Transcript Communication

Southern NH Medical Center
Specific Mandatory
Orientation Module
For Student Nurse
Academic Year
2013-2014
Our Standards of Behavior at SNHHS
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Communication: Communication is clear, timely and
respectful.
Showing Respect and Earning Trust: Respectful,
cooperative and trusting behaviors are the hallmarks of
providing a higher level of care.
Spending Quality Time: Employee's interactions with
others are always meaningful and of high quality regardless
of our time limits.
Organizational Pride: Organizational pride means making a
commitment to the organization and constantly striving to
support the culture.
Emergency Codes:
Medical Center & West Campus
Refer to your “Red Card of Courage” attached to your ID badge for a
code listing or the Emergency Code Manual located in your Medical
Center or West Campus unit/department.
The most common emergency codes include:
–Red: Fire/fire alarm activation (R.A.C.E)
–Medical Alert: Medical assistance
–Blue: Cardiac/respiratory arrest, unresponsive person
–Grey: Unruly patient/visitor/staff
Important reminders:
Code Gold (Controlled Access or Egress): You must have your name badge to enter the
Medical Center. You may be ask to secure an exit.
Code White (Internal/External Disaster): Report to your department or practice.
Code Silver (Hostage Situation/Weapon): Stay away from/leave area. If you can’t leave,
seek secure area (office with lockable door), turn off lights and remain quiet. Call x4100 in
Medical Center or 911 for off-site locations as soon as it is safe.
Code Amber (Missing Patient/Person) Monitor exit as assigned. A common method of
kidnapping is for a person to dress as a health care worker and carry a child. SNHMC staff
are not authorized to transport patients by carrying them between departments or on
discharge.
Emergency Telephone Numbers
Medical Center
West Campus
Practices &
Off-Sites
X4100 connects you immediately
to operator and should be used in
all emergency situations in hospital
X72 connects you to the
overhead paging system
Dial 911 for all
emergency
situations
X72 connects you directly to the
overhead paging system.
Use only if X4100 is not working.
Dial 911 for additional
emergency assistance
Our Culture of Quality and Safety at SNHHS
How do we achieve the Right Care for
the Right Patient at the Right Time –
EVERY TIME?
#1 Promote teamwork through respectful and
effective communication at all levels.
#2 Know how, who, and when to call for help in
unsafe or urgent situations, and teach your
patients how to call for appropriate help.
#3 Use checklists that contain evidence based
standards to guard against missing steps
or making errors in critical procedures such
as surgery or in hand-off communications.
#4 Partner with patients and families for safety,
such as keeping patients safe from falling
and harming themselves or others.
#5 Use at least 2 ways to identify the right
patient before taking him or her anywhere,
conducting tests or giving medications.
Other Quality and Safety Initiatives at
SNHHS:
•Eliminate healthcare acquired
infections by paying strict attention to
hand washing and sterile technique.
•Eliminate preventable patient harm as
part of the NH initiative through the
Foundation for Healthy Communities.
•Consistent use of the Surgical Safety
Checklist in all procedures as part of
participation in the NH Quality
Assurance Commission.
Promoting Safety Through
Respectful Dialogue
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Safety “takes a village”, and we like to say that we
“have each others’ backs”.
That means we take every opportunity to point out
missed opportunities through direct and respectful
communication.
If there is a chance that the patient may be harmed;
then an immediate, respectful discussion is
appropriate. Examples: when not using two patient
IDs, not maintaining hand hygiene or skipping steps in
the Medical Center’s safety checklist.
It isn’t always easy to speak up this way, but we
continue to foster a culture of gratitude for this
partnership.
If you ever encounter a barrier to communicating a
safety concern, speak with your faculty person or
resource nurse and they will bring this to SNHMC
leadership.
Our “Just Culture” Recognizes that…
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Even caring and competent professionals make mistakes.
Most humans working in a complex environment like health care will make a mistake at
some point. Some key risk factors that promote mistakes are listed, and we should have a
heightened awareness of these:
– Interruptions or multi-tasking
– Fatigue
– Unnecessary complexity or number of steps
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Blaming someone for an error can drive mistakes “underground”.
The best way to eliminate events that harm patients and staff is to encourage reporting
of all errors and near misses (close calls), so that they can be analyzed for
opportunities for improvement – especially since most patient harm can be eliminated
by these steps:
– Providing and promoting standardized training
– Designing systems, procedures (like checklists) and processes that take into
account the risks and “guard against error”.
– Paying careful attention to factors that shape performance such as interruptions,
which can promote error.
– Constantly scanning the environment for and correcting risky behaviors: like
drifting away from best practices. (Do you wash your hands every time?)
A culture of safety can only exist when people are held accountable for blatant
disregard for policies or procedures.
Occurrence Reporting
An occurrence is any circumstance, accident or unusual happening, which
is not consistent with the routine care of the patient or routine (hospital)
operations that results in actual or potential personal injury, property loss
or property damage.
Examples of occurrences include:
Falls
Malfunctioning equipment
Property damage
AMA/Elopements
Unexpected complications
Hazardous spills
Medication events
Unplanned returns to the OR
Disruptive behavior
Specimen issues
Unexpected treatment outcomes
“Near misses”
Occurrence Reporting:
• Provides information for investigation and to prevent future occurrences.
• Alerts Risk Management and Administration of possible claims.
• Helps identify trends and high-risk areas requiring corrective measures.
Responsibilities: Occurrence Reports
As part of the SNHHS Quality Programs, we recognize our responsibility to:
• Provide a safe environment for patients, visitors, students and employees
(Malfunctioning equipment).
• Strive to minimize and eliminate or prevent such occurrences (such as
medication errors, falls, delays in care, unexpected outcomes of care)
• Provide immediate, honest and meaningful communication with the patient
and his/her family after an occurrence.
• Allow any person who has concerns about safety or quality of care provided
at SNHMC that have not been addressed, to report these to the Joint
Commission without fear of retribution..
If an Occurrence should occur, you should:
• Notify your instructor and the resource nurse
• Notify the patient’s nurse and physician/provider if a patient is involved.
• Include circumstances, interventions and treatment in the patient’s medical
record.
• Assist in making a report as soon as possible.
You should not:
• State in patient’s medical record or inform patients/visitors that an
Occurrence Report has been completed or that Risk Management has been
notified. Occurrence Reports are quality assurance documents, and the
information is considered privileged.
Material Safety Data Sheets (MSDS)
Material Safety Data Sheets (MSDS) are supplied by the
manufacturer and contain more information than will fit
on a label. They include physical, health and fire hazards
as well as first aid measures and recommended personal
protection.
MSDS copies are located in each department’s/
practice’s MSDS binder. The master copy is located in
the Environmental Services Department. They can also
be found on the Environmental Services intranet
homepage by clicking the link for msdsonline.com.
If a Chemical Spill Occurs…
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Remove patients or staff in room/area from immediate
danger.
Close door (if applicable) to the room/area involved.
Minor and Major Spill criteria and follow-up.
– Minor Hazardous Spills (Less than one Gallon and
Unlikely to Produce a Harmful Concentration in Air).
Contact nursing leadership and/or resource nurse.
Trained individuals will use spill kits located on their units
• Major Hazardous Chemical Spills (One Gallon Or
More; Or Any Amount Likely To Produce a Harmful
Concentration in Air). All major spills will be addressed
through outside resources which will be facilitated by
Security. (Call X4100- Code Orange). Obtain the Material
Safety Data Sheet prior to Security’s arrival. For
Formalin spills, if feasible, neutralize the spill by using
formalin polymizer.
Off-Site Locations--- Call 911 if you are unable to manage the
spill with on-site spill kit.
At the Medical Center
report major hazardous
chemical spills to Security
not Environmental
Services.
Hazardous Waste Tips
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Never use any hazardous materials without proper
training.
Never mix chemicals.
Always keep chemicals tightly secured in original
containers.
Always keep different chemicals segregated.
Keep flammable materials in flameproof closed containers
away from sources of ignition and high temperatures.
Use the least hazardous material appropriate to the job.
Dispose of hazardous substances according to the MSDS
or SNHMC Waste Segregation Chart or the procedure for
your Practice.
Know where your eye wash station is.
Always use proper protective equipment.
Waste Segregation Chart
(Refer to Waste Segregation Chart in your area for examples of each type of waste.)
Non-Hazardous
Pharmaceutical Waste
All pharmaceuticals
without a sort code.
Hazardous
Pharmaceutical Waste
Syringe or Sharp with
Pharmaceutical in it
Pharmaceuticals with a
sort code BKC, BK6,
PBKC, SP, SPO, SPC,
DW. (These medications
will be labeled)
Pharmaceutical with no sort code
in the form of a syringe, broken
vial or ampoule.
Medical Center Waste Segregation Chart
(Refer to Waste Segregation Chart in your area for examples of each type of waste.)
Regulated Medical
Waste
Sharps-Sharps
Containers
Chemo-Trace amounts
RCRA Empty
Clear Plastic Bags
Non-sharp items
visibly soiled with
blood/other infectious
body fluids, which
could leak or flake off.
Sharps or
contaminated items
that are broken and
have the ability to
puncture a red bag. (
(The State of NH
defines a sharp as a
syringe with or without
a needle, regardless of
how it was used)
Chemo to include IV
bags, tubing, empty
vials, syringes…
Miscellaneous items
that do not go in other
containers such as
tissues, packaging
materials, diapers…
Password Guidance
Password Requirements
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Minimum of 8 characters
Must change at least every 90 days
Suggestions for a STRONG password:
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Don’t use something that is easy for others to guess such as your birthday
or child’s name.
Use mix of upper/lower case letters, numbers and other characters.
Use a phrase with numbers and punctuation such as “I Like 2 Eat Ice
Cream”.
Don’t use words in a dictionary (easy to hack).
Don’t write your password down; commit it to memory.
Recommendation: Change passwords for different systems together, so you
don’t forget.
Confidentiality Tips
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Refrain from talking about confidential patient information in public
areas even in general terms. Some general information can be
enough to identify a patient.
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Friends and acquaintances of yours are patients when they are here.
Treat their privacy and confidentiality with the same respect.
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Computers shouldn’t be left unattended or visible to others when PHI is
up on the screen. “Lock” or log-off when leaving your computer to
prevent unauthorized access and maintain patient confidentiality.
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Do not leave PHI on desks, fax machines or copiers. It can be picked
up by unauthorized individuals.
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Always dispose of PHI properly. Recycle bins or shredders are located
throughout the Health System. Do not throw PHI in the trash.
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SNHHS allows PHI to be transmitted by e-mail using a secure method
of transmission. PHI by e-mail is not preferred (only done as
necessary by staff and providers).
Electronic Systems and PHI
• SNHHS reports should not contain PHI unless absolutely necessary.
• Reports with PHI should have the absolute minimum number of unique
patient identifiers. All reports (paper or electronic) remain the property of
SNHHS.
BEST PRACTICE:
• Keep all PHI in core applications such as Soarian and Centricity
(Picis/Logicare).
• If you must move data from these systems, store the data on corporate
servers. Do not save data to CDs, ZIP drives, USB sticks, Smart Phones,
iPads or local drives (especially if you have a laptop) without consulting IT.
Did You Know?
Lost laptops cause the most security breaches in
health care each year.
System Auditing: Electronic Systems
and PHI
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All of our clinical systems have extensive audit capabilities:
– Regular audits are performed on our IT systems.
– Dismissal will occur if a patient’s privacy is violated.
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The audit trail is the official record of your activity.
– Log out or lock screen when you walk away and don’t leave PHI on
screen.
– Do not share your password with anyone.
– Call the Helpdesk (x2222) immediately if you think your password has
been compromised.
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Best Practice:
– Curiosity is the enemy.
– Proactively report mistakes.
– Access only the information you “need to know”
to do your job.
Harassment
Harassment is broadly defined as a repeated pattern of
unwanted or unwelcome behavior.
The perception of the victim is the most important factor in
considering a complaint; the intent of the harasser does not
matter.
A victim can be the person to whom the inappropriate behavior
is directed, or someone who witnesses or hears it.
Harassment can take many forms, including:
• Unwelcome physical conduct such as rubbing, touching,
grabbing or brushing against another person’s body.
• Inappropriate pictures
• Swearing
• Dirty jokes
• Making offensive comments about someone’s race, color,
ethnic background, religion or sexual orientation
SNHHS Harassment Policy
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It is the policy of SNHHS to prohibit harassment of any person
by any other student, employee, patient, volunteer or visitor.
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Any claim of harassment will be investigated as soon as
possible and management will determine appropriate action to be
taken. Corrective action, up to and including termination (or
dismissal from your clinical rotation) may be taken.
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We will not allow any form of retaliation against any individual
who reports harassment or is involved in the investigation.
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If you believe you are being harassed, you can speak directly to
the harasser if you are comfortable doing so. You may also
contact Human Resources, your faculty member, the
resource nurse or any member of administration with whom
you feel comfortable. Students can also report harassment
complaints anonymously by calling the Corporate Compliance
Hotline at 888-414-2743.
COMMUNICATION IS THE
CORNERSTONE OF PATIENT SAFETY
COMPLIANCE
It is the law, SNHHS Policy, and our responsibility to
provide equal access to healthcare services for limited
English & non English speaking patients.
Mandated by:
• American Disabilities Act (ADA)
• Title VI of Civil Rights Act
• SNHMC Interpreter Services Plan
Interpreter Services & Auxiliary Aids are
Free of Charge to the Patient…
Communication Service Toolkits
• Toolkits are located in the
following areas:
– Emergency Department
– All nursing units’
medication rooms
– Security office
– Practices
– West Campus
– Call Center
Communication Access
IMMEDIATE Communication Access Options 24/7:
1. Language Line – Non-English speaking
(DT Interpreting 1-866-237-0173)
2. NexTalk – Deaf/Hard of Hearing (ASL)
Use NexTalk computer/video remote interpreter when no live
Interpreter is available for Deaf or Hard of Hearing patients.
3. Page Interpreter Services On-call 221-0650
for all ASL and urgent interpreter needs
Long Term Solutions
Be proactive and anticipate interpreter needs in
advance….submit your request online….Go to the internet
homepage…Look in the center under “Care Resources” click
“interpreter Request or Cancellation”.
DOCUMENT daily all communication resources utilized for patient
Tips for Working with an Interpreter
Coordinate testing, assessments, MD
visits when using live interpreters,
NexTalk, or the Language Line
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Speak directly to the patient,
not the interpreter.
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Use first-person dialogue.
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Remember, everything you
say will be interpreted to the
patient.
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Interpreters are trained
professional staff. They may
ask for clarification for better
patient understanding.
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Interpreter Services On-Call
221-0650
Pager
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Patricia Greene,
Director of Patient
and Family
Services
564-1759
Pager
305-2018
Work Cell
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Rute Ferreira,
Interpreter
Services
Coordinator
221-0650
Pager
577-2584
Voice Mail
Interpreter Waiver
• Document that the patient
has declined the use of
hospital interpreter services
and prefers to use his/her
own interpreter.
• Waiver forms are on the
intranet. Use the Language
Line or NexTalk for Patient to
understand and sign (not
family).
• SNHMC will need to provide
an interpreter when the
person whom the patient
identified is not available.
Medical Center Security
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Security is on duty 24 hours a day/ 7 days a week. The
Security Office is located on the ground floor of The Medical
Center off the Emergency Department lobby and in the main
lobby of the West Campus.
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You can immediately contact Security by cell phone at all
times. Cell phone numbers are listed on the Red Emergency
Card attached to your ID badge.
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Your ID badge must be worn at waist height at all times while
on Health System property according to State Law. Some
exceptions are allowed in sterile areas. Temporary badges
are available from Security.
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In the unlikely event of electronic door system access failure,
the Blue Emergency Pull Stations can be used for
emergency door access.
Emergency
Pull to Exit
Security Services
(Main and West Campus)
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Escort Service: Employee, student and visitor escorts are
available upon request at any time for any reason at The
Medical Center and West Campus. If unavailable, leave with
others or have someone watch for you.
Car problems: If possible, Security will assist with jump
starts, but please try to arrange for other assistance.
Visitor Control: After 9 pm in The Medical Center, all visitors
are required to sign in at Emergency Department lobby. With
clinical approval, visitor badges are issued.
Patient Valuables: Patient safes are available in each room
in The Medical Center. High value items can be stored in
Security.
Lost and Found: Security manages lost and found items.
Emergency Call Boxes: Located in the parking garage
outside the elevators and in some parking lots.
Security Mirrors: Located in garage elevators and stairwells.
Exterior Lighting: All exterior light fixtures are numbered.
Please notify Security of non-working lights.
What to Do with a Combative Person
• Plan an escape route in advance.
• At the Main Campus, initiate a “Code Grey” by
pushing the Code Grey button or by calling x4100.
• At the West Campus, initiate a “Code Grey” by
calling x72.
• If off-site, call the police at 911.
Periodic training on workplace violence prevention
is offered at SNHHS. Department training can be
requested through the Security Department.
Code Grey
alarm in select
Medical Center
departments
Corporate Integrity (Compliance) Program
At SNHHS, we operate in accordance with all applicable laws, regulations
and standards. The Corporate Integrity Program (CIP) puts into writing these
standards - in its Code of Conduct handbook and related policies
Every student must agrees to understand and comply with all aspects and
principles of the Program.
If something doesn’t feel right, each of us has the ethical and legal responsibility
to pursue it. If you’re not sure about what to do, ask the question. As our
partner, you, too, are committed to honor the SNHHS mission. You understand
your responsibility to:
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Conduct yourself with honesty and integrity and in accordance with the
highest ethical standards.
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Perform your duties in accordance with the principles set forth in the
SNHHS Code of Conduct and CIP policies and program.
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Follow the laws and regulations under which SNHHS operates.
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Report or disclose any questionable situations promptly.
Corporate Integrity Includes:
-Workforce Conduct
-Confidentiality
-Patient Care
-Treatment of Employees and Clinicians
-Marketing & Public Affairs
-Resources/Assistance
-Reporting Concerns
-Enforcement
-Compliance with the Law
To Access more information on the Corporate Integrity Program access via our internet:
http://intranet.snhmc.org/snhhs/groups/mc_risk-mgt/corp-integrity-program.html
Q. To whom should you direct your Corporate Integrity
Program questions or concerns?
A. We encourage you to talk to your faculty member and/or nursing
leadership. However, if for any reason you do not feel comfortable talking
to either of them or if your question was not fully answered; contact the
Corporate Compliance Officer or designee.
If you feel your concerns about the safety or quality of care provided at
SNHHS have not been addressed, refer to SNHHS policies addressing
reporting such concerns, including to the Joint Commission, for further
guidance.
Q. How can a student report corporate compliance concerns
anonymously?
A. Students may call the Compliance Reporting Hotline at 1-888-414-2743 or
file a Compliance Report Form. The hotline is a secure voice mailbox
designed to allow anyone to report concerns confidentially and
anonymously.
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Can I post pictures and/or amusing stories about patient
encounters on Facebook or other social media sites?
Probably not. Good professional judgment must be applied. Under no
circumstances can any information identifying the patient be published.
This may include not just names, but personal attributes such as
distinctive tattoos or specific events in the local news.
A patient’s family is angry about the patient’s treatment. What
should I do?
Patients and/or family members may express or submit complaints or
grievances to any SNHHS staff member or directly to Administration.
Any student who receives a patient complaint should immediately
address the concern, either individually or by accessing appropriate
resources such as the patient’s nurse, the resource nurse, other
members of nursing management or social services. Patient complaints
that cannot be resolved quickly to the patient’s reasonable satisfaction
should be forwarded to Administration to assure a timely and fair review
of the grievance. Patients also have a right to contact the State of New
Hampshire Department of Health and Human Services.
Q. What should I do if I suspect my patient has been abused?
A. There are mandatory reporting requirements for health care
providers to report any potential victims of child and elderly abuse, if
they have reason to suspect that child or elderly abuse has
occurred. Refer to the Abuse Policy for regulatory requirements and
guidance on reporting. Hospital reports are coordinated by social
workers from our Patient and Family Services Department. If you
have reason to suspect a patient has been abused at SNHMC or a
Foundation practice site, you must contact your faculty, resource
nurse, supervisor or a member of senior administration immediately.
Human Resources and the Compliance Hot Line may also be used
to report, but since these options are only available Monday-Friday
during business hours, it is important to make immediate reports
through managers who are on site.
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A patient with a chronic health condition is frequently seen for
treatment at SNHMC. He routinely offers to tip the healthcare
workers and/or to give them gifts. May the staff or students
accept any gifts?
No. Students and staff may not accept cash or gifts from anyone
with whom we have a business relationship.