Transcript MSU Nursing Students MDG Orientation

MSU Nursing Students
MDG Orientation
Welcome
We are excited to have students at the
5 Medical Group (5 MDG) and would
like to extend a warm welcome to you.
The following slides are a compressed
MDG orientation. Please read through them
carefully and if you have questions, don’t
hesitate to ask a staff member when you
arrive at the MDG.
Informing Patients of Student Status
It is required that all students working at a
medical facility ALWAYS inform patients that
they are students PRIOR to asking the patient
any questions, conducting any type of assessment,
or providing any type of treatment. Most patients
are happy to have students help them out and will
gladly accept you as a member of their care team.
So, let the patient know at the beginning of the
encounter that you are a student.
th
5
Medical Group
CHAPERONES
Definitions


Chaperone – A person, especially an older or married
woman, who accompanies a young unmarried woman in
public; an older person who attends and supervises a
social gathering for young people. {Webster’s II New
Riverside University Dictionary}
Medical Chaperone – A third party, usually the same
gender as the patient, who maintains a presence during an
exam or treatment
• Promotes patient/provider comfort and safety
• Guards against professional impropriety and/or
unethical treatment
Who Can Chaperone?



All patient care staff members, including
administrative personnel, can serve as
chaperones.
The chaperone should, in most cases, be the
same gender as the patient.
• If a same-gender chaperone is not available,
the patient may consent to an oppositegender chaperone. Document consent
thoroughly.
If required chaperone is not available during
duty hours, contact the flight commander.
When Is a Chaperone Needed?




Any time a minor is examined or treated
(parent/legal guardian is acceptable)
• A parent/legal guardian must be present
except during emergencies or life-threatening
situations, or if the visit concerns sexually
transmitted diseases.
Any time a provider exposes, examines or treats
the genitalia or rectum of a patient of the
opposite sex
Any time a male provider exposes, examines or
treats a female’s breasts
Upon patient or provider request
Duties of Chaperone



Ensure patient privacy
Be present at all times during exam or treatment
Identify and report suspected misconduct
• Suspected misconduct (and any other
concerns regarding chaperones) will be
reported to the flight commander.
• If warranted, the flight commander will report
the suspected misconduct to the Chief,
Medical Staff (SGH), and to the squadron
commander.
Suspected Misconduct?



The nature/purpose of the exam or treatment
and extent/purpose of disrobing not fully
explained to the patient prior to the procedure
• Explain what the patient can expect and feel
during exam or treatment; avoid surprising
patient
Patient not provided privacy during undressing
and dressing
• At a minimum, draw privacy curtain; shut
door if possible
The extent of required disrobing inconsistent
with exam or treatment
• A patient need not disrobe (usually) for a foot
exam
Suspected Misconduct? (cont.)


Exam inconsistent with patient’s complaint or
purpose of visit
• Every woman does not need a breast exam
every visit
Provider’s comments unprofessional
• Comments should not be obscene or
demeaning
• Off-colored jokes or comments about patient’s
anatomy inappropriate
• Excessive flattery about patient’s body/body
parts inappropriate
Patient Misconduct?



Chaperones protect provider as well as patient
Provider responsible for managing inappropriate
patient behavior
• Serious consideration should be given to
documentation of patient behavior
Recommend documenting name of chaperone
when present
• Concerns may arise long after issue (and
name of witnessing chaperone) forgotten
Infection Control:
Goals of infection control within 5 MDG


It establishes prevention, control and
reduction interventions for
NOSOCOMIAL, community acquired
and clinic acquired infections.
Infection control practices minimize the
risk and spread of infection throughout
the hospital
BLOODBORNE PATHOGENS
Health care facilities are concerned about the
occupational (work related) exposure of their
employees to diseases transmitted through
contact with blood or body fluids. The two blood
borne diseases that hospital employees are most
at risk for developing are :






HEPATITIS
&
HIV


The single most important aspect of effective infection control is handwashing
Proper Technique







Wet hands to reduce irritation from the
soap
Keep hands lower than elbows to keep
contaminants from running onto clothing
Use antiseptic soap
Wash vigorously for 10 seconds
Rinse under running water to remove
contaminants
Use paper towels to dry hands
Use towels to turn off water to prevent
cross contamination and so you don’t recontaminate hands on dirty faucet handles
STANDARD PRECAUTIONS
treat everyone as if
they are infectious....

TRANSMISSION BASED ISOLATION
- AIRBORNE
- DROPLET
- CONTACT
Types of isolation used in 5 MDG (two-tiered)
Standard Precautions: apply to blood, body fluids, secretions and excretions,
nonintact skin and mucous membranes. Standard precautions are used for each
and every patient.
Transmission-based precautions: used for patients with known or suspected
infections by epidemiologically important pathogens spread by airborne, droplet
transmission or by contact with dry skin or contaminated surfaces..
MDGI 44-15 attachment 4 lists specific precaution and discusses type and
duration of precautions needed for selected infections and conditions.
ALL personnel are responsible to comply with the requirements of isolation
or precautions.
PPE
...
PPE = Personal Protective Equipment.
Also known as: PPA = Personal Protective Attire
WHAT “PPE” TO WEAR?
WEAR GLOVES - any time contact with
blood or other body fluids may
occur. For example:



when touching any mucous
membranes or broken skin
when handling items or surfaces
soiled with blood or other body fluids
when drawing blood
Change gloves if they’re torn, and
after contact with each patient. Do
NOT reuse disposable gloves.
Washing hands with gloves on is not an acceptable practice.
Gloves are cheap compared to the cost of treating an infection!
MORE PROTECTION!!
USE MASKS AND EYE PROTECTION - or protective face shields if
there’s any chance that blood or other body fluids may splash
into your mouth, nose or eyes.
WEAR A GOWN - or apron if splashing of blood or other body
fluids is likely.
AND REMEMBER TO WASH YOUR HANDS AND OTHER SKIN
SURFACES IMMEDIATELY AFTER:




direct contact with blood or other body fluids
removing gloves, gown or other protective
clothing
handling potentially contaminated items
all patient interactions
PPE is only effective if it is used appropriately. It is not a total
prophylactic. Hand washing is still necessary
Basics of sharps/needle safety




USE SHARPS CONTAINERS FOR
DISPOSAL
REPORT INCIDENTS
DON’T SCRUB INSTRUMENTS AT
USER LEVEL
DON’T RECAP
Needlestick Protocol
Needlestick protocol to be followed in the 5 MDG
 Wash area immediately
 Report to Public Health; if after
hours report to after hours clinic
 Supervisor completes incident
report
• AF Form 765


Prophylactic medication if patient is
infected with HIV/Hepatitis
Follow-up care
Take CARE when using sharps
NOT CHANCES!!
Take care when using sharps, NOT CHANCES! Pay attention to
what you are doing when handling sharps. Do not jeopardize
coworkers or your own safety.
RED BAG WASTE
Red bag is for potentially infectious,
contaminated material ONLY.
Must be saturated with body fluids
before qualifying for disposal
in red bag. Non-saturated
dressings, band aids, outer
wrappers go in regular
trash.
VERY EXPENSIVE to dispose of!


Either complete the Nosocomial
Infection Report Form ACC 323 or
inform the ICO of a known infection and
ICO will fill out the form.
If you fill out the form, turn into
Infection Control Officer
• within 24 hours of suspicion
Whenever a suspected nosocomial infection is
discovered, fill out a report form.
SAFETY-RELATED
INCIDENTS
BACKGROUND
Safety-related incidents are those that directly
pose a health threat to staff and patients, can
directly impact the mission, and that are
generally considered preventable. The most
common safety-related incidents in the 5th
Medical Group are medication errors,
needlestick/sharps injuries, falls (both patient
and staff), and exposures to blood-borne
pathogens and chemicals.
PREVENTION



DoD requires analysis of processes that place
patients and staff at-risk
Failure Mode and Effects Analysis (FMEA) is one
the tools the MDG uses to proactively reduce
and prevent injuries and incidents.
MDG Safety Committee tracks and trends
incidents that occur.
REPORTING

Use AF Form765, Medical Facility
Incident Report
• FormFlow version on LAN



Turn in to Quality Services within 24
hours
Seek medical care for injuries
Report exposures to Public Health
Incidents are unexpected occurrences such as:
sharps injuries
medication errors
patient falls
exposures to blood-born pathogens
equipment failures during patient care episodes
INCIDENT EVALUATIONS



Reviewed by supervisor, flight/squadron
leadership, and Risk Management
Non-attributional except in cases of gross neglect
or intentional misconduct
Presumed to be a system error unless proven
otherwise – errors and accidents cannot be
completely eliminated and thus are treated as a
workplace process that can be improved
th
5
Medical Group
MANAGEMENT
OF VIOLENT
PERSONS
Governing Directive
(The 5th MDG is a restraint free facility!)

5 MDGI 44-121, Management of Violent Persons
 This instruction establishes the policy for
managing persons with specific behavioral
health needs/issues (e.g., psychotic and/or
violent behavior).
 Nonviolent, restraint-free intervention is
emphasized and safety of all personnel is
primary concern.
Staff Education
(The 5th MDG is a restraint free facility!)
5 MDGI 44-121, Management of Violent
Persons, mandates orientation and
annual training on use of nonviolent
intervention
It discusses expected outcomes (goals) of
nonviolent intervention and steps for
implementing nonviolent intervention
Definitions

Restraints fall into three categories:
Protective Devices – devices used to protect patient, or
posturally support or assist to obtain/maintain normative
bodily functions; such as bedrails, halter restraints,
orthopedic devices, braces, etc.; not considered restraints
Medical Immobilization – mechanisms employed during
procedures, without which patient could suffer harm; such
as body restraint during surgery or soft restraints to
prevent dislodgement of intravenous lines; associated with
normal behavior; not considered restraints
Restraint – use of physical or mechanical devices used to
involuntarily hinder movement of all or portion of person’s
body to control physical activities, thereby protecting
person or others from injury; key is the intent for its use; is
person’s behavior itself that determines the need
Definitions (cont.)


Dr. Strong – a code for requesting an immediate
show of force to subdue a potentially hostile or
violent person or to defuse a potentially
dangerous situation
 THE USE OF FORCE BY 5 MDG WILL BE
AVOIDED IF AT ALL POSSIBLE
Code Black – a code used during a general state
of duress at a location within the confines or
surrounding grounds of 5 MDG; announced
location is to be avoided by all personnel because
of presence of possibly dangerous person
Responsibilities







Manage person using nonviolent interventions
Consult Life Skills Support Center regarding persons
suspected of being violent or psychotic
Contact Ambulance Services when behavior suspicious of
becoming violent
May assist in transfer of person in need of care to
appropriate (e.g., psychiatric) facility
Document all care on progress notes in medical record
Physicians may administer medications to address targets
behavioral symptoms based on clinical judgement and the
person’s
Ambulance Services will announce Code Black/Dr. Strong
and location via overhead paging system and Will contact
Security Forces for assistance managing violent persons
who cannot be managed effectively using nonviolent
means
Procedures/Interventions
Egress immediate area ASAP; behind locked doors
if possible
 DO NOT ATTEMPT TO APPREHEND OR SUBDUE
 If you cannot egress area safely, lock all personnel into
a room, avoiding doors and windows
 Primary Care Staff will clear the atrium of personnel
and lock them in clinic area
Notify Ambulance Services or activate automated
alarm when safe to do so
Ambulance Services will announce twice, “Code
Black/Dr. Strong in (location).”
Procedures/Interventions (cont.)




Drop cage windows immediately
Lock hallway doors once personnel evacuated
from main hallways
Lock all interior doors once all personnel safely
inside
Ambulance Services will contact Security Forces
and inform them of situation and location of
aggressor(s) if possible. If it is not safe to do
so, they will activate the duress alarm.
Procedures/Interventions (cont.)

Remain in secure locations until given “All
clear!”
 Ambulance Services will announce “All clear!” overhead
when assured the situation safe.
 Ambulance Services will authenticate “All clear!” in
following manner: “This is Ambulance Services control.
Code Black/Dr. Strong is terminated at this time (by
Security Forces).”
 Will announce authentication twice

In event of casualties, Ambulance Services will
activate Medical Group Control Center (MGCC)
and implement Disaster Casualty Control Plan
(DCCP).
Procedures/Interventions (cont.)
Facility Management will survey premises and
determine any structural damage that might
jeopardize safety and if necessary, will activate
alternate facility plan
Ambulance Services will document events in the
shift log
If the MCC was activated, documentation will be
consistent with MDG’s DCCP.
Expected Outcomes



The person will regain control of his/her
behavior.
The person will not harm patients, community
members or staff.
The dignity of all will be maintained.
FIRE SAFETY
ITEMS EVERYONE SHOULD KNOW
1. Know the location of the nearest alarm pull station.
2. Know the location of the nearest fire extinguisher.
3. Know by heart the number for the Ambulance service. (5627)
4. Know by heart the number of Facility Management. ( 5260)
5. Know who your safety monitor for your section is.
6. Know who your area fire marshal is.
7. Know the fire escape plan for your area.
8. Select an area that everyone meets to have a head count.
9. Always use the outside stairs to evacuate the building.
10. Your 5th Medical Group Primary safety officer is Ms. Carrie Mullin
Fire Safety
The 5th Medical Group is on a fire zone
system. When a fire alarm is activated, the
system generates two series of rings. The
first series indicates on which floor the fire
alarm has been activated. This is followed
by a brief pause, followed by a series of
rings that indicates where on the floor the
alarm has been pulled.
Fire Safety
Know what fire zone you are in at all times.
Reason: If you are in a zone that has a fire in it, you only
need to go to the next fire zone to have more time to escape.
Unless Fire Dept evacuates whole building
How do I know what fire zone I am in????
You need only to look at the fire alarm bells it is printed on
each one also it is on each pull station.
Where are alarm stations
and pull station located?



All alarm stations are located near the ceiling in
hallways.
All pull stations are located in hallways near
doorways at about shoulder height.
Both have printed on them the floor and zone
that you are in. Such as (1-4, or 2-1 or 3-2).
Fire Extinguishers
Fire extinguishers in the facility are of the "ABC" variety.
These extinguishers can be used on ALL types of fires.
If the fire is small and you feel you
have the ability to extinguish it using an
extinguisher, remember the acronym
PASS.
P - Pull pin: you will need to pull hard on
the pin to break the seal
A - Aim: at the base of the fire, ensure you
do not stand too close or the force of the
extinguisher may spread the fire
S - Squeeze: the trigger
S - Sweep: side to side at the base of the
fire
Fire Safety
If at any time you doubt whether you have the ability to
put out the fire using an extinguisher, leave, ensure the
fire alarm is activated and the Fire Department is
notified. Life safety takes precedence over
anything. It is everyone's responsibility to know the
locations of fire alarm pull stations and fire
extinguishers in their work ar
Evacuate upper floors via the four corner stairways, leave
the atrium stairs for upcoming traffic--NEVER USE THE
ELEVATORS DURING A FIRE.
In case of fire at the 5 MDG you would call 9-911.
Fire Safety
Listen for the location of the fire through
the overhead. If you are located adjacent
to the fire area, close all doors to rooms
and wait for further instructions. If the fire
is in your area begin RACE procedures.
R- REACT by shouting FIRE & RESCUE
A - ACTIVATE the fire warning/ alarm
system-KNOW location of nearest
alarm pull box
C - CLOSE all doors in affected fire zone
E - EVACUATE ALL PERSONNEL
Questions?

Contact Carrie Mullin at 723-5260
Hospital Employee
Health Program
Initial Screening




Recent (within past year) TB skin test
Hepatitis B Vaccination
• Required for all Active Duty
• Offered to Civilian employees
HIV
• Required for personnel potentially
exposed to blood/body fluids
Evidence of immunity to chickenpox,
rubella, and rubeola (measles)
Annual Screening

TB skin test
• Required for everyone

HIV
• Required for personnel potentially
exposed to blood/body fluids
Sick employees




Must see PCM to determine duty
restrictions needed to prevent
transmission to patients and coworkers
PCMs should complete Quarters
Authorization form and provide a copy to
Public Health
Public Health reports numbers to Infection
Control Committee
Should see PCM upon return to work if still
sick
Bloodborne Pathogens
Exposure


If you get exposed do the following:
• Fill out an incident report
• Get the name of the patient you were
exposed to if at all possible
• Go to Public Health with the incident
report and patient if possible
Public Health will order lab work
(HIV/Hepatitis Panel) on you and the
patient and have you seen by your PCM.
Bloodborne Pathogens
Exposure Follow-up Labs

3 Months and 6 Months
• HIV
• Hepatitis Panel
TB Exposure Control




Active TB risk for Minot is low
No isolation facilities available here
Suspected or confirmed cases should
be referred downtown
If you suspect an active case:
• Mask the patient and yourself
• Isolate as much as possible
• Contact Infection Control & Public
Health
5TH MEDICAL GROUP HEALTH
INSURANCE PORTABILITY and
ACCOUNTABILITY ACT (HIPAA)
TRAINING
WHAT ARE THE
HIPAA RULES?
HELP ME
UNDERSTAND HIPAA.
HOW DOES
HIPAA APPLY
TO ME?
TABLE OF CONTENTS






Why HIPAA
Notice of Privacy Practices (NOPP)
Authorizations
Patient Rights
Penalties
Contacts
Why HIPAA?
1996 – In Tampa, a public health worker sent to two newspapers
a computer disk containing the names of 4,000 people who
tested positive of HIV.
2000 – Darryl Strawberry’s medical records from a visit to a New
York hospital were reviewed 365 times. An audit determined
less than 3% of those reviewing his records had even a remote
connection to his care.
2000 –An Atlanta truck driver lost his job in early 1998 after his
employer learned from his insurance company that he had
sought treatment for a drinking problems. (USA Today, 23 Mar
2000)
2001 - Elli Lilly accidentally sent e-mail to Prozac users on an
informational list server revealing identities of numerous other
Prozac users.
Cast of Characters

Amn Notsofarfrumpukin – Our Military
Patient

Mrs Imsik – Our Civilian Patient

Ms Lookemup – Our Records Technician

Mr Doody – Our Front Desk Clerk

Mr Shhh – Our Privacy Officer (HPO)
(HIPPA PRIVACY OFFICER)
Protected Health Information
What is
Protected
Health
Information?
It
Basically,
is a subset
anyof
information
individually
pertaining
to
identifiable
an individual’s
health
information
treatment
(click)
Including payment for
the provision of health
care
Amn Notsofarfrumpukin reports to your clinic and you notice that the
Notice of Privacy Practices (NOPP) has not been signed.

Per DOD 6025.18 and MDGI 41-10,
clinics are required to check the
medical records for signature.
• Ask if he has received the NOPP


If not, give him one and have him sign the
sticker.
If he has, and has not signed the sticker, have
him sign and give him another NOPP if he wants
one.
• Refusal to sign will not impede medical
care.
• Front desk clerk will initial the NOPP on
appropriate line if the patient refuses to
sign.
Amn Notsofarfrumpukin’s 1st Sgt calls and wants to
know if he made his appointment
and the nature of the appointment.

Under the Military Command Authority
(MCA) rule, Commanders, 1st
Sergeants and those designated in
writing by the Commander may receive
Protected Health Information (PHI).
• We must verify position
• Give only minimum information necessary
Amn Notsofarfrumpukin’s
supervisor calls for information
on the appointment.

Since the supervisor is not the 1st Sgt
or Commander, he is not entitled to
the information.
• You can tell him that if the Amn is
available, you will have him return the call
or
• Ask him to have the 1st Sgt call.
DISCLOSURE REPORTS

When Personal Health Information
(PHI) is accessed, used or disclosed
without patient authorizations
(except for those purposes that are
exempted) a signed and completed
PHI Disclosure Report must be
completed and forwarded to the
HIPAA Privacy Office for filing.
Lets’s look at some other
examples
I received a phone call
from the base legal
office for records on an
Amn, can I give it to
them?
However, we will
need the request in
writing and only
minimum
information should
be given, and the
legal office should
be specific about
what they are
looking for.
Yes, under HIPAA, if
there is an ongoing
investigation we can
release Information
Authorizations
Will I have to do a
disclosure report?
Yes, disclosures
that do not have
written authority
to release,
require a
disclosure report.
Authorizations
We have a patient that
came from another state.
We need her records to
continue her care. Does
she need to request
them?
However, if the
patient is available,
it is always a good
idea to get a
signature.
No, under
Treatment,
Payment, and
Healthcare
Operations (TPO)
we can request the
records without
authorization.
There are other occasions where
authorizations are not required.













To Public Health Authorities
To Military Command Authority (i.e., Commanders and First
Sergeants)
Judicial and Administrative Proceedings
Required by law
Victims of abuse, neglect or domestic violence
Health oversight committee
Law enforcement
Identification and location purposes
Reporting crime in emergencies
Corners, Medical Examiners and Funeral Directors
Research involving minimal risk
Avert serious threat to health and safety
Worker’s Compensation
Remember a disclosure report is required
Lets take a look at Patient Rights
under HIPAA.
I would like a
copy of my
medical
records
Under DOD 6025-18R and
MDGIS 41-10 and 41-12,
patients have a right to inspect
or have copies of their medical
records.
Patient Rights – Medical
Records




We must comply with the
request within 30 days.
A one time extension of 30
days may be granted.
A one-time copy will be
prepared without cost to
the patient. Other copies
can be provided at a fee
determined by the
Business Operations Flight.
There are circumstances
where access is denied. If
you have any questions
contact the Privacy Office
at ext 5134 or 5206.
Patient Rights -continued


To file a grievance or
complaint about any
aspect of their PHI or
the MTF’s practices
and policies.
They have a right to
designate a personal
representative with
authority to act on
their behalf
Un-emancipated minors,
under ND law, may only
consent to treatment for drug
and alcohol abuse, treatment
for sexually transmitted
diseases and medical
emergencies.

Patient Rights - Continued
I have a problem
with a notation in
my records and I
would like it
amended.
Under HIPAA a patient has
the right to request an
amendment or correction. The
physician needs to review the
records. The request may be
denied if:
Patient Rights-Reasons for
denial



The information was not created by
the 5th Medical Group.
The information is not part of the
record set (medical records)
The information is accurate.
The Privacy Officer will be consulted
prior to any denial to the Patient.
Other Patient Rights Include:


The right to full disclosure of release
of disclosures, except for those that
have been authorized.
Request restrictions of the uses of
PHI, but the MTF is not necessarily
required to follow the request (i.e.
would there be a mechanism in place
to monitor the restriction).
Penalties
What if I mess up
and release PHI to
the wrong individual?
Notify the Privacy Officer
immediately
Document it on an AF Form 765,
Medical Facility Incident Report and
forward to the Risk Manager within 24
hours
Persons making intentional unauthorized
disclosures will be referred to their unit
commander for appropriate administrative or
disciplinary action.
What are the
Medical OIs
concerning HIPAA?
MDGI 41-12 – Patient’s
Rights Under HIPAA.
MDGI 41-10 – Implementation of
Privacy Practices
MDGI 41-11 – Accounting
of Disclosures of PHI
Located on the “U” drive;
Shared folder; HIPAA
Compliance folder
Points of contact

If you have any questions please contact:

Lorenda Poissant-Salling (Privacy Officer)
• ext 5206
OR

Kim Lemley (Privacy Assistant)
• ext 5134
Responsibilities

Remember, everyone
who works with or
comes in contact with
protected health
information (PHI) or
any medical
information is
responsible to
maintain the
confidentiality of that
information.
Patient Rights
ACCESS
Patients have the right to
receive care within a
reasonable period of time
What is considered
reasonable depends on
the type of care required
ACCESS


The access to care standards at the 5th
Medical Group are as follows:
Acute/Urgent appointments within 24
hours

Routine Care within 7 days

Wellness appointments within 30 days
TREATMENT
Patients have the right to receive the
appropriate care required to achieve or
maintain the highest possible quality of life.
That may include not only physical care
but…..
psychosocial
spiritual
cultural
end of life
Patients have the right to be
involved in any decision that
involves their care including:
Advance Directives
Conflict Resolution
ADVANCED DIRECTIVES
Advance Directives are written or
verbal Statements made by the
patient indicating his or her
treatment wishes in the event
the patient becomes incapacitated.
Patients must be given the
opportunity to make these
provisions
Advanced Directives may
include living wills,, durable
powers of attorney, or similar
documents or documentation
conveying the patient’s
preferences.
Advance Directives



Patients may obtain advance
directives from their attorneys
For Active Duty members this service
is provided for free at the base legal
office
If you do have an advance directive,
please ensure that a copy of it gets
placed in your outpatient medical
record
PATIENT ADVOCACY PROGRAM
A patient has a right to voice
complaints about his or her
care and to have those
complaints reviewed, and when
Possible, resolved.
PATIENT ADVOCACY
PROGRAM



5th MDGI 41-18 - Patient Relations
Program outlines the mechanism for
investigation and resolution of patient
complaints/concerns
Each section involved in patient care
has an appointed Patient Advocate, as
does the Medical Group
The goal is to resolve the issue at the
lowest level, whenever possible
Patient Advocate


The 5th Medical Group’s primary
Patient Advocate is Mrs. Jean Cadell
(723-5109)
The 5th Medical Group’s alternate
Patient Advocate is Mrs. Lorenda
Poissant-Salling (723-5206)
RESPECT
Patients have the right to be treated with respect in all
interactions. Respect involves numerous issues
including:
Confidentiality/Privacy
-only those needing specific information in order to
provide care are allowed access to patient information
-sharing patient information is restricted to staff involved
in the patient’s care and is limited to information essential
to that care
Spatial-Patients have the right to physical privacy during
interviews, procedures, etc.
Security-Patients have the right to a safe, secure
environment, for themselves and their property.
Communication-Patients have the right to be treated as
valued individuals in all interactions.
ETHICS
MDGI 37-1 outlines the facility’s Ethics
policy and provides the mechanism
for obtaining assistance in making
ethical decisions involving patient
care
The Ethics Committee meets on an as
needed basis to discuss ethical issues.
Members are available to assist in the
decision making process.
Questions?
Contact Mrs. Lorenda Poissant-Salling at
723-5206 or Mrs. Jean Cadell at 723-5109
CODE BLUE
PROCEDURE
DEFINITION
CODE BLUE: Code name for
cardiopulmonary arrest or any
situation in which a cardiopulmonary
arrest is imminent.
BLS AND ACLS




A – Airway
B – Breathing
C – Circulation
D – Defibrillation
INITIATING A CODE BLUE

Dependent on 4 factors:
•?
•?
•?
•?
Normal duty hours
Non-duty hours
Adult
Pediatric
INITIATING A CODE BLUE

ADULT – NORMAL DUTY HOURS
• FIRST PERSON



Assess the patient
Overhead Page by dialing 2-0 and announce
“CODE BLUE and LOCATION” twice.
Initiate CPR by using the ABCD assessments
of BLS and ACLS
INITIATING A CODE BLUE

ADULT – NORMAL DUTY HOURS
• SECOND PERSON


Activate the code if necessary
Assist with CPR until team arrives
INITIATING A CODE BLUE

PEDIATRIC – NORMAL DUTY HOURS
• FIRST PERSON




Assess the patient using the ABCD of BLS
Perform CPR for 1 minute if necessary
Overhead Page by dialing 2-0 and announce
“Pediatric Code Blue and Location” twice
Resume CPR
INITIATING A CODE BLUE

PEDIATRIC - NORMAL DUTY HOURS
• SECOND PERSON


Activate code if necessary
Assist with CPR until team arrives
INITIATING A CODE BLUE

ADULT OR PEDIATRIC AFTER HOURS
• Dial 9-911 and report if the coding
patient is adult or pediatric and the
location of the patient.
• Ambulance services will be the sole
responders.
WHO RESPONDS TO A CODE
BLUE??
Normal duty hours:





All available credentialed providers
Ambulance Services paramedic and
technician
X-ray, pharmacy and laboratory technicians.
Pediatrician or PALS-trained Pediatric Nurse
Practitioner for children under age 16
(pediatric code)
Available clinic nursing staff and two clinic
technicians
WHO RESPONDS TO A CODE
BLUE??

NON-DUTY HOURS
• Ambulance Services Paramedic and
Technician
• Patient will be transferred downtown
LOCATION OF ADULT CRASH
CARTS
LOCATION
 Dental Clinic
 Internal Medicine
COVERAGE
 2ND Floor
 1st Floor Clinics
 All areas of the
facility
LOCATION OF PEDIATRIC
CRASH CARTS
LOCATION
 Pediatric Clinic
(GREEN TEAM)
COVERAGE
 Clinic areas of
MDOS

All areas of the
facility
AFTER A CODE BLUE



Pharmacy will restock the drugs
Unit personnel should inventory and
restock all other supplies
Pharmacy will issue a new lock for
the crash cart
WORDS OF WISDOM FOR
CODE BLUES


Most Pediatric Codes start with the airway,
so remember the ABCDs. Airway is
always first.
Don’t wait too long to call a code. If you
think a patient is in trouble, call a code. It
is the fastest way to get help.
SUMMARY



KNOW THE LOCATION OF YOUR
CRASH CARTS AND BE FAMILIAR
WITH THE CONTENTS
REVIEW THE USE OF THE LIFEPACK
12 DEFIBRILLATOR
REMEMBER TO DIAL 2-0 FOR HELP
DURING THE DAY AND 9-911
AFTER HOURS
Questions?

Education & Training #723-5662
MEDICAL EQUIPMENT
MAINTENANCE
5 MDSS/SGSLR
723-5256
Training Objectives






User Responsibilities
Medical Device Related Incidents
Service/Calibration Label
Medical Maintenance Services
Electrical Safety
Emergency Procedures
Overview

Equipment operators (YOU) have a
key role in managing the equipment
in the facility
• Insuring the equipment is used for its’
intended purpose
• Insuring any staff members using
medical group equipment are trained
Medical Device
Related Event

A medical device related event is
when a medical device (supply or
equipment):
•
Has caused or may have contributed
to the injury, illness, or death of a
patient, visitor or staff member
Medical Devices Event
Common Causes






Equipment malfunction
Operator error
Poor device design or inadequate labeling
Defects in laboratory or imaging equipment
Sterilizer spore tests inaccurately indicating proper
sterilization
Utility problems (electricity, medical gases,
plumbing)
Operator Preventive
Maintenance

Preventive Maintenance Checks
- Check case/housing for damage
- Replace leads/hoses/tubing, as required
- Replace batteries/bulbs if accessible without tools
- Perform function checks; report deficiencies
- Reference manufacturer’s operator manuals
- Keep equipment clean
- Ensure battery-operated devices are plugged
in to maintain charge & prevent internal damage
Medical Devices Event
User Responsibilities






Remove item(s) from service
Do not change settings
Keep accessories with unit
Recover any accessory packaging
(lot number/date information)
Notify section supervisor
Notify Medical Maintenance and
Quality Control immediately
Service/Calibration
Verification Label



Visual reminder that equipment is certified to
operate within manufacturer’s design parameters
You are responsible for checking the “Date Due”
PRIOR TO use of equipment to assure equipment
is calibrated
If expired service label is found, do not use the
equipment.
• Contact Medical Maintenance at 723-5256
Service Due Date
Services Provided by
Medical Maintenance




Provide or arrange for all
maintenance services for medical
equipment
Assembly and installation of
equipment
Operator training on equipment
during initial issue or upon request
Hazard surveillance for medical
equipment
Equipment Supported by
Medical Maintenance



Medical, Dental, Lab, Radiological, and Veterinary
devices used in the diagnosis, treatment or
rehabilitation of patients
Not supported: Ice makers, coffee pots,
refrigeration systems, televisions, typewriters,
computers not connected to medical equipment,
nurse call system, desk lamps, beepers, or locks
When in doubt, please call us at 723-5256.
Electrical Safety

Extension cords, outlet strips, and
outlet adapters are prohibited from
use with medical equipment
•
•
•

Tripping Hazards
Fire Hazards
Electrical Safety Hazards
If a longer power cord is necessary
to operate equipment, contact us for
assistance.
Summary





User Responsibilities
Medical Equipment Events
Service/Calibration Label
Medical Maintenance
Services
723-5256
MSgt Jim Britt
Electrical Safety
SSgt Chasity Force
SrA Patryk Gasiewski