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					Student Packet 2008
               ABOVE ALL ELSE, WE ARE COMMITTED
               TO THE CARE AND IMPROVEMENT OF
               HUMAN LIFE. IN RECOGNITION OF THIS
               COMMITMENT, WE STRIVE TO DELIVER
               HIGH QUALITY, COST EFFECTIVE
               HEALTHCARE TO THE Communities
               WE SERVE.




     During the time you are completing this module, you
    may call 802-3382 for any questions. Also the Infection
    Control nurse is here Monday through Friday 8-4:30 at
    ext. 4969. During other times, the nursing supervisor is
    available for questions.
A TRADITION OF CARING
We believe the following value statements are
essential and timeless:
   We recognize and affirm the unique and
    intrinsic worth of each individual.
   We treat all those we serve with
    compassion and kindness.
   We act with absolute honesty, integrity and
    fairness in the way we conduct our business
    and the way we live our lives.
   We trust our colleagues as valuable members
    or our healthcare team and pledge to treat
    one another with loyalty, respect, and
    dignity.
Care Values
   Redmond Regional Medical Center has a set of
    organizational values that express to everyone who
    enters our facility what we stand for as a leading
    health care provider.
   These values are:
       Customer …………………….... Always First
       Actions ….. Speak Louder Than Words
       Respect ……………...…. The Golden Rule
       Excellence ……………... Is Our Standard
    These values are basic elements of our strategy to
    ―exceed customer expectations‖ in providing service
    to our patients and other guests.
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.
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.
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.
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.
EMTALA
   When a patient comes to the emergency
    department, the hospital must screen for a
    medical emergency.
   If an emergency medical condition is
    found, the hospital must provide stabilizing
    treatment.
   Patients with emergency medical
    conditions may not be transferred out of the
    hospital for economic reasons.
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.
       Stay up-to-date on the legality and ethics of
        using high-dose opiates for physical pain.
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.
Sexual Harassment
   You should promptly report the incident to your
    supervisor, who will investigate the matter and take
    appropriate action, including reporting it to the Human
    Resources Department.
   If you believe it would be inappropriate to discuss the
    matter with your supervisor, you may bypass your
    supervisor and report it directly to the Human Resources
    Department, which will undertake an investigation.
   Or you may call the Ethics Line at 1/800-455-1996. The
    complaint will be kept confidential to the maximum
    extent possible.
SERVICE EXCELLENCE
   Redmond’s Service Standards are ways for you to
    fulfill the CARE values. By practicing these, you
    will be better able to meet and exceed the needs of
    all of our customers.
       Display a service attitude that is courteous
        and caring.
       Anticipate the wants and needs of the people
        we serve.
       Present a professional image.
       Maintain a safe and clean environment
       Use good elevator manners.
SERVICE EXCELLENCE
    Positively represent Redmond Regional
     Medical Center in the workplace and the
     community.
    Listen to one another and to the people we
     serve, then respond promptly and reliably.
    Keep the people we serve informed about
     their care and treatment.
    Respect the privacy and confidentiality of the
     people we serve.
    Strive to master the skills needed to do your
     best for the people we serve.
    Utilize communication tools to assist us in
     responding to our guests.
What is teamwork?
   A cooperative effort by members of a group
    or team trying to achieve a common goal
   The concept of people working together
To make teamwork happen…
   Communication is a necessity
   Must have interaction with others
    even when things aren’t going as
    planned
   Get Feedback from other associates
    and managers
   Share the responsibility
Skills for teamwork:
   Listening
   Questioning
   Respecting and supporting ideas
   Helping
   Sharing
   Participation
Why will Teamwork work for you?
   Increases productivity and output.

   Boosts morale.

   Increases customer satisfaction.

   Actively involves everyone.
Benefits of Team Work
   You have more minds working on a
    project
   You can improve product quality
   You are able to improve associate
    morale
   You can improve productivity
   You have more cross functional skills
HCA Mission and Values Statement
   We trust our colleagues as valuable
    members of our healthcare team and
    pledge to treat one another with loyalty,
    respect and dignity.
Employee Health Services
INJURIES AND ILLNESSES
Non-Work Related
EHS will provide care for non-work related injuries and
  illnesses as an immediate care program. Our goal is
  for all employees to have their own primary care
  provider (PCP), however, when an employee is
  unable to see their PCP and they are ill at work, EHS
  is available for evaluation and treatment as
  appropriate. Employees may be referred to their
  PCP for further evaluation, treatment, and/or follow-
  up. EHS stocks many over-the-counter medications;
  these are available for employees as needed.
Employee Health Services
INJURIES AND ILLNESSES
Work Related
Paula Dunwoody with EHS is Redmond’s Injury
  Coordinator. This role involves employee safety
  and prevention of work injuries as well as follow-
  up of all work related injuries. All work related
  injuries must be evaluated in EHS as soon as
  possible after the injury.
What To Do If You Are
Injured On The Job

   If you are injured on the job, report the injury to
    your supervisor, no matter how minor. Your
    supervisor should be notified prior to the end of your
    shift.
   Redmond policy requires a notification (incident)
    report for an injury no later than 24 hours after the
    incident occurs. This report is completed in our
    Meditech computer system. If you do not have access
    to Meditech, your supervisor or Employee Health
    Services can assist you with this report .
What To Do If You Are Injured On The
Job (continued)
   All employee on-the-job injuries must be
    evaluated in Employee Health Services.
   Management and/or treatment of the injury
    may be completed in Employee Health Services.
    If the extent of the injury warrants a physical
    evaluation, the employee must choose a panel
    physician. The physicians panel is updated
    periodically and is posted on the HR bulletin
    board, across from the time clock on the first
    floor, and in Employee Health Services.
What To Do If You Are Injured On The
Job (continued)
   In an emergency situation, employees may go directly to
    Redmond’s Emergency Room. Please discuss this with
    your supervisor.
   If you have a work-related injury and your condition
    changes (for example: new onset of difficulty walking or
    worsening pain), report to Employee Health Services
    immediately. If this office is closed, then contact your
    immediate supervisor and notify EHS when the office
    opens.
   For any questions or concerns about a work-related injury,
    contact Employee Health Services 706-236-4968.
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.
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.
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.
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.
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.
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.
Prevent Bloodborne Pathogen
Exposures
   Use appropriate barriers such as gloves, eye protection, or
    gowns when contact with blood is expected.
   Wash your hands with soap and warm running water as
    quickly as possible after contact with blood or potentially
    infectious materials.
   Don’t eat, drink, smoke, apply cosmetics or lip balm, or
    handle contact lenses in area with possible exposure to
    bloodborne pathogens.
   Do not store food in refrigerators, freezers, cabinets,
    shelves, or on countertops where blood or other body
    fluids are present.
Bloodborne Pathogen Exposure
   Report to Employee Health Services or the E.R. immediately after a
    Bloodborne Pathogen Exposure. If you go the E.R., then follow-up with
    Employee Health Services as soon as the office opens.
   Following a bloodborne pathogen exposure, the risk of infection may vary
    with factors such as these
              the pathogen involved
              the type of exposure
              the amount of blood involved in the exposure
              the amount of virus in the 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
Needle Stick/Sharps Injury
What is the risk of infection after exposure?

   HBV
       Healthcare personnel who have received
        hepatitis B vaccine and developed immunity
        to the virus are at virtually no risk for
        infection.
       For a susceptible person, the risk from an
        exposure can range from 6 – 30% and
        depends on the status of the source
        individual.
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.
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%.
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).
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.
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.
Respirator and Respirator Fit Testing to
Prevent Transmission of Airborne Illnesses
   N-95 Respirator
       A respirator is designed to provide
        respiratory protection for the wearer.
       An NIOSH approved N-95 mask has a filter
        efficiency level of 95% or greater against
        particulate aerosols free of oil.
       It is fluid resistant, disposable, and may be
        worn in surgery.
       It can fit a wide variety of face sizes.
Respirator and Respirator Fit Testing
   Intended Use
       RRMC’s N-95 Respirators 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.
Respirator and Respirator Fit Testing
   Employees Wearing Respirators
       Any employee with the possibility of
        exposure to airborne illness will participate in
        the respiratory protection program.
       This includes all employees who could enter
        a patient care room when a patient is placed
        in airborne precautions.
Respirator and Respirator Fit Testing
   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 and Respirator Fit Testing
   Fit Testing
      All employees must 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)
       Some employees may not pass fit testing. These
        employees cannot wear a respirator.
       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.
Respirator and Respirator Fit Testing
   Mask Size
       Every employee fit tested for a respirator is responsible for
        knowing what size mask they wear.
       Employee will have a sticker with mask brand and size placed
        on the back of their ID badge 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.
   Problems
       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
    blood borne pathogens were mandated in 1987. Latex can trigger
    three types of reactions: irritant contact dermatitis, allergic contact
    dermatitis, and immediate hypersensitivity. Many medical devices
    contain latex that might trigger serious systemic reactions by
    cutaneous (skin) exposure, (i.e. ECG electrodes, masks, bandages,
    catheters, gloves, and tape.) There are some diagnostic tests to
    determine if a person has an allergy to latex. If a patient tells you
    they are allergic to latex, notify Materials Management and they will
    provide a cart with latex-free products. Need more information?
    Contact the Nursing House Supervisor at ext. 3037. For associates
    with latex allergies, contact Employee Health Services ext. 4968.
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.
Ergonomic Safety
   Apply these tips to your job: Adjust chair height and backrest
    (feet should be flat on the floor, knees level with hips, and
    lower back supported). Sit an arm's length away from the
    computer screen. Keep wrists straight and elbows at right
    angles. Alternate tasks. Use proper body mechanics when
    lifting, transferring, etc. Avoid reaching and stretching
    overhead.
    You may recommend ways to reduce the chance of
    developing musculoskeletal disorders to your supervisor. Your
    work space may be evaluated for ergonomic safety by
    notifying Paula Dunwoody at ext. 4968. Your departmental
    safety representative may assist with body mechanic in-
    services. Report signs, symptoms, illnesses ,and injuries to your
    supervisor, complete an occurrence report, and obtain medical
    treatment in Employee Health Services.
12 Principles of Ergonomics
   Keep everything in easy reach
   Work at proper heights
   Reduce excessive forces
   Work in good postures
   Reduce excessive repetition
   Minimize fatigue
   Minimize direct pressure
   Provide adjustability and change of position
   Provide clearance and access
   Maintain a comfortable environment
   Enhance clarity and understanding
   Improve work organization
Ergonomics
The ―Do Nots‖
   Upper Extremity
       Shoulder
          Reaching over 90 degrees (vertical flexion)
          External rotation of greater than 45 degrees
       Elbow
          Avoid static hold time of flexion

   Lower Extremity
       Sitting position
          The hip, knee, and ankle should be placed at 90 degrees
          Body positions to avoid
          Deep knee bends
          Constant standing in hip and knee extension
          Walking with feet externally rotated
Ergonomics
   Self Care
       Ice THEN heat
       Stretch regularly
       Use good posture
       Exercise!!!!!
       Work smart
       Play smart
   Ergonomic Tips
      The best way to avoid the discomfort of MSDs is:
           Change body positions frequently/Set up work
            stations to fit your body/Stretch every 45 minutes
            to an hour/Perform stretches that are designed to
            decrease discomfort for job specific tasks

 Decrease Fatigue                 Increase Recovery
   Warm-up    exercises              Physical fitness

   Interrupt sustained postures      Proper nutrition

   Proper ergonomics                 Good sleeping postures

   Appropriate work methods          Iceafter activities
   Limited overtime                  Avoid smoking

                                      Alternative job placement
Performance Improvement
Continual Quality Improvement

 What is        PI?
     PI is a work philosophy that encourages
      every employee to find new and better ways
      of doing things. All accredited healthcare
      organizations are required to have an
      improvement program. Redmond is
      accredited by The Joint Commission.
Performance Improvement
Continual Quality Improvement
     Excellent organizations make sustained and continuous
      efforts to improve their care and services. Healthcare,
      our business, is constantly changing; what made us
      successful last year may no longer be appropriate. Even
      if we think today's solution is perfect, tomorrow will
      teach us that it wasn't perfect; it was just the best that
      we could do at the time
     Even though a process may appear to work most of the
      time, we are challenged to look at the process and ask
      ourselves, "Is there a better way to do this?" or "Why
      are we doing this?‖ Because we live in a rapidly
      changing environment that is fast-paced and stressful,
      change brings many opportunities to improve our care
      and services.
      Performance Improvement
       Continual Quality Improvement
    Key Points to Remember
    Customers come first.
    Every employee is important.
    Communication is essential.
    Tasks (processes) are streamlined whenever possible.
    Ongoing improvement is crucial.
    Improvement should be maintained.

    We want to improve everything we do! We owe this to our
    ultimate customer ~ the patient.
        Performance Improvement
         Continual Quality Improvement
        What does this mean to me?
   Management provides support and guidance, and they bear
    ultimate responsibility, but the best improvement ideas come
    from people who work providing care and services for our
    customers. Continually improving one’s own performance
    and their own job processes are essential for producing great
    patient outcomes. Within your department, you have the
    responsibility to think about your ―daily work life‖ to
    determine if there are processes that can be improved. At the
    department level, the organization has determined that the
    Pillars of Excellence should be continually improved. There
    are five pillars: Service, Quality, People, Growth, and
    Finance.
Performance Improvement
Continual Quality Improvement
What does this mean to me?
   You can make suggestions for improvement to your
    supervisor by expressing the idea and asking if an
    improvement team could be organized to work on
    the project. There is also an ―Improvement
    Suggestion Form‖ in your department’s PI Manual
    (or posted on your department’s Communication
    Center); you can fill out the form and turn in to
    your supervisor. If the idea only relates to your
    job, your supervisor may ask you to ―just do it.‖
    You may be asked to serve on an improvement
    team or lead an improvement project; you should
    accept this as an honor.
Risk Management/Patient Safety
2008 National Patient Safety Goals for Hospitals
                             (new items indicated in red)


   Improve the accuracy of patient
    identification.
       Use at least two patient identifiers when
        providing care, treatments, or services.
Risk Management/Patient Safety
2008 National Patient Safety Goals for Hospitals (new items indicated in red)

   Improve the effectiveness of
    communication among caregivers.
         For verbal or telephone orders or for telephonic reporting
          of critical test results, verify the complete order or test
          result by having the person receiving the order or test
          result "read-back" the complete order or test result.
         Standardize a list of abbreviations, acronyms and
          symbols that are not to be used throughout the
          organization.
         Measure, assess and, if appropriate, take action to
          improve the timeliness of reporting, and the timeliness of
          receipt by the responsible licensed caregiver, of critical
          test results and values.
         Implement a standardized approach to "hand off"
          communications, including an opportunity to ask and
          respond to questions.
Risk Management/Patient Safety
2008 National Patient Safety Goals for Hospitals (new items indicated in red)

   Improve the safety of using medications.
         Identify and, at a minimum, annually review a list
          of look-alike/sound-alike drugs used in the
          organization and take action to prevent errors
          involving the interchange of these drugs.
         Label all medications, medication containers
          (e.g., syringes, medicine cups, basins), or other
          solutions on and off the sterile field.
         Reduce the likelihood of patient harm associated with
          the use of anticoagulation therapy.
Risk Management/Patient Safety
2008 National Patient Safety Goals for Hospitals (new items indicated in red)

   Reduce the risk of health                             care-
    associated infections.
         Comply with current World Health
          Organization (WHO) Hand Hygiene
          Guidelines or Centers for Disease Control
          and Prevention (CDC) hand hygiene
          guidelines.
         Manage as sentinel events all identified
          cases of unanticipated death or major
          permanent loss of function associated with
          health-care associated infection.
Risk Management/Patient Safety
2008 National Patient Safety Goals for Hospitals (new items indicated in red)

   Accurately and completely reconcile
    medications across the continuum of
    care.
         There is a process for comparing the patient’s current
          medications with those ordered for the patient while
          under the care of the organization.
         A complete list of the patient’s medications is
          communicated to the next provider of service when a
          patient is referred or transferred to another setting,
          service, practitioner or level of care within or outside
          the organization. The complete list of medications is
          also provided to the patient on discharge from the
          facility.
Risk Management/Patient Safety
2008 National Patient Safety Goals for Hospitals (new items indicated in red)


   Reduce the risk of patient harm
    resulting from falls.
         Implement a fall reduction program and
          evaluate the effectiveness of the
          program.
Risk Management/Patient Safety
2008 National Patient Safety Goals for Hospitals (new items indicated in red)


   Encourage patients’ active
    involvement in their own care as a
    patient safety strategy.
         Define and communicate the means
          for patients and their families to report
          concerns about safety and encourage
          them to do so.
Risk Management/Patient Safety
2008 National Patient Safety Goals for Hospitals (new items indicated in red)

   The organization identifies safety risks
    inherent in its patient population.
         The organization identifies patients at risk
          for suicide. [Applicable to psychiatric
          hospitals and patients being treated for
          emotional or behavioral disorders in
          general hospitals – NOT APPLICABLE TO
          CRITICAL ACCESS HOSPITALS).]
Risk Management/Patient Safety
2008 National Patient Safety Goals for Hospitals (new items indicated in red)

   Improve recognition and response to
    changes in a patient’s condition.
         The organization selects a suitable method
          that enables health care staff members to
          directly request additional assistance from
          a specially trained individual(s) when the
          patient’s condition appears to be
          worsening. [Critical Access Hospital,
          Hospital]
Patient rights
   We believe that most patients want to understand and
    participate in their care. Therefore, it is important that each
    patient understand his or her rights and responsibilities
    while at Redmond. It is also necessary as healthcare workers
    that we understand patient rights and responsibilities to
    ensure that quality care is provided.
   How are patients informed of their rights?
     Upon admission, each patient is given a handbook,
       which includes a list of patient rights and
       responsibilities. This patient bill of rights tells a
       patient and his or her family what they can
       expect of caregivers and what caregivers expect of
       them.
Patient rights
   What is your role in patient rights?
       Everyone is involved in protecting the rights of patients,
        not just those involved in direct patient care. For
        example, the right to confidentiality means not telling
        your friends and/or relatives when someone you know
        has been a patient. Also, you provide privacy for
        patients by making sure you always knock before
        entering a patient’s room or any room where a patient
        might be having a procedure.
       Patients have a right to a secure environment, which
        means you should know how to respond during a
        disaster or fire in the building.Patients are informed of
        their right to establish advance directives.
       Patients also have a right to file a grievance. You can
        assist with the investigation and response by contacting
        Risk Management at ext. 3950 or Administration at ext.
        4100 should you have a question.
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.
Patient rights
   Access the Ethics Committee and the Ethic Resolution Process.
    Phone: 802-3037.
   Access the grievance process. Express complaints or concerns
    regarding care or services, including discharge.
                 Facility contact: 706-802-3950
     Independent Agency:
Office of Regulatory Health
2 Peachtree Street N.W., Suite 200   Humana Military Healthcare
Atlanta, Georgia 30329
     Telephone: 1-404- 657-5726
                                     Services, Inc [Champus]
      Peer Review Organizations:    931 South Semoran Blvd.
Georgia Medical Foundation [Medicare]
57 Executive Park South, Suite 200   Suite 218
Atlanta, Georgia 30329               Winter Park, Florida 32702
Telephones: 1-800-282-2614
1-404-982-0411                       Telephone: 1-800-658-1405
Pain Management
   Four major goals of pain management
       Reduce the incidence and severity of patients' acute
        postoperative or posttraumatic pain.
       Educate patients about the need to communicate
        unrelieved pain so they can receive prompt evaluation
        and effective treatment.
       Enhance patient comfort and satisfaction.
       Contribute to fewer postoperative complications and, in
        some cases, shorter stays after surgical procedures.

   The importance of effective pain management
    increases beyond patient satisfaction when additional
    benefits for the patient are realized, e.g., earlier
    mobilization, shortened hospital stay, and reduced
    costs.
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.
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.
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.
Occurrence Reporting
   Look-up key (F9 or F17) displays a pull down menu
   Previous field key (F6 or F 14) allows you to backup
     The enter key allows you to move forward one field.
   Magic or file key (F12 or F20)
     This key will provide the menu for selection.
     You MUST FILE to save your work.
   Exit key (F11 or F 19)
     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.
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.
        Redmond Regional Medical Center’s employees and the
         medical staff should report to the appropriate department
         leader and Risk Management at 3950or Regulatroy
         Compliance at 3038 in the event that any of the above
         situations occur to a patient at Redmond. A multidisciplinary
         group will review the situation, complete the State forms, and
         provide them to the Office of Regulatory Services within 24
         hours of knowledge that the event meets one of the State
         definitions.
Suspected Impairment of Licensed
Independent Practitioner
   Redmond Regional Medical Center makes every
    effort to ensure that licensed independent
    practitioners providing care to our patients are
    competent and able to carry out their patient care
    responsibilities free of any impairment(s) that
    adversely affect their judgment or clinical
    performance. A licensed independent practitioner
    (LIP) is defined as any individual permitted by law
    and the hospital to provide care, treatment, and
    services without direction or supervision.
Identification of an Impaired LIP
   An impaired LIP is defined as one who is
    unable to provide care, treatment, or
    services with reasonable skill and safety to
    patients because of a physical or mental
    illness, including deterioration through the
    aging process or loss of motor skill or
    excessive use or abuse of drugs including
    alcohol.
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
Reporting a LIP Suspected of
Impairment
   If any individual in the hospital has a
    reasonable suspicion that a LIP may be
    impaired and this impairment may
    adversely affect patient care and safety,
    take immediate action by notifying your
    supervisor and following the appropriate
    Chain of Command listed in policy LD 05.
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.
   Patients should initial and date a copy of the directive(s) and the
    hospital staff should place it inside the current medical record.
   Social Services can assist by answering general questions and provide
    blank forms.
Environment of care
   EMERGENCY PREPAREDNESS CODES
       Code Red—Fire RACE
        Rescue/Activate/Contain/Extinguish
       Code Gray—Bomb Threat—Notify Switchboard
       Code Blue—Adult Cardiopulmonary Arrest
       Code Blue PEDS — Pediatric Cardiopulmonary Arrest
       Code Pink – Pediatirc Abduction
       Code White – Adult Patient Elopement
       Code Yellow—Trauma—Emergency Room
        Support—Do not call ER
       Code Green— Hostage Situation
       Code Orange—Hazardous Material Event
    Environment of care
   EMERGENCY PREPAREDNESS CODES
       Code Triage—Community Disaster
          Standby: An event has occurred in the community

          Activate: Begin Disaster Plan
          Stand-down: Return to normal operations

       Code 900—Show of Force—All Males Respond
       Code 1000—Visitor Needs Assistance—Stay with
        person — Notify switchboard
Environment of care
   Tornado Warning
       Tornado warnings will no longer be
        announced as a Code Black. Instead a more
        recognizable announcement will be made so
        that both staff and visitors will be aware of
        the severe weather potential.
       The announcement will be, ―Attention,
        attention, attention. Floyd County is
        currently under a tornado warning‖.
Environment of care
   CONTACTS
       Extension 4000— Emergency line to Operator/PBX
       Labor Pool Location—Classroom C (Ext. 2273)
       Facility Privacy Officer — Pam Watkins
       Facility Information Systems Officer — Brad Treglow
       Quality Director — Barbara Garner
       Risk Management – Marisa Pins
       Patient Safety Officer – Debbie Smith
       Facility Safety Officer — Clay Callaway
       Infection Control Director — Terri Aaron
       Ethics and Compliance Officer — Deborah Branton
       Service Excellence Administrator — Missy Ragland
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 to
   RRMC utilizes an all hazards approach
When you hear a code--
   Do not call PBX!

They do not know what you are supposed to
  do – they know what they are to do!

Call your supervisor or leader
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!
Code Orange
   Hazardous Material Event
   Haz Mat Team will respond
   If they walk 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
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
   Code Blue PALS
       Pediatric cardiac or respiratory event
       ED Nurse will respond to assist with running the
        code
Code 900
   You are in a situation in which you are
    threatened verbally or physically
   All males respond
   Crisis Prevention Intervention (CPI)
    training is available
   DO NOT USE THIS CODE FOR
    LIFTING HELP!!
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
Tornado Warning
   A Tornado has been reported in our area
       Close patient doors
       Get everyone out of halls and away from glass
       Discourage visitors from leaving
   Turn beds to inside walls
   Clear area of anything that can become a projectile
   Instruct family members & ambulatory patients to
    go into the bathrooms and cover themselves
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
Code Grey
   There has been a bomb threat
       If you get it, notify the switchboard
   Look for packages or people that should not be in
    your area
   Only if there is a legitimate reason would we
    evacuate
   Take direction from Incident Command or law
    enforcement
   Leave lights alone!
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.
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
Code Yellow - Trauma
   Trauma patient is coming or has arrived
   ED needs:
       Lab
       Radiology
       General notice for House Supervisor
   Don’t go unless you are assigned
   Don’t call the ED to find out what it is!
Severe Weather
   Each leader will review staffing and
    supplies for the anticipated period.
   It is your responsibility to get here!
   We will provide housing
   We can provide child care
       If you have a special needs situation, we need
        to know before hand
   Transportation may be provided
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
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!
   Annual flu shots are recommended to
    decrease the risk of a pan flu event
   For more information, visit
    www.pandemicflu.gov
Prepare Your Family
    Have a plan for your family
    Rewiew your Personal Preparedness Planning Kit
    Make sure you have a plan for pets
    You will be required to work
    If you have special needs, let us know
        Special needs adult or children and no other adult
         to care for them
        Military obligations
        DMAT, other volunteer organization
Do Not Use
Abbreviations, 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)                X mg
   Lack of leading zero (.X mg)           0.X mg
      MS, MS0 4, & MgSO4            morphine sulfate or
                                    magnesium sulfate
                µg                          Mcg

              T.I.W.                   3 times weekly

               c.c.                          Ml

   ii, etc. (apothecary symbols)          2 or two
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.
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
What is HIPAA?
   The Health Insurance Portability and Accountability Act
    deals with patient privacy and security of information and
    systems. HIPAA was developed to protect health insurance
    coverage, improve access to healthcare, reduce fraud and
    abuse, and in general improve the quality of healthcare.
    The privacy section will govern the use and disclosure of
    individually identifiable health information and patient
    rights in regard to their protected health information (PHI).
    The security section will ensure that we protect
    confidentiality, availability, and integrity of individually
    identifiable information. HIPAA is a federally mandated
    law. Compliance is mandatory. The law has both civil and
    criminal penalties for non-compliance.
HIPAA’s TOP TEN
   Properly dispose of PHI (Privileged Health      When PHI is discussed within the
    Information) in shred boxes, not trash           workplace, lower your voice or move to a
    cans.                                            private area if others might overhear you.
   Access, use or disclose only the minimum        NEVER discuss any information relating
    necessary amount of PHI to accomplish a          to any patient outside of the workplace,
    task.                                            including elevators and hallways, for any
   Take reasonable measures to prevent              reason.
    unauthorized access to PHI - conceal, turn      Respond to patient questions, concerns and
    over, or secure PHI that is not needed for       complaints about privacy and security of
    immediate use — turn off computer                their PHI respectfully and as quickly as
    screens or use screen savers when you            possible. All concerns and complaints
    leave your work area — NEVER share               should be reported to the Facility Privacy
    computer passwords with others.                  Official immediately.
   Close patient doors and pull curtains when      If you have any questions or are ever in
    discussing and administering procedures.         doubt about what to do, ask your Facility
   Immediately report improper disclosures          Privacy Official.
    of PHI, whether accidental or otherwise,        But in emergencies, always put patient care
    to your Facility Privacy Official — Pam          ahead of all else — even HIPAA.
    Watkins — 3095.
Protecting Patient Privacy
   All health care personnel must obtain
    permission from the patient prior to
    discussing any health care issues in front of
    a patient’s visitors.
Organ Donation
   Timely referrals of potential organ donors
       Healthcare professionals are required to
        identify and refer all deaths and imminent
        deaths (brain deaths) to the Donation Referral
        Line at (800) 882-7177. Timely referrals
        preserve the option of donation for families
        of medically suitable patients.
INFECTION PREVENTION
   Each year, it is estimated that millions of infections occur in the
    United States as a result of hospitalizations. The cost to treat these
    infections is enormous.
    Our goal is to identify and reduce risks of healthcare associated
    infections in patients, visitors, and healthcare workers.
    Hand washing is the single most effective way to prevent the spread of
    infection. Routine hand washing involves a rigorous rubbing together
    of well lathered hands for 15-20 seconds followed by a thorough
    rinsing under running water. Must use soap and water if hands are
    visibly soiled.
   Hand hygiene with an alcohol based product is acceptable as long as
    the hands are not visibly soiled. (Always wash hands with soap and
    water if the patient you are caring for has C. Difficile).
    IC Champions monitor handwashing in our facility. The use of
    gloves does not eliminate the need for good hand washing.
Hand Hygiene:
   Wash hands at least in the following situations:
       Before donning sterile gloves when inserting a central
        intravascular catheter
       Before inserting indwelling urinary catheters, peripheral
        vascular catheters, or other invasive devices that do not require
        a surgical procedure
       After contact with a patient’s intact skin (e.g. when taking a
        pulse or blood pressure, and lifting a patient)
       After contact with body fluids or excretions, mucous
        membranes, non-intact skin, and wound dressings
       If moving from a contaminated body site to a clean body site
        during patient care
       After contact with inanimate objects (including medical
        equipment) in the immediate vicinity of the patient
       After removing gloves
       Before eating and after using the restroom
Partners in Your Care        sm




   A comprehensive hand hygiene program
    involving the patient.
   Signs have been placed in patient rooms
    ―It’s OK to Ask‖. Patients have a right
    to ask if you washed your hands before
    you take care of them
    Goal for Hand Hygiene is 100%
Artificial Nails:
   Direct patient care givers can not wear
    artificial nails. Also some departments
    such as OR, can not wear them.
   Nail polish may be worn in most
    departments as long as it is not chipped.
    Check with IC or your leader if you have
    questions about whether you can wear
    polish in your department.
Personal Protective Equipment
   Personal Protective Equipment (PPE) is provided at no cost
    to the associate
   Worn when there is a chance of contact with blood or other
    potentially infectious body material (OPIM).
   PPEs include, but are not limited to: gloves, gowns, goggles,
    pocket masks, and shoe coverings. PPEs are available in each
    department.
   Wear gloves when it can be reasonably anticipated that there
    may be hand contact with blood or OPIM and when handling
    and touching contaminated items or surfaces. Replace them
    if torn or punctured or if their ability to function as a barrier
    is compromised.
   Gloves must be removed before leaving the room. Hands
    must be washed after glove removal.
Personal Protective Equipment
   Wear appropriate face and eye protection when
    splashes, sprays, splatters, or droplets of blood or
    OPIM may pose a hazard to the eye, nose, or mouth.
   Remove immediately, or as soon as feasible, any
    garment contaminated by blood or OPIM.
   PPEs may be disposed of in the regular trash unless
    contaminated with blood or other OPIM, if
    contaminated they must be disposed of in red
    biohazard bags.
   Each department has a list of tasks and what PPE is
    recommended or mandatory to wear while performing
    those tasks. Ask your leader about this list.
Standard Precautions
   Standard Precautions apply to all blood or body fluid
    which is considered potentially infectious. Very
    important to wear appropriate PPE when dealing with
    blood or body fluids.
   By using standard precautions you will substantially
    reduce your risk of infection with a blood borne
    pathogen.
   In addition to standard precautions, there are three
    types of transmission based precautions (isolation
    precautions) used for patients with documented or
    suspected transmissible pathogens that require more
    than standard precautions.
Isolation Precautions:
   Contact (wear gown, gloves,
    sometimes mask)
   Airborne (wear N 95 mask)
   Droplet (wear regular mask)
Contact Precautions
     Used in addition to standard precautions
     Bacteria transmitted by direct patient contact or
      by indirect contact by touching environmental
      surfaces.
     Isolation gowns and gloves must be worn and
      sometimes a mask.
     Private room for patient or placed with patient
      with the same bacteria.
     Patients should wear an isolation gown and
      wash hands before leaving the room.
     Environmental services should be notified on
      patient discharge to terminal clean room.
Airborne Precautions
     Used in addition to standard precautions for illnesses
      transmitted by airborne droplets.
     Patient is placed in a negative air flow room.
     If patient must leave room, they are given a mask to
      wear.
     Staff must be fit tested for an N 95 mask before
      entering this type of isolation room. Staff members
      who have not been fit tested may not go in this room.
     Visitors are taught by the nurse how to wear the
      mask.
     Persons not immune to measles or varicella (chicken
      pox or disseminated varicella) should not enter the
      room of patients with these illnesses.
Droplet Precautions
     Used in addition to standard precautions
      for illnesses transmitted by large droplets.
     A regular mask is worn in this room.
     Patient must be placed in a private room.
     If the patient needs to leave the room, they
      are given a mask to wear.
Methicillin-Resistant Staphylococcus
Aureus (MRSA)
   Staph aureus are bacteria commonly found on the skin
    of healthy people.
   MRSA can be present without causing disease. When
    there is no associated disease, we call their presence
    colonization. If MRSA is causing disease such as fever or
    pneumonia, we call it infection.
   MRSA is spread by contact thus contact precautions are
    implemented (gown and gloves)
   Good hand washing is the best prevention for the
    spread of MRSA.
MRSA:
   Use disposable equipment, such a B/P cuffs as much
    as possible.
   Any equipment taken in to the room must be
    cleaned/disinfected prior to removing it from the
    room.
   Education is given to patient/visitors by the nurse.
    The visitor may decide for themselves whether or
    not to wear a gown or gloves.
   If the visitor will be visiting other patients during this
    visit, they must wear a gown and gloves in the
    patient’s room who has MRSA, just like our
    associates.
MRSA:
   Notify receiving department that the patient is on
    contact precautions .
   If possible, schedule procedures when there are
    fewer patients in the area.
   The patient should wear an isolation gown and
    wash hands prior to transport.
   Have the area where the patient has been terminally
    cleaned by Environmental Services.
Screening for MRSA
   Certain high risk populations are screened
    for MRSA on admission by having a nasal
    swab screening completed.
   If they have MRSA in their nose, they are
    placed on contact precautions to reduce the
    risk of MRSA to others.
   You may have noticed more patients on
    isolation precautions because of this
    process.
Community MRSA
   Patients who already have MRSA on
    admission to our facility have Community
    Acquired MRSA. This is different from
    MRSA acquired in a healthcare setting.
   Usually it is a skin infection or MRSA
    colonization in the nose.
   Community MRSA is increasing
    throughout the US.
Tuberculosis (TB) Update
   Spread from person-to-person through the air when a
    person who has an active case of the disease coughs, sneezes,
    laughs or sings and the bacteria is inhaled by a person close
    by. Infection is usually detected by a positive PPD skin test
    and an abnormal chest x-ray.
   A person can also have the TB germ which is dormant (not
    active TB). This person has a positive skin test but they are
    not ill. They cannot spread the bacteria to others, however
    they do have an increased risk of eventually acquiring active
    TB during their lifetime and may be asked to take
    medications to prevent the development of active
    tuberculosis.
   Upon hire, associates are required to have a PPD skin test to
    detect possible TB unless they have ever had a positive skin
    test. RRMC is a low risk facility for TB. This means we do
    not have to have annual skin testing except in certain areas.
Tuberculosis (TB) Update
   Symptoms of TB include: greater than three weeks of
    cough, unexplained fever, weight loss, and night
    sweats.
   Persons who have active TB are capable of spreading
    the infection to others.
   Associates with active tuberculosis will be placed on a
    work furlough until cleared by the health department
    as no longer being a risk of transmission to others and
    healthy enough themselves to perform the tasks of
    their occupation.
   Patients suspected of having active tuberculosis are
    placed on airborne precautions in a private room with
    negative air flow. The door must remain closed at all
    times except when entering and exiting the room.
   Special masks (N 95) are worn by healthcare
    personnel when entering the room .
N 95 Masks
   Notify Employee Health Services if your facial
    structure changes. This change can be due to weight
    loss or gain, dental work which changes your facial
    structure, or other changes.
   If your mask does not fit for any reason, or you have a
    problem with wearing the mask, contact Employee
    Health Services.
   Personnel should fit check the mask before entering
    the patient’s room. The mask must be discarded if it
    becomes soiled or at the end of your shift. Masks are
    stored in the ante room.
How would the hospital 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.
Blood Borne Pathogens
   A copy of our plan is available to any associate.
   The plan explains the processes we have in place to minimize
    exposures, and what we do if there is an exposure to a blood
    borne pathogen.
   The following fluids are considered to be potentially
    infectious: 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.
What is Hepatitis B (HBV)?
    Hepatitis B is a serious liver disease.
    Symptoms include jaundice, fatigue, fever, nausea and
     abdominal pain.
    It can be transmitted by contact with infected blood and
     body fluids.
    HBV is much easier to transmit than HIV and lives on
     surfaces for longer periods of time.
    You can help protect yourself from acquiring Hepatitis
     B if you practice infection control guidelines and get
     vaccinated.
    The Hepatitis B vaccination is given free of charge to
     associates. Generally people have few side effects from
     the vaccine. If you previously declined the vaccination,
     you may notify Employee Health Services if you choose
     to begin this series.
What is Hepatitis C (HCT)?
   Hepatitis C is a disease that attacks the liver.
   It is transmitted by contact with an infected
    person’s blood or blood products which enters the
    body of a person who is not infected.
   HCV infection often occurs without symptoms or
    with mild symptoms. The symptoms are very
    similar to those of Hepatitis B.
   There is no vaccine that offers protection from
    Hepatitis C.
What is HIV?
      Human Immunodeficiency Virus (HIV) is the virus that
       causes the disease 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.
      To become infected with HIV, the virus must get into your
       body and enter your bloodstream.
      Many people who are infected with HIV do not have
       symptoms for years. Persons who are HIV infected (with or
       without symptoms, diagnosed with AIDS, or recently
       exposed with a negative HIV antibody test) can spread HIV
       to others.
      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.
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 hugiene, 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.
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 Practitioner 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.
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 Blood borne pathogen plan? On the
    intranet under IC policies, in the nursing office or
    can be obtained through employee health services
If you have any questions about Infection
Prevention or Blood Borne Pathogens, you
may contact Infection Control ext 4969 or
ext 3394 (8:00 – 4:30 pm Monday through
Friday)

By beeper: Terri Aaron 770-553-0430 or
Rebecca Alexander 770-553-0970. If
Infection Control is not available contact
your Department Leader or the Nursing
House Supervisor
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.
Hazardous Material and
Waste
Read 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 Steve Wilson in the Lab at ext. 3116 or 4050
                                   if you have questions.
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 with needles — Sharps containers
           (needle boxes)
          All sharps (needles, scalpels, suture needles, etc.) — Sharps
           containers (needle boxes) *Always activate the safety
           device
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
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
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
Emergency, someone
call FOR HELP!!!
   Question: What do you do in the hospital
    when you need help in a hurry?
   Answer: Call extension 4000 or 4060. 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!
RECOGNIZING ABUSE & NEGLECT
   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
Reporting Abuse
   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.
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
RECOGNIZING ABUSE & NEGLECT
   Signs and Symptoms of Neglect
       Failure to thrive
       Poor hygiene
       Dehydration
       Malnutrition
       Poor social skills
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.
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.
   Cultural reference materials are available in each of
    the patient care areas. These reference materials
    cover various cultures and religions.
CULTURAL COMPETENCY
   Some of the major cultural domains that need to be
    addressed in the delivery of transculturally-competent
    patient care include:
       Communication (language)
       Family roles and family organization
       High-risk health behaviors
       Nutritional habits and preferences
       Pregnancy and childbearing practices
       Death rituals
       Spirituality/religion
       Healthcare practices
       Alternative healthcare providers (folk practitioners)
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.
CULTURAL COMPETENCY
   Communication begins with identifying the
    patient’s primary language. Family members,
    friends, and other Healthcare providers can
    assist with interpretation of the patient’s history,
    chief complaints, needs, etc.
   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.
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.
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
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.
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.
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.
Information Security
   Redmond Regional Medical Center relies heavily on computers to meet its
    operational, financial, and informational requirements. The computer systems,
    related data files, and the derived information are important assets of the
    company. Redmond has established a system of internal controls to safeguard
    these valuable assets by processing information in a secure environment. As a
    Redmond employee, you are expected to share the responsibility for the security,
    integrity, and confidentiality of this information.
   Policy Enforcement
Any employee who has knowledge of a violation of the IT & S Security policy must
    immediately report the violation to his/her supervisor. Anyone who violates
    the policy is subject to:
          Suspension
          Termination
          Civil and/or criminal prosecution
          Other Disciplinary action



                                                              Secure your workstation at all times!
Information Security
   RRMC standards and policies include
    information about:
        Individual accountability for the use of any computing and
         network resources
        The authentication process to allow access to, and use of,
         systems and networks
        Audit trails of sensitive security events
        A means to ensure the integrity of systems, networks, and
         processes
        The design and implementation of security controls with
         adequately met identified risks
        The controls necessary to interface Redmond computer
         systems/networks with foreign computer systems/networks
   Please refer to policies IS.SEC.001 – 005 for additional
    information.
Information Security
   Appropriate Access
       Access is based on your job function and your
        ―Need to Know‖.
   User ID and Password
       Your assigned 3-4 ID and password identifies
        and authenticates you as a valid user of an
        electronic system or application. In order to
        insure proper documentation, you should
        never write down or give your User ID or
        Password to anyone else. You should never
        use anyone else’s User ID and Password.
Information Security
   Guidelines for creating a good quality password
         Eight characters or more
         Uppercase and lowercase letters
         Combinations of letters and numbers
         Easy to type
         Made up of a ―pass phrase‖. Think of a phrase that is unique
          and familiar to you, easy to remember, but not easy to guess.
   Inferior passwords
         Your User ID or Account Number
         Your Social Security Number
         Birth, death, or anniversary dates
         Family members names (including pets)
         Your name (forward or backwards)
         Your favorite song, artist, author, etc
         A word or name found in any dictionary
Information Security
   Workstation Security
       Protection of the workstation and its equipment is each employee’s
        responsibility. Control your work area fully so that ALL your
        equipment and information is kept secure.
   Secure Workstations
       When not in use, hard copy information is kept in a secure place
       Information on any screen or paper is shielded from casual public view
       Terminals are not left active or unlocked and unattended
       Short (5-20 minutes) Screensaver ―time-out‖ settings
       Company approved anti-virus software actively checks files and
        documents
       Only company approved, licensed, and properly installed software is
        used
       ―Shareware‖ or downloaded Internet programs are not permitted
       User ID and Passwords are not written down and physically displayed
       ―Log Off‖ and ―Shut Down‖ your PC before leaving work each day
Information Security
    Electronic Communications
    Promote effective and efficient                  Send only relevant information to
     business communication                            people who need it
    Use e-mail and the Internet in a                 Do not use publicly accessible areas
     productive manner                                 of the Internet to transmit or
    Transmit information only to                      display info
     individuals that are authorized to               Use e-mail and the Internet for
     see it                                            highly limited personal use
    Do not bypass system security                    Do not distribute chain letters
     mechanisms                                        rules to e-mail addresses outside
    Do not automaticaly forward                       hospital
     messages using mailbox                           Do not address another persons e-
    Do not access or distribute obscene,              mail
     abusive, libelous, or confidential               Do not transmit unsecured patient
     information                                       identifiable or other sensitive and
    Do not conduct any type of personal               offensive material
     solicitation
                  Maintain and enhance the hospital’s public image
*Do not use electronic communication for any purpose which is illegal, against
         company policy, or contrary to the company’s best interest
Information Security
Social Engineering
   ―Social Engineers‖ are individuals who attempt to gain access to
    systems of confidential information through the manipulation of
    others. Using a combination of basic knowledge about a given
    business with some personal information or details that the ―victim‖
    will recognize, the Social Engineer converses with, wins the trust of,
    and extracts information from an employee.
   To combat social engineering:
        Limit your conversations in public areas
        Be aware of your surroundings and who listens to your
         conversations
        Identify as fully as possible anyone asking you for information

				
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