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase “or the

risk thereof” includes any process variation for which a recurrence would carry a significant

chance of a serious adverse outcome.

These events signal the need for immediate investigation and response, a Root Cause Analysis

(RCA).

Examples of Sentinel Events Include:

• Suicide of any patient receiving care, treatment and services in a staffed around-the-

clock care setting or within 72 hours of discharge.

• Unanticipated death of a full-term infant.

• Abduction of any patient receiving care, treatment, and services.

• Discharge of an infant to the wrong family.

• Rape, assault (leading to death or permanent loss of function), or homicide of any

patient receiving care, treatment, and services.

• Rape, assault (leading to death or permanent loss of function), or homicide of a staff

member, licensed independent practitioner, visitor, or vendor while on site at the health

care organization.

• Hemolytic transfusion reaction involving administration of blood or blood products

having major blood group incompatibilities (ABO, Rh, other blood groups).

• Invasive procedure, including surgery, on the wrong patient, wrong site, or wrong

procedure.

• Unintended retention of a foreign object in a patient after surgery or other invasive

procedures.

• Severe neonatal hyperbilirubinemia (bilirubin >30 illigrams/deciliter).

• Prolonged fluoroscopy with cumulative dose >1,500 rads to a single field or any delivery

of radiotherapy to the wrong body region or >25% above the planned radiotherapy dose.

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Report potential sentinel events immediately to Charge Nurse, Immediate Supervisor, Unit

Manager OR Nursing/Operations Supervisors. Leadership will immediately report to Risk

Management.

Near Miss

A near miss is any process variation which did not affect the outcome, but for which a

recurrence carries a significant chance of a serious adverse outcome.

• Report near misses to your supervisor.

• Enter a risk notification thru Meditech.

• Talk about how the near miss could have been avoided.

• Make suggestions if you see a way to avoid the same thing from happening again.

Reporting Safety Concerns

• A strong safety culture is one in which safety of operations is a primary goal, reporting of

concerns is welcomed, the approach to errors is free of blame, collaboration across the

hierarchy is encouraged, and organizational resources are committed for addressing safety

concerns.

• Harnett Health’s focus is building a strong safety culture. Reporting safety concerns should

be completed without fear of retaliation.

• Reporting safety concerns is a job responsibility to ensure safety of operations, safety for

patients, employees, and visitors.

• If individuals fail to report near misses and significant events, underlying systemic issues

will remain unseen and unaddressed.

• Risk Notifications are used to strengthen the oversight activities, improve the quality of

care and safety of patients. These include issues such as patient rights, care of patients,

safety, infection control, medication use, and security.

Reporting Tip: If anything abnormal occurs on your shift…..REPORT

HAZARDOUS MATERIALS

Hazardous Materials are substances that are potentially dangerous to your health and safety.

Harnett Health System has developed a system that manages hazardous material from the point

they enter the hospitals to the point of final disposal.

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Hazardous Materials can be classified as chemical, physical, biological, infectious or radiological.

OSHA (Occupational Safety and Health Administration) has developed a “Hazard Communication

Standard or Program” and the “Employee Right-to-Know Policy” which tries to reduce illness and

injuries related to hazardous chemicals in the workplace. This standard applies to “any chemical,

which is known to be present in the workplace in such a manner that employees may be exposed

under normal conditions of use or in a foreseeable emergency”.

Know where you can find the Safety Data Sheet (SDS) for chemicals. They are available at

MSDS.com.

MSDS.com can be accessed from the Policy Manual Icon on your computer. Click on MSDS

Solutions. The procedure for obtaining MSDS online is as follows:

Go to the website www.msds.com

Enter product name

Enter manufacturer name (if known)

Hit search

Enter username: BJRH (capital letters)

Enter password: bjrh (lower case letters)

Hit log in

Product should come up

The hospital spill team should be contacted in the event a cleanup of hazardous material is

needed. This team consists of:

Laboratory Ext. 4178

Environmental Services Ext. 4713

Facility Services Ext. 4142 (contact the Nursing Supervisor to notify

after hours)

FALL PREVENTION

This program identifies patients at risk for falls and to facilitate the use of prevention intervention.

The Morse Fall Scale is utilized to do risk assessments. . All patients with a score greater than 45

is place on fall precautions. The patient will:

Wear a yellow arm band

Have a yellow sticker on their charts

Have a yellow magnet on their door frame

Wear yellow socks

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You must contact the Nursing Supervisor, ext. 8465, for all visitor and patient falls.

MEDICAL DEVICE REPORTING

The Safe Medical Device Act requires health care facilities to report to the manufacture or the

Federal Drug Administration any event in which a medical device caused or contributed to the

death or illness of a patient. Any employee who discovers, witnesses, or is notified of a medical

device incident that they suspect may have caused death or injury must notify the attending

physician and department manager.

ADVANCE DIRECTIVES

North Carolina law recognizes five types of Advance Directives:

Living Wills

Medical Power of Attorney

Advanced Instruction for Mental Health Treatment

DNR Order

Medical Order Scope of Treatment (MOST)

On every admission the patient must be asked about and provided information on Advance

Directives. If the patient has had a previous admission and gave the hospital a copy of their

Advance Directive on that admission, a copy can be obtained from Health Information

Management.

Family members or anyone who could gain financially by the patient’s death or any hospital

employee cannot witness Advance Directives. The witness ideally should be someone the patient

knows.

HOSPITAL SECURITY

Every employee plays an active role in hospital security by:

Understanding and following hospital rules and regulations

Being alert for irregularities and suspicious activity

Being safety conscious

Enforcing hospital rules

Sensitive Areas (high security risks)

Emergency Department – threat of community violence extending into the ED

Pharmacy – large quantities of drugs

Nursery – threat of infant kidnapping

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Health Information Management (Medical Records) – security and confidentiality of

medical records

Employee Heath Office – security and confidentiality of employee health records

Pediatric Unit – threat of pediatric abduction

Workplace Violence

For many years, healthcare workers have been faced with significant risks of job related violence.

A Workplace Violence Prevention Program has been established utilizing OSHA’s Violence

Prevention guidelines. Violence, threats of violence, intimidation, harassment or other types of

inappropriate behavior by employees, patients, or visitors will not be tolerated on hospital

property. Physical contact does not have to take place for workplace violence to occur. The

hospital is committed to preventing violence through engineering controls, workplace

adaptations, and education. All violent incidents are reported to Risk Management, ext. 4109.

Hospitals are at risk for violent incidents due to:

Prevalence of handguns

Decreased medical and mental health treatment

Availability of drugs and money in the hospital

Staff shortages

Public access

Long waits by patients and family

Dealing with a Volatile Patient

Leave the door open

Never turn your back to the patient

Remain at a safe distance

Position yourself sideways to avoid less surface area of contact

Use a calm, reasoning, firm approach

Always call security

NIMS

The Harnett Health System Emergency Operations Plan lists responses to events that pose

immediate danger to the health and safety of patients, staff and visitors and or disrupt normal

operations. It is designed to provide resources and maintain patient care during an emergency.

The Emergency Operations Plan can be found in the Harnett Health System Intranet Policies and

Procedures. The Emergency Management Committee is responsible for developing, implementing,

monitoring and taking action based on disaster drills and /or real events.

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An emergency is a natural or manmade event that significantly disrupts care, treatment and

services or results in sudden significantly changed or increased demands for the hospital services.

Some emergencies are called “disasters”. An “Internal” disaster is one that occurs inside the

facility’s walls, in example: bomb threats, electrical failures, water outages, emergency

evacuations. An “External” disaster is one that occurs outside the facility, in example: mass

casualty events, tornado warnings, biohazard events, pandemic events.

Harnett Health uses a nationally recognized command structure during an emergency

event/incident, the Hospital Incident Command System (HICS). The Incident Command System

sets up a Chain of Command that maintains a flow of communication and responsibility

throughout the organization and with other local, county, state and federal agencies. Harnett

Health works cooperatively with all of Harnett County, State and Federal agencies. In an

emergency event/incident, the Incident Command is set up in the Betsy Johnson Boardroom or

the Central Harnett Boardroom on the first floor of the hospital. The Staffing pool is set up by the

Resource Unit Leader in the Administrative classroom on the first floor. If you are ever called in

for an emergency event/incident, you would report to the Resource Unit Leader in the

Administrative classroom.

The Emergency Operations Plan process starts with notification. Overhead pages will be called

when an emergency has been determined. All employees are responsible for knowing the

Emergency Codes and understanding their response to the event. The Nursing Supervisor will brief

all of the following (if available) so they may determine when an emergency incident/event will be

called: Administration on Call, Clinical on Call, Chief Nursing Officer and Facility Services Manager.

The code will then be announced. The Incident Command Center is set up. Notification of

Administration, Management and staff will be implemented. Each department is required to

maintain an updated Phone Tree for use in a disaster. All staff should provide their manager with

any phone numbers or address changes. Departments will assess their staffing needs and report

the number of available staff to the Resource Unit Leader. If additional staff is needed, the

department can request additional staff from the Incident Command. In an emergency

event/incident:

Staff can be requested to report to work and assist in their normal duties or be assigned to

other areas needing assistance.

You should remain calm.

Reassure patients and visitors.

At all times maintain patient confidentiality.

Do not discuss disaster information with anyone other than appropriate staff. Please direct

all questions and information to the Public Information Officer.

The Public Information Officer will coordinate the release of information to the media and

general public.

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Those not scheduled to work should not tie up phone lines calling to find out what is

“going on”.

At work, use the telephones only when necessary and leave at least one line open at all

times. Please, do not tie up the switchboard staff with phone calls regarding pages, notices

and/or questions.

Remain alert during a code until an “All Clear” is called.

A code status will remain in effect until the Incident Commander determines the event

/incident is over, at that time an “All Clear” will be announced overhead.

Employees must always wear their Harnett Health System employee badges. Identification

will be necessary in the event of an emergency event/incident to gain admittance to the

facility during a lockdown, to identify who you are if you are moved to another

department, and to maintain security and record keeping during an emergency

event/incident.

FIRE SAFETY

Harnett Health System is committed to the safety of our patients, guests, and employees. In the

event of a fire, a facility wide response is necessary. It is your responsibility to know your

Department specific role in the event of a fire. Please locate all fire pulls and fire extinguishers in

your area.

Our Fire Plan is RACE.

R RESCUE all persons who are in immediate danger

A ALARM others. Pull the closest fire alarm and call the emergency number

C CONTAIN the fire by closing all doors and windows

E EXTINGUISH fire using a proper fire extinguisher

HHS uses ABC fire extinguishers. These fire extinguishers are portable multi-purpose fire

extinguishers that can be used on ordinary combustibles, flammable liquids, or electrical fires.

Remember; fight the fire only if it is small and contained (as in the case of a trash can fire). Be sure

the area has been evacuated and the fire has been announced.

If you do fight the fire using a fire extinguisher, remember the word PASS.

P PULL the pin

A AIM the nozzle at base of fire

S SQUEEZE the handle

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S SWEEP from side to side at base of fire

TOBACCO POLICY

• As of Nov 3, 2008 Harnett Health is tobacco free.

• Tobacco use on Hospital property by an employee is a violation of policy that is subject

to discipline, which may include termination.

• It is the responsibility of ALL STAFF to enforce the Tobacco Free Policy.

ELECTRICAL SAFETY

Red outlets through the hospital are connected to emergency power.

MRI SAFETY

Two most important points:

A. Site access restrictions

B. MRI safety education

The American College of Radiology (ACR) in July 2002 published guidelines for Magnetic

Resonance Safe Practice

There are four zone areas at Betsy Johnson Hospital

Zone III and IV are restricted areas

All MR personnel shall be trained in MR safety

Zone I and Zone II are unrestricted. (DO NOT ENTER the lift area on the mobile unit

without MR personnel)

To enter Zone III and IV one has to have a MR safety screen done by MR personnel

The MRI unit shall be locked when staff is not present

The guidelines pertain to all patients, staff, and family members of the patient. Patients

with pacemakers and other ferromagnetic objects are NOT permitted in the MR unit.

Harnett Health System educates all staff about MR safety annually

If you need a MR exam or to accompany a patient during an exam, you will need to

answer all screening questions accurately so that we are able to proved a safe

environment

During an emergency the patient must be removed from the MRI unit. Non MR

personnel DO NOT ENTER the room or the control area; the MR staff are responsible

for starting basic life support and removing the patient (the MR table removes from the

unit) from the truck and into the main hall where Non MR personnel can continue life

support measures

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Examples of ferrous objects: oxygen tanks, wheelchairs, stretchers, scissors, pens,

zippers, cell phones, buckets, guns, screwdrivers, flashlights, etc…..

CORPORATE COMPLIANCE

Harnett Health System is committed to comply with rules and regulations that govern the

healthcare industry. The Corporate Compliance Council and Compliance Director oversees all

aspects of the compliance program.

Areas covered by the program:

Wage and Hour Laws

Americans with Disability Act

Sexual Harassment

Employment Laws/Regulations

Federal and State Regulations/Standards

OSHA

Reimbursement/Coding/Billing

Conflict of Interest

Corporate Record Maintenance

Intellectual Property (copyright laws)

Code of Conduct

The Harnett Health System Code of Conduct is designed to safeguard the hospital’s tradition of

strong moral, ethical, and legal standard of conduct. All employees, students and volunteers must

review and sign the Code of Conduct on an annual basis. Employees, students and volunteers who

do not feel comfortable talking directly to their immediate Supervisor or Management about a

compliance issue may call the Compliance Hotline at 1-866-418-2850. The Hospital’s Corporate

Compliance Program/Policies/Procedures are located in the Compliance Manual.

If you have concerns about the safety or quality of care provided within Harnett Health you may

address the concerns with your Director/Manager, Administration, Risk Management or through

the Compliance Officer.

Concerns can also be reported to the Joint Commission or NC Division of Health Services

Regulation:

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The Joint Commission, Division of Accreditation One Renaissance Boulevard Oakbrook Terrace, IL 60181

1-800-994-6610 Or email: complaint@jointcommission.org

The NC Division of Health Services Regulation

2711 Mail Service Center Raleigh, NC 27699-2711

Complaint Hotline: 1-800-624-3004

There will be no retaliation or disciplinary action because an employee reports safety or quality of

care concerns to the Joint Commission.

Billing and Claims

A. The hospital may not submit a claim to Medicare or Medicaid that is substantially in

excess of the amount that it charges commercial payers or individuals. The hospital may,

however, allow discounts to uninsured and underinsured patients in some circumstances.

B. When claiming payment for services, the hospital has an obligation to its patients, third

party payers and the state and federal governments to exercise diligence, care and

integrity.

C. Many people throughout the Hospital have responsibility for entering charges and

procedure codes. Each of these individuals is expected to monitor compliance with

applicable billing rules. Any false, inaccurate, or questionable claims should be reported

immediately to a manager, administrative staff or to the Compliance Officer.

D. False billing is a serious offense. Medicare and Medicaid rules prohibit

knowingly and willfully making or causing to be made any false statement or

representation of a material fact in an application for benefit or payment. It is also

unlawful to conceal or fail to disclose the occurrence of an event affecting the right to

payment with the intent to secure payment that is not due.

E. A provider or supplier who violates the false claims rule is guilty of a felony

and may be subject to fines and penalties. The person (as well as the Hospital) may be

excluded from participating in the Medicare and Medicaid programs.

F. Violation of assignment and reassignment rules are misdemeanors and carry

fines up to $2000 and imprisonment of up to six months, or both.

G. Neither the Hospital nor its agents are permitted to make, or induce others to make, false

statements in connection with the Hospital’s Medicare certification.

H. The Hospital or individual health care providers will be excluded from the Medicare and

Medicaid programs for at least five years if convicted of a Medicare- or Medicaid-related

crime or any crime related to patient abuse.

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I. It is illegal to make any false statements to the federal government, including statements

on Medicare or Medicaid claim forms.

J. It is illegal to use the U.S. mail in a scheme to defraud the government.

K. The Hospital promotes full compliance with each of the relevant laws by maintaining a

strict policy of ethics, integrity, and accuracy in all its financial dealings.

L. Each employee who is involved in submitting charges, preparing claims, billing, and

documenting services is expected to maintain the highest standards of personal,

professional, and institutional responsibility.

M. Any employee who perceives or learns of an act of non-compliance should either speak to

his/her manager, administrative staff, the Compliance Officer or call the Compliance Hot

Line.

N. There will be no direct or indirect retaliation or retribution against any employee who in

good faith raises concerns, points out problems or reports to a government agency.

HEALTH INSURNACE PORTABILITY AND ACCOUNTABILITY ACTT (HIPPA)

The Health Insurance Portability and Accountability Act of 1996, (HIPAA), became effective April

14, 2003. This law requires hospitals and healthcare providers to have privacy provisions in place

that will protect patients’ health and financial information. Healthcare organizations found in

violation of this law can be subject to civil and/or criminal sanctions.

Harnett Health System is required to provide all patients a privacy notice. This notice details how

we will disclose their information, and how they can access their records and request additions

and amendments. In addition, this practice states that patients can request an accounting of

disclosures and request restrictions of their protected health information (PHI).

Any questions should be directed to our Health Information Management Department ext. 4128.

HUMAN RESOURCES

Corporate Image

A. Identification Badges: Identification badges must be worn above the waist and vital information such as the name must be visible at all times. Badges may not be defaced with stickers, pins, etc.

B. Personal Hygiene: Personal hygiene should be foremost in everyone’s mind, considering the close contact with patients and fellow workers necessitated by the job. Staff should use and keep on hand those items (deodorant, etc.) necessary to maintain good hygiene throughout the shift.

C. Hair: Hair must be clean, neat, dry, and well-groomed. Hair color must appear natural. Unnatural colors include but are not limited to blue, purple, green, yellow, magenta, burgundy and orange. Extreme hairstyles (such as Mohawks) are not allowed. Hair styles

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and lengths should be appropriate to the work environment with consideration for safety and health. If required for infection control standards, hair nets or other hair covering must be worn.

D. Make-up / Fragrances / Jewelry: Make-up must be conservative and tasteful. Jewelry must be appropriate and safe based on the area in which you are working.

Dangling earrings should be avoided in clinical areas. There should be no more than two pierced earrings in each ear.

Fingernails must be an appropriate length based on job responsibilities and polish must be near and unchipped, if worn. In Clinical and Dietary departments, for infection control, nails length must be no more than 1/4 inch. Artificial nails will not be permitted in patient contact areas.

Due to the fact that many people are allergic to fragrances such as cologne, etc., employees are asked not to wear strong scented fragrances.

E. Tattoos and body piercing: Tattoos, body jewelry, and/or other body ornamentation (other than earrings), MUST NOT be visible while on duty. Body ornamentation includes, but is not limited to: ear gauge, nose rings, lip rings, tongue rings, etc.

F. Clothing: As employees of the hospital, we are expected to dress in a neat and professional manner. Employees not required to wear uniforms should dress to meet the best business and professional standards. While Directors need to determine what the appropriate dress code for their department is, Betsy Johnson has established the following guidelines for professional dress: Clothing must be clean, neat, pressed, and non-tattered. Shirts and blouses designed with shirttails must be tucked-in. Business/office attire may be required due to level of public visibility, public

representation, and/or job duties. When required, business attire must be conservative. Examples include dress slacks, dress skirts, dress shoes, ties, business suits, blazers with coordinating skirt/pants, business dresses, etc.

Uniforms and dresses/skirts must be a conservative, professional length and should provide an element of modesty when sitting or standing.

Clothes and shoes must be in good repair. Clean athletic shoes are acceptable when appropriate for the type of work performed. Open-toe dress shoes and dress are acceptable in non-patient care areas only. For safety, heels should not exceed 2 1/2 inches.

Socks or hosiery are to be worn if working/visiting inpatient care areas. A lab coat must be worn for employees who are called in during the on-call status if

they aren’t dressed in the appropriate departmental uniform. Any reasonable clothing or shoes may be worn in to or from the organization by

employees who change into uniforms on-site. During the Holiday period from December 15 through January 2, and on October 31,

appropriate seasonal attire may be acceptable, however it must be modest, clean, and neat.

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The following are examples of inappropriate attire: Soiled, spotted, wrinkled or stained clothing. Denim jeans, cut-off pants, warm-up suits, and sweatshirts/pants. Transparent, see-through, low-cut, or revealing clothing. Tight-fitting clothing that is revealing. Clothing worn without undergarments. Shorts or skorts. Hats or other head coverings except as required as part of a uniform or for religious

purposes. T-shirts or apparel with advertising or slogans. Visible pierced accessories other than earrings. Socks and athletic shoes with business attire. (These are acceptable when coming

into/leaving the organization or walking on a break period. They may also be acceptable due to the type of work that is being performed.)

Beach sandals, thongs, and flip-flops. Undergarments that are visible.

G. Uniforms/Scrubs:

In general, it is the responsibility of each employee to purchase required uniforms at his/her expense, except in those areas where uniforms are provided.

In those areas where uniforms/scrubs are provided, it is the responsibility of department directors to order, maintain, and issue uniforms to employees.

Uniforms are to be of consistent color and style within departments. The department director and applicable Vice President approve uniform styles and colors.

Harnett Health System provides scrub apparel for all employees assigned to areas where scrubs are mandated by infection control policies. In these areas, employees must wear street clothes to work and change into scrubs in the department. Scrub apparel may not be worn outside Harnett Health System. Removal of scrub apparel from Harnett Health System is considered theft and may result in disciplinary action.

Harassment

Employees, affiliates, and contractors at Harnett Health System are subject to standards set

forth in the Human Resources Policy and Procedure regarding harassment. Any individual who

feels harassed should report the incident immediately to their manager or to Human Resources.

Harnett Health System will not tolerate any form of harassment and will take appropriate

disciplinary action against anyone who engages in harassment.

Sexual Harassment

Harnett Health System is firmly committed to the policy that all employees are entitled to work

in an environment free from all forms of harassment or discriminatory intimidation because of

an individual's race, gender, sexual orientation, religion, age, national origin, or disability. Please

read and review the attached harassment policy, HRM 200, “Unproductive Work Environment”.

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Policies are located in the Human Resources (HR) Policy and Procedure Manual on the Intranet

Policy Manual.

What is Sexual Harassment?

There are two types of sexual harassment recognized by the Equal Employment Opportunity

Commission (EEOC).

Quid Pro Quo - Unwelcome sexual advances, requests for sexual favors, and other verbal or

physical conduct of a sexual nature can constitute "quid pro quo" sexual harassment when (1)

submission to such conduct is made either explicitly or implicitly a term or condition of an

individual's employment, or (2) submission to or rejection of such conduct by an individual is

used as the basis for employment decisions affecting such individual.

Hostile Environment - Unwelcome sexual advances, requests for sexual favors, and other verbal

or physical conduct of a sexual nature can constitute "hostile environment" sexual harassment

when such conduct has the purpose or effect of unreasonably interfering with an individual's

work performance or creating an intimidating, hostile, or offensive working environment.

Who can be a victim of sexual harassment? The victim may be a man or a woman. The victim

does not have to be of the opposite sex. The victim does not have to be the person harassed,

but could be anyone affected by the offensive conduct.

Who can be a sexual harasser? The harasser may be a man or a woman. He or she can be the

victim's supervisor, an agent of the employer, a supervisor in another area, a co-worker, or a

non-employee regardless of intent.

What should a sexual harassment victim do? The victim should directly inform the harasser

that the conduct is unwelcome, and must stop. It is important for the victim to communicate

that the conduct is unwelcome, particularly when the alleged harasser may have some reason

to believe that the advance may be welcomed. However, a victim of harassment need not

always confront his/her harasser directly, so long as his/her conduct demonstrates that the

harasser's behavior is unwelcome. The victim should also use any employer complaint

mechanism or grievance system available.

What is Harnett Health System's procedure for handling sexual harassment claims? The

employee must report the incident immediately to any supervisor, member or management,

the Human Resources Department, a Vice President, or the President.

Management and Supervisors are responsible for ensuring that their departments remain free

of harassing behaviors and that employees are aware of this policy and expectations. When

they are made aware of harassing behavior, they should inform the applicable VP and the HR

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Department immediately. Failure to report knowledge or suspicion of harassment may result in

disciplinary action and personal liability.

The HR Director will conduct a thorough investigation of any report of harassment, maintaining

confidentiality to the greatest extent possible. Based on the outcome of the investigation, the

HR Director will recommend an appropriate course of action, up to and including discharge, if

harassing behaviors are confirmed.

No retaliation will be taken against any employee for reporting alleged harassment or for

participating in the investigation of any harassment report.

Solicitation/Political Activities

Solicitation and distribution of information/products by Harnett Health System employees,

affiliates, and contractors is prohibited. No political activities may be conducted at Harnett Health

System. Employees, affiliates, and contractors are not to identify themselves in any way as a

representative of Harnett Health System in regard to individual political involvement.

Drug Free Workplace

Employees, affiliates, and contractors may not possess, use, or distribute illegal drugs or alcohol

on any Harnett Health System property, nor may they report to work under the influence of drugs

or alcohol.

Cultural Diversity

All employees, affiliates, and contractors at Harnett Health System are responsible for treating

everyone with respect, dignity, and professional courtesy, no matter of cultural differences. This

includes avoiding stereotypes of others based on age, race, ethnic background or any other

cultural factors. Healthcare professionals are encouraged to learn about their patient’s culture,

values, beliefs, and practices to enhance the healing process.

Holidays

Harnett Health System observes the following holidays: New Years Day, Easter Monday, Memorial

Day, Independence Day, Labor Day, Thanksgiving Day, and Christmas Day. Employees, affiliates,

and contractors should contact their supervisor to determine if their department is closed.

Annual Requirements

All employees, affiliates, and contractors are required to annually review and document

completion of the Safety procedures, Blood Borne Pathogens, Emergency Codes, Corporate

Compliance, HIPAA and the Code of Conduct.

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QUALITY PERFORMANCE IMPROVEMENT

Harnett Health System is committed to meeting the needs of our patients and community by

providing the best possible care though continuous improvement of care and services provided

through the collaborative efforts of the Board, Administration, Medical Staff, and Employees.

Purpose of the Quality Performance Improvement (QPI) Program

The purpose of the Quality Performance Improvement Program is to provide a multidisciplinary,

planned, systematic, comprehensive, organization-wide approach to designing, measuring,

assessing, and improving quality of care provided to patients including neonates through

geriatric patients.

This includes:

Improving customer satisfaction

Focusing on improving patient outcomes and hospital processes

Measuring how well our processes work

Creating an environment that fosters collaborative problem solving rather than placing

blame

Use of multidisciplinary teams to address hospital wide QPI opportunities

Promoting communication on QPI principles and goals among staff

Employee Responsibilities:

Every employee in the hospital should be involved in the QPI process regardless of your

job position. You play an important role in helping the hospital provide high quality

patient care

Employee responsibilities include:

o Participation in quality performance improvement educational in-service classes

o Assist in data collection for departmental quality performance improvement

activities

o Participate in standards assessment teams and other multidisciplinary teams as

appointed

o Promote the hospital’s quality performance improvement vision

Key Points Regarding QPI:

The customer comes first – customers can be external, patients and families or internal,

hospital staff and physicians

Customers are the best judges of quality

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Hospital leaders depend on the employees doing the work to give ideas for

improvement. The leaders provide guidance and support

Teamwork and communication are a must

One-time successes aren’t enough – improvements need to be maintained

Performance improvement is ongoing – even when something is working well, there’s

room for improvement

Every employee is important – all employees need to participate in the improvement

process. Your manager will be able to provide you information on quality performance

improvement activities in your department.

Harnett Heath System’s Model for Improvement

PDCA

P - Plan the improvement.

D - Do the improvement to the process.

C - Check the results.

A - Act – to hold the gain and continue to improve the process.

ORYX (Core Measures) is a Joint Commission on Accreditation of Healthcare Organizations

initiative to help healthcare organizations get standardized data for use in benchmarking. Each

quarter Harnett Health System (and all other hospitals) sends data to the Joint Commission and

CMS (Centers for Medicare and Medicaid Services) on patients that have been treated on an

outpatient or inpatient basis for a certain diagnosis. They have determined “best practice”

criteria for the care of these patients.

This data is now available publically for our patients, etc. to compare how well our hospital

compares with other hospitals (www.hospitalcompare.gov). This data can also affect the

financial reimbursement the hospital receives from Medicare, etc.

There are outpatient, inpatient, and global core measures in which every patient will fall into

the measure. Examples of outpatient core measures: ED Chest Pain/AMI, Pain

Management/long bone fracture, stroke, ED throughput, and colonoscopy utilization. Inpatient

core measures include: VTE, PNC (perinatal-mothers and newborns), Sepsis, Stroke, ED

admissions. Global measures include immunizations.

Tips for individuals to help them improve the hospital’s performance

A. Pay attention to details – this will help you do the job right the first time.

B. Listen to your customers – compliments and complaints from internal and external

customers are tools to help you improve quality.

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C. Avoid finger pointing – it can only make matters worse. Instead, adopt a supportive

attitude and try to become part of the solution.

D. Express your appreciation – congratulate people and teams responsible for improving

quality.

E. Improve your skills – make an effort to attend training sessions and learn from

coworkers. You’ll increase your job satisfaction and become more valuable to the

hospital.

Performance Improvement and the Joint Commission

The Joint Commission requires organizations to make ongoing efforts to improve patient care

and to improve individual, departmental, and organizational performance. The Joint

Commission surveyors will expect you to know:

1. How you perform your job (procedures).

2. The hospital’s model for performance improvement (PDCA).

3. What performance improvement efforts your department is making and your role in

these.

Priorities

Improve publically reported measures to national benchmarks

Improve percentile ranking on service excellence

Improve compliance with National Patient Safety Goals

Improve reduction of hospital acquired infections

Improve our prevention of pressure ulcers

Improve care of the behavioral health patient

Improve compliance on safety/environment of care rounds

National Patient Safety Goals

Goal 1: Improve the accuracy of patient identification.

Goal 2: Improve the effectiveness of communication among caregivers.

Goal 3: Improve the safety of using medications. Accurately and completely reconcile

medications across the continuum of care.

Goal 6: Reduce the harm associated with clinical alarm systems.

Goal 7: Reduce the risk of health-care associated infections.

Goal 15: The organization identifies safety risks inherent in its patient population.

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Universal Protocol

Universal Protocol is the method for preventing Wrong-site, Wrong-person, and Wrong-

procedure/surgery.

INFECTION CONTROL

Harnett Health System is committed to preventing the spread of infectious microorganisms

among patients, health care workers, and visitors. The best way to do this is to practice good hand

hygiene. All employees should follow standard precautions and use Personal Protection

Equipment (PPE) such as gloves, goggles, and face shields. Isolation principles, practices and the

regulatory text can be found in your Infection Control Manual in your Department. Each employee

should familiarize themselves with the location of these materials as well as the content. Any

questions should be directed to Infection Control Manager at ext 5247.

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Wash Hands ~

~

~

Wash hands after touching blood, body fluids, secretions and contaminated items. Wash immediately after gloves are removed and between patient contact. Wash your hands for at least 15 seconds using lots of friction, approved soap, and warm water. Clean between your fingers, palm of the hand and wrist area. Rinse thoroughly. Use a paper towel to turn off the faucet. Use lotion to keep the hands moist.

Personal Protective Equipment ~ Know the location of PPE within departments

~ Communicate PPE need or special requests to your supervisor.

Wear Gloves ~ Wear gloves when touching blood, body fluids, secretions and contaminated items.

~ Put clean gloves on just before touching mucous membranes and non-intact skin.

~ Change gloves between tasks and procedures on the same patient after contact with material that may contain high concentrations of microorganisms.

~ Remove gloves promptly after use.

~ Remove gloves before touching non-contaminated items and environmental surfaces.

~ Remove gloves before going to another patient’s room.

~ Wash hands immediately after removing gloves.

Wear Mask and Eye Protection and Face

Shield

Pro

Protection or Face Shield

~ Protects skin and prevents soiling of clothing during

procedures that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions

Wear Gown ~ Protects skin and prevents soiling of clothing during procedures that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions. ~ Remove soiled gown as promptly as possible.

~ Wash hands to avoid transfer microorganism.

Patient Care Equipment ~

~

~

Handle used patient care equipment soiled by blood, body fluids, secretions or excretions in a manner that prevents skin and mucous membrane exposures. Ensure reusable equipment is NOT used for the care of another patient until it has been properly cleaned and reprocessed. Ensure single use items are disposed of properly.

Isolation Room Signs ~ Isolation signs including procedures will be posted on patients’ doors. You must follow all procedures posted and contact Infection Control with questions.

Environmental Control ~ Follow hospital procedures for routine care, cleaning, and disinfecting of environmental surfaces, bedrails, bedside equipment and other frequently touched surfaces.

~ Handle, transport and process used linen soiled with blood, body fluids, secretions or excretions in a manner that prevents exposure and contamination.

Occupation Health and Blood ~ Prevent injuries when using needles, scalpels and

Borne Pathogens other sharp instruments after procedures, when cleaning and when disposing of used needles.

~ Never re-cap used needles using both hands or any technique that involves directing the point of the needle toward any part of the body.

~ Use either the one-handed scoop technique or a mechanical device designed for holding the needle sheath.

~ Do not remove used needles from disposable syringes by hand, and do not break, bend, or otherwise manipulate used needles by hand.

~ Use resuscitation devices as an alternative to mouth-to-mouth resuscitation.

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Patient Placement ~ Use a private room for a patient who contaminates the environment or who does not or cannot be expected to assist maintaining appropriate hygiene.

~ Consult Infection Control if a private room is not available.

If an exposure incident occurs:

Wash affected area thorough Notify Employee Health nurse to complete necessary paperwork and appropriate

treatment o If nights, weekends, or holidays please contact the nursing supervisor

Tuberculosis Control Information (TB)

Required by OSHA to decrease the exposure to and spread of Tuberculosis

Sets treatment and isolation standards

Defines what personal protective equipment is required

Required TB screening of anyone in a healthcare environment

Types of TB

Active State – Signs

• Lasting Cough

• Fatigue

• Fever

• Loss of appetite

• Weight Loss

Inactive State – Signs

• Only detected if tested

EMPLOYEE HEALTH

The following information does not pertain to all contract employees and

volunteers. Please see your immediate direct report or Employee Health for

specific questions.

Employees are required to be current on the following immunizations:

Measles

Mumps

Rubella

Varicella vaccine or history of disease

Tetanus/Tdap

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TST or TB screening form

Annual Flu Vaccine

Tetanus vaccines are optional but declination form is required if vaccine declined.

Hep B vaccines are offered to clinical staff. Titers will be drawn for MMR and

booster vaccine will be given if not immune.

When necessary, employees are sent notices of employee health needs. The

employee has 10 days to comply with the request. After 10 days the employee’s

direct report will be contacted. If the employee is not compliant within 3 days of

notification by the direct report the employee will be taken off the schedule and be

subjected to disciplinary action by their direct report.

Workplace injuries are to be reported to your direct report and Employee Health

immediately. If it is a night, weekend, or holiday you must contact the Nursing

Supervisor, ext. 8465. Any medical evaluations needed will be scheduled through

employee health unless life threatening, which will be evaluated in the Emergency

Department.

Hospital Employee Accident Report

Hospital Employee Accident Report (HEAR) is completed when an employee, student, or

volunteer is injured. Immediately inform your direct report about the injury. Employee

Health must be notified, as they will direct care. If the injury occurs nights or weekends

contact the Nursing Supervisor immediately.

TB Skin Test

All new employees will be evaluated for Tuberculosis. Two step baseline TST will be

performed on new employees who have no previous TST results, previous negative TST

results > 12 months before new employment, previous undocumented positive TST

results (unless the test was associated with severe ulceration or anaphylactic shock),

previous BCG vaccination. For baseline positive TST employee, proof of chest X-ray’s

performed within 6 months prior to employment will be accepted if the employee has

no symptoms of Tuberculosis as verified by the Tuberculosis screening tool. May

obtain chest x-ray during employment screening if positive TST and no current chest x-

ray (within six months), or for signs and symptoms of tuberculosis, as evidenced by

questions from TB screening tool.

Note: When employees, contractors or affiliates have a disease or illness that is

infectious to others, they are not to report to work until the possibility of spreading

the infection has passed. If you are ill you should contact your supervisor.

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Please contact our Employee Health Department at extension 4017 or 4018 for any

questions or concerns pertaining to employee health.

ERGONOMICS

Back Injury Prevention Tips:

Think ahead before lifting

o How much does this weigh?

o Do I need help?

o Is there a better way to move this? Arrange for mechanical help

(dolly, pushcart, lift devices and slides)

Lift properly and establish firm footing

Bend at the knees and not at the waist

Keep back straight (head upright, shoulders back, small arch in lower back)

Tighten stomach muscles and use your legs as power to lift

If you are injured on duty, notify your direct report and Employee Health

immediately to ensure documentation is completed and medical attention is

provided

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Our Creed

I will introduce myself to every team member and guest. Address people by name, whenever possible.

I will smile and greet everyone, making eye contact. Say "please" and "thank you" when appropriate.

I will actively listen to others without interruption.

I will devote all of my attention to each guest in my presence.

I will value everyone's time. Take care of guest's needs promptly OR "hand-off" to someone who can. Follow-up later in the shift to make sure the guest's needs were met.

I will communicate frequently with all our guests. Anticipate their needs, asking, "Is there anything else I can do for you?"

I will offer an apology to every guest and team member for any inconveniences, without placing blame on anyone.

I will show courtesy and respect to all team members and guests.

I will speak positively about other team members, our guests, and the hospital.

Every guest is my guest. I will make time to assist other team members without being asked.

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What I will do better or differently?

Your Customer

1. I recognize that “What I believe doesn’t count as much as what my customer perceives.”

2. Be aware that a happy customer will tell 5 other people about us and an unhappy customer will tell at least 12.

Excellence

1. Learn one new customer service idea every day, and do it in a better way. Do 1000 things 1% better.

Communication

1. 38% of all communication is non-verbal. 2. Be aware that both my verbal and non-verbal communication defines my

customer relationships. “Customers judge you by the way you look, what you say, how you say it, what you do, and how you do it.” -- Dale Carnegie

Attitude

1. Tell your patients what you CAN do, not what you CAN’T do. 2. “It’s your attitude, not your aptitude that determines your altitude.” --Napoleon

Hill

People

1. Personally acknowledge one co-worker for service above and beyond every day. 2. Practice the “Greatest management principle in the world” -- “What gets

recognized and rewarded gets repeated.” – Michael LeBoeuf

Service Recovery

1. Practice the complaint golden rule that when we “mess up, we fess up, and dress up” by utilizing our Service Recovery Fund.

2. People who start out mad but are helped to feel better tell 10 others about it as a positive experience.

What one thing will you do better or differently to improve the patient experience at HARNETT HEALTH SYSTEM?

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Harnett Health System Wide

Orientation Test Questions

Please answer the following questions on

the bubble sheet found in the test packet.

If you have any questions about the

material provided in this packet please

contact

Human Resources

(910) 892-1000 ext. 4123.

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1. Harnett Health System is dedicated to providing quality personalized care with

_____________ and ______________ . We are committed to making a difference

through Service Excellence.

A. Respect and Compassion B. Service and Excellence C. Vision and Values D. Mission and Vision

2. Who is required to wear an identification badge?

A. Security Officers B. Physicians C. Volunteers D. All of the above

3. A Medical Alert - Code Blue is called when there is a:

A. Fire B. Heart Attack C. Infant Abduction D. Bomb Threat

4. A Code Red is called when there is a:

A. Fire B. Heart Attack C. Infant Abduction D. Bomb Threat

5. When a Code Pink is called you should:

A. Secure nearest entrance/exits B. Pull Fire Alarm C. Move patients from the windows D. Nothing

6. The security sensitive areas at Betsy Johnson are:

A. Emergency Department, Cafeteria, Pharmacy, Nursery, Employee Health, Peds B. Emergency Department, Pharmacy, Nursery, Health Information Management,

Employee Health, Peds C. Emergency Department, Pharmacy, Nursery, Facility Services, Employee Health,

Peds D. Emergency Department, Pharmacy, Nursery, Rehab, Employee Health, Peds

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7. Under the OSHA Hazard Communication Standard, all employees have the right to know

about hazardous chemicals with which they may work with.

A. True B. False

8. The hospital spill team consists of:

A. Emergency Room, Environmental Services, Facility Services B. Emergency Room, Administration, Facility Services C. Emergency Room, Environmental Services, Chaplain D. Laboratory, Environmental Services, Facility Services

9. Only managers should be involved in the Hospital’s QPI process?

A. True B. False

10. The acronym “RACE” is defined as:

A. Run and Call Engineering B. Record, Announce, Contact, Evacuate C. Rescue, Alarm, Contain, Extinguish D. Rescue, Alarm, Call, Exit

11. The acronym “PASS” is defined as:

A. Pass at Safe Speed B. Pull, Aim, Shut, Stay C. Pull, Aim, Squeeze, Sweep D. Pull, Air, Shoot, Safely

12. What type of fire extinguishers are used in our hospital?

A. AB and Fire Hoses B. AC C. A D. ABC

13. What do the red outlets signify?

A. Emergency Power B. 220 Volts C. Do not use D. No significance

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14. Which of the following is NOT a proper lifting technique?

A. Establish firm footing B. Tighten stomach muscles C. Get help when needed D. Keep items as far away from your body as possible

15. The Health Insurance Portability and Accountability Act of 1996 requires hospitals and

healthcare providers to have privacy provisions in place to protect a patient’s health and

financial information?

A. True B. False

16. The Compliance Hotline is to be used anytime an individual does not want or feel

comfortable discussing a matter of compliance with their immediate supervisor?

A. True B. False

17. An occupational injury or illness is to be reported:

A. Never B. Immediately C. Next shift D. When Convenient

18. All of the items listed below are examples of Personal Protective Equipment EXCEPT:

A. Gloves B. Face Shields C. Eye Protection D. Identification Badge

19. The proper length of time for hand washing is:

A. 3 seconds B. 5 seconds C. 30 minutes D. 15 seconds

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20. Who should report infection control risks?

A. Only Nurses B. Volunteers C. Everyone D. All Medical personnel

21. H.E.A.R. (Hospital Employee Accident Report) is completed when:

A. You are out of work more than 3 days B. When you are requesting time off C. When you have a work related accident or exposure D. A visitor falls

22. All workplace injuries/exposures are managed through:

A. Your personal physician B. Employee Health C. Emergency Department D. Human Resources

23. An example of a ferrous object would be:

A. Book B. Wheelchair C. Plastic container D. Coffee cup

24. May a patient with a pacemaker have an MR exam at Harnett Health System?

A. Yes B. No C. Maybe D. If they turn it off