VVC Nursing : General Orientation : Fall 2011


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  • Code Green is “Missing Person” at DVH
  • At DVH == Code Assist
  • Arms are always facing upward to allow water and soap suds to drip toward the elbows.
  • Meaning of some observations you will notice.
  • Minimum distance between the sterile field and non-sterile staff is 12 inches
  • Hoping this Introduction to the OR helps to allay anxiety yet at the same time emphasize the vigilance which surgical personnel focus on:Reduce the cost of surgical site infectionsCreate a learning environment Provide optimum patient safetyBest wishes for your success.
  • I know that you are getting tired of Dress Code Policy – we seem to harp on it a lot.Not just VVC – but also the clinical hospitals require us to adhere to a very strict dress code.So……. Here we are going to go over it again.
  • VVC Nursing : General Orientation : Fall 2011

    1. 1. WELCOME<br />General Orientation<br />To All<br />High Desert Hospitals<br />FALL 2011<br />Presenter:<br />Renate Longoria, RNc, MSN, PHN <br />
    2. 2. You have the right to:<br />Considerate, respectful, safe care, & to be made comfortable.<br />Know the name of your physician …<br />Receive information about your health status, course of treatment and prospects for recovery in terms you can understand.<br />Make decisions regarding medical care, and receive as much information ….. As you need in order to give informed consent or to refuse a course of treatment.<br />Request or refuse treatment, without coercion, discrimination or retaliation …<br />Reasonable responses to any reasonable requests made for service.<br />Request or reject the use of any or all modalities to relieve pain, including opiate medication, if you suffer from severe chronic intractable pain.<br />
    3. 3. You have the right to:<br />Formulate advance directives.<br />Have personal privacy respected.<br />Confidential treatment of all communications and records pertaining to your care and stay in the hospital.<br />Access information contained in your records within a reasonable time frame….<br />Receive care in a safe setting, free from all forms of abuse or harassment …<br />Be free from restraints and seclusion of any form that are not medically necessary or are used as a means of coercion, discipline, convenience, or retaliation by staff.<br />Reasonable continuity of care, right to know the reasons for proposed change in the Professional staff, and to know in advance the time and location of appointments as well as the identity of the persons providing the care.<br />
    4. 4. You have the right to:<br />Be informed by the physician or continuing health care requirements and to know the reasons for transfer or discharge from the hospital.<br />Know the hospital rules and policies apply to your conduct while a patient.<br />Be informed of the source of the hospital’s reimbursement for services and/or limitations which maybe be placed upon care.<br />Designate vis8tiors of your choosing….<br />Have your wishes considered….<br />Examine and receive and explanation of the hospital[s bill regardless of the source of payment ….<br />The patient’s family has the right of informed consent of donation of organs or tissues.<br />Exercise these rights and have impartial access to treatment without regard to gender, age, …..<br />File a grievance/complaint with the hospital, a state agency regarding quality of care or premature discharge. <br />
    5. 5. Patient Responsibilities<br />You, your family, and visitors are responsible for following the rules involving patient care and conduct. These include hospital visitation and no smoking policies. <br />You are responsible for providing a complete and accurate medical history. This history should include all prescribed and over-the-counter medications that you are taking (including herbs and vitamins). <br />You are responsible for informing us about all treatments and interventions that you are involved in. <br />
    6. 6. Patient Responsibilities<br />You are responsible for following the suggestions and advice prescribed in a course of treatment by your health care providers. <br />Your refusal of treatment prevents us from providing care according to ethical and professional standards, we may need to end our relationship with you after giving you reasonable notice. <br />You are responsible for being considerate of the rights of other patients and hospital personnel and property.<br />
    7. 7. Patient Responsibilities<br />You are responsible for providing information about unexpected difficulties you have involving your health care. <br />You are responsible for making it known whether you clearly understand your plan of care and the things you are asked to do. <br />You are responsible for providing us with correct information about your sources of payments and ability to pay your bill.<br />
    8. 8. Violation of Patient Rights<br />Examples:<br />Altering, falsifying, miss-statements of facts or making a material omission on any patient chart … or any other Hospital chart or record.<br />Disclosure of confidential information pertaining to patients, physicians, volunteers, other employees, or any other organization etc., (Up to $ 25.000 in fines to individual and/or hospital; hospital rejects nursing school attendance for clinical).<br />Use of private cell phones while on duty for the purpose of outside communications, taking pictures of patients, co-workers or Hospital property.<br />
    9. 9. Violation of Patient Rights<br />Examples:<br />Negligence or willful in-attention in performance of duties.<br />Soliciting tips, gifts, or other gratuities or favors from patients or their families or accepting gifts with more than a nominal value.<br />Offering unauthorized medical or health advice.<br />
    10. 10. Advance Directives<br />Patient Self-Determination Act of 1991 <br /> Health Care Facilities are obligated to:<br />Inform Patients<br />Honor Patients Advanced Directives<br />Advance directives are legal documents that allow the person to convey their decisions about end-of-life care ahead of time. <br />They provide a way for the person to communicate their wishes to family, friends and health care professionals, and to avoid confusion later on.<br />
    11. 11. Advanced Directives<br />A Living Will: tells how the person feels about care intended to sustain life. The person can accept or refuse medical care. Issues that can be addressed, include:<br />The use of dialysis and breathing machines <br />Wanting to be resuscitated if breathing or heartbeat stops <br />Tube feeding <br />Organ or tissue donation <br />A durable power of attorney for health care is a document that names the health care proxy. A proxy is someone the person trusts to make health decisions if they are unable to do so. <br />
    12. 12. Advanced Directives<br />Process:<br />DECIDE – What is important ! – Right to “revoke” at any time<br />What type of care – palliative care, hospice care etc.<br />DISCUSS – With Family, Friends, Physician<br />DESIGNATE – The person you want to make <br /> important medical decisions for you if you <br /> are unable to make them<br />DOCUMENT – Forms – Your Signature, Two witnesses<br />(Students can not be a witness)<br />DISTRIBUTE – Copies to Important Folks -- Bring a copy <br /> with you every hospital visit <br />Don’t keep a secret !!!<br />
    13. 13. Customer Service<br />AIDETS<br />Acknowledge<br />Introduce<br />Duration<br />Explain<br />Thank You<br />Survey<br />
    14. 14. Customer Service AIDETS<br />Acknowledge<br />
    15. 15. Customer Service AIDETS<br /> Introduce<br />
    16. 16. Customer Service AIDETS<br /> Duration<br />
    17. 17. Customer Service AIDETS<br /> Explain<br />
    18. 18. Customer Service AIDETS<br /> Thank You<br />
    19. 19. Customer Service AIDETS<br /> Survey<br />
    20. 20. Customer Services<br />Internal vs. External Customer<br />Answer call lights promptly – “Hour Rounder”<br />Intervene to assure patient comfort is achieved – Be proactive rather than reactive: 5 P’s<br />Potty <br />Pain <br />Position<br />Property<br />Problem<br />
    21. 21. Customer Services<br />Respect:<br />Patients <br />Privacy & Confidentiality<br />Diversity –<br /> “We may have different religions, different languages, different colored skin, but we all belong to one human race.” (Kofi Annan)<br />Physicians<br />Colleagues<br />Maintain a neat, and clean environment <br /> (NOT MY JOB !!!)<br />Patient room, bathroom <br />Nurses’ station<br />
    22. 22. Customer Service<br />ARMC DVD<br />Customer Service <br />for Students<br />
    23. 23. Workplace Violence<br />Healthcare workers are at a greatly increased risk (85%) of being victims of workplace assaults than are private sector workers.<br />Workplace violence ranges from offensive or threatening language to homicide.<br />National Institute of Occupational Safety & Health defines workplace violence as violent acts directed toward persons at work or on duty. This includes:<br />Verbal, written, or physical threats<br />Destroying property<br />Using weapons<br />Robbery<br />Stalking<br />Physical acts such as slapping, punching, kicking<br />
    24. 24. What can you do to prevent Workplace Violence?<br />REMEMBER – violence can happen anywhere.<br />Be aware of warning signs and recognize signs of trouble early.<br />Treat co-workers, patients, and visitors appropriately and with respect.<br />Take all threats seriously.<br />Do not try to handle situations alone.<br />
    25. 25. Recognize the Warning Signs of Violence<br />Use of an angry or threatening tone of voice, shouting, screaming or cursing.<br />Abrupt movement, restlessness or nervous pacing.<br />Unreasonable demands.<br />Postural position tense with clenched fists, tightly gripping objects.<br />Facial expressions usually red face, scowling or frowning with clenched jaws.<br />Verbal threats.<br />Violent gestures, throwing, breaking or pounding on objects.<br />Staggering, slurred speech, irrational speech or other signs of being under the influence of alcohol or drugs. <br />
    26. 26. What should you do when confronted with a violent person?<br />Call a Code “Gray” and maintain self-control.<br />Take immediate action to protect yourself, keep your distance.<br />Leave yourself an escape path.<br />Stay calm and alert, talk calmly and slowly.<br />Listen to the person, this alone can diffuse the situation.<br />
    27. 27. What should you do when confronted with a violent person?<br />Do not try to restrain or disarm the person.<br />Your goal is to prevent harm to yourself and others.<br />Be also aware of “Lateral Violence.”<br />Regardless of how “small” or meaningless the attack may seem, report the incident to your instructor immediately. <br />
    28. 28. Performance Improvement<br />A process that identifies areas of concern in a hospital or on a nursing unit, and the goal is to improve quality of services.<br />Performance Improvement focuses on: <br />What is important to the customers<br />Improving processes -- ongoing<br />Identifying problems<br />Preventing problems<br />The Ultimate Goal: Quality Patient Care<br />
    29. 29. National Quality Care: CORE Measures<br />As defined by Regulatory Agencies (i.e. HFAP, Medicare)<br />“Core Measures are standardized performance measures that can be applied across health care; they are comprised of precisely defined data elements based on uniform medical language.” <br />Accredited Health care organizations that wanted to keep their accreditations were required to look at their hospital’s performance and report statistical data.<br />The ORYX Performance Measurement Requirements started 1998 – hospitals began to collect and report monthly statistics for specific measures. <br />Medicare is looking at the compliance percentage – reimbursement to hospitals <br />
    30. 30. National Quality Care:CORE Measures<br />The CMS/Core Measures Initiatives covers five focus areas:<br />Acute Myocardial Infarction (AMI)<br />Congestive Heart Failure (CHF)<br />Community Acquired Pneumonia (CAP)<br />Surgical Care Improvement Project (SCIP)<br />Stroke (Stroke)<br />
    31. 31. Patient Confidentiality/ HIPAA<br />Health Insurance Portability and Accountability Act (HIPAA)<br />Law was designed to protect the privacy of certain health information<br />Information that relates to the health of an individual and identifies or can be used to identify, the individual<br />There are penalties both civil ($10,000 or $25,000) and criminal for failure to comply with HIPAA requirements.<br />
    32. 32. HIPAA-Student’s responsibilities<br />All discarded paperwork that contains patient information must be shredded, and never placed in the regular trash.<br />If the HIPAA standards are not followed, the hospital is put in jeopardy of receiving a fine.<br />Never discuss patient or patient health information in public areas such as hallways, cafeterias and elevators.<br />
    33. 33. HIPAA-Student’s responsibilities<br />Never discuss patient or patient health information with your family or friends.<br />Patient’s charts should always be placed in a secured area.<br />Never write name of patient on any of your forms. Use only initials. <br />Never photocopy patient information.<br />
    34. 34. EMTALA<br />Emergency Medical Treatment and Labor Act<br />Patient Anti-dumping Law<br />Hospital must provide appropriate medical screening examination… to determine whether or not a medical emergency exists.<br />If a medical condition exists, the patient must be stabilized before transfer or discharge.<br />
    35. 35. Risk Management<br />Goal<br />To minimize the risk to the institution from an error or problem that could result in legal action or liability.<br />Risk Management:<br />A formal process of identifying, analyzing, treating and evaluating real and potential hazards or pt. issues.<br />It addresses liability and financial losses.<br />Grievance -> departmentally resolved -> report to Charge Nurse and Instructor<br />Include wellness and prevention of injury programs for staff.<br />Risk management is part of continuous performance improvement program.<br />
    36. 36. Environment of Care (EOC) – General Hospital Safety<br />Report any unsafe condition to your clinical instructor or the nurse you are working with.<br />When walking in the halls and stairway, keep to the right and use special caution at intersecting corridors and at door openings.<br />Use a ladder or stepstool to reach items higher than you can reach.<br />
    37. 37. EOC-General Hospital Safety<br />If there is a spill, stay in the area, call for help, then clean or block area until environmental services can get there.<br />Follow “Wet floor” caution signs by walking only on areas that are dry.<br />Remove all defective equipment and furniture from service immediately. Tagging the item as “Defective, Do not use”. Report equipment to the Engineering Department.<br />
    38. 38. EOC-General Hospital Safety<br />Lock all medication cabinets, and supply cabinets when not in use.<br />Student injuries must be reported immediately to clinical instructor.<br />Find out where students should park their car prior to clinical day and comply with facility policy.<br />Patients & Patient’s Families always have the right-of-way.<br />
    39. 39. EOC-Fire Safety<br />R- Rescue<br />A- Alarm<br />C- Contain<br />E- Evaluate/Extinguish<br /> Evacuate (only if directed) <br />
    40. 40. EOC-Fire Extinguishers<br />A<br />Trash, paper or wood fires<br />ABC<br />Flammable liquid, trash, wood or electrical fire<br />P- pull<br />A- aim<br />S- squeeze<br />S- sweep <br />Student role when code red is called<br />Help close all doors to patient’s rooms<br />
    41. 41. EOC-Emergency Codes<br />CODE REDFire<br />What do you do if the alarm goes off?<br />CODE GREENEvacuation<br />
    42. 42. EOC-Emergency Codes<br />Code GrayCombative/Disruptive Person<br /> G = Go get help<br />Code Yellow Bomb Threat<br />Code Silver Person w/Weapon – Hostage Situation<br />S = Stay away<br />
    43. 43. EOC-Emergency Codes<br />Code BlueMedical Emergency <br /> (Adult)<br />Code White Medical Emergency (Pediatrics)<br />Code Pink Infant Abduction<br />Code Purple Child Abduction<br />Code Orange Hazardous Materials Spill <br />
    44. 44. EOC-Emergency Codes<br />Triage InternalInternal Disaster<br />Triage External External Disaster<br />Code Triage AlertActivation of Personal<br />Safe Surrender Site<br />
    45. 45. Electrical Safety<br />All electrical equipment must have a three-prong safety plug.<br />All red electrical receptacles are emergency powered.<br />Patient beds must be plugged into the marked “bed” receptacles.<br />Grasp plug not cord when unplugging equipment from the wall.<br />All electrical equipment brought into the hospital by patient or visitors must have bio-med approval before use.<br />Become familiar with the equipment before you use it.<br />
    46. 46. Many industrial, medical and laboratory operations require the use of compressed gases for a variety of different operations. Compressed gases present a unique hazard. Gases may be: <br />▬ Flammable or combustible <br />▬Explosive <br />▬Corrosive <br />▬Poisonous <br />EOC-Compressed Gas Cylinder Safety<br />
    47. 47. Careful procedures are necessary for handling the various compressed gases, the cylinders containing the compressed gases, regulators or valves used to control gas flow. <br />EOC-Compressed Gas Cylinder Safety<br />Since the gases are contained in heavy, highly pressurized metal containers, the large amount of potential energy resulting from compression of the gas makes the cylinder a potential rocket or fragmentation bomb.<br />
    48. 48. Gas cylinders must be secured at all times<br />to prevent tipping:<br />● During Patient transport:<br />Put Oxygen tanks in the appropriate space under the bed <br /> or gurney or a properly designed wheeled cart to ensure <br /> stability.<br />● Cylinders should never be rolled or dragged.<br />EOC-Compressed Gas Cylinder Safety<br />
    49. 49. EOC-Radiation Safety<br />Radiation is a part of our natural environment<br /> (Cosmic, salt substitutes, fertilizers, pottery).<br />The radiation risk incurred by a person working in a hospital, depends on the magnitude of the radiation dose received.<br />The biggest man-made contribution to radiation exposure in a hospital are from medical x-rays and from radioactive materials for diagnoses and treating diseases.<br />
    50. 50. EOC- Radiation Safety: ALARA Concept<br />To reduce exposure to radiation the “As low as reasonable achievable” concept (ALARA) is followed:<br />Limit time in the area where radiation exposure may occur.<br />Increase your distance from areas where radiation exposure may occur.<br />Use appropriate shielding in radiation areas.<br />
    51. 51. EOC-Radiation Safety Guidelines for students<br />Use protective gear or distance yourself when the portable x-ray machine is activated in a patient room. (stand behind the X-ray technician).<br />If asked to assist during an x-ray you should always wear a shielding apron.<br />Follow all instructions posted on a patient’s door who has a radiation sign, do not ignore the signs.<br />
    52. 52. EOC-Material Safety Data Sheets (MSDS)<br />MSDS are available to you for review on each unit, on computers, or via a 1-800 telephone #.<br />Information on all possible substances that are used<br />What the substance is<br />What danger rating it has<br />Storage guidelines<br />What to do when it enters your body<br />Any necessary phone #s for further information<br />
    53. 53. EOC-Security<br />Personal Safety:<br />Best way to be safe is to remain alert, aware and responsive to your surroundings.<br />Call Security if you see someone that does not belong in your area or is a suspicious person.<br />Always wear your Victor Valley College badge.<br />When you leave at the end of your clinical day use the buddy system to go to yourcar or have Security escort you.<br />
    54. 54. EOC-Security<br />Belongings Safety:<br />Patient Belongings: Dentures, Hearing Aids, Glasses, Money.<br />Student Belongings:<br />Do not bring large sums of money or credit cards to the hospital.<br />If you bring books, purses or other belongings into the hospital find out from your instructor where it would be safe to leave them.<br />Some people do not respect what belongs to you – the less you bring into the hospital the less temptation is there for it to be taken. <br />
    55. 55. EOC-Emergency PreparednessHICS<br />Hospital Incident Command System (HICS)<br />Designated to minimize the confusion and chaos that swirls around disaster<br />During a incident listen and do as assigned<br />Keep your cool and pay attention<br />
    56. 56. EOC-Emergency Preparedness Earthquake Safety<br />During Earthquake<br />Inside <br />Protect yourself first:<br />Take shelter under tables (breathable space), desk, doorways<br />Stay away from windows<br />Do not leave building until safe to do so<br />Outside<br />Step into a doorway (do not hold unto the door frame) or move to an open area<br />After<br />Use phone only for emergency<br />Check on patients and assist where possible<br />Expect aftershocks<br />Do not use elevators<br />
    57. 57. EOC-Emergency Preparedness Bioterrorism Response<br />This is a newer area of terrorism:<br />Hospitals and clinics may be the first opportunity to recognize and initiate a response to a bioterrorism-related outbreak.<br />Hospital staff is trained in decontamination <br />Reporting (Infection Control, CDC, FBI)<br />Potential Agents<br />Anthrax, Botulism, Plague, Smallpox<br />Isolation Precautions – follow directions<br />Psychological aspects of bioterrorism<br />
    58. 58. 10 minute Break<br />
    59. 59. GOAL #1: Improve the accuracy of patient identification:<br />Identify patients with at least two identifiers <br />Name <br />Date of Birth <br /> when providing care, treatment, and service.<br />If using armbands, they must be attached to the patient.<br />National Patient Safety Goals<br />
    60. 60. GOAL #2: Improve the effectiveness of communication among caregivers<br />Read back telephone or verbal orders <br />Limit the number of abbreviations, acronyms, symbols:<br />U = write units<br />IU = write international units<br />QD, QOD = write daily, every other day<br />MS, MGSO4, MSO4 = write out morphine and magnesium sulfate<br />0.1mg = always use a leading zero when using a decimal point<br />Never use a trailing zero 1.0mg write 1mg<br />National Patient Safety Goals<br />
    61. 61. GOAL #2: Improve the effectiveness of communication among caregivers<br />Utilize the SBAR (Situation, Background, Assessment, Recommendation) process for “hand off” communication<br />RN to RN communication.<br />Shift to shift reports.<br />Lunch breaks.<br />Physician calls.<br />Patient Transfers to higher or lower levels of care.<br />“Ticket to Ride”<br />National Patient Safety Goals<br />
    62. 62. GOAL #3: Improve the Safety of Using High Alert Medications:<br />Remove concentrated electrolyte medications from patient areas, review look-a-like/sound-a-like drugs<br />Medications and solutions labeled even in only one being used.<br />Unlabeled medications/solutions are immediately discarded.<br />Labeling not required if medication / solution is drawn and immediately administered. Preparing two medications at the same time does not meet this definition; therefore each would have to be labeled.<br />National Patient Safety Goals<br />
    63. 63. GOAL #3: Improve the Safety of Using High Alert Medications:<br />Reduce the likelihood of patient harm associated with the use of anticoagulation therapy.<br />All orders for warfarin (Coumadin) must include an indication for use.<br />A baseline INR is to be obtained and reviewed before the first dose is given.<br />Dose to be given at 1700 and to be documented on MAR with corresponding INR result.<br />National Patient Safety Goals<br />
    64. 64. GOAL # 7: Reduce the risk of health care associated infections:<br />Comply with the current Centers of Disease Control and Prevention (CDC) hand hygiene guidelines, prevent HAI’s due to multiple drug-resistant organisms.<br />Encourage your patients to ASK if you have sanitized or washed your hands.<br />GOAL # 8: Accurately and completely reconcile medications across the continuum of care:<br />Compare patient’s current medications with those ordered for the patient while in the hospital, complete list of medications to the patient upon discharge. <br />National Patient Safety Goals<br />
    65. 65. GOAL # 9: Reduce the risk of patient harm resulting from falls:<br />Fall reduction program – Every hospital has a process in place to prevent patient falls.<br />Morse Fall risk assessment:<br />Once per shift.<br />Any time there is a change is status.<br />Includes a Medication Assessment.<br />Patient / family educated on fall reduction program and individual strategies to reduce fall risk.<br />National Patient Safety Goals<br />
    66. 66. GOAL # 10: Reduce the risk of influenza & pneumococcal disease in hospitalized older adults:<br />Patients are screened and if they have not received an immunization, with their consent, will receive these vaccinations. <br />GOAL # 13: Encourage patient’s active involvement in their own care as a safety strategy:<br />Patients are asked to report concerns about safety.<br />Condition H or Condition HELP “Speak –Up”<br />Condition H allows for patients and family members to call for immediate help if they become concerned about a patient’s condition. <br />National Patient Safety Goals<br />
    67. 67. GOAL # 14: Prevent Health Care Associated Pressure Ulcers:<br />Every hospital has a process in place to prevent skin breakdown on their patients (Hospital acquired Stage III & Stage IV pressure ulcers – are reportable to state agencies). <br />Risk Assessment on every patient on admission and every shift.<br />Skin Breakdown/Decubitus Prevention Protocols<br />Treatment of skin ulcers and/or pressure ulcers<br />Documentation of skin ulcers and/or pressure ulcers<br />National Patient Safety Goals<br />
    68. 68. GOAL # 15: The organization identifies risks inherent in its patient population:<br />Identifying patients at risk for suicide if they are treated for emotional or behavioral disorders. <br />GOAL # 16: Improve recognition and response to changes in a patient's condition:<br />Health care staff can request additional assistance form a specially trained individual when the patient’s condition appears to be worsening.<br />Rapid Response Team /Code Assist (DVH)<br />National Patient Safety Goals<br />
    69. 69. The use of restraints is considered only after less restrictive means have been attempted and the results of such efforts have been documented.<br />A Dr’s order is required – each order may not exceed 24 hours (Restraints may not be written as a PRN order).<br />Behavioral restraints – patients need to be evaluated by a physician within one hour and re-evaluated every 4 hours.<br />Perform and document ongoing assessment for continued need for restraints and when patient meets criteria for release form restraints. <br />Restraints<br />
    70. 70. Patient SafetyIs everyone's RESPONSIBILITY!<br />
    71. 71. Introduction to the Operating Room<br />Purpose<br />Policy<br />
    72. 72. Entrance to the Operating Room<br />Traffic patterns<br />Proper Surgical attire<br />
    73. 73. Proper Surgical Attire<br />Correct and Incorrect application of Attire<br />
    74. 74. Positive air pressure<br />Air flow<br />Humidity<br />Temperature<br />
    75. 75. Unoccupied surgical suite<br />
    76. 76. Anesthesiologist’s domain<br />Active in Patient safety<br />Controls normothermia especially in the elderly<br />
    77. 77. Surgical Hand Scrub <br />
    78. 78. Good and bad behavior with sterile technique<br />Scrubbed & sterile gowned person’s behavior <br />
    79. 79. Sterile Technique Principles<br />Notice the distance between the two:<br />Minimum 12 inches <br />
    80. 80. Emphasis of keeping your distance between sterile and unsterile fields<br />Emphasis on keeping your distance between sterile and unsterile fields<br />Emphasis of keeping your distance between sterile and unsterile fields<br />
    81. 81. The Five “Rights”<br />Final Patient Identification and “Timeout”<br />SIGN IN: Before beginning of Anesthesia<br />(Identity of patient; procedure, consent, Allergies)<br />TIME OUT: Before skin Incision<br />(Baseline Sponge count – Surgical team reviews: <br /> Pt. procedure; Site)<br />SIGN OUT: Before patient leaves Operating Room <br />(Correct Sponge & Needle count; specimens correctly labeled) <br />
    82. 82.
    83. 83. Keeping your distance<br />Assumption:<br /> If sterile is blue, it must be true<br />
    84. 84. Fire safety<br />Fire triangle<br />
    85. 85. Surgical Team grouped around operative site, displaying surgical etiquette<br />
    86. 86. Conclusion<br /><ul><li> Allay anxiety
    87. 87. Specific focus </li></li></ul><li>Abuse Reporting<br />Abuse<br />Every Healthcare Worker is a mandated reporter for the following types of abuse: <br /> CHILD ABUSE<br /> ELDER ABUSE<br /> DOMESTIC VIOLENCE<br />REMEMBER:<br />Student Nurses report any suspicion of abuse to their clinical instructor !!!!<br />
    88. 88. Abuse Reporting<br />According to the National Child Abuse and <br />Neglect Data System (1999);<br />of the estimated 826,000 victims of child <br />abuse – <br />58 % suffered from neglect<br />21 % were physically abused<br />11 % were victims of sexual abuse<br />
    89. 89. Abuse Reporting<br />Types of Abuse:<br />Physical Abuse<br />Is intentional injury to a child by the caretaker.<br />It may include but is not limited to burning, beating, kicking, and punching.<br />It is usually the easiest to identify because it often leaves bruises, broken bones, or unexplained injuries.<br />Physical abuse is not accidental, but neither is it necessarily the caretaker’s intent to injure the child.<br />
    90. 90. Abuse Reporting<br />Neglect:<br />Most common type of reported and substantiated maltreatment.<br />Sexual Abuse:<br />“ employment use, persuasion, inducement, enticement, or coercion of any child to engage in, assist any other person to engage in any sexually explicit conduct or stimulation of such conduct for purpose of producing a visual depiction of such conduct.”Any type of touching of a child for sexual gratification.<br />Emotional Abuse:<br />Can be defined as verbal , psychological, or mental abuse in which the damage inflicted leaves lasting emotional scars.<br />It can include blaming, belittling, or rejecting a child; constantly treating siblings unequally; and a persistent lack of concern by the caretaker for the child’s welfare.<br />
    91. 91. Social Services<br />Types of Elder Abuse:<br />Physical -- assault or injury from inappropriate transfers etc.<br />Financial – misusing funds, having an elder sign financial documents they do not understand.<br />Neglect – failure to provide food, clothing, hydration, showers etc.<br />Self-Neglect – the person does not provide for their own care.<br />Emotional –ridicule, taunting.<br />Sexual– any unwanted physical touching, sexual comments, requests or simply glaring at the person’s body.<br />
    92. 92. Social Services<br />Domestic Violence<br />Is the physical assault or threat of doing bodily harm to a spouse, domestic partner, or roommate.<br />Perpetrators can be prosecuted under the domestic violence statute or criminal statutes from assault and battery to attempted murder.<br />
    93. 93. Infection Control: Modes of Transmission<br />Microorganisms are transmitted by various routes, and the same organism may be transferred by more than one route:<br />Contact route<br />Direct - physical transfer between a susceptible host and infected or colonized person;<br />Indirect - personal contact of susceptible host with a contaminated intermediate object;<br />Droplet - as a result of coughing, sneezing, walking by an infected person;<br />Vehicle route – diseases transmitted through contaminated items such as water, food, drugs etc.<br />Airborne route – dissemination of either droplet nuclei or dust particles in the air containing an infectious agent<br />Vector-borne route – West Nile Virus, Bird Flu, Malaria <br />
    94. 94. Infection Control: Respiratory Hygiene/Respiratory Etiquette<br />Prevent transmission of all respiratory infections (H1N1 virus, influenza)<br />Cover nose/mouth when coughing or sneezing.<br />Use tissues to contain secretions – dispose in nearest waste receptacle.<br />Perform Hand Hygiene – after having contact with secretions & contaminated objects/materials.<br />Hospitals to provide tissues and waste receptacles for used tissue disposal. <br />Hospitals to provide alcohol-based hand rub dispensers.<br />
    95. 95. Infection Control: Student Responsibility<br />Stay home from clinical if you have a contagious illness (follow VVC policy on contacting clinical instructor)<br />
    96. 96. MRSA TODAY – It’s faces<br />Slides: Courtesy of Arrowhead Regional Medical Center – Infection Control<br />
    97. 97. MRSA TODAY – It’s consequences<br />Slides: Courtesy of Arrowhead Regional Medical Center - Infection Control<br />
    98. 98. Epidemiology of MRSASlides: Courtesy of Arrowhead Regional Medical Center - Infection Control<br /><ul><li>For every infected patient with MRSA, there are many more who carry the organism without any symptoms (colonized)
    99. 99. Colonized patients can serve as a source of infection or colonization for others through direct or indirect contact</li></ul>98<br />
    100. 100. The human and financial impact of MRSA is high:<br /><ul><li> Over 126,000 hospitalized persons are infected by MRSA annually
    101. 101. 3.95 MRSA infections occur per 1,000 hospital discharges nationally
    102. 102. 1.25 infections per 1,000 discharges at ARMC for 2006-2007, .39 Jan-Sept ‘08
    103. 103. Over 5,000 patients die as a result of these infections annually
    104. 104. Over $2.5 billion excess health care costs are attributable to MRSA infections
    105. 105. Non-reimbursement from CMS for treating healthcare-acquired infections</li></ul>On average, for each patient with MRSA infection this means:<br /><ul><li> 9.1 days excess length of stay
    106. 106. Over $20,000 in excess cost per case (range $7,000 – $32,000)
    107. 107. 4% in excess in-hospital mortality</li></li></ul><li>TYPES OF INFECTIONS CAUSED BY MRSA<br />Slides: Courtesy of Arrowhead Regional Medical Center - Infection Control<br />Catheter-associated blood stream infections<br />Wound infections<br />Surgical site infections<br />Sepsis, septic shock<br />Ventilator-associated pneumonia<br />Urinary tract infections<br />
    108. 108. INFECTION CONTROL PRACTICES<br />Hand Hygiene<br />Standard Precautions<br />Personal Protective Equipment<br />Isolation Precautions<br />Proper care of invasive devices<br />Removal of devices when no <br /> longer medically necessary<br />Proper care of surgical sites<br />
    109. 109. Hand Hygiene<br />CDC Hand Hygiene Guidelines:<br />Before patient contact<br />After patient contact<br />Before donning gloves<br />After removal of gloves <br />Hand washing<br />Washing hands with plain soap & water for 15 sec.<br />Antiseptic hand rub agent to all surfaces of hands<br />Surgical hand antiseptic<br />Performed pre-op by surgical personnel with antiseptic hand wash/rub to eliminate or reduce hand flora<br />The CDC recommendation for healthcare workers who have direct contact with patients, food, or patient care equipment not wear artificial nails or natural nails over 1/4” long. <br />Hand hygiene is still the #1 way to stop the spread of infection!<br />
    110. 110. When to perform hand hygiene:Slides: Courtesy of Arrowhead Regional Medical Center - Infection Control<br /><ul><li>After contact with patients or patient care equipment
    111. 111. After contact with environmental surfaces
    113. 113. Before & after any procedure involving patient care
    114. 114. After coughing/sneezing into hands
    115. 115. After using restroom </li></li></ul><li>Standard Precautions<br />Work practices that help prevent the spread of infections and infectious diseases.<br />ALLPATIENTS SHOULD BE CONSIDERED INFECTIOUS!!!<br />And don’t forget: <br /><ul><li> employees
    116. 116. registry staff
    117. 117. visitors
    118. 118. physicians
    119. 119. students
    120. 120. vendors
    121. 121. contractors</li></li></ul><li>Standard Precautions<br />Standards for every person admitted to the Hospital:<br />Hand Hygiene<br />PPE – Personal Protective Equipment: (come in contact w/blood, body fluids, secretions, excretions, non-intact skin, and mucous membranes)<br />Gloves<br />Mask, eye protection, or face shields<br />Gowns<br />Sharps Safety<br />
    122. 122. Isolation Precautions<br />Airborne Infection Isolation<br />For tuberculosis, chickenpox and measles only<br />For MRSA, MDRO in sputum, bacterial meningitis, mumps<br />Droplet Isolation<br />Droplet Isolation<br />For drug resistant organisms in wounds, abscesses, RSV<br />Contact Isolation<br />
    123. 123. Infection Control: Isolation Precautions<br />Airborne<br />Transmitted by small droplet<br />Measles<br />Varicella<br />Shingles<br />Tuberculosis<br />Private room, negative airflow, door closed at all times, staff wears N95 respirator mask, visitors wear a regular mask<br />If patient leaves room, must wear a regular mask<br />
    124. 124. Infection Control: Isolation Precautions<br />Droplet<br />Transmitted by large droplets<br />Haemophilus influenza type B<br />Bacterial Meningitis<br />MRSA, MDRO in sputum<br />Bacterial respiratory infections such as:<br />Pertussis (whooping cough) or <br />Streptococcal infection<br />Viral infections such as:<br />Adenovirus, Mumps, Rubella, Scarlet Fever<br />Private room, mask, goggles, keep 3 ft distance when possible, if patient transported must wear mask <br />
    125. 125. Isolation Precautions<br />Contact<br />Transmitted by direct contact with patient or indirect contact with contaminated objects or persons <br />GI, Resp, Skin, or wound infections especially if infected with:<br />MRSA, VRE, or Clostridium -Difficille<br />Respiratory Infections in children and infants:<br />RSV, para-influenza virus, or enteroviral infections<br />Skin infections such as:<br />Herpes simplex, Varicella, Impetigo, Scabies<br />Conjunctivitis (pink eye)<br />Private room, gloves, gowns, mask as needed, equipment dedicated for single patient use<br />
    126. 126. Slides: Courtesy of Arrowhead Regional Medical Center - Infection Control<br />Environmental cleaning<br />Extremely important that all staff assist in maintaining a clean and sanitary patient care environment. <br />Please clean up after yourselves. Clean up spills promptly or call EVS for large spills. <br />Dispose of all waste properly.<br />
    127. 127. Remember…<br />Saving lives is in<br />our hands.<br />Slides: Courtesy of Arrowhead Regional Medical Center - Infection Control<br />
    128. 128. Regular Garbage: (found in Patient Rooms)<br />EXAMPLES:<br />a. Empty IV bags, bottles & tubing without needles (take <br /> patient identification off)<br />b. Empty urine cups, Foley bags/tubing, diapers, chux<br />c. Exam & cleaning gloves<br />d. Disposable basins, paper towels, band aids, cotton <br /> balls<br />e. Disposable bedpans, urinals<br />f. Sanitary napkins & tampons (personal)<br />g. PPE (worn, but not soiled w/blood)<br />h. Paper & plastic boxes, wrappers, office waste, <br /> packaging<br />i. Food products & waste (i.e. pizza boxes, soda cans, <br /> paper cups, plastic utensils)<br />Hospital Waste Management:Regular Waste<br />
    129. 129. Biohazard Bags (Red Bags)<br />1. Blood-saturated items: bloody gauze, bloody <br /> dressings, bloody gloves<br />2. Bags and IV tubing containing blood products<br />3. Isolation Waste: discarded materials/contaminated with <br /> excretions or secretions from humans who are required <br /> to be isolated.<br />4. Containers, catheters, or tubes w/fluid blood <br /> or blood products: <br />Suction Canisters <br />Hemovacs<br />Chest drainage units <br />5.Hemodialysis products<br />6. Microbiology specimens, used culture plates, <br /> tubes, bottles, & devices<br />7. Blood spill clean - up materials<br />Hospital Waste Management:Biohazard Waste<br />
    130. 130. Hospital Waste Management:Sharp Safety<br />SHARPS:<br />CONTAINERS w/Biohazard Label<br />1. Needles & Syringes<br />2. Scalpels w/blades, lancets<br />3. Broken contaminated glass<br />4. Staples & wires<br />5. Disposable suture sets & biopsy forceps<br />Pharmaceutical Waste <br /> (non-hazardous):<br />BLUE/WHITE CONTAINERS<br />1. Syringes (w/o sharps) <br />containing meds<br />2. Wasted Narcotics<br />3. Propofol – Diprovan<br />4. Partial Tubes/Bottles of: Creams/Ointments<br /> Oral Liquids<br /> Eye or Ear Drops/Ointments<br />5. Ampoules with Medications<br />6. Vials with Medications<br />7. Tablets, Capsules<br />
    131. 131. Student Health/Certificates <br />All students must have in their file:<br />Current TB<br />MMR titer<br />Hepatitis B titer<br />Varicella (Chickenpox) titer<br />Physical<br />Student must have their CPR card with them on clinical days.<br />Random urine drug screen – requirement by hospitals.<br />
    132. 132. Dress Code<br />Personal Hygiene<br />Uniforms must be clean and wrinkle free <br /> (VVC dress code)<br />Hair must be up and off collar to prevent contamination of self or patient – Natural hair color<br />Mustache and beards must be trimmed and neat <br /> (VVC dress code)<br />Personal basic hygiene measures must be followed<br />Clean body<br />No body odor – after smoking (mints)<br />No strong perfume or cologne (VVC dress code)<br />
    133. 133. Dress code<br />ID Badges –<br />Must be worn at all times while in the hospital.<br />Must be worn above the waist.<br />Picture must be visible with no stickers or pins covering the face.<br />Common Sense –<br />Undergarments not visible (male & female)<br />Piercing – one post in each ear<br />Makeup worn in moderation<br />Fingernails must be clean and trimmed (not > ¼ inch long); <br />Nail overlays (silk, acrylic, gel) are not allowed<br />
    134. 134. Dress code<br />Common Sense –<br />Tattoos must not be visible<br />Leather-like shoes (closed toes & heels) – <br /> clean, no logos<br />No gum chewing<br />Cellular Telephones<br />Should not be used in patient care areas where we serve customers (including texting)<br />Bluetooth devices – not acceptable <br />If kept on your person, cell phones should be on silent or on vibrate at all times.<br />
    135. 135. Infection Control:Student Injury<br />If an injury or exposure occurs at the clinical site do the following:<br />Immediately contact your clinical instructor<br />
    136. 136. Harassment<br />Includes any behavior or conduct that unreasonably interferes with an individuals work performance or creates an intimidating, hostile or offensive work environment.<br />Verbal Harassment – jokes, negative stereotyping, using words like ‘honey’ or ‘sweetheart’.<br />Physical Harassment – impending, unwelcome physical contact, intimidating. <br />Visual Harassment – offensive materials such as photos, posters, cartoons or drawings; unwelcome notes or letters.<br />Threats & Demands to submit to sexual requests as a condition of continued employment or benefits.<br />Retaliation for having reported or threatened to report harassment.<br />
    137. 137. Body Mechanics<br />Use your strongest muscles to do the job<br />Shoulders, upper arms, hips and thighs<br />Maintain a broad base of support when assisting patients.<br />Point your toes the direction of movement.<br />Bend from the hip and knees and keep your back straight.<br />Use the weight of your body to push or pull an object, and push instead of pull whenever possible.<br />
    138. 138. Body Mechanics<br />Carry heavy objects close to your body<br />Avoid twisting your body as you work<br />Pivot with your feet, and use your legs to do the work<br />If a patient or object is too heavy for you to lift alone, always get help<br />Tighten stomach muscles without holding your breath when lifting objects.<br />
    139. 139. THE END<br />