Student Orientation 2013

 During the time you are completing this module, you may call 802-3382 for any questions. Also the Infection Prevention Nurse is here Monday through Friday 8-4:30 at ext. 4969.  Questions that you have at night or on the weekends may be directed to the House Supervisor at 3037.

Our Mission StatementAbove all else, we are committed to the care and improvement of human life. In recognition of this commitment, we will provide exceptional healthcare to our expanding communities with compassion and integrity pursuing excellence in all we do.

Helping, Healing, Giving HOPE.

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Vision Statement

As the Nationally recognized tertiary care provider of the largest healthcare system in NW GA, Redmond will support and engage our medical staff, expand and modernize our facilities, grow our Primary Care, Occupational Health, and EMS networks, and enhance our community presence. We will promote staff development and deliver exceptional patient care every time. Our reputation for success will be recognized through service line growth, increased market share, exceptional clinical outcomes, and superior patient, physician and employee satisfaction.

We are Redmond.

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Values With Excellence

Compassion Accountability Respect & Ethics...

We are Redmond!

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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.

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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.

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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.

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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.

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EMTALA When a patient comes to the emergency

department (emergency can be located on any part of the hospital campus), 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.

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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 patient’s comfort needs near the end of life. This includes psychosocial, spiritual, and physical needs.

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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.

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Pet PartnerAnimal Visitation Program

Animal visitation is a short term intervention to help improve the patient’s well being and reduce loneliness. Pets provide opportunities for patients to display affection and emotion, practice social skills, and have positive experiences. The visit is determined by the patient’s needs at a particular time. Pets used for animal assisted activity are not patient’s pets. The adult dogs or cats brought to this facility will be certified through Delta Society (www.deltasociety.org).

Animal must be appropriately restrained with identification. Identification will include a Redmond picture ID Badge attached to the animal’s vest or collar.

Pet Partner Volunteer will contact the charge nurse on the floor of the patient on the day of the visit.

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Pet PartnerAnimal Visitation Program Staff Responsibility

Ensures that patient meets criteria for an animal visit. Animals are restricted from food preparation service

areas, and other high risk areas including: any patient with a decubitus, surgical patients, open wounds or burns, open tracheotomy, immune-suppression, all isolation precautions rooms, critical care area patients, patients with tuberculosis, salmonella, campylobacter, shigella, streptococcus A, MRSA, ringworms, giardia, and amebiasesis are excluded from this program.

In the event that a patient receives a bite or scratch, the patient’s nurse will complete an occurrence form about the incident. The nurse will notify the patient’s physician and the Infection Prevention Director.

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Teamwork: A cooperative effort by members of a group trying to achieve a common goal.

To make teamwork happen…Communication is a necessity.Must have interaction with others even when things are not going as planned.Get Feedback from other staff members and managers.Share the responsibility.

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Skills for Teamwork: Listening Questioning Respecting and supporting ideas Helping Sharing Participation

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Teamwork People who work in a hospital situation know how to

manage high-stress situations, but frustrations can build. Working as a team will reduce situations where a staff member feels overwhelmed by his/her workload or the temperament of an unpleasant staff member.

Compassion and common courtesy are appropriate not only when communicating with patients; they are also vital in how you treat your coworkers.

If everyone does his/her job in an efficient manner and is aware of the needs of other staff members, he/she can contribute to the overall morale.

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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.

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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 Rhonda Culp 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.

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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 FatigueWarm-up exercisesInterrupt sustained posturesProper ergonomicsAppropriate work methodsLimited overtime

Increase RecoveryPhysical fitnessProper nutritionGood sleeping posturesIce after activitiesAvoid smokingAlternative job placement

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Eligible All Redmond Employees Spouses/Dependents

insured thru HCA Occupational Health EMS IT & S Shared Services

PAS Supply Chain - Materials

Not Eligible Redmond Spouses/Dependents

not insured thru HCA insurance HCAPS

Family Care Centers Team Health

Anesthesia ED Providers

Surgery Center (ASC) Volunteers Contractors (i.e. Sudexo,

Securitas, etc)

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Employee Safety and Workers’ Compensation

Our facility’s commitment is to you. We have programs in place to make our facility as

safe as possible for you, our patients, and visitors! We will work in your best interest to ensure

accidents are handled properly and you get the medical care you need.

With your help, our program will be effective!

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Employee Safety Committee

Consists of members from key departments within this facility.

Meets bi-monthly to review injury statistics and address prevention needs.

Completes quarterly hazard surveillance rounds to identify and correct hazards.

Progress is monitored by Senior Leadership.

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Area’s of Concern 2013 Compliance with all policies & procedures. Timely hazard reporting. Timely accident reporting. Always wear appropriate Personal

Protective Equipment. Slip, trip & falls prevention. Patient management.

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Compliance with all Policies and Procedures

Employees are responsible for following current RRMC policies and procedures and notifying their supervisor for identified safety hazards.

Wear Personal Protective Equipment Employees are responsible for wearing the

appropriate personal protective equipment for isolation precautions (see Infection Prevention slides for details).

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Timely Hazard Reporting Hazards will ultimately injure one of our staff, a

patient, or a visitor. We are all responsible for ensuring hazards are

eliminated. Report potential hazards to Clay Callaway, Safety

and Security Officer and/or Rhonda Culp, Employee Health Services.

Discuss potential hazards during staff meetings.

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Timely Accident Reporting If you are injured on the job you should report the

accident to your supervisor immediately! The appropriate medical care will be coordinated

for you. Contact Employee Health Services for panel physician authorization.

A post-accident investigation will be performed by your manager to determine what, if anything, can be done to prevent a similar occurrence from happening again.

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Slip, Trip, & Fall Accident Prevention

A slip occurs when there is too little traction or friction between the shoe and the walking surface. Some common causes of slips are wet surfaces, occasional spills, weather hazards, and loose rugs.

A trip occurs when a person’s foot contacts an object in their way or drops to a lower level unexpectedly, causing them to be thrown off-balance. Common causes of trips are obstructed view, poor lighting, clutter, wrinkled rugs, uncovered cables or cords, bottom drawers not being closed, and uneven walking surfaces.

A fall occurs when you are too far off balance. This can occur as a same level fall or a fall to a level below the one you are walking on. Falls from elevations such as ladders, stairs, and loading docks can be much more severe.

There are numerous personal factors that may increase an individual’s risk of a slip, trip, or fall. These include age, body shape or mass, gait dynamics (the particular way an individual walks), physical condition, perception (an individual’s ability to see and their awareness of their surroundings), and psychological and psychosocial factors (stress and distractions).

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Slip, Trip, & Fall Accident PreventionHere are some simple ways to alter your behavior and help avoid slips, trips, or falls: Watch where you are going while walking – pay attention and look for slip, trip, and fall

hazards Walk, don’t run – make sure you give yourself enough time to get where you are going Don’t engage in activities that may be distracting – for example: reading or texting while

walking Use handrails when climbing or descending stairs Check that your walkway is clear and that your view is not blocked before you lift

anything Don’t carry a load that you can’t see over or around while carrying Walk carefully and slowly when transitioning from one walking surface to another Slow down and take small steps if the walking surface is cluttered, narrow, uneven,

slippery, or at an angle Wear stable proper fitting shoes with non-slip soles – avoid backless shoes to help

decrease your risk for slips, trips, or falls When entering a building on a wet day, remove as much water from your shoes as possible

– walk carefully as the floors may be slippery

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Patient Management Accident Prevention

Patient Transfers - Bed to Chair Make sure everyone involved knows their role and expectations for the transfer

Call for assistance if the patient is a mod or max transfer Call for assistance if the patient has required more than one person in the

past Call for assistance if you are unsure how the patient will do

Make sure that the surface you are leaving and the surface you are going to are close and that all brakes are applied

If one side is weaker, it is best to transfer to the stronger side Ensure the patient is wearing proper foot wear  Transition the patient from supine to sitting edge of bed Give the patient time to adjust to this position to ensure they do not get dizzy

or lightheaded

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Patient Management Accident Prevention Continued…

Help the patient scoot to the edge of the bed so their feet are resting on the floor for balance and support 

Place a gait belt around the patient Position yourself for the transfer Have patient rock with you and stand on the count of

three to ensure everyone is assisting at the same time  Pivot to the chair Have patient reach for the surface/arm rests of the

surface they are transferring to Remove gait belt

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Patient Management Accident Prevention Continued

Patient Transfers – Bed to Bed or Bed to Stretcher Make sure everyone involved knows their role and expectations for

the transfer  Ensure sheet is adequately under the trunk and buttocks of the patient Ensure enough people are present for the size of the patient Those on the side being transferred to, kneel on the bed to pull the

patient half-way Make sure patient keeps their arms folded across their chest One person takes charge and counts to three for everyone to go Patient is transferred halfway, then the people receiving the patient get

off the bed onto the floor and the people sending get on the bed for the remaining half

Ensure everyone is ready and the lead counts to three again.

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Patient Management Accident Prevention Continued

Patient Transfers – Repositioning in Bed Use gravity to assist if able and place the bed in Trendelenburg Have the patient bend their knees to assist with the push Have them place their arms across their chest Ensure the pad/sheet is adequately under them Ensure everyone knows their role  One lead counts to three for patient to push with their legs and those

assisting to pull Make sure you move with the transfer and do not twist or torque

your body, rather move your feet and step For all transfers, know your precautions: Cardiac, Total Hip Precautions,

Lumbar Precautions following surgery, Hemiparesis, etc… Contact our Rehab department as needed for questions.

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Safety: A Shared Responsibility Redmond’s responsibility is to provide a

safe work environment that facilitates safe work procedures.

Each employee’s responsibility is to practice safe work skills that incorporate proper body mechanics and work procedures while keeping their body well and fit for their work tasks.

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If you are Injured on the Job Report the injury to your supervisor IMMEDIATELY! Workers’ Compensation benefits may apply to your

injury, please follow up with Employee Health Services. Workers’ Compensation provides the following benefits:

Medical - Follow-up after emergency treatment and evaluation by authorized providers is coordinated through Employee Health Services.

Lost Wages – The state has limits on the amount of lost wages you may receive if you miss time from work.

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Direct Cost of Injuries

Inability to continue working Impact on your wages Disruption of your family life and routines YOUR CAREER

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Set Good Examples Be proactive in the identification of hazards and

prevention of injuries. Report injuries timely and work with Employee

Health Services throughout the rehab process.

Maintain Communication Maintain contact with your department Director. Contact Employee Health Services with any issues

related to your injury!

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Transitional Duty

Light-duty or transitional duty may be accommodated if a department has a need and is able to utilize an employee for job duties that fall within the employee’s treating physician job restrictions and charge these hours to their department without going over productive staffing targets or creating overtime as a result of accommodating light duty.

This will be reviewed and approved on a case by case basis by the department director, Employee Health Services, and the HR director as needed.

If the department becomes no longer able to provide these job duties without going over productive staffing targets, then light-duty work will not be an available option.

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Employee Health Services (EHS)Non-work Related Illness or Injury

EHS stocks many over-the-counter medications; these are available for employees as needed.

EHS also provides free blood pressure checks, weight checks, and basic first aid.

You will report to EHS annually for your required health update and Respirator Fit test (if appropriate for your job).

For conditions requiring prescription medications, labs, x-rays, and that require the attention of a nurse practitioners, Rome Redmond Wellness Center or West Rome Family Care Centers can provide those services.

Employees may be referred to their Primary Care physician for further evaluation, treatment, and/or follow-up.

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Blood Borne Pathogen Plan A copy of our plan is available on the RRMC intranet site. The plan explains the processes we have in place to

minimize exposures, and what to do if there is an exposure to a blood or body fluids.

Potentially infectious fluids: blood, semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, amniotic fluid, or any other fluid that is visibly contaminated with blood and all body fluid where it is difficult or impossible to differentiate, saliva in dental settings, tissue and organs that are not fixed other than intact skin (from any human living or dead), HIV containing cell or tissue cultures or organs, and tissue from experimental animals infected with blood borne pathogens.

How to Reduce Transmission of Blood Borne Pathogens? Observe engineering controls; needle-less systems, safety

devices, sharps disposal containers, biohazard waste containers, needle boxes at appropriate height.

Observe work practices; never recap needles, perform hand hygiene, use appropriate PPEs, do not bend or break needles, do not eat or drink in areas where there is potential for exposure, do not store food or drinks in a refrigerator that is used to store blood or other potentially infectious material (OPIM), use red biohazard bags for disposal of infectious wastes.

Know the job tasks in your department that may involve exposure to blood or OPIM and wear appropriate PPEs. Ask your leader for a list of tasks in your department and the required PPE.

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.

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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.

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What Can You Do To Prevent Sharps Injuries?Follow Policies Don’t 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.

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What Can You Do To Prevent Sharps Injuries?Dispose of Sharps with Care Don’t 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.

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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.

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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.

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Hepatitis B Hepatitis B is a contagious blood borne disease

affecting the liver Can be mild lasting a few weeks or a serious lifelong

illness Symptoms may include jaundice, fatigue, fever,

nausea, and abdominal pain Spreads when infected blood and body fluids enters

the body of a person who is not infected Exposures may occur with needle-sticks/sharps

injuries

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.

Hepatitis B vaccines are free. For a susceptible person, the risk from an

exposure can range from 6 – 30% and depends on the status of the source individual.

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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).

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What is Hepatitis C? Hepatitis C is another contagious blood borne disease

affecting the liver. Can be a mild illness lasting a few weeks to a serious

lifelong illness that attacks the liver. It is primarily spread through contact with the blood

of an infected person . HCV infection often occurs without symptoms or

with mild symptoms. The symptoms are very similar to those of Hepatitis B.

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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.

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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.

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What is HIV?

Human immunodeficiency virus (HIV) is a virus that can lead to acquired immune deficiency syndrome (AIDS).

HIV damages the immune system and makes a person with AIDS more likely to get serious infections and other diseases.

It may be transmitted by contact with an infected person’s blood or body fluids which enter the body of a person that is not infected.

Within a few weeks of being infected with HIV, some people develop flu like symptoms that last for a week or two, but others have no symptoms at all.

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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%.

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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.

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What is an Exposure? Contact with another person’s blood or OPIM such as in needle

sticks/sharps exposures, mucus membrane exposure, or exposure to non intact skin.

If you are exposed to blood or OPIM, you should clean the skin injury site with soap and water. If it is a mucous membrane exposure, flush the area with water.

Inform your supervisor or the designated charge person and go to Employee Health Services (may go to the Emergency Room during other hours) to be evaluated.

Complete occurrence form. You will receive risk information, be evaluated by the ER physician or

the Nurse in Employee Health Services, be informed of recommendations of treatment, and receive care.

You should follow up after your initial evaluation the next day with Employee Health Services.

You will receive a written opinion for any future recommended follow up in approximately 15 days.

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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:

the pathogen involved the type of exposure the amount of blood involved in the exposure the amount of virus in the patient’s 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

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Biohazards Biohazard Labels

These labels are warnings that the contents of the container are possibly infectious materials.

Linens Use standard precautions when

handling linens. Linens are treated as if potentially infectious. Linens removed from isolation rooms should be taken to the laundry chute.

Biohazardous Waste Management

It is VERY important that hazardous medical waste be placed in the appropriate disposal system. The following are considered hazardous waste and must be disposed of properly: Chest tubes — Place in red bags Anything “wet” with blood or body fluid (gauze,

disposable towels, etc.) — Place in red bags Suction canisters — Use isolyzer and place in red bags Blood bags after infusion completed — Place in red bags All used syringes — Sharps containers (needle boxes) All sharps (needles, scalpels, suture needles, etc.) —

Sharps containers (needle boxes) *Always activate the safety device

Five Questions OSHA might ask about Blood Borne pathogens: What is standard precautions? All blood and body

fluids are treated as if potentially infectious by wearing appropriate PPE when dealing with them.

What do you do when there is a blood spill? Wear PPE, locate spill kit, follow directions, dispose of properly in red bag and disinfect area where spill occurred.

What do you do with contaminated sharps and laundry? Used sharps go in designated sharps containers made of hard plastic that are puncture resistant, linen goes in the dirty linen hamper or is taken to linen chute.

Questions continued Have you been offered the hepatitis B vaccination

free of charge? Yes, by employee health services (all employees have opportunity to receive the vaccine).

Where is the Bloodborne pathogen plan? On the intranet under IC policies, in the nursing office, or can be obtained through employee health services.

If you have questions about Bloodborne

Pathogens, contact Employee Health at ext 4968, or Infection Prevention ext 4969

8:00am – 5:00 pm

Monday through Friday

If EH or IP is not available, contact your Department Leader or the Nursing

House Supervisor.

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

Prepare Your Family Have a plan for your family Review 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

How would Redmond handle an influx of infectious patients?

If a large number of infectious patients suddenly presented to the hospital, we would activate our emergency preparedness plan.

This plan addresses staffing, supplies, and other issues that might occur as a result of the increased patient load.

INFECTION PREVENTIONOur goal is to reduce risks

and prevent infection in our patients. Why all the fuss about hand hygiene?

Most common way to transmit bacteria is hands. Hand hygiene is very effective in reducing

transmission of infections. Two products can be used: Soap and water –lather hands using friction for

15-20 seconds, rinse under running water. Use soap and water if hands are visibly soiled or in case of tier 2 (high rate or outbreak) for c difficile.

Alcohol based product –Cover all surfaces of hands and fingers and rub together. Once dry, your hands are safe.

Indications for Hand Hygiene Before:

–Patient contact or contact with environment

–Donning gloves when inserting a CVC

–Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don’t require surgery

After:

–Contact with a patient’s skin, body fluids or excretions, non-intact skin, wound dressings

–Contact with patient’s environment

–Removing gloves

Nails: Direct Patient Care Givers Natural nail tips should be kept to ¼ inch in

length Artificial nails are not to be worn (includes a

few non clinical departments) Nail polish may be worn in most departments

as long as it is not chipped

Check with your department leader if you have questions about whether you can wear polish or artificial nails while at work

Standard Precautions

Assume that every person is potentially infected or colonized with a bacteria that can be transmitted to others. Applies to another person’s blood or body fluid.

Wear appropriate Personal Protective Equipment (PPE) when you anticipate contact with blood or body fluids.

Remove PPE before leaving patient’s room.

Transmission Based Precautions: Used in addition to Standard Precautions

Contact Precautions (gown, gloves, and sometimes mask)

Airborne Precautions (wear N 95 mask) Droplet (wear regular mask)

Enhanced Droplet Precautions (wear regular mask except a N 95 mask must be worn when doing aerosol generating activities)

Transmission Based PrecautionsContact Precautions Airborne Precautions

Used for illnesses transmitted by airborne droplets.

Patient is placed in a negative air flow room.

Patient wears a regular mask if they need to leave the room.

Staff must wear N 95 mask when entering room (staff who have not been fit tested may not go in this room).

Visitors are instructed on how to wear an N 95 mask by the nurse.

Used when patient has a bacteria transmitted by direct patient contact or by indirect contact by touching environmental surfaces in patient room.

Gowns and gloves must be worn and sometimes a mask.

Private room for patient or placed with patient with the same bacteria.

Before leaving the room, patient should put an isolation gown over their attire, and wash hands. If patient is bed bound, place the gown on the end of the bed with the chart on top of it.

Notify Environmental Services to terminal clean room when patient is discharged.

Transmission Based PrecautionsDroplet Precautions

Used for illnesses transmitted by large droplets.

Staff wear regular mask. Patient is placed in a private

room, may be placed in room with another patient with same pathogen.

Patient wears a regular mask when leaving room.

Visitors wear regular mask in room.

“Enhanced” Droplet Precautions

Applies when patient has influenza. Staff wear regular mask, EXCEPT

wear N 95 mask if performing aerosol generating activity (move patient to negative air flow room when feasible).

Ask visitors to step out of room when aerosol generating activities are being done.

Keep patient on precautions for 7 days after onset of illness or until 24 hours after the resolution of fever and respiratory symptoms which ever is LONGER!

Personal Protective Equipment (PPE)Gloves

Wear gloves when contact with blood or other potentially infectious materials is possible.

Change gloves when going from dirty area to a clean area.

Remove gloves after caring for a patient and wash hands.

Do not wear the same pair of gloves for the care of more than one patient.

Do not wash gloves for reuse.

Gowns Wear a gown to protect skin

and prevent soiling or contamination of clothing during procedures and patient-care activities when contact with blood, body fluids, secretions, or excretions is anticipated.

Remove gown and perform hand hygiene before leaving patient environment.

Do not reuse gowns.

Multi Drug Resistant Organisms (MDRO’s)

Methicillin-Resistant Staphylococcus Aureus (MRSA) MRSA is a staph bacteria resistant to some antibiotics. MRSA can be transmitted by direct contact with the patient or their

environment. Colonization with MRSA –means it is present, but does not cause

the person to be sick. Infection with MRSA-causes the person to be sick.

High risk patients admitted to our hospital are screened for MRSA upon admission. If their test is positive (meaning they have MRSA in their nose), they are placed on contact precautions. This is why you are seeing more patients on contact precautions.

Redmond has a very low rate of MRSA acquired at our hospital!

MDRO’s

Vancomycin Resistant Enterococcus (VRE) Bacteria that has become resistant to certain antibiotics. Contact Precautions should be used. High risk patients are screened for VRE on admission. Most patients who have VRE are colonized, not infected

with VRE. Redmond had zero VRE infections acquired at our

hospital last year. Carbapenum Resistant Enterobacteriaceae

Most common – Klebseilia Pneumoniae Carbapenemaic (KPC)

Contact Precautions should be used.

Clostridium Difficile (C diff)

May develop due to prolonged use of antibiotics. Causes diarrhea and more serious intestinal conditions. Can be transmitted by hands. Recently released information allows hand hygiene with

alcohol gel or soap and water in non outbreak situations.  In case of tier 2 (high rate or outbreak) of c difficile, soap and water is required.  Infection prevention will inform staff of tier 2 recommendations.

Environmental services cleans room at discharge using bleach wipes or bleach.

Preventing MRSA, VRE, and C Difficile Wash hands before and after contact with patient or

environment. Disinfect medical equipment between patients (this

includes your stethoscope). Staff wear gown and gloves upon entering room (Contact

Precautions). Encourage visitors to wash their hands. Education sheet to patient/visitors. Visitor may decide for themselves whether or not to wear

a gown or gloves. Exception: if the visitor is visiting other patients they must wear a gown and gloves in a contact precaution room.

Use disposable equipment, such as B/P cuffs and stethoscopes when possible.

Transporting Patients on Contact Precautions: Notify receiving department that patient is on contact precautions. Patient should wear isolation gown over their attire if transported by

wheelchair, if bed bound place folded gown over end of bed and chart on top of gown, and wash patients hands prior to transport.

Transporter washes hands and dons isolation attire upon entry to room.

Transporter assists patient on stretcher or in wheelchair. Transporter removes isolation attire and washes hands.

If transporter anticipates they might have contact with patient’s blood or body fluid while transporting patient, the transporter can don new attire after washing hands prior to transporting patient out of room.

A second person, not wearing isolation attire, should assist with transport of the patient. The second person performs all the environmental contact during the move such as opening doors and pressing elevator buttons.

Transporter will don new isolation attire (gown and gloves) before helping patient off stretcher or wheelchair at destination.

Preventing Surgical Site Infections (SSI)

Surgery patients may be given a special product to use to bathe or shower before surgery

Hair is removed by clippers NOT razors OR staff perform hand scrub prior to case Special attire is worn by OR staff during surgery Antibiotic is given before surgery Antibiotic is discontinued within 24 – 48 hours

depending on the surgery

~250,000 Blood stream infections occur every year in the U.S.

Why Aim for Zero Many blood stream infections related to central lines

are preventable. Bundle practices help prevent blood stream

infections.

Insertion Bundle Practices: Wash hands prior to

inserting and handling line.

Provider (and assistant) inserting line wears sterile mask/gown/gloves, and cap.

Patient is covered with a large drape.

Patient’s skin is cleaned with a special skin prep.

Maintenance Bundle Practices: Assess need of line daily. Perform hand hygiene before touching

line or dressing. Use CHG unless contraindicated for site

care and dressing changes. Change gauze dressings every 2 days or

clear dressings every 7 days unless soiled, dampened, or loosened.

Replace tubing and connectors per policy.

Scrub the hub for 10-15 seconds before accessing device.

Preventing Ventilator Associated Event

Head of bed up 30 degrees unless contraindicated

Daily “sedation vacation” and daily assessment of readiness to extubate

Peptic Ulcer Disease Prophylaxis Deep Venous Thrombosis Prophylaxis

(unless contraindiated)

Preventing Foley Related Urinary Tract Infections

Hand hygiene prior to inserting a foley Only staff who have completed competency

may insert catheters Insert catheters only when necessary Assess need daily, ask physician for order to

remove when no longer needed Keep bag below the level of the bladder at all

times

Tuberculosis (TB) Update

Spread person-to-person by air droplets

Symptoms: greater than three weeks of cough, unexplained fever, weight loss, and night sweats.

Active TB is contagious. Airborne Precautions with

negative air flow room required. Door must remain closed at all

times except when entering and exiting the room.

N 95 masks are worn when entering the room.

A person can have a positive PPD skin test without active TB. Clinician must determine whether active or not.

Associates with active tuberculosis can not work until cleared by the health department and employee health.

RRMC is a low risk facility for TB. Annual PPD skin tests are not required except for staff in microbiology and histology.

Respirator and Fit Testing toPrevent Transmission of Airborne Illnesses

N-95 Respirator Designed to provide respiratory protection for the wearer. Filter efficiency level of 95% or greater against

particulate aerosols free of oil. Reduce the wearer’s exposure to certain airborne particles

in a size range of 0.1 to 10.0 microns, including those generated by electrocautery, laser surgery, and other powered medical instruments.

The masks are designed to be fluid resistant to splash and splatter of blood and other infectious materials.

These masks are not designed for industrial use.

Respiratory Fit TestingFit Testing Employees with a possibility of

exposure to airborne illness will be fit tested with one of the masks available here at RRMC before they can wear a respirator. 3M 1860 Regular and Small (blue

mask) Tecnol Fluidshield Regular and

Small (orange duck-bill) Compliance with OSHA standards

requires fit testing completion with hire and repeat fit testing annually thereafter.

Fit testing will be completed in Employee Health Services during month-of-hire annual evaluation.

Medical Evaluation

A medical evaluation questionnaire is required for all employees wearing a respirator in the workplace.

This evaluation will determine whether or not an employee is medically able to wear a respirator. All employees may not pass this evaluation.

Employees who do not pass the medical evaluation cannot wear a respirator and should not enter rooms were a patient is on airborne precautions.

Respirator Mask

Every employee fit tested for a respirator is responsible for knowing what size mask they wear.

A sticker is placed on back of ID badge with mask brand and size at the time of fit testing.

Employee Health Services and department supervisors will have documentation of mask size for employees that have been fit tested.

The mask must be discarded if it becomes soiled or at the end of your shift. Masks are stored in the ante room in a open plastic bag labeled with staff name.

Concerns Any employees with medical problems, respirator

problems (such as fit seal difficulty), or any concerns should contact Employee Health Services.

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 bloodborne 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. 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, use the latex free supplies located in the green bin in your supply room. Need more information? Contact the Nursing House Supervisor at ext. 3037. For associates with latex allergies, contact Employee Health Services ext. 4968. 87

Performance Improvement(PI) Performance Improvement means simply doing

things a little bit better tomorrow than we did them today. Redmond is accredited by The Joint Commission which requires that we have an improvement plan in place. To make our improvement efforts as visible as possible, Redmond uses a tool called FAST-PDCA to document our improvement projects.

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Performance Improvement High quality organizations make continuous efforts to improve

their services and products. Opportunities to “do things better” exist in all departments of our hospital.

Performance improvement occurs the fastest when every employee asks themselves, "Is there a better way to do this?" or "Why are we doing this at all?” You know when a process is broken because you have to work with it every day. FAST-PDCA allows us to test a new or better idea, fine tune it if needed, then implement it.

Another way for patient care departments to improve their care delivered is to implement evidence-based medicine that has already been determined to be the best way, or best practice, to deliver medical care. Healthcare delivery changes constantly due to new innovation and continuing research. We have the responsibility to know what constitutes best practice and to see that it is implemented at Redmond. Please contact your manager or quality department when you hear, see, or read of best practices implemented at other facilities.

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Performance Improvement Core Measures, which are a series of evidence-based best

practices, are an integral part of how we deliver patient care at Redmond.

They are not optional for a couple of reasons: They represent best care. How well we adhere to Core Measures is compared to every other

hospital in our region and state, as well as across the United States, as an objective way for consumers to compare how well we deliver care.

Medical charts are audited continuously to determine our adherence to the Core Measures.

When we fail to adhere to them, an opportunity exists to improve our processes. If you were involved in a missed opportunity, the Quality Department will reach out to you to help determine how to improve our care delivery.

Nurses should commit to memory the next 8 slides on Core Measures, it’s that important!

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CORE MEASURES: Myocardial Infarction

• Beta blocker at discharge or document a reason if with-held

• Document LVSD or Ejection Fraction (EF)• ACEI or ARB for EF<40% or document a reason if

with-held• ASA for chest pain/or MI on arrival and discharge or

document reason if with-held• PCI within 90minutes for STEMI or LBBB• LDL within 24hrs of admit• LDL >100 discharged on statin or document a reason if

with-held

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CORE MEASURES:Congestive Heart Failure Document LVSD or EF ACEI or ARB for EF<40% or document a

reason if with-held Discharge instructions must include:

Activity & Diet & Follow-up visit Worsening symptoms Weight monitoring List medications as found on Med Reconciliation

Form

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CORE MEASURES:Pneumonia Blood cultures before antibiotics

1st antibiotic in ED within 6 hrs of arrival

Flu vaccine given – October–March (Must be current season – Remember to document)

Appropriate antibiotic selection

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CORE MEASURES:Surgical Care (SCIP) Prophylactic antibiotic 1 hour prior to incision (2 hours for

vancomycin)

Appropriate antibiotic

D/C antibiotic within 24hr (48 for CABG) after surgery end time or document reason for continuing antibiotic

Clip hair only/never shave

(continued)

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CORE MEASURESSurgical Care (SCIP) (continued)

Continue beta blockers (never stop abruptly and document received the day before surgery and/or the day of surgery as well as POD 1 or POD2!)

VTE (clot) prevention within 24 hours before surgery to 24 hours after surgery

6am blood sugar on Day 1 and Day 2 for CABG and valve patients

D/C foley by POD#2 or document reason95

CORE MEASURESVenous Thromboembolism (VTE) NEW CORE MEASURE FOR 2013! Documentation required for:

VTE prophylaxis for ALL inpatients OR “Patient at low risk for VTE, no prophylaxis

needed” If VTE prophylaxis is not built in to an order

set, there is a new universal order set for VTE prophylaxis

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CORE MEASURESImmunization Measure

NEW UNIVERSAL MEASURE FOR 2013! Pneumonia vaccine status:

vaccines must be given, refused, or medically contraindicated due to allergy or current active chemotherapy

Influenza vaccine status: Oct 1-March 31 – If received prior to admission, it

must have been for the current flu season

CORE MEASUREStroke Core Measure NEW CORE MEASURE FOR 2013! Venous Thromboembolism Prophylaxis

by the end of hospital Day 2 Antithrombotic Therapy:

for ischemic stroke patients by end of hospital Day 2

Discharged on statin medication Assessment for Rehabilitation Stroke Education

Opportunities for Improvement

If you want to learn more about Performance Improvement or feel you have a better way of doing things at Redmond, please see your manager or Jon King, Quality Director (located in the Lower Level near Human Resources at extension 3155).

Thank you for all you do!

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2013 HospitalNational Patient Safety Goals

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.

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Identify Patients Correctly Use at least two ways to identify patients. For

example, use the patient’s name and date of birth. This is done to make sure that each patient gets the medicine and treatment meant for them.

Make sure that the correct patient gets the correct blood type when they get a blood transfusion.

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Improve Staff Communication Get important test results to the right staff

person on time. Critical results from lab, radiology, or

cardiology must be reported within 30 minutes to physicians. Time can be a factor when addressing these issues for patient health.

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Use Medicines Safely 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. Educate the family and the patient. Record and pass along correct information about a

patient’s medicines. Find out what medicines the patient is taking. Compare those medicines to new medicines given to the patient. Make sure the patient knows which medicines to take when they are at home. Tell the patient it is important to bring their up-to-date list of medicines every time they visit a doctor.

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Prevent Infection Use the hand cleaning guidelines from the Centers

for Disease Control and Prevention or the World Health Organization.

Use proven guidelines to prevent infections that are difficult to treat.

Use proven guidelines to prevent infection of the blood from central lines.

Use proven guidelines to prevent infection after surgery.

Use proven guidelines to prevent infections of the urinary tract that are caused by catheters.

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Prevent Mistakes in Surgery Make sure that the correct surgery is done

on the correct patient and at the correct place on the patient’s body.

Mark the correct place on the patient’s body where the surgery is to be done.

Pause before the surgery to make sure that a mistake is not being made.

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Identify Patient Safety Risks Find out which patients are at risk for

committing suicide, or are abused or neglected.

Keep the patient safe and notify the physician.

Make sure these patients are referred for appropriate care and are kept safe in our hospital.

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I-Privilege If you are un-sure if a physician is

credentialed to perform a service here at RRMC you can use I-Privilege to look up his/her credentials.

From our home page click on the I-Privilege link in the right hand column

Then on the left of the screen that is pulled up click on I-Privilege again

Then use our COID -31052 for your User ID and Password

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Guidance Document: Tubing and Line Safety using I-TRACE

Behavioral expectations

I: Illuminate the patient care area whenever invasive medical lines and tubes are manipulated (initiated, accessed, maintained, or discontinued).

T: Perform hand hygiene. Touch the line or tube and trace it from the insertion point on the patient back to the point of origin.

R: Perform a cognitive review. What is the purpose/expected outcome of the line/tube intervention about to

occur? Visualize the actions planned; take time to ensure the planned actions will deliver the expected outcome.

Has a 2 point patient identification been carried out? Has BCMA been utilized to the fullest extent possible for the intervention about to

occur (e.g. medications; TPN)?

A: Act if any mismatch between the planned activity and desired outcome is discovered, either through BCMA alerts, independent double checks, or a cognitive review.

C: Clarify and correct. Concerns expressed by primary caregivers, colleagues, patients, or family member are valid and sufficient reasons to seek clarification before proceeding with a task involving lines and tubes. Correct any discrepancies before proceeding with the intervention.

E: Expect to use the ITRACE process: each time a line or tube is accessed, manipulated, or discontinued and when care is handed-off to another clinician or care team. 108

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 two109

Rapid Response Team The purpose of the Rapid Response Team is to provide

critical decision making and intervention at the first sign of patient decline; to prevent arrest situations, and save patient lives. The utilization of a Rapid Response Team will bring critical care expertise to the patient bedside before a crisis situation results in a cardiac/pulmonary arrest. The call is initiated by dialing (706) 233-5625 and

entering the patient’s three digit room number. Hospital staff or patient's family/visitors may initiate.

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Rapid Response Team The role of the Rapid Response Team (RRT)

will be to: Assess the patient and the situation. Assist with stabilizing and transporting, if needed, to a

higher level of care. Assist with organizing information to be communicated to

the patient’s physician using the SBAR tool. Educate and support the nursing staff. The RRT does not “replace” calling the primary physician –

but supplements, organizes, and expedites information to the physician.

Family members and visitors can also call the RRT.

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FALL RISK Nursing staff will assess the patient for safety/fall risk

at the time of admission, and as indicated by the unit assessment/ reassessment policy and with each change in condition: Identify problem as potential for injury related to fall risk on the care plan/problem list.

Safety rounds (with a purpose) are completed and documented Q 1 hour until 10pm, then Q 2 hours through 7am and also PRN.

For example, explain that you are there to assist the patient to the bathroom.

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FALL RISKFall Reduction Activities

Place a yellow sign at the head of the bed. Place a yellow bracelet on the patient. Place yellow socks on the patient. Place fall risk magnetic stickers on the patient’s doorframe. Educate the patient and family about the risk of falling and

to call for help. See if family members can stay when patients do not follow

instructions. If they are not able, outside resources may be hired by the family.

Frequently round for pain, potty, proximity of patient needs, and position.

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Hand-off Communication Process The hand-off communication process for

Redmond is based on the SBAR communication format.

SBAR stands for S – Situation B – Background A – Assessment R – Recommendation

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Hand-off Communication Process The tools used in the hand-off process

include: Direct face-to-face communication. Phone report. Reports printed from Meditech - SBARD. Communication is a factor in more than 90%

of Sentinel Events reported to the Joint Commission.

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Patient rights Patients and healthcare workers need to understand patient rights

and responsibilities to ensure that quality care is provided and that the patient can participate fully in their treatment and care.

How are patients informed of their rights? Patient Hand Book Patient Bill of Rights Signage in all areas of the hospital.

Patients have a right to an advocate to stay with them during their hospitalization as long as it does not infringe upon other patient’s rights or interfere with clinical care or pose risk.

Patients must be asked about what language they prefer to receive their healthcare information. The hospital is responsible to provide information in the requested language.

A patient or an advocate who is participating in their care must have the opportunity to use a competent translator in the preferred language. If a patient or family member refuses to utilize the provided interpreter, a waiver must be signed.

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Patient rights What is your role in patient rights?

Everyone is involved in protecting the rights of patients. For example, the right to confidentiality means not telling your friends or relatives when someone you know has been a patient.

We provide privacy for patients by always knocking before entering a patient or procedure room.

Patients have a right to a secure environment. Know how to respond during a disaster or fire.

Patients are informed of their right to establish advance directives or to change their current advance directive status.

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.

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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 Redmond’s Intranet site.

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Patient rights Access the Ethics Committee and the Ethic Resolution

Process. Phone: 706-802-3037. Any concerns over patient safety may be reported to the Joint

Commission. Phone: 800-994-6610. Access the grievance process. Express complaints or

concerns regarding care or services, including discharge.   Facility contact: 706-802-3950

Independent Agency:Office of Regulatory Health2 Peachtree Street N.W., Suite 200Atlanta, Georgia 30329Telephone: 1-404- 657-5726  Peer Review Organizations:Georgia Medical Foundation [Medicare]57 Executive Park South, Suite 200Atlanta, Georgia 30329Telephones: 1-800-282-26141-404-982-0411

 

Humana Military Healthcare

Services, Inc [Champus]

931 South Semoran Blvd., Suite 218

Winter Park, Florida 32702

Telephone: 1-800-658-1405

 

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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.

Effective pain management has additional benefits for the patient ,e.g., earlier mobilization, shortened hospital stay, and reduced costs.

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Unanticipated Adverse Events and How to Report

Occurrence Reporting An occurrence is an event that is unusual, significant or

notable. Categories include: Patient, Non-Patient (visitor, MD,

volunteer, student, facility, equipment) or Employee Examples include: Near Miss, Fall, Medication, Treatment and/or Testing, Adverse Effect, Equipment, Property, Assault (abuse or harassment), Error, Failure to follow policies & procedures, Failure to follow MD’s orders, User/Operator error, Defective or malfunctioning products, Incorrect action/activity, Inappropriate action/activity, Omission, Delay, Complications, Loss or theft of personal belongings, or Auto events with facility vehicles.

Occurrences should be documented in Meditech during the working shift or definitely within 24 hours. The department manager or house supervisor should be notified at the time of the event. Please notify the Risk Manager of all serious and potentially legal situations.

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Occurrence Reporting Meditech Reporting

Log onto Meditech - Select 500 Occurrence Reporting - Select Facility - Select Category - (If patient) At prompt type A# then the account number - (If Non-Patient or Employee) Type N into the first field to create a new report (For employee type in last name and press the look-up key) - If no previous Occurrence report exists for this patient , you will receive a message “No available notifications for this patient. Create a new one? “ Answer Y (Yes) - Answer all questions in field - Input will be by free text or pull down menu selection - Enter all the information you know or can obtain.

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Occurrence Reporting Look-up key (F9 ) displays a pull down menu. Previous field key (F6) allows you to backup. The enter key allows you to move forward one field. Magic or file key (F12):

This key will provide the menu for selection. You MUST FILE to save your work.

Exit key (F11): Caution exit does not save your work.

Text fields require typing from keyboard. An occurrence report is a confidential facility report that

should not be referenced in documentation on the patient’s record. If you have any difficulties, please don’t hesitate to contact

RISK MANAGEMENT at 3950.

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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 patient’s 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.

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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 patient’s 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. We report all deaths where the patient has been in

restraints within the previous 24 hours to CMS or if a restraint was implicated in the cause of death

Report to the appropriate department leader and Risk Management at 3950 or Regulatory Compliance at 3038 in the event that any of the above situations occur . The situation is reviewed and reported to the Office of Regulatory Services within 24 hours of knowledge that the event meets one of the State definitions.

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Suspected Impairment of Licensed Independent Practitioner All healthcare workers including physicians and

nurses should be 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 (e.g., doctor).

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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, loss of motor skill, excessive use or abuse of drugs including alcohol.

127

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

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Reporting a LIP Suspected of Impairment If any individual in the hospital has a

reasonable suspicion that a LIP (or any other healthcare workers) 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.

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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 person’s 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. If the patient has a copy, obtain a copy for the chart BY CONTACTING HIM or BEDBOARD.

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 providing blank forms.

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Emergency, someone call FOR HELP!!!

Question: What do you do in the hospital when you need help in a hurry?

Answer: Call extension 4000. The switchboard will answer your call immediately. This extension should be used the same as if you needed “911”. It is designed for emergency situations, not just to get through to the switchboard in a hurry. For example, this line could be used for a Code Blue or if a visitor was seriously hurt.

NEVER use this phone line for anything other than emergencies!

When you hear a code announced do not call PBX! They do not know what you are supposed to do

– they only know what they are supposed to do! Call your supervisor or leader.

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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. Don’t wait for an emergency to learn what you

should do. RRMC utilizes an all hazards approach.

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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.

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Environment of care EMERGENCY PREPAREDNESS CODES

Code Red—Fire Code Gray—Bomb Threat—Notify

Switchboard Code Blue—Adult Cardiopulmonary Arrest Code Blue PEDS — Pediatric

Cardiopulmonary Arrest Code Pink – Pediatric Abduction Code White – Adult Patient Elopement Code Green— Hostage Situation Code Orange—Hazardous Material Event Code Silver —Active Shooter Code Black - Structural damage to facility

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Environment of care

EMERGENCY PREPAREDNESS CODES Code Triage - Provides guidelines for

operations in the event of an emergency Code 900 - Show of force Code 1000 - Visitor, associate, family member

needs assistance Code Manpower – Lifting assistance Tornado – Tornado warning for Floyd County

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Environment of care CONTACTS

Extension 4000— Emergency line to Operator/PBX

Labor Pool Location — Classroom C (Ext. 2273)

Facility Privacy Officer — Santrell Marsh Facility Information Systems Officer —

Angie Turner VP Quality, Risk, Ethics and Compliance —

Deborah Branton Patient Safety Officer – Edma Diller Risk Management – Kathy Shapiro Facility Safety Officer — Clay Callaway Infection Prevention Director — Terri Aaron

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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!

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Code Manpower Associate should call for lifting assistance for any patient

that has lifting restrictions; is in position which prevents safe lift; patient lift would allow for injury of associate or may injure patient.

All associates should respond immediately to assist. Upon assessing the situation, the Nurse providing initial care and the Charge Nurse should develop a plan with the Physical Therapy associate to lift the patient without injury to the patient or themselves. Any patient requiring being placed on backboard should call EMS at 4911 and request a unit to respond to assist with equipment.

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Code Gray There has been a bomb threat

If you get the call, notify the switchboard at ext. 4000

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!

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Code Blue & Code Blue PALS Code Blue

Adult cardiac or respiratory event. Don’t forget the Rapid Response Team (Call for the

Rapid Response Team when you feel a patient’s clinical status is in decline).

Know how to call a code and where your supplies are located.

Code Blue PALS Pediatric cardiac or respiratory event. ED Nurse will respond to assist with running the

code.

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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 harm’s way

Get a good description of person, vehicle, tag, etc. Make sure unoccupied rooms and areas are checked

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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

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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

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Code Silver “Active Shooter” Lock down your area immediately. Move any

patients, family members /bystanders or staff to safe area.

Call ext 4000 to report threat if safe and then call (9) 911 on in house lines or 911 on cell to report issue to 911.

Assist by describing any features of the event or shooter to Police.

Provide care to injured as possible, but do not enter “hot” area until danger is removed.

Code triage will not be called until all areas are safe.

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Code Orange Hazardous Material Event Haz Mat Team will respond If someone who has been contaminated walks

in – don’t touch them – take them back out the way they came in

Stay uphill and upwind! Decon is in ED or outside Don’t forget your PPE’s

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Code Black Associates will call operator at extension 4000

to report physical or structural damage which would occur from either natural or man-made disaster. Admin rep, Security, Maintenance, Plant Engineer, and EMS to respond to area and additional resources to be called as needed through HIC. No associate should attempt to enter unstable area for rescue unless trained to respond, wearing appropriate PPE, and having recovery assistance.

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Code 900 You are in a situation in which you are

threatened verbally or physically Show of Force All males respond No physical contact DO NOT USE THIS CODE FOR

LIFTING HELP!!

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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

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Tornado Warning Tornado warnings are announced by PBX as tornado

warning. This way 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”.

If a Tornado Warning 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 themselves149

Inclement Weather Each leader will review staffing and

supplies for the anticipated period. It is your responsibility to get here! We will provide housing. Transportation may be provided.

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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

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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 152

Eye Wash Stations Know where they are located Do not block access to the station Flush eyes for 15 minutes unless MSDS indicates

different flush time for the substance involved in the exposure

Water should be temperate (not too hot or cold) Weekly checks and flushes must be performed for each

eye wash station Eye wash stations must be available everywhere

corrosive materials are used or stored

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Eye Wash Station Locations Employee Heath Outpatient - Med Room and Room 24 Decontamination ER Outpatient Oncology – 5th Floor Lab (3) Pharmacy Radiology Cardiology BioMed Maintenance – Boiler Room Maintenance - Chiller Housekeeping CCA Housekeeping OR

154

O2 Tank Storage O2 tanks are considered empty when they

have less than 500 psi A cylinder should never be left standing on

the floor unsecured.

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Hazardous Material and WasteRead Container Labels—Before handling any chemical container, always read the label.

Warnings may be in words, pictures, or symbols.

Consult the Material Safety Data Sheet (MSDS)– A MSDS gives more detailed information on a chemical and its hazards. It also gives you specific precautions for protecting yourself from dangerous exposure. Your department should have a notebook with a list of the chemicals used in your area.

Use Proper Handling Techniques– Always wear proper personal protective equipment.

Dispose of Chemicals Properly– Carry and store chemicals only in approved, properly labeled, safety containers. Never dispose of chemicals in containers used for ordinary waste. Never pour them down sewers or drains. Always consult the MSDS sheet for approved method of disposal.

Contact Mike Stewart in the Lab at ext. 3117 or 4050

if you have questions.

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FIRE SAFETY Make good housekeeping part of your work

routine. Keep passageways and exits clear.

Don’t let furniture or equipment block stairways, halls, or exits.

Keep floors clear of waste and spills. Make sure exit paths and doors are well-lit and clearly

marked. Know your area.

Where are the fire pull stations and extinguishers Know how to extinguish

Cover and smother Be careful to not fan the flames

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FIRE SAFETY

Check fire doors.  Make sure nothing is blocking them. Never wedge or prop them open.

Dispose of trash safely. Put waste in approved containers.

Keep these away from heat sources. Put flammable substances in

approved metal cans or containers.

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FIRE SAFETY Prevention is the best defense

against fires. To prevent fires related to

electrical malfunction remove damaged or faulty equipment from service and submit malfunctioning equipment for repair.

To prevent fires related to equipment misuse do not use any piece of equipment you have not been trained to use. 159

FIRE SAFETYIt's easy to use a fire extinguisher if you can remember the acronym PASS, which stands for Pull, Aim, Squeeze, and Sweep.

Pull the pin. This will allow you to discharge the extinguisher.

Aim at the base of the fire. If you aim at the flames (which is frequently the temptation), the extinguishing agent will fly right through and do no good. You want to hit the fuel.

Squeeze the top handle or lever. This depresses a button that releases the pressurized extinguishing agent in the extinguisher.

Sweep from side to side until the fire is completely out. Start using the extinguisher from a safe distance away, then move forward. Once the fire is out, keep an eye on the area in case it re-ignites.

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IF YOU DISCOVER A FIRE – REMEMBER:

RACE R - RESCUE anyone

in immediate danger A - Activate the

ALARM C – CONFINE or

CONTAIN the fire (close the door)

E - EXTINGUISH small controllable fires/or EVACUATE

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All Foam and Gel Hand Cleaners Foam and gel hand cleaners are becoming very popular for hand

cleaning in the healthcare environment. For them to be effective, they must contain more than 60% alcohol. That makes the hand cleaners FLAMMABLE. It is not unsafe to use the hand cleaners, but you should be aware of the following information each time the hand cleaner is being used: After applying the gel or foam, the alcohol on the hands should be

allowed to evaporate for 30 seconds. You could wave your hands in the air to accelerate the evaporation.

The solution on your hands is flammable until the alcohol evaporates. If a flame or spark is near your hands before the alcohol evaporates, a

fire could occur. There have been reports of healthcare workers whose hands caught on fire from a spark or from static electricity after using an alcohol based hand cleaner.

Alcohol burns very clean and the flame is almost clear.

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Organ Donation Timely referrals of potential organ donors

is critical. 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.

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Heart Disease Remains #1 Cause of Death in the U.S.

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Each year, approximately 1.2 million Americans suffer a heart attack, and nearly one-third of these individuals die…many before they reach the hospital.

About every 26 seconds an American will suffer a coronary event, and about every minute someone will die from one.

Hundreds of thousands of Heart Attack victims survive, but are left with a damaged heart.

Heart Attack Facts

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A heart attack occurs, in most cases, when a blood vessel supplying the heart muscle becomes completely blocked. The vessel has become narrowed by a slow buildup of fatty deposits made mostly of cholesterol. These may crack open, forming a clot.

Heart Attack Facts

When a clot occurs in this narrowed vessel, it completely blocks the supply of blood to the heart muscle. That part of the muscle will begin to die if the individual does not seek immediate medical attention.

Blocked artery (before treatment)

Same blocked artery (with restored flow after

treatment) 166

The best way to stop the heart attack process is todetect the symptoms early, before damage to the heart muscle occurs.

It is critical for those who experience any chestdiscomfort or heart attack symptoms to call 9-1-1 and quickly get to the Emergency Department.

It is just not the heart attack itself that kills; it is alsothe time wasted when one is trying to decide whetheror not to go to the hospital.

Heart Attack Facts

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Delays in time result in loss of heart muscle.

It is important to note that 85% of muscle damage takes place within the first hour. This is often referred to as the “golden hour.” It is within this timeframe that the blocked heart vessel needs to be opened.

Complete destruction of the muscle being supplied by the blocked vessel continues over a six-hour period.

Time Wasted = Muscle Lost!!

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Time Wasted….Why?!

People often dismiss heart attack warning signs, such as chest pain, thinking they merely have heartburn or a pulled muscle. The unfortunate conclusion is that many people wait too long before getting help.

Because every minute counts when having a heart attack, it seems that getting to the ED as quickly as possible would be everyone’s first choice. Unfortunately, more than 50 percent of all patients experiencing chest pain walk into the ED rather than calling 911.

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Know the frequent signs of a heart attack Chest discomfort. Most heart attacks involve discomfort in the center

of the chest. The discomfort lasts for more than a few minutes or it may go away and come back. The discomfort may feel like pressure, squeezing, fullness, or pain.

Discomfort in other areas of the upper body. This may include pain or discomfort in one or both arms, the back, neck, jaw, or stomach.

Shortness of breath may occur with or before chest discomfort.

Other symptoms may include breaking out in a cold sweat, nausea, or light-headedness. Treatments are most effective when they occur in the early stages of chest pain.

What You Need to Know

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Heart Attack Signs/Symptoms in Women include: Unusual fatigue Upper abdominal pressure or discomfort Nausea or Vomiting Lower chest discomfort Dizziness Unusual shortness of breath Back pain Light-headedness, fainting, sweating, Pressure, fullness, squeezing pain in the center of the

chest, spreading to the neck, shoulder, jaw or arm

Know that heart attacks are NOT just a man's problem! More women in the United States die of heart disease each year than men. Women often experience signs and symptoms that are different from men. Or signs in women may go unnoticed altogether.

What You Need to Know

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Be able to recognize the early symptoms of a heart attack. Educate others in early heart attack care.

Be an advocate for the exceptional heart attack care coordinated by Redmond EMS and Redmond Regional Medical Center.

Inform others that our 911 dispatchers and Emergency Medical Services (EMS) are trained to recognize heart attack symptoms. Our EMS units transmit EKG’s directly to our ED from the scene so that by the time the patient arrives, the ED, Cardiologist and Cath Lab team are ready to assist.

What You Need to Do

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Know the signs of a heart attackCall 9-1-1 to get to the hospitalimmediately if you are concerned

Know your risk factors Be an advocate for your own health

Consider healthy lifestyle changes Get off the couch- begin exercising 20 minutes per day, 4-6 days per week

Stay active physically, mentally and socially Build social relationships through family, church,

even pets Eliminate stress by finding a hobby ……and always……REMEMBER REDMOND…………. FOR COMPLETE HEART CARE!

What You Need to Do

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We at Redmond take the “Golden Hour” Seriously!

In 2012, Redmond’s average D2B time was

55 minutes!

The speed of opening the blocked artery is measured in door-to-balloon (D2B) time.

The time starts when the patient enters the hospital and ends when the clot causing the blockage is removed in the Cardiac Cath Lab.

The National goal for D2B time is less than 90 minutes. Redmond’s goal is 60 minutes!

Our new focus in 2013 is on teaching the community to recognize symptoms and get to the hospital sooner!

We are Redmond! 174

And We Have the Awards to prove it!

Redmond’s Chest Pain program is accredited by the Society of Cardiovascular Patient Care and by The Joint Commission for Cardiovascular and Disease Specific Heart Attack care.

The accreditation philosophy is based on process improvement. It Encourages us to improve our quality by standardizing care processes across departments, including EMS, provide outreach education, and improve patient, physician, and staff education.

We promote EHAC (Early Heart Attack Care) which is a public awareness campaign to educate the public about signs of an impending heart attack AND that these signs and symptoms can occur days or weeks before the actual event.

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Heart Failure Facts

Heart failure is the leading cause of morbidity (ill health) and mortality (death) in the U.S.

The most common reason for admission to the hospital in the age group 65 years and older!

1 in 5 people diagnosed with Heart failure die within 5 years of diagnosis.

Many people can lead a full and enjoyable lives if Heart Failure is managed with lifestyle changes, education, diet, and medications.

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What is Heart Failure? A condition resulting from the heart’s inability to pump

an adequate amount of blood to meet the body’s needs. It can be sudden, but usually develops over time. Basically the heart can’t keep up with the body’s

workload.

It Does Not mean your heart is going to STOP beating.

It Does mean the heart pump is weak.

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What Causes Heart Failure?

Anything that can damage the heart!!

• High blood pressure.. Common cause

• CAD and Heart attack….Most common cause

• High cholesterol and arrhythmias

• Damage to heart valves

• Diabetes & Obesity

• Viruses, drugs, excessive alcohol

• Advancing age or congenital heart defects

• Heart muscle disease

• Etc.

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When your heart is damaged

At first the weakened heart tries to make up for it’s inability to meet the needs of the body by: Enlarging to contract more strongly Beating faster (got to get that oxygen to the cells!) Blood pressure increasing to perfuse the organs

These temporary measures mask the problem of heart failure, but they don’t solve it. Heart failure continues and worsens until these substitute processes no longer work, and you start seeing signs of heart failure.

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Warning signs of Heart Failure

Shortness of breath Swelling in feet,

ankles, stomach Weight gain from

FLUID (not fat weight) Fatigue, tiredness Increased heart rate Coughing when lying

down

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Prevention of Heart Failure Lose weight (weight causes increased work) Stay active (exercise helps everything) Quit smoking (and avoid second hand smoke) Keep your BP under control Eat healthy (low fat …low SALT)…lower your

Cholesterol Limit alcohol (If you drink alcohol, do so in moderation.

This means no more than one or two drinks per day for men and one drink per day for women)

Control your Diabetes Routine MD checkups and immunizations

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Treatment of Heart Failure Treat the underlying cause (BP, CAD, etc.). Weigh daily… looking for fluid build up. Heart healthy 2 GM Sodium diet …no added salt. Limit fluid intake (less than 2 liters). Medications for heart failure and BP control….Be

compliant! Lifestyle changes…(weight loss, exercise, smoking,

etc.). Limit stress. Know the signs of heart failure.

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Redmond Regional Maintains Advanced Certification for the

treatment of Heart Failure with the Joint Commission. Our goal is to improve the lives of individuals with heart failure and decrease the incidence of heart failure in our community.

Redmond has Gold Plus Achievement with American Heart Association in the treatment of Heart Failure.

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Facts About Stroke3rd leading cause of death in the United States.

Risk increases with age, but people of any age can have a stroke.

Leading cause of adult disability in the U.S.: Without treatment, 62% of people who have

a stroke will have moderate to severe impairment.

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What is a stroke?

Old Term: CVA or Cerebrovascular accident.Bad term because stroke is preventable and treatable.New Terms: Stroke, TIA

It’s not an “accident.” A stroke occurs when something happens to interrupt the steady flow of blood to the brain.

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Three Types of Strokes

Mini-Stroke or Transient Ischemic Attacks (TIA) – brief episodes of stroke symptoms.

Ischemic Stroke is caused by blood clot. The clot blocks flow of blood to brain.

Hemorrhagic Stroke is caused by bleeding. Results from burst or leaking blood vessels in the brain.

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Stroke Symptoms: Remember “FAST”

Only one symptom

is necessary

to indicate stroke

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F = FaceF = Face • Droops on left or right side

• Sudden drooling

• Numbness

Ask person Ask person to smileto smile

• Look for difficulty holding things or putting on clothing

• Numbness

• One arm drifts down or won’t go up

• May have trouble walking

A = ArmsA = Arms

Ask person to Ask person to raise both armsraise both arms

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S = SpeechS = Speech • Slurred speech• Doesn’t make

sense• May not

understand what other people are saying

• Forgets how toread or write

Ask to Ask to repeat repeat phrase phrase or name or name objectobject

• Time lost is brain lost

• Save time and brain cells

• Go in an ambulance

T = TimeT = Time

At any sign, At any sign,

Call 9-1-1Call 9-1-1

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Stroke Prevention: Know your Risk Factors and develop a lifestyle to decrease you risk

High Blood pressure Tobacco use Diabetes TIAs Carotid or other artery

disease Atrial Fibrillation or

other heart disease Certain blood disorders

High blood cholesterol Physical inactivity and

obesity Excessive alcohol intake Illegal drug use Increasing age Gender Heredity and Race Prior stroke

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“Stroke Alert” EMS and Emergency Department play key role

in coordinating care of stroke patients admitted to our hospital

What if the patient is already here and starts having signs and symptoms of a stroke????

Call our Rapid Response Team at:

706-233-5625

Redmond Regional Medical Center is certified by The Joint Commission

as a Primary Stroke Center.

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Sexual Harassment

The following is prohibited: Unwelcome sexual advances, requests for sexual favors, and

all other verbal or physical conduct of a sexual or otherwise offensive nature.

Behavior that engenders a hostile or offensive work environment will not be tolerated. These behaviors may include but are not limited to: offensive comments, jokes, innuendoes and other sexually-oriented or culturally insensitive/inappropriate statements, printed material, material distributed through electronic media or items posted on walls or bulletin boards.

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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 our Ethics and Compliance Officer, Deborah Branton, at 3036 or the Ethics Line at 1/800-455-1996. The complaint will be kept confidential to the maximum extent possible.

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VIOLENCE PREVENTION Violence can happen in any department or

area. Before violence strikes, there are usually

warning signs. These include:

Making threats, talking about or carrying weapons

Screaming, cursing, challenging authority Restlessness, pacing Violent gestures, such as pounding on a desk A loner, someone angry and depressed

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VIOLENCE PREVENTION You can help prevent violence by:

Treating everyone with respect Checking the patient charts for history of

violence or aggression, alcohol or other drug abuse

Trusting your gut feelings Watch for warning signs Try to spot—and head off—trouble before it

turns to violence Staying calm if someone starts to lose

control Don’t let your escape path get blocked

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VIOLENCE PREVENTION To reduce your risk for potential injury use

the following guidelines: Notify security at the first sign of a potentially

violent situation Communicate in a low, calm tone of voice Allow the person to voice their feelings It’s important to stay calm and maintain self-control Avoid defensive words or angry gestures Do not argue Do not turn your back on the person If possible, give the person what they demand

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RECOGNIZING ABUSE, NEGLECT And Exploitation Signs of Abuse

History inconsistent with nature and extent of injury

Delay in seeking medical treatment Frequent Emergency Room visits Accident prone Discrepancy in patient’s and family’s story Bruises in various stages of healing History of previous trauma in patient or

sibling

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The Definitions Abuse

To treat in a harmful, injurious or offensive way Neglect

To omit through indifference or carelessness Signs and symptoms include;

Failure to thrive Poor hygiene Dehydration Malnutrition Poor social skills

Exploitation To use for profit, to ask for money or materials

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Reporting Abuse, Neglect or Exploitation

Nursing Interventions: Routinely screen during each patient encounter. Screen one-on-one in a private environment. Assess patient’s immediate safety. Listen with a non-judgmental attitude. Document in the medical record the following: abuse history (subjective

and objective), results of safety assessment, authorities notified, family notified, treatment given, and any safety instructions provided.

The person suspecting the abuse should notify Social Services during weekday hours and the House Supervisor at night and on weekends to inform them of the situation. These resource persons will assist with the notification of the authorities.

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Reporting Abuse

Reporting Responsibilities: Notify the MD. Notify DFACS or Adult Protective Services (APS) of the possibility

and the appropriate authorities. GA has general mandatory reporting laws. MUST report to law

enforcement the following: injuries resulting from general violence and injuries inflicted by gun, firearm, knife, or other sharp object.

Resources: Department of Family and Children Services (DFACS): 706-294-6500 / Police Dept: 911 / Battered Woman/Domestic Violence Hotline: 1-800-334-2836 / Prevent Child Abuse GA: 1-800-532-3208 /

Adult Protective Services: 1-888-774-0152

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Population Served at RRMCDemographic RRMC Population Served

White 84%

African American 12%

Hispanic 2%

0 - 19 Years Old 8%

20 - 44 Years Old 24%

45 - 65 Years Old 35%

Greater Than 65 Years Old 33%

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Population Served at RRMCMost Common Principal Diagnosis

Coronary Artery Disease

Acute Myocardial Infarction

Osteoarthritis Chest Pain

Atrial Fibrillation Renal Failure Pneumonia Congestive Heart

Failure Stroke

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CULTURAL COMPETENCY Cultural competence means

providing medical care in a way that takes into account each patient’s values, beliefs, and practices.

Culturally competent care promotes health and healing.

203

CULTURAL COMPETENCY The healthcare provider must have an

understanding of the predominant cultures that exist in the geographic area in which s/he provides patient care. Because the U.S. is so diverse, certain cultures may not be seen in all areas of the country.

204

CULTURAL COMPETENCY A very important aspect of cultural

competency is the avoidance of stereotyping.

We must not presume that all people of a certain culture adhere to all aspects of their culture. The healthcare provider must identify which aspects are appropriate for each patient during the admission process.

205

CULTURAL COMPETENCY Communication begins with identifying the

patient’s primary language. Patient must be offered an interpreter in their

preferred language free of charge. If family interprets, a waiver must be signed.

As a staff member, if you have any cultural or religious preferences that might impact on your delivery of patient care please let your supervisor know.

206

Cultural Competency To achieve the important goal of preventing, identifying and resolving barriers

maintain the following principles : Inclusiveness. Strive to prevent exclusion any of patient or staff member. Respect is showing appreciation and regard for the rights, values and

beliefs of others. Respect. Foster an environment that maintains respect for cultural

differences between patients and staff members. Value. Appreciate and value cultural differences. Diversity is a state of being diverse; difference; unlikeness; variety;

multiformity. Service. Strive to provide accessible services to every patient. Understanding. Try to assess and identify the needs of the culturally

evolving patient population and incorporate those needs into your programs and practices.

Compliance. Adhere to all applicable federal and state laws and regulations addressing limited English proficiency and cultural competency.

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Federal Privacy Rules• HIPAA: Health Insurance Portability &

Accountability Act – Protected Health Information (PHI) – established federal rules for healthcare organizations & staff to protect patient privacy

• HITECH: Health Information Technology for Economic and Clinical Health Act – expanded rules regarding breach notification to patients and government

208

Patient Rights RegardingProtected Health Information

• Right to Privacy• Right to Access/Review• Right to Opt Out of Directory (Census listing)• Right to Request an Amendment• Right to Request Privacy Restrictions• Right to Confidential Communications• Request an Accounting of Disclosures (who received information) • HIPAA privacy standards require that facilities use and disclose only the

minimum amount of protected health information (PHI) necessary to accomplish the intended purpose.

• Authorization for uses and disclosures of protected health information (PHI) must be obtained for uses and disclosures outside of treatment, payment and health care operations, unless otherwise permitted by law

• HITECH require Breach Notification to the patient and the Department of Health and Human Services. The media must also be notified when breaches involving more than 500 individuals in the same state or jurisdiction occur.

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Protected Health Information Once patient information is given as

identification, it is protected; Name, DOB, SSN, insurance # ID, address,

telephone number, etc. Diagnosis, treatment, personal information Paper/electronic medical record, images,

photographs, voice recordings, spoken word

210

Staff Responsibility• Protect health information

– Don’t leave PHI in plain site (counters/monitors)– Discard paper in shredding bin– Ask patient permission before discussing PHI in front of

visitors– Validate requestors authorization to information BEFORE

discussing or releasing– Share only what is minimally necessary– Refer privacy complaints/restriction requests to Facility

Privacy Officer– Document /log disclosures to others outside organization– Secure electronic media– Encrypt confidential emails

211

Violations/Breaches Facility Privacy Officer to investigate

(Santrell Mrash, Extension 3095) Substantiated Breach Notification to:

Patient Department of Health & Human Services Media, if more than 500 patients impacted

(example: loss of laptop with PHI on it)

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Examples of Breaches• Fax information to wrong number• Discuss PHI with unauthorized person• Throw PHI in the regular trash• Leave PHI unattended in public area• Write PHI on white board with patient ID in public

area• Take a photo of a patient without permission• Post PHI on Facebook or Twitter• Access electronic medical record on family member • Give patient another patient’s paperwork by mistake

213

Violations/SanctionsTypes of Violations: Negligent: Accidental, oversight, lack of

education or failure to follow acceptable protocols

Intentional: Deliberate action/inaction

Employee Sanctions: Re-education Disciplinary action up to termination

214

Civil & Criminal Penalties• Facility AND/OR the staff member who breaches

PHI may face: – Civil Penalties– Criminal Penalties

IT ISN’T WORTH IT TO LOSE:– Lose your job– Lose your credibility– Lose professional license– Pay a financial fine– Go to jail

215

Information Security - Increasing AwarenessInformation Security Protects Data about: Patients Company Information Employees

Good security practices promote Information: Confidentiality Integrity Availability

  AND --------- Builds Public Trust 216

Information Security - Increasing Awareness

Healthcare shares the same need as other businesses to: Avoid malicious virus attacks. Protect against “hackers”. Support use of difficult to crack passwords. Defend against loss of confidential data through “Social

Engineering” and “Phishing.”

Federal and State laws make each person responsible for

ensuring information is correct and appropriately used.

Laws mandate that we must: Protect the confidentiality of individual information. Set standards for electronic and personal security measures.

217

Information Security - Increasing Awareness

Treat all information as if it was about you or a member of your family. Access only the systems you are officially authorized to access, and

only with your assigned User ID and password. Only access information needed for your job. Only share sensitive and confidential information with others that

“NEED-TO-KNOW”. Keep sensitive and confidential information in a locked cabinet or

drawer when not in use. Lock up portable storage and hand-held devices when not in use. When transferring Electronic Protected Health Information (EPHI) to

media such as USB drives, diskettes, and removable drives, use passwords, encrypt when possible, and physically protect the media. Report loss or theft immediately.

218

Information Security - Increasing Awareness Use only your assigned User ID and Password to access

applications. Always exit from systems and applications before leaving work. Practice good physical security - Workstation Security Create a “hard to guess” password and never share it.

HCA will never ask for your password

-- At a minimum your password must contain 7 characters,

Uppercase (A) and lowercase (a) letters, and a combination of letters and numbers

Change the password frequently – When requested by the system. Anytime you feel someone has seen it or guessed it. Anytime you accidentally share it or someone sees you enter it.

219

Information Security - Increasing Awareness Questions About SecurityYour Security Resource List for breaches or

other suspected violations Facility Information Security Official (FISO) – Angie

Turner Director of Information Technology & Services – Brad

Treglown Ethics and Compliance Officer (ECO) – Deborah

Branton The Ethics line 1-800-455-1996 can be used to report

concerns or suspected violations The Helpdesk number is 1-888-821-1065

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Information Security - Increasing Awareness: Electronic Communication Users of the Company's electronic communications

should have no expectation of privacy when sending or receiving messages.

Personal files and communications are generally regarded as private with the expectation that managers and administrators will not read or access these files without justification, but the Company retains the right to monitor the use of e-mail, the Internet, and other means of communication at any time and without prior notice.

A good “rule of thumb” is to never send any communication that you would not want distributed on the front page of the newspaper.

221

Information Security - Increasing Awareness: Electronic Communication

Employees must also agree to NEVER: Use electronic communication for any purpose which is

illegal, against Company policy, or contrary to the Company's best interest.

Impersonate another user or mislead others about your identity.

Distribute chain letters. Harass, intimidate, or threaten others. Access or distribute obscene, abusive, libelous, or offensive

material. Access another person's e-mail (unless specifically authorized

to do so). Participate in political or religious debates during working

hours or using company-owned equipment.

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Information Security - Increasing Awareness: Electronic Communication

And each individual must also make a commitment to:

Use secure methods specifically approved in advance by IT&S to transmit information to appropriate individuals outside the Company.

Discuss with your manager the department and facility guidelines for acceptable personal use of electronic communications.

Use e-mail and the Internet for highly limited personal use. Compress large documents or files before attaching them to e-

mail. Graphics, clip art, or other elaborate images or backgrounds in

your e-mail take up too much memory space. Discontinue their use unless absolutely necessary.

223

Information Security - Increasing Awareness: Workstation Security

Evaluate work locations and equipment by ensuring that: Information on computer screens or paper is shielded

from public view. Short (5 – 20 minutes) Screensaver “time out” settings

are activated. Only Company-approved, licensed, and properly

installed software is used. Printouts, reports or other forms of hard copy

information are kept in a secured (locked) place when not in use. A secure workstation will only remain protected if the people A secure workstation will only remain protected if the people

who use the workstation practice good security measures. who use the workstation practice good security measures.

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Information Security - Increasing Awareness: Workstation Security

What is the role of the individual?

Each individual must make a commitment to: Never by-pass or turn off security measures including anti-virus

software. Activate the Screensaver when leaving the workstation,

especially in public areas. Always exit or log out of applications/systems as soon as the

work is complete. “Log off” your workstation before leaving work each day. Always keep portable equipment/devices with you and in your

sight. Be aware of your surroundings. Who is able to view information

or watch when PIN numbers or Passwords are entered?

225

Information Security - Increasing Awareness: Phishing

Phishing is an attempt to criminally and fraudulently acquire sensitive information, such as passwords and credit card details by masquerading as a trustworthy entity such as a bank or even HCA.

Phishing is typically carried out by email and often directs you to enter details at a website or clicking a link.

“Phishing”, is difficult to guard against because it requires you to recognize that you are being scammed.

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Recognizing a Phishing Attempt

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