Student Orientation 2013
Our Mission Statement
Above all else, we are committed to the care and improvement of
human life....
Vision Statement
As the Nationally recognized tertiary care provider of
the largest healthcare system in NW GA, Redmond wi...
Values
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With
Excellence

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Compassion
Accountability
Respect &
Ethics...

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We are Redmond!

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3
Ethics and Compliance
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Redmond and HCA have a comprehensive, values-based
Ethics and Compliance Program, which is a vita...
Ethics and Compliance
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If you have questions or encounter any situation which you
believe violates the provisions of ...
Georgia False Claims Laws
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There is a federal False Claims Act, and there are also
Georgia laws that address fr...
EMTALA
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The Emergency Medical Treatment and
Active Labor Act is commonly known as
the Patient Anti-Dumping Statute.
T...
EMTALA
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When a patient comes to the emergency
department (emergency can be located on any
part of the hospital cam...
Medical Ethics:
End of Life Care
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Palliative Care
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The goal of palliative care is not to cure the
patient. The goal ...
Medical Ethics:
End of Life Care
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End-of-Life Decisions
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Patients have the right to refuse lifesustaining treatme...
Pet Partner
Animal Visitation Program
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Animal visitation is a short term intervention to help
improve the patient’...
Pet Partner
Animal Visitation Program
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Staff Responsibility
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Ensures that patient meets criteria for an animal vi...
Teamwork: A cooperative effort by members of a
group trying to achieve a common goal.

To make teamwork happen…
Communica...
Skills for Teamwork:
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Listening
Questioning
Respecting and supporting ideas
Helping
Sharing
Participation
14
Teamwork
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People who work in a hospital situation know how to
manage high-stress situations, but frustrations can ...
Ergonomic Safety
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Ergonomic Safety is adapting the equipment,
procedures and work areas to fit the person in order to...
Ergonomic Safety
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Apply these tips to your job: Adjust chair height and
backrest (feet should be flat on the floor, k...
Ergonomic Tips
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The best way to avoid the discomfort of
MSDs is:
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Change body positions frequently/Set up work
station...
Eligible
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All Redmond Employees
Spouses/Dependents
insured thru HCA
Occupational Health
EMS
IT & S
Shared Ser...
Employee Safety and
Workers’ Compensation
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Our facility’s commitment is to you.
We have programs in place to mak...
Employee Safety Committee
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Consists of members from key departments
within this facility.
Meets bi-monthly to r...
Area’s of Concern 2013
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Compliance with all policies & procedures.
Timely hazard reporting.
Timely accident r...
Compliance with all Policies and
Procedures
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Employees are responsible for following current
RRMC policies and procedure...
Timely Hazard Reporting
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Hazards will ultimately injure one of our staff, a
patient, or a visitor.
We are all r...
Timely Accident Reporting
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If you are injured on the job you should report the
accident to your supervisor immedia...
Slip, Trip, & Fall Accident Prevention
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A slip occurs when there is too little traction or friction between the...
Slip, Trip, & Fall Accident Prevention
Here are some simple ways to alter your behavior and help avoid slips, trips, or fa...
Patient Management Accident Prevention
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Patient Transfers - Bed to Chair
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Make sure everyone involved know...
Patient Management Accident Prevention
Continued…
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Help the patient scoot to the edge of the bed so their...
Patient Management Accident Prevention
Continued
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Patient Transfers – Bed to Bed or Bed to Stretcher
 Make sure everyon...
Patient Management Accident Prevention
Continued
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Patient Transfers – Repositioning in Bed
 Use gravity to assist...
Safety: A Shared Responsibility
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Redmond’s responsibility is to provide a
safe work environment that facilitates safe...
If you are Injured on the Job
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Report the injury to your supervisor IMMEDIATELY!
Workers’ Compensation benefits may...
Direct Cost of Injuries
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Inability to continue working
Impact on your wages
Disruption of your family life and rou...
Set Good Examples
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Be proactive in the identification of hazards and
prevention of injuries.
Report injuries timely a...
Transitional Duty
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Light-duty or transitional duty may be accommodated if a
department has a need and is able to u...
Employee Health Services (EHS)
Non-work Related Illness or Injury
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EHS stocks many over-the-counter medication...
Blood Borne Pathogen Plan
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A copy of our plan is available on the RRMC intranet site.
The plan explains the process...
How to Reduce Transmission of Blood
Borne Pathogens?
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Observe engineering controls; needle-less systems, safety
de...
What Can You Do To Prevent Sharps
Injuries?
Be Aware
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Keep the exposed sharp in view.
Be aware of people around ...
What Can You Do To Prevent Sharps
Injuries?
Be Prepared
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Complete your Hepatitis B vaccine series and
titer in Emp...
What Can You Do To Prevent Sharps
Injuries?
Follow Policies
 Don’t recap needles.
 Never use needles with the needleless...
What Can You Do To Prevent Sharps
Injuries?
Dispose of Sharps with Care
 Don’t remove contaminated sharps with your hands...
Disposal of Sharps With Care
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Place all used sharps in biohazard
containers, see policy IC-45.
Securely close bi...
Additional Sharps Injury Prevention
for the OR
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Use a neutral zone when passing sharps
instruments. Pass sharps o...
Hepatitis B
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Hepatitis B is a contagious blood borne disease
affecting the liver
Can be mild lasting a few weeks...
Needle Stick/Sharps Injury
What is the risk of infection after exposure?
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HBV
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Healthcare personnel who have rece...
Needle Stick/Sharps Injury
Treatment For The Exposure
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HBV
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Hepatitis B vaccine for all healthcare
personnel who ha...
What is Hepatitis C?
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Hepatitis C is another contagious blood borne disease
affecting the liver.
Can be a mild ...
Needle Stick/Sharps Injury
What is the risk of infection after exposure?
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HCV
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The average risk for infection after...
Needle Stick/Sharps Injury
Treatment For The Exposure

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HCV
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There is no vaccine against hepatitis C and
no treatme...
What is HIV?
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Human immunodeficiency virus (HIV) is a virus that can
lead to acquired immune deficiency syndrome...
Needle Stick/Sharps Injury
What is the risk of infection after exposure?
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HIV
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The average risk of infection aft...
Needle Stick/Sharps Injury
Treatment For The Exposure

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HIV
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There is no vaccine against HIV.
Postexposure prop...
What is an Exposure?
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Contact with another person’s blood or OPIM such as in needle
sticks/sharps exposu...
Bloodborne Pathogen Exposure
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Report to Employee Health Services or the E.R.
immediately after a Bloodborne Pathogen ...
Biohazards
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Biohazard Labels
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These labels are warnings that the
contents of the container are possibly
infectious ...
Biohazardous Waste Management
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It is VERY important that hazardous medical waste be placed in
the appropriate disposal s...
Five Questions OSHA might ask
about Blood Borne pathogens:
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What is standard precautions? All blood and body
fluid...
Questions continued
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Have you been offered the hepatitis B
vaccination free of charge? Yes, by employee
health servic...
If you have questions about Bloodborne
Pathogens, contact Employee Health at
ext 4968, or Infection Prevention ext 4969
8:...
Pandemic Influenza
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A pandemic is an infectious event that has
a global impact (such as those in 1918,
1958, ...
Prepare Your Family
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Have a plan for your family
Review your Personal Preparedness Planning Kit
Make sure you ha...
How would Redmond handle an
influx of infectious patients?
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If a large number of infectious patients
suddenly present...
INFECTION PREVENTION
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Our goal is to reduce risks
and prevent infection in our patients.
Why all the fuss about hand hyg...
Indications for Hand Hygiene
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Before:
–Patient contact or contact with environment
–Donning gloves when inserting a C...
Nails: Direct Patient Care Givers
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Natural nail tips should be kept to ¼ inch in
length
Artificial nails are not t...
Standard Precautions
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Assume that every person is potentially
infected or colonized with a bacteria that
can be tr...
Transmission Based Precautions:
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Used in addition to Standard Precautions
 Contact Precautions (gown, gloves, and
somet...
Transmission Based Precautions
Contact Precautions
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Used when patient has a bacteria
transmitted by direct pa...
Transmission Based Precautions
Droplet Precautions
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Used for illnesses transmitted by
large droplets.
Staff w...
Personal Protective Equipment (PPE)
Gloves
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Wear gloves when contact
with blood or other
potentially infecti...
Multi Drug Resistant Organisms (MDRO’s)
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Methicillin-Resistant Staphylococcus Aureus (MRSA)

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MRSA is a staph bacteria...
MDRO’s
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Vancomycin Resistant Enterococcus (VRE)
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Bacteria that has become resistant to certain antibiotics....
Clostridium Difficile (C diff)
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May develop due to prolonged use of antibiotics.
Causes diarrhea and more serio...
Preventing MRSA, VRE, and C Difficile
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Wash hands before and after contact with patient or
environment.
Dis...
Transporting Patients on Contact Precautions:
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Notify receiving department that patient is on contact precau...
Preventing Surgical Site Infections (SSI)
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Surgery patients may be given a special product to
use to bathe or ...
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~250,000 Blood stream infections occur every year in the
U.S.
Why Aim for Zero
 Many blood stream infections relate...
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Insertion Bundle Practices:
 Wash hands prior to
inserting and handling
line.
 Provider (and assistant)
inserting lin...
Preventing Ventilator Associated Event
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Head of bed up 30 degrees unless
contraindicated
Daily “sedation vacatio...
Preventing Foley Related Urinary Tract
Infections
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Hand hygiene prior to inserting a foley
Only staff who have...
Tuberculosis (TB) Update
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Spread person-to-person by air
droplets
Symptoms: greater than three
weeks of coug...
Respirator and Fit Testing to
Prevent Transmission of Airborne Illnesses
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N-95 Respirator
 Designed to provide respirat...
Respiratory Fit Testing
Fit Testing
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Employees with a possibility of
exposure to airborne illness will be
fit test...
Respirator
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Mask
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Every employee fit tested for a respirator is responsible
for knowing what size mask they ...
Latex Allergies
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Latex allergies pose a serious problem for nurses, other
health care workers, and for 1% to 6% of the g...
Performance Improvement
(PI)
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Performance Improvement means simply doing
things a little bit better tomorrow than we did...
Performance Improvement
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High quality organizations make continuous efforts to improve
their services and products. Oppo...
Performance Improvement
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Core Measures, which are a series of evidence-based best
practices, are an integral part of ...
CORE MEASURES:
Myocardial Infarction
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•
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•
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•

Beta blocker at discharge or document a reason if withheld
Document LV...
CORE MEASURES:
Congestive Heart Failure
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Document LVSD or EF
ACEI or ARB for EF<40% or document a
reason if with-he...
CORE MEASURES:
Pneumonia
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Blood cultures before antibiotics

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1st antibiotic in ED within 6 hrs of arrival

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

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Appro...
CORE MEASURES
Surgical Care (SCIP)

(continued)

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Continue beta blockers (never stop abruptly and document
received the ...
CORE MEASURES
Venous Thromboembolism (VTE)
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NEW CORE MEASURE FOR 2013!
Documentation required for:
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VTE prophyl...
CORE MEASURES
Immunization Measure
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NEW UNIVERSAL MEASURE FOR 2013!
Pneumonia vaccine status:
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vaccines must be g...
CORE MEASURE
Stroke Core Measure
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NEW CORE MEASURE FOR 2013!
Venous Thromboembolism Prophylaxis
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Antithrombotic T...
Opportunities for Improvement
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If you want to learn more about Performance
Improvement or feel you have a better way ...
2013 Hospital
National Patient Safety Goals
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The purpose of the National Patient
Safety Goals is to improve patient safe...
Identify Patients Correctly
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Use at least two ways to identify patients. For
example, use the patient’s name and date...
Improve Staff Communication
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Get important test results to the right staff
person on time.
Critical results from lab,...
Use Medicines Safely
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Label all medicines that are not already labeled. For
example, medicines in syringes, cups a...
Prevent Infection
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Use the hand cleaning guidelines from the Centers
for Disease Control and Prevention or t...
Prevent Mistakes in Surgery
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Make sure that the correct surgery is done
on the correct patient and at the correct
...
Identify Patient Safety Risks
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Find out which patients are at risk for
committing suicide, or are abused or
neglec...
I-Privilege

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If you are un-sure if a physician is
credentialed to perform a service here at
RRMC you can use I-Privileg...
Guidance Document: Tubing and Line
Safety using I-TRACE
Behavioral expectations

I: Illuminate the patient care area whene...
Do Not Use
Abbreviations, Acronyms, and Symbols
Abbreviation

Preferred Term

U

Unit

IU

International Unit

Q.D. & Q.O....
Rapid Response Team
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The purpose of the Rapid Response Team is to provide
critical decision making and intervention at t...
Rapid Response Team
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The role of the Rapid Response Team
(RRT) will be to:
Assess the patient and the situation.
 Assis...
FALL RISK
Nursing staff will assess the patient for safety/fall
risk at the time of admission, and as indicated by
the uni...
FALL RISK
Fall Reduction Activities
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Place a yellow sign at the head of the bed.
Place a yellow bracelet on...
Hand-off Communication Process
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The hand-off communication process for
Redmond is based on the SBAR
communication for...
Hand-off Communication Process
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The tools used in the hand-off process
include:
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Direct face-to-face communicati...
Patient rights
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Patients and healthcare workers need to understand patient
rights and responsibilities to en...
Patient rights
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What is your role in patient rights?
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Everyone is involved in protecting the rights of
patie...
Patient rights
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Where can you find a list of
patient rights?
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In facility Policy RI-04 Rights and
Responsibilities of ...
Patient rights
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Access the Ethics Committee and the Ethic Resolution Process.
Phone: 706-802-3037.
Any concerns over...
Pain Management
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Four major goals of pain management
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Reduce the incidence and severity of patients' acute
p...
Unanticipated Adverse Events and How to
Report

Occurrence Reporting
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An occurrence is an event that is unusual, signifi...
Occurrence Reporting
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Meditech Reporting
 Log onto Meditech - Select 500
Occurrence Reporting - Select Facility Select ...
Occurrence Reporting
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Look-up key (F9 ) displays a pull down menu.
Previous field key (F6) allows you to ba...
Sentinel events
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A sentinel event is an event which results in
unanticipated death or major permanent
loss of function, ...
Reportable Events
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State (Georgia) Reportable Events:
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The following type events should be reported to
the State of Ge...
Suspected Impairment of Licensed
Independent Practitioner
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All healthcare workers including physicians and
nurses sho...
Identification of an Impaired LIP
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An impaired LIP is defined as one who is
unable to provide care, treatment, or
servic...
Signs and Symptoms of
Impairment
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Signs and symptoms of potential impairment
include, but are not limited to:
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...
Reporting a LIP Suspected of
Impairment
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If any individual in the hospital has a
reasonable suspicion that a LIP (or any...
ADVANCED DIRECTIVES
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Advance Directives include Living Will and Durable Power of
Attorney (DPOA) for Heal...
Emergency, someone
call FOR HELP!!!
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Question: What do you do in the hospital when you
need help in a hurry?
Answ...
Emergency Preparedness
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Designed to provide a safe environment for all.
Drills are used to improve effectivene...
Environment of Care
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Defective Equipment
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Security Related Incidents
Any incident requiring Security assistance (i....
Environment of care
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EMERGENCY PREPAREDNESS CODES
 Code Red—Fire
 Code Gray—Bomb Threat—Notify
Switchboard
 Code Blue...
Environment of care
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EMERGENCY PREPAREDNESS CODES
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Code Triage - Provides guidelines for
operations in the e...
Environment of care
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CONTACTS
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Extension 4000— Emergency line to
Operator/PBX
Labor Pool Location — Cl...
Mass Casualty Event
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Code Triage
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Standby: An event has occurred – facility must
decide if we can meet demands or util...
Code Manpower
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Associate should call for lifting assistance for any patient
that has lifting restrictions; is in posi...
Code Gray
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There has been a bomb threat
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If you get the call, notify the switchboard at ext.
4000

Look for p...
Code Blue & Code Blue PALS
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Code Blue
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Adult cardiac or respiratory event.
Don’t forget the Rapid Response Tea...
Code Pink
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Pediatric Abduction
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Patient Care Coordinator
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Call ext. 4000
Give gender and age
Building ...
Code White
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Patient Elopement
Patient Care Coordinator
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Call ext. 4000
Give gender and age and clothing d...
Code Green
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Hostage situation is occurring
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Lock down your area

Do not try to negotiate
Police should be alerted...
Code Silver “Active Shooter”
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Lock down your area immediately. Move any
patients, family members /bystanders...
Code Orange
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Hazardous Material Event
Haz Mat Team will respond
If someone who has been contaminated
walks in...
Code Black
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Associates will call operator at extension 4000
to report physical or structural damage which
would occur fr...
Code 900
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You are in a situation in which you are
threatened verbally or physically
Show of Force
All males res...
Code 1000
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Visitor or family member is ill or injured

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Stay with person and have someone call ext. 4000
to report the...
Tornado Warning
Tornado warnings are announced by PBX as tornado
warning. This way both staff and visitors will be aware o...
Inclement Weather
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Each leader will review staffing and
supplies for the anticipated period.
It is your responsibi...
Evacuation
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Move from unsafe to safe area
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Horizontal Evacuation
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Floor to floor

Full Scale
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Room to R...
Bio-terrorism Update
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Healthcare facilities may be the initial site of recognition
and response to bio-terrorism e...
Eye Wash Stations
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Know where they are located
Do not block access to the station
Flush eyes for 15 minutes ...
Eye Wash Station Locations
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Employee Heath
Outpatient - Med Room and Room 24
Decontamination E...
O2 Tank Storage
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O2 tanks are considered empty when they
have less than 500 psi
A cylinder should never be left stand...
Hazardous Material and
Waste
Read Container Labels—Before handling any chemical container, always read the label.
Warnings...
FIRE SAFETY


Make good housekeeping part of your work routine.
 Keep passageways and exits clear.
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Know your a...
FIRE SAFETY


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

Dispose of t...
FIRE SAFETY


Prevention is the best defense
against fires.


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To prevent fires related to electrical
malfunction remo...
FIRE SAFETY
It's easy to use a fire extinguisher if you can remember the acronym
PASS, which stands for Pull, Aim, Squeeze...
IF YOU DISCOVER A FIRE –
REMEMBER:
 RACE
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R - RESCUE anyone
in immediate danger
A - Activate the
ALARM
C – CON...
All Foam and Gel Hand Cleaners
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Foam and gel hand cleaners are becoming very popular for hand
cleaning in the healthcare...
Organ Donation
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Timely referrals of potential organ donors
is critical.
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Healthcare professionals are required to
i...
Heart Disease Remains #1 Cause of Death in the U.S.

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Heart Attack Facts
Each year, approximately 1.2 million Americans
suffer a heart attack, and nearly one-third of these
ind...
Heart Attack Facts
A heart attack occurs, in most cases, when
a blood vessel supplying the heart muscle
becomes completely...
Heart Attack Facts
The best way to stop the heart attack process is to
detect the symptoms early, before damage to the
hea...
Time Wasted =
Muscle Lost!!
Delays in time result in loss of
heart muscle.
It is important to note that 85% of muscle dama...
Time
Wasted….Why?!
People often dismiss heart attack warning signs, such as
chest pain, thinking they merely have heartbur...
What You Need to Know
Know the frequent signs of a heart attack


Chest discomfort. Most heart attacks involve discomfort...
What You Need to Know
Know that heart attacks are NOT just a man's problem! More women
in the United States die of heart d...
What You Need to Do


Be able to recognize the early symptoms of a heart
attack. Educate others in early heart attack car...
What You Need to Do
Know the signs of a heart attack
Call 9-1-1 to get to the hospital
immediately if you are concerned

K...
We at Redmond take the
“Golden Hour” Seriously!


The speed of opening the
blocked artery is measured in
door-to-balloon ...
And We Have the Awards to
prove it!
Redmond’s Chest Pain program is accredited by the Society of
Cardiovascular Patient Ca...
Heart Failure Facts
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Heart failure is the leading cause of morbidity
(ill health) and mortality (death) in the ...
What is Heart Failure?
A condition resulting from the heart’s inability to
pump an adequate amount of blood to meet the
bo...
What Causes Heart Failure?
Anything that can damage the heart!!

• High blood pressure.. Common cause
• CAD and Heart atta...
When your heart is damaged


At first the weakened heart tries to make up for it’s
inability to meet the needs of the bod...
Warning signs of Heart Failure
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Shortness of breath
Swelling in feet,
ankles, stomach
Weight gain from
FLUID...
Prevention of Heart Failure
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

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Lose weight (weight causes increased work)
Stay active (exercise helps ever...
Treatment of Heart Failure
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Treat the underlying cause (BP, CAD, etc.).
Weigh daily… looking for fluid b...
Redmond Regional
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Maintains Advanced Certification for the
treatment of Heart Failure with the Joint
Commission. Our ...
Facts About Stroke
3rd leading cause of death in the United States.
Risk increases with age, but people of any age
can hav...
What is a stroke?
It’s not an “accident.”
A stroke occurs when
something happens to
interrupt the steady
flow of blood to ...
Three Types of Strokes

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

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Mini-Stroke or Transient Ischemic Attacks
(TIA) – brief episodes of stroke symptoms.
Isch...
Stroke Symptoms: Remember
“FAST”

Only one
symptom
is
necessary
to indicate
stroke

187
F = Face
Ask person
to smile

• Droops on
left or right
side
• Sudden
drooling
• Numbness

A = Arms
• Look for difficulty
...
S = Speech
Ask to
repeat
phrase
or name
object

T = Time
At any sign,
Call 9-1-1

• Slurred speech
• Doesn’t make

sense
•...
Stroke Prevention: Know your Risk
Factors and develop a lifestyle to
decrease you risk
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High Blood pressure
...
“Stroke Alert”
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EMS and Emergency Department play key role
in coordinating care of stroke patients admitted
to our hos...
Sexual Harassment
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The following is prohibited:
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

Unwelcome sexual advances, requests for sexual favors,
and all oth...
Sexual Harassment
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



You should promptly report the incident to your
supervisor, who will investigate the matter and...
Redmond Student Orientation
Redmond Student Orientation
Redmond Student Orientation
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Redmond Student Orientation
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  • Heart failure is not something you can catch from someone.
    In a minute, we’ll talk about some of the common symptoms of heart failure. But before we do that, let’s start by reviewing the risk factors.
    Muscle damage and scarring caused by a heart attack is among the greatest risks for heart failure.
    Cardiac arrhythmia (irregular heartbeat) also increases heart failure risk.
    Uncontrolled high blood pressure increases the risk of heart failure by 200 percent.
    The degree of heart failure risk appears directly related to the severity of the high blood pressure.
    People with diabetes have a two to eight-fold greater risk of heart failure than those without.
    Women with diabetes have a greater risk then men with diabetes.
    A single risk factor is enough to cause heart failure, but multiple risk factors greatly increases the risk.
    Advanced age also adds to the potential impact of any heart failure risk.
    If you have any of these risk factors you should consult your physician.
  • TYPES OF STROKES:
    Not all strokes are the same so they are not all treated in the same way. There are many new and promising treatments for every type of stroke.
    There are three types of strokes:
    Mini-strokes are also called transient ischemic attacks or TIAs . But it’s easiest to remember mini-strokes.
    Ischemic strokes, or strokes caused by blood clots.
    Hemorrhagic strokes, or strokes caused by bleeding.
    DISCUSSION AND ACTIVITY IDEAS:
    You may want to mention other terms previously used for stroke:
    Brain Attack
    Apoplexy
    CVA (cerebral vascular accident)
  • FAST: (FACE)
    Let’s look a little more closely at each symptom that was shown in the video. First, the face.
    Depending on the part of the brain where the stroke happens, the face may look uneven because of weakness on one side.
    The face will appear to droop down on left or right side.
    Weakness can also cause sudden drooling.
    Or numbness. You may see them touching their face or lips, trying to ‘feel’ their face.
    Ask the person to smile. When a person tries to smile the difference between the affected side of the face and the unaffected side will be much more obvious, as you can see in this picture.
    DISCUSSION AND ACTIVITY IDEAS:
    Have members of the group practice the FAST skills on each other.
    What should you do if someone’s face looks like this? Call 9-1-1.
  • FAST: (SPEECH)
    A stroke can affect speech in different ways.
    The speech may be slurred. The person may sound drunk.
    Or they may speak clearly but without making sense. Words may be jumbled…
    They may not understand what other people are talking about.
    Or they may suddenly forget how to read or write.
    To see if speech is being affected…
    Ask the person to repeat a simple phrase, for example ‘the sky is blue’. Does it sound normal? Or is it slurred, confused or jumbled?
    Show them a common object and ask them what it is.
    It is not enough to ask if they are okay.
    DISCUSSION AND ACTIVITY IDEAS:
    What should you do if someone’s speech sounds strange? Call 9-1-1.
  • Redmond Student Orientation

    1. 1. Student Orientation 2013 Our Mission Statement Above 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. • During the time you are completing this module, you may call 8023382 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. 1
    2. 2. 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. 2
    3. 3. Values   With Excellence  Compassion Accountability Respect & Ethics...  We are Redmond!    3
    4. 4. Ethics and Compliance  Redmond and HCA have a comprehensive, values-based Ethics and Compliance Program, which is a vital part of the way we conduct ourselves. Because the Program rests on our Mission and Values, it has easily become incorporated into our daily activities and supports our tradition of caring – for our patients, our communities, and our colleagues. We strive to deliver healthcare compassionately and to act with absolute integrity in the way we do our work and the way we live our lives. All work must be done in an ethical and legal manner. It is your responsibility and your obligation to follow the code of conduct and maintain the highest standards of ethics and compliance. 4
    5. 5. Ethics and Compliance   If you have questions or encounter any situation which you believe violates the provisions of the code of conduct or the corporate integrity agreement, you should immediately consult your supervisor, another member of the management team, the Human Resources Director (Patsy Adams ext 3023), the Ethics and Compliance Officer (Deborah Branton ext 3036), or the HCA Ethics Line (1800-455-1996). 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. 5
    6. 6. Georgia False Claims Laws     There is a federal False Claims Act, and there are also Georgia laws that address fraud and abuse in the Georgia Medicaid program. Any person or entity that knowingly submits a false or fraudulent claim for payment of funds is liable for significant penalties and fines. The False Claims Act has a “qui tam” or “whistleblower” provision. This allows a private person with knowledge of a false claim to bring a civil action on behalf of the US Government. If the claim is successful, the whistleblower may be awarded a percentage of the funds recovered. For additional information, please see the Georgia False Claims Statutes Policy. 6
    7. 7. EMTALA   The Emergency Medical Treatment and Active Labor Act is commonly known as the Patient Anti-Dumping Statute. This statute requires Medicare hospitals to provide emergency services to all patients, whether or not the patient can pay. 7
    8. 8. 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. 8
    9. 9. Medical Ethics: End of Life Care  Palliative Care   The goal of palliative care is not to cure the patient. The goal is to provide comfort. Understand the importance of addressing all of the patient’s comfort needs near the end of life. This includes psychosocial, spiritual, and physical needs. 9
    10. 10. Medical Ethics: End of Life Care  End-of-Life Decisions    Patients have the right to refuse lifesustaining 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. 10
    11. 11. Pet Partner Animal 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. 11
    12. 12. Pet Partner Animal 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. 12
    13. 13. 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. 13
    14. 14. Skills for Teamwork:       Listening Questioning Respecting and supporting ideas Helping Sharing Participation 14
    15. 15. 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. 15
    16. 16. 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 16
    17. 17. 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 17 treatment in Employee Health Services.
    18. 18. 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 Warm-up Fatigue exercises Interrupt sustained postures Proper ergonomics Appropriate work methods Limited overtime Increase Recovery Physical fitness Proper nutrition Good sleeping postures Ice after activities Avoid smoking Alternative job placement 18
    19. 19. 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   Team Health      Family Care Centers Anesthesia ED Providers Surgery Center (ASC) Volunteers Contractors (i.e. Sudexo, Securitas, etc) 19
    20. 20. 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! 20
    21. 21. 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. 21
    22. 22. 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. 22
    23. 23. 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). 23
    24. 24. 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. 24
    25. 25. 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. 25
    26. 26. 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 26 psychological and psychosocial factors (stress and distractions).
    27. 27. Slip, Trip, & Fall Accident Prevention Here 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 27
    28. 28. 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 28
    29. 29. 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 29
    30. 30. 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 . 30
    31. 31. 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. 31
    32. 32. 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. 32
    33. 33. 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. 33
    34. 34. Direct Cost of Injuries     Inability to continue working Impact on your wages Disruption of your family life and routines YOUR CAREER 34
    35. 35. 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! 35
    36. 36. 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. 36
    37. 37. 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, xrays, 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- 37
    38. 38. 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.
    39. 39. 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.
    40. 40. 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. 40
    41. 41. 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. 41
    42. 42. 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. 42
    43. 43. 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. 43
    44. 44. 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. 44
    45. 45. 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. 45
    46. 46. 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
    47. 47. 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. 47
    48. 48. 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). 48
    49. 49. 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. 49
    50. 50. 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. 50
    51. 51. 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. 51
    52. 52. 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. 52
    53. 53. 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%. 53
    54. 54. 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. 54
    55. 55. 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. 55
    56. 56. 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 56
    57. 57. 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.
    58. 58. 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
    59. 59. 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.
    60. 60. 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.
    61. 61. 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.
    62. 62. 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
    63. 63. 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
    64. 64. 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.
    65. 65. INFECTION PREVENTION  Our 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.
    66. 66. 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
    67. 67. 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
    68. 68. 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.
    69. 69. 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)
    70. 70. Transmission Based Precautions Contact Precautions      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. 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.
    71. 71. Transmission Based Precautions Droplet 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!
    72. 72. 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.
    73. 73. 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!
    74. 74. 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.
    75. 75. 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.
    76. 76. 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.
    77. 77. 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.
    78. 78. 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
    79. 79.   ~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.
    80. 80.  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.     
    81. 81. 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)
    82. 82. 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
    83. 83. 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.
    84. 84. Respirator and Fit Testing to Prevent 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.
    85. 85. Respiratory Fit Testing Fit 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.
    86. 86. 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.
    87. 87. 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 87
    88. 88. 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. 88
    89. 89. 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. 89
    90. 90. 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! 90
    91. 91. CORE MEASURES: Myocardial Infarction • • • • • • • Beta blocker at discharge or document a reason if withheld 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 91
    92. 92. 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 92
    93. 93. 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 93
    94. 94. 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) 94
    95. 95. CORE MEASURES Surgical 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 reason 95
    96. 96. CORE MEASURES Venous 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 96
    97. 97. CORE MEASURES Immunization 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
    98. 98. CORE MEASURE Stroke Core Measure   NEW CORE MEASURE FOR 2013! Venous Thromboembolism Prophylaxis   Antithrombotic Therapy:     by the end of hospital Day 2 for ischemic stroke patients by end of hospital Day 2 Discharged on statin medication Assessment for Rehabilitation Stroke Education
    99. 99. 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! 99
    100. 100. 2013 Hospital National 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. 100
    101. 101. 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. 101
    102. 102. 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. 102
    103. 103. 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. 103
    104. 104. 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. 104
    105. 105. 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. 105
    106. 106. 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. 106
    107. 107. 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 IPrivilege 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 107
    108. 108. 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
    109. 109. 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) Lack of leading zero (.X mg) X mg 0.X mg MS, MS04, & MgSO4 morphine sulfate or magnesium sulfate µg Mcg T.I.W. 3 times weekly c.c. Ml ii, etc. (apothecary symbols) 2 or two 109
    110. 110. 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. 110
    111. 111. 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. 111 
    112. 112. 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. 112
    113. 113. FALL RISK Fall 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. 113
    114. 114. 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  114
    115. 115. 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. 115
    116. 116. 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. 116
    117. 117. 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. 117
    118. 118. 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. 118
    119. 119. 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 Health 2 Peachtree Street N.W., Suite 200 Atlanta, Georgia 30329 Telephone: 1-404- 657-5726   Peer Review Organizations: Georgia Medical Foundation [Medicare] 57 Executive Park South, Suite 200 Atlanta, Georgia 30329 Telephones: 1-800-282-2614 1-404-982-0411  Humana Military Healthcare  Services, Inc [Champus] 931 South Semoran Blvd., Suite 218 Winter Park, Florida 32702 Telephone: 1-800-658-1405 119
    120. 120. 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. 120
    121. 121. 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. 121
    122. 122. 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 NonPatient 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 122 obtain.
    123. 123. 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. 123
    124. 124. 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 124
    125. 125. 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 125
    126. 126. 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). 126
    127. 127. 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
    128. 128. 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 128
    129. 129. 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. 129
    130. 130. 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. 130
    131. 131. 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. 131
    132. 132. 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. 132
    133. 133. Environment of Care  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 133    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”.
    134. 134. 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 134
    135. 135. 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 135
    136. 136. 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 136
    137. 137. 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! 137
    138. 138. 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. 138
    139. 139. 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! 139
    140. 140. 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. 140
    141. 141. Code Pink  Pediatric Abduction   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   Can be a patient or visitor Get a good description of person, vehicle, tag, etc. Make sure unoccupied rooms and areas are checked 141
    142. 142. 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 142
    143. 143. 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 143
    144. 144. 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. 144
    145. 145. 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 145
    146. 146. 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. 146
    147. 147. 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!! 147
    148. 148. 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 148
    149. 149. 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 themselves 149
    150. 150. 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. 150
    151. 151. Evacuation  Move from unsafe to safe area    Horizontal Evacuation   Floor to floor Full Scale   Room to Room, Wing to Wing Vertical Evacuation   Ambulatory first Sickest last Triage and transport area will be established Make sure you account for all patients 151
    152. 152. 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
    153. 153. 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 153
    154. 154. 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
    155. 155. 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. 155
    156. 156. 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 Mike Stewart in the Lab at ext. 3117 or 4050 if you have questions. 156
    157. 157. FIRE SAFETY  Make good housekeeping part of your work routine.  Keep passageways and exits clear.     Know your area.   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. Where are the fire pull stations and extinguishers Know how to extinguish   Cover and smother Be careful to not fan the flames 157
    158. 158. 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. 158
    159. 159. 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 159
    160. 160. FIRE SAFETY It'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. 160
    161. 161. 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 161
    162. 162. 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. 162
    163. 163. 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. 163
    164. 164. Heart Disease Remains #1 Cause of Death in the U.S. 164
    165. 165. Heart Attack Facts 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. 165
    166. 166. Heart Attack Facts A heart attack occurs, in most cases, when a blood vessel supplying the heart muscle becomes completely blocked. The vessel has Blocked artery become narrowed by a slow buildup of fatty (before treatment) deposits made mostly of cholesterol. These may crack open, forming a clot. Same blocked artery (with restored flow after treatment) 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. 166
    167. 167. Heart Attack Facts The best way to stop the heart attack process is to detect the symptoms early, before damage to the heart muscle occurs. It is critical for those who experience any chest discomfort 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 also the time wasted when one is trying to decide whether or not to go to the hospital. 167
    168. 168. Time Wasted = Muscle Lost!! 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. 168
    169. 169. 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. 169
    170. 170. What You Need to Know 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. 170
    171. 171. What You Need to Know 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. 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 171
    172. 172. What You Need to Do  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. 172
    173. 173. What You Need to Do Know the signs of a heart attack Call 9-1-1 to get to the hospital immediately 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! 173
    174. 174. We at Redmond take the “Golden Hour” Seriously!  The speed of opening the blocked artery is measured in door-to-balloon (D2B) time.  The National goal for D2B time is less than 90 minutes. Redmond’s goal is 60 minutes!  The time starts when the patient enters the hospital and ends when the clot causing the blockage is removed in the Cardiac Cath Lab.  In 2012, Redmond’s average D2B time was 55 minutes!  Our new focus in 2013 is on teaching the community to recognize symptoms and get to the hospital sooner! We are Redmond! 174
    175. 175. 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. 175
    176. 176. 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. 176
    177. 177. 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. 177
    178. 178. 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. 178
    179. 179. 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. 179
    180. 180. 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 180
    181. 181. 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 181
    182. 182. 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. 182
    183. 183. 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. 183
    184. 184. Facts About Stroke 3rd 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. 184
    185. 185. What is a stroke? It’s not an “accident.” A stroke occurs when something happens to interrupt the steady flow of blood to the brain. Old Term: CVA or Cerebrovascular accident. Bad term because stroke is preventable and treatable. New Terms: Stroke, TIA 185
    186. 186. 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. 186
    187. 187. Stroke Symptoms: Remember “FAST” Only one symptom is necessary to indicate stroke 187
    188. 188. F = Face Ask person to smile • Droops on left or right side • Sudden drooling • Numbness A = Arms • Look for difficulty Ask person to raise both arms holding things or putting on clothing • Numbness • One arm drifts down or won’t go up • May have trouble walking 188
    189. 189. S = Speech Ask to repeat phrase or name object T = Time At any sign, Call 9-1-1 • Slurred speech • Doesn’t make sense • May not understand what other people are saying • Forgets how to read or write • Time lost is brain lost • Save time and brain cells • Go in an ambulance 189
    190. 190. 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 190
    191. 191. “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. 191
    192. 192. 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. 192
    193. 193. 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 1/800455-1996. The complaint will be kept confidential to the maximum extent possible. 193
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