Transcript Core Orientation Module for Students and Faculty

Student and Faculty Core
Orientation©
Approved 5 23 2011, Revised 4 22 2015
1
Introduction
Welcome to the Student and Faculty Core Orientation!
This presentation includes common orientation information
that is required by healthcare agencies for faculty and
health science students completing clinical rotations in North
Carolina. The presentation is developed and maintained by
the Clinical Consortium for Education and Practice. The NC
AHEC Program website is the host for the Core Orientation
presentation.
If you have trouble accessing the presentation, please
contact your school coordinator.
2
Objectives
Upon completion of this orientation the participant will be able to
describe the following as related to clinical practice:
• Standards of Behavior
• Corporate Compliance- HIPAA, EMTALA, Reporting Code of
Conduct/Breaches
• Infection Control
• Policies and Procedures- Pain Management, Falls, Restraints
• Emergency Codes
• Patient Safety
• Cultural Diversity
• General Guidelines
3
Expectations
To provide the best healthcare possible, we believe that
everyone must be committed to the healthcare agency’s
values and standards of behavior.
4
Standards of Behavior
While in Healthcare Agencies Faculty
and Students Demonstrate:
1. Professional Appearance
• Wear PHOTO nametag at all times.
• Comply with dress code policy*.
* See dress code slides
2. Positive Attitude
• Acknowledge the presence of patients and visitors.
• Don’t conduct personal and non-emergent conversations around
patients and family members.
5
Standards of Behavior
3. Professional Conduct
• Respect the rights of others.
• Be careful not to tell inappropriate jokes.
4. Compassionate and Courteous
Communication
• Address all patients/families by their names, not room numbers.
• Avoid terms such as “Honey” and “Sweetie.”
• Acknowledge patient/family complaints and concerns.
5. Clean/Safe/Attractive Environment
• Keep workstations and patient rooms/environment neat and clean.
6
Standards of Behavior
6. Caring for Individuals: Anticipate Needs
• Be aware of individuals who may need assistance.
• Ask “Is there anything else I can do?” before leaving the patient.
7. Maintaining Privacy and Confidentiality
• When entering a patient room/residence, knock and wait for a
response.
• Identify yourself.
• State the purpose of your visit.
7
Standards of Behavior
8. Be Aware of Workplace Harassment
• Harassment – Sexual harassment or any form of physical, mental or
emotional abuse will not be tolerated.
• Notify instructor or supervisor if you experience any issues which concern
you.
8
Standards of Behavior
American Hospital Association - The Patient Care
Partnership:
Understanding Expectations, Rights and
Responsibilities
• High Quality Care
• Clean & Safe Environment
• Involvement in Care
• Privacy Protection
Adapted from: http://www.aha.org/content/00-10/pcp_english_030730.pdf
9
Standards of Behavior
Dress Code
• Picture identification badges must be worn above the waist
and must be fully visible.
• Clothing must be clean, neat, pressed and non-tattered.
• Shoes should be in good repair. No sandals or open toe
shoes in patient care areas.
• Good personal hygiene. Use good grooming habits, regular
bathing and shampooing, to avoid obvious and unpleasant
odors.
• No perfumes, fragrances or after-shaves are to be worn in
patient-care areas.
• Hair should be styled as not to interfere with patient care.
Beards and mustaches should be short, neat and trimmed.
10
Standards of Behavior
Dress Code
• Tattoos and body art- see Healthcare agency policy.
• Nails must be neat, clean and short. NO artificial nails, nail
applications or overlays are allowed for direct bedside
caregivers.
• Underclothing must be worn and not visible.
• Use discretion for professional attire in the healthcare
agency. Wear a lab coat over street clothes. NO tank tops,
bare midriff, revealing clothing, sweat pants, leggings,
active wear, denim, shorts or flip flops.
• Jewelry – Conservative and safe, based on the area
assigned. Keep to a minimum in patient care areas.
11
Corporate Compliance:
HIPAA Privacy and Security
These are laws and regulations students and faculty
should know.
HIPAA = Health Insurance Portability and
Accountability Act
12
Corporate Compliance:
HIPAA Privacy and Security
What is Personal Health Information (PHI)?
• Information that identifies a person who is living or deceased
• Past, present, or future health information
• Health information that is electronic, in paper form, or spoken in
conversation such as lab reports, conversations among clinicians,
x-rays, and nursing notes.
PHI identifiers may include information such as:
• Name
• Name of relatives/family member/employer
• Mailing and e-mail address
• Phone number or fax number
– Social security number or medical record number
– Date of birth, dates of service
– Insurance and bank account numbers
– Face photos, voice, finger or retinal prints
– ZIP code
– Unique identifiers
13
Corporate Compliance: HIPAA
Corporate Compliance: HIPAA
Privacy & Security
The Privacy Rule:
1. Allows patients to restrict their health information such as:
- Hospital Directory: Release of their condition, information given to clergy
- Providers involved in their care
- Right to review their PHI (Personal Health Information)
2. Disciplines workforce for inappropriate access to PHI
3. Potentially bars students from clinical rotation and future employment when PHI is
intentionally accessed inappropriately or PHI is disclosed and harm occurs
DO NOT

Write down, print, copy or remove confidential patient identifiers from the healthcare
agency
The Security Rule:



Protects an individual’s health care information maintained or transmitted electronically
Requires administrative, physical, and technical safeguards for electronic PHI (ePHI)
Disciplines workforce members who fail to comply with security policies and procedures
14
Corporate Compliance:
HIPAA Privacy & Security
• HIPAA is a federal law.
• Any information about a person’s healthcare
treatment or payment plan that allows you to identify the
individual is Protected Health Information (PHI) by HIPAA.
• Any information that can be used to deduce an individual’s
identity, such as an account number or health plan enrollment
number is also Protected Health Information (PHI).
15
Corporate Compliance:
HIPAA Privacy & Security
Confidentiality is more than a legal and
regulatory issue.
It is:
• A basic show of respect for all patients and employees.
• A trust issue. All patients must be able to trust the
healthcare agency to protect their medical information from
inappropriate access.
16
Corporate Compliance:
HIPAA Privacy and Security
Did you know?
Within the Electronic Medical Records systems,
ACTIONS CAN BE TRACKED
• Each time a patient’s record is accessed.
• Which parts are accessed.
• Who accesses a record.
• How long a record is accessed.
Health Information Management (Medical Records) also
tracks who accesses paper records.
17
Corporate Compliance:
HIPAA Privacy and Security
What Information Can YOU Access?
It must be:
• Information to perform your duties as a faculty/student.
• Patient must be in your care.
You CANNOT Access
• Medical records of friends, family, high-profile patients,
other employees or your own record.
• Former patients, even to see how they are progressing.
Remember: This information is Protected Health
Information (PHI) and not needed for your duties.
18
Corporate Compliance:
HIPAA Privacy and Security
If a student or faculty member needs his/her medical
information or that of a family member, he/she MUST contact
the appropriate healthcare agency Medical Records section
or Health/Medical Information Management.
19
Corporate Compliance:
HIPAA Privacy and Security
Always ask your instructor, preceptor, agency
liaison, clinical coordinator or supervisor before
sharing PHI without an authorization. They will
guide you as to the correct procedure.
• Note specific healthcare agency policy for patients who
don’t want to be identified for any reason.
20
Corporate Compliance:
HIPAA Privacy and Security
When Can Information Be Given Without Prior
Authorization?
• In medical emergencies (life or death) when there is no one
available to give consent.
• If there is a possibility of abuse and neglect, healthcare
workers follow legal guidelines for reporting (follow health-care agency policy).
• If there is a communicable disease, it must be reported to public health
agencies.
Therefore, you need to notify your instructor, who will notify the
appropriate person/Infection Prevention/Control Department.
• In verifying medical treatment for insurance claims/Medicare payments.
• For subpoenas or court orders.
21
Corporate Compliance:
HIPAA Privacy and Security
Ask yourself this question:
Can I identify the patient from the information shown?
If the answer is “yes,” then this patient care information
must be hidden from public view.
22
Corporate Compliance:
HIPAA Privacy and Security
Caution
• Confidentiality extends to social networking (Facebook,
Twitter, YouTube, etc.) sites. As these become more
commonplace, it is imperative no one discusses or posts
patient information on these sites. Taking/posting
photographs is not allowed.
• Always adhere to academic and healthcare agency policies.
• For more information specific to nursing please visit:
https://www.ncsbn.org/NCSBN_SocialMedia.pdf
23
Corporate Compliance:
HIPAA Privacy and Security
Some Reasonable Safeguards to Protect PHI
Remember that PHI can be spoken, written and electronic
• Place charts and reports facedown.
• Log off before leaving the computer.
• Avoid discussing patients in public areas (elevators, cafeteria, hallways).
• Place census lists in an area not visible to the public.
• All hard copy reports – worksheets or report sheets- developed during
clinical, and all electronic reports are to be protected from public view
and must not leave the healthcare agency.
• Copies of medical information with PHI are not permitted to leave the
healthcare agency.
• See healthcare agency’s policy regarding process for copying and/or
destroying paperwork.
24
Corporate Compliance:
HIPAA Privacy and Security
Incidental Uses and Disclosures
Factors that determine incidental use and disclosures are:
• PHI is communicated without intent while performing
normal and permitted activities.
• These cannot be prevented using reasonable measures
and are limited in nature.
NOTE: The HIPAA Privacy Rule is not intended to impede these customary
and essential communications and practices and, thus, does not require that
all risk of incidental use or disclosure be eliminated to satisfy its standards.
Rather, the Privacy Rule permits certain incidental uses and disclosures of
protected health information to occur when the covered entity has in place
reasonable safeguards and minimum necessary policies and procedures to
protect an individual’s privacy.
http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/incidentalusesanddisclosures.html
25
Corporate Compliance:
HIPAA Privacy and Security
How to Prevent Violations?
• Keep telephone calls and oral reports confidential.
• Protect computer passwords.
• Verify fax numbers.
• Remove patient names or other
information that identifies a
patient before recycling papers.
−Use the identified Shred containers or
−Use a heavy black marker
• “De-identify” other patient materials, e.g., such as armbands, before throwing
away.
De-identify means removing all PHI identifiers, i.e., any item that can identify a patient.
26
Corporate Compliance:
HIPAA Privacy and Security
How to Prevent Violations?
• “De-identify” Includes this type of information:
 Information cannot include parts or derivatives of identifiers, such as the last
four digits of a Social Security number or a patient’s initials.
 For dates directly related to an individual all elements (except year) should be
removed
 Only the three initial digits of a zip code may be included where the population
of that zip code exceeds 20,000.
 For populations of less then 20,000 - no portion of the zip code may be used.
 The name of health care providers may be included in de-identified information
http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/Deidentification/guidance.html#rationale
• Place all information in a secure container for disposal or cut them into
small pieces before leaving the clinical area.
• Check with your instructor to assure your compliance.
27
Corporate Compliance:
HIPAA Privacy and Security
Written Authorization
• The patient’s written authorization is required before
information from the medical record is given out.
• Contact your Instructor, Health/Medical Information
Management or Medical Records for guidance.
• Refer to the healthcare agency policies on uses and
disclosures of Protected Health Information.
• Refer to academic and healthcare agency Social Media
Policy for information on written authorization.
28
Corporate Compliance:
HIPAA Privacy and Security
How to Say “No” with a Smile
• “I can’t talk about it. It’s private.”
• “We are required to protect the patient’s privacy.”
29
Corporate Compliance:
HIPAA Privacy and Security
HIPAA Violations
• Patient charts left open in the healthcare agency or
information is observable in vehicles.
• Discussions about patients in hallways, elevators, cafeteria,
telephones or other public places.
• Computer screen open and visible.
• Reports left on fax machines and printers.
30
Corporate Compliance:
HIPAA Privacy and Security
Report Privacy Violations
• Reports of a privacy violation should be reported per healthcare
agency policy.
 A healthcare agency must notify patients, the Department of Health and
Human Services (DHHS) and/or the NC Attorney General (NCAG) of any
inappropriate disclosure of PHI that compromises the confidentiality or
security of PHI including inappropriate access.
• It is crucial that a known or suspected privacy breach is reported as
soon as possible:
 Discuss first with your instructor,
 Other appropriate personnel to approach would be the charge nurse, or the
healthcare agency Privacy Officer or Corporate Compliance Officer.
31
Corporate Compliance: Code of Conduct
The Health Information Technology for Economic and Clinical Health Act
(HITECH)
HITECH Act of 2009 Final Rule includes additional regulatory requirements related
to:
•Breach Notifications
•Business Associate Agreements (BAA)
•De-Identification of Information
http://www.hhs.gov/ocr/privacy/hipaa/administrative/enforcement
rule/hitechenforcementifr.html
32
Corporate Compliance: Code of Conduct
HITECH Act
Breach Notifications
• Breaches are now presumed reportable unless, after completing a risk analysis
applying four factors, it is determined, that there is a “low probability of PHI
compromise.”
• This risk assessment is completed by the organization’s Compliance Office.
• Breaches must be reported to patient and/or federal agency (HHS) within 60
days.
 This means you MUST report a breach or a potential breach to your
instructor and facility Compliance Office AS SOON AS YOU ARE AWARE
OF THE SITUATION.
 This enables them to conduct the investigation and determine the
notifications that need to be made by the 60 day deadline.
33
Corporate Compliance: Code of Conduct
HITECH Act
• Breach Notifications
 Penalties for violations of privacy and security laws have been substantially
increased.
 Breach enforcement civil penalties were increased - up to $1.5 million per year
for each violation
 Criminal charges may result for breaches – even if information was not used for
personal gain.
• Business Associates
 Entities that do work on behalf of providers and health insurers are subject to
the same privacy and security rules as providers.
 Includes subcontractors of Business Associates
 PHI storage providers
34
Corporate Compliance: Code of Conduct
Federal False Claims Act (FFCA)
It is a crime for any person or organization to knowingly
make a false record or file a false claim with the government
for payment.
No proof of
specific intent
to commit fraud
is required.
35
Corporate Compliance: Code of Conduct
What Is a Violation
of the Federal False Claims Act?
• Providing services such as drugs, oxygen or X-rays
without a documented physician order and allowing
billing to occur for those services.
• Caregivers without current licensure and required
certifications.
36
Corporate Compliance: Code of Conduct
Important Compliance Issues and Definitions
• Fraud is intentionally filing an incorrect claim to state or
federal government for payment.
• Abuse is filing a claim that you did not know was incorrect.
• Anti-kickback laws govern issues such as paying for
referral of patients or accepting inappropriate gifts.
37
Corporate Compliance: Code of Conduct
Important Compliance Issues and Definitions
• Stark Law - report any known or suspected violations to the healthcare
agency’s compliance officer
 The Stark Law applies to physicians who refer Medicare patients for
designated health services (DHS) such as:
 Clinical laboratory services
 Radiology services
 Home health services
 Outpatient prescription drugs or
 Inpatient/outpatient hospital services
 Referrals for DHS can not be made to a healthcare agency with which a
physician or any immediate family members have a financial relationship.
 If a referral is made, the healthcare agency may not bill for the DHS unless an
exception applies.
 This is to prevent self-interests from out-weighing sound medical judgment.
38
Corporate Compliance: Code of Conduct
Gifts from Patients
• Students/Faculty cannot personally accept gifts, tips,
money or other gratuities from patients and/or their
families.
• To allow the patient to show appreciation for care, small
tokens such as cards, flowers, plants or candy may be
accepted on behalf of the unit/healthcare agency, but they
are discouraged.
39
Corporate Compliance: Code of Conduct
Consequences if Students
and/or Faculty Don’t Comply
• Students/Faculty and/or the Academic Institution could lose
clinical privileges and/or working in the healthcare agency.
• Fines and/or imprisonment for healthcare agency and
school, (everyone involved).
• Healthcare agency could lose its Medicare and Medicaid
funding and ability to treat patients.
40
Corporate Compliance: Code of Conduct
Questions or Concerns?
• Talk to your instructor, department
director/manager.
• See Compliance and Privacy (HIPAA) information in the
specific healthcare agency’s policies/guidelines.
• Call the healthcare agency’s Compliance/Privacy Officer
or hotline.
41
Corporate Compliance: EMTALA
EMTALA: What Is It?
• It is a federal law.
• EMTALA: Emergency Medical Treatment
Labor Act.
• Every patient who comes to the Emergency
Department requesting emergency medical care gets
evaluated:
- By a qualified healthcare provider within the healthcare
agency.
- Regardless of the individual’s ability to pay.
• If there is an emergency condition, the patient is treated or
transferred to another hospital with specialized care.
Also known as COBRA and
“Antidumping” Act
42
Corporate Compliance:
Reporting Abuse
Required to Report Concerns
•
Abuse
- intentional inflection of pain, injury or mental anguish. Signs: multiple injuries,
•
bruises, inappropriate burns or fractures, repeated ED visits, no opposition to painful
procedures.
Neglect – failure to provide adequate materials, shelter or food necessary for the health.
Signs: poor hygiene, hunger, emaciation, delay in reporting injuries, abandonment.
Exploitation – the illegal or improper use of a child or a disabled adult or the person’s
resources for another’s profit or advantage. Signs: sudden change in banking practices,
unpaid bills when resources are available, previously uninvolved relatives claiming rights to
possessions.
Children, Disabled and Aged are the most susceptible
•
If you suspect any of the above, seek guidance from Instructor/Care Provider.
•
43
Corporate Compliance:
Safety Management and Reporting
 Be certain you have training before using equipment or performing
procedures
 You have a responsibility to report workplace hazards to your
instructor/supervisor.
 You must IMMEDIATELY report the following incidents to your
instructor or supervisor:
 Broken equipment or utility interruptions
 Injuries
 Spills
 Any other health and safety incident
44
Corporate Compliance:
Reporting Malfunctioning Equipment
Safe Medical Devices Act (SMDA)
Medical devices include anything, other than drugs, used in a
patient care or diagnostic setting such as:
• Beds
• Rehab Equipment
• Implants
• Defibrillators
• IV Sets
• Wheelchairs
• Bandages
• Infusion Pumps
• Lab Devices
• Lift Equipment
• Monitors
• Catheters
45
Corporate Compliance: Reporting
Safe Medical Devices Act (SMDA)
Federal law requires a report of all incidents where there is a
reasonable suspicion that a medical device caused or
contributed to a patient’s:
• Serious injury
• Serious illness
• Death
Incidents are reportable if they:
• Require surgery or medical intervention.
• Result in permanent impairment of a body function.
OR
• Permanently damage a body structure.
46
Corporate Compliance: Reporting
Safe Medical Devices Act (SMDA)
If a patient is injured by a medical device, you should:
1. Take care of the patient’s immediate needs.
2. Remove the device (save all settings and disposables).
3. Label device “Do not use” and include date and time.
4. Alert your instructor, so he/she can alert the supervisor.
5. Report unsafe device according to the healthcare agency policy.
47
Infection Prevention/Control
Hand Hygiene
The expectation is that each healthcare
worker (including students) will perform
proper hand hygiene whether wearing gloves or not:
• Before touching a patient or his/her environment.
• After touching a patient or his/her environment.
48
Infection Prevention/Control
Hand Hygiene Compliance
As a healthcare agency, we take
proper hand hygiene very seriously.
What if I fail to perform proper hand
hygiene?
• If a student is observed failing to perform
proper hand hygiene, the clinical instructor, as
well as the school may be notified.
• Repeated failings could jeopardize a student’s
clinical rotation.
49
Infection Prevention/Control
Bloodborne Pathogens
The healthcare agency’s Bloodborne Pathogen (BBP)
Exposure Control Plan provides information on:
• Hepatitis B Vaccinations.
• Jobs and tasks that are risky.
• How to choose Personal Protective Equipment (PPE).
If you have questions about BBP:
• Contact appropriate agency department or refer to the agency’s policy
manual/resource.
• After hours, contact the house supervisor or equivalent.
• To review the BBP Exposure Control Plan, access the healthcare
agency’s resource/policy manual.
50
Infection Prevention/Control
Blood Spills and PPE
When handling blood or “Other Potentially Infectious
Materials” (OPIM) and anytime there is a risk of a splash,
you MUST use the following Personal Protective Equipment
(PPE):
• Gloves – When handling blood, OPIM or non-intact skin.
• Gowns – When there is a risk of splash of blood or OPIM to clothing.
• Masks and Goggles (both) or Face Shields – When blood or OPIM could
splash your face.
Make sure you know where to find these items and how to
use PPE.
If it is wet, dripping, and does not belong
to you, wear PPE!
51
Infection Prevention/Control
Blood Spills and Exposures
In the event of a blood spill or exposure:
1. Follow healthcare agency policy.
2. Report the spill or exposure to the instructor, preceptor or agency liaison.
If you are exposed to blood or
other body fluids:
1. IMMEDIATELY wash the exposed skin with soap and water or flush mucous
membranes with water or saline.
2. Report to infection prevention/control department or specialist/department per
the agency policy.
3. Complete an appropriate report per agency policy.
52
Infection Prevention/Control
Sharps Safety
Sharps Safety Devices are for your protection and, by law,
you MUST use them. Examples of Sharps Safety devices:
•
IM/SQ needles and syringes.
•
Needle-less IV tubing sets.
•
Safety lancets.
•
Phlebotomy devices.
•
IV safety catheters
Sharps should be thrown away in a Sharps disposal box
or use an approved alternative method for home use
http://www.epa.gov/osw/education/pdfs/han-care.pdf
53
Infection Prevention/Control
Standard Precautions
In addition to hand hygiene, PPE and safe injection
practices, other elements of standard precautions include:
• Care and cleanliness of the work area.
• Cough etiquette and respiratory hygiene.
• Safe handling of laundry.
• Use of bag technique
•http://journals.lww.com/homehealthcarenurseonline/Fulltext/2014/01000/Bag_Technique__Preventing_and_Controlling.6.aspx
• Patient isolation and transportation.
• Handling of dirty patient-care equipment, instruments and devices.
Guidelines for Isolation Precautions
Refer to healthcare agency policies and procedures
54
Infection Prevention/Control
TB Precautions
To prevent the spread of TB, patients suspected of having TB
must:
• Wear a surgical mask until they are placed in a negative pressure,
private room.
• Be placed on “Airborne Precautions.”
• Wear a surgical mask anytime they are outside the negative pressure room.
Any one entering the room of a patient on Airborne Precautions
must wear an N-95 mask or Powered Air Purifying Respirator
(PAPR). Fit-testing is required for N-95 mask wear.
Students/faculty NOT fit-tested for N-95 masks should
NOT be caring for patients with Airborne Precautions.
55
Infection Prevention/Control
Frequent Safety Round Issues
Frequent infection prevention issues cited during safety
rounds:
• No food or drink in clinical areas.
• Linen – Clean linen must be covered. NEVER
place bags of linen on the floor.
• Portable patient care equipment – Must
be cleaned between patients and identified as “CLEAN” per
agency policy.
56
Policies and Procedures
• Contact specific healthcare agency to find out where to
access Policies and Procedures.
• It is important you are familiar with individual agency’s
Policies and Procedures in providing patient care.
57
Policies and Procedures
Patients have a Right to Pain Management
•
Pain is the fifth Vital Sign assessment
•
Tools:
•
•
Medications
•
Emotional Support
•
Comfort measures
•
Alternative therapies
Refer to the healthcare agency’s Pain Assessment &
Reassessment Policy & Procedure
58
Policies and Procedures
FALL REDUCTION
Is Everyone’s Business
In a hospital, an accidental fall can change a short stay for a minor problem into
a prolonged stay.
•
Prevent Falls
o
o
o
o
o
o
o
o
o
o
•
identify “At Risk” Patients
bed in low position
call device in reach
non-clutter and removal of throw rugs
pain assessment & med administration/ med evaluation
routine checks
adequate lighting
non-skid footwear
routine toileting/ bedside commode if indicated
bed or chair alarm
Refer to the healthcare agency’s policies
59
Policies and Procedures
RRT: Rapid Response Team
For Deterioration in a Patient’s Condition
Purpose is to provide early and rapid interventions to promote positive
outcomes
• Identify Early Warning Signs & Report
• Refer to healthcare agency’s process for managing unstable patient
situations
60
Policies and Procedures
Safety Reporting Systems (SRS)
Reportable Events
Events that are inconsistent with Standards of Care
Types of Events:
• Near Misses
• Serious & Non-Serious
• Sentinel Events
• Goal: Improve quality & safety
• Refer to the healthcare agency’s Reporting of Adverse Events Policy & Procedure
61
Policies and Procedures
RESTRAINTS
Limited use for Medical or Behavioral Reasons
•
Alternative Measures First
•
Preserve Safety & Dignity
•
Requires training
•
Required periodic release and offer of food, water & toileting
•
Requires physician time-limited order, not PRN
Refer to the healthcare agency’s Restraint Policy & Procedure
62
Policies and Procedures
Hazardous Material or “Haz Mat” Incident
When a significant chemical spill/exposure has occurred within the
health agency.
•
Avoid the area until “all clear” is announced.
•
Trained health agency personnel will respond to the scene and notify the
Fire Department if necessary.
•
Nearby departments should prepare to receive re-routed traffic and be
ready for possible evacuation.
•
Other departments throughout the building are on stand-by to assist if
needed.
No announcement is made for spills that are
manageable within the department.
Department staff should be trained to clean spills of
chemicals they use regularly.
63
Policies and Procedures
Controlling Chemical Hazards
•
•
•
•
•
•
•
•
•
•
Respect and understand chemical characteristics.
Use only if you are qualified.
Use only properly labeled containers.
Never use unidentified chemicals.
Store chemicals in approved areas.
Immediately report spills, leaks, or accidents.
Use Personal Protective Equipment (PPE).
Properly dispose of used chemicals/ containers.
Ask instructor/supervisor if you don't understand label
information.
Know what to do in an emergency.
64
Policies and Procedures
Internal Haz Mat Incident
For the protection of employees, students, etc., safety information
about chemicals used within the healthcare agency is available:
• On product labels.
• Via the Globally Harmonized System of
Classification and Labeling of Chemicals
(GHS).
• In departmental training.
You have the right to
know about the risks
associated with the
hazardous chemicals
that you use.
• In safety policies.
Every chemical container must include:
Chemical Name
Manufacturer
Warnings
If a product is transferred into a new container, ALL the above
information must be on the new container.
65
Policies and Procedures
“Haz Mat” Incident
A GHS tells how to:
•
•
•
•
•
Use
Store
Clean up a spill
Offer first aid
Dispose of a chemical
GHS information is available online.
Know how to access the GHS
information in the area you are
assigned.
For emergencies:
Follow healthcare agency’s
policy.
66
Policies and Procedures
Hazardous Waste
Regulated Medical Waste:
 Blood or body fluids in containers > 20 ml





Pathological waste (lab, tissues, organs)
Microbiological waste
Bloody (saturated) dressings, gauze
Blood transfusion bags and tubing
Materials used for cleaning blood spills if > 20 ml
67
Policies and Procedures
Hazardous Waste
Red Sharps Boxes
•
Used syringes/needles
Unregulated Waste
“Plain down the drain”
Plain IVs – Can still go down the drain. Examples include:
Saline, Potassium, D5, Electrolytes, and Lactated Ringers.
(No Medications Instilled)
Empty IVs, vials, wrappers, and syringes will continue to be disposed of according to
current procedures. An item is empty if it contains 3% or less of it’s original volume.
NARCOTICS and other
Follow healthcare agency policy and procedure.
Controlled
Substances
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Policies and Procedures
Pharmaceutical Waste
 Pharmaceutical Waste is defined as medication: partially administered in
vials/ampules, leftover or unused, not given or refused such as:
 IV bags and tubing w/ >10% medication remaining
 Oral medications
 Ointments and creams
 Physician samples
69
Policies and Procedures
Hazardous Waste
Each healthcare agency will have a policy for the disposal for hazardous
pharmaceutical waste. The appropriate container may be:
 Indicated on the pharmacy medication label
 Indicated in the medication dispensing system
 Check the healthcare agency’s policies for appropriate disposal
70
Policies and Procedures
External Haz Mat Incident
If a chemical spill/exposure occurs in the community, and the
agency is expecting to decontaminate and treat victims in the
Emergency Departments, external haz mat precautions will be
initiated.
In response:
• Members of the HazMat response team should
respond to the Emergency Department.
• Contaminated patients should not be allowed into
hospitals without decontamination.
• Other directions will be given per healthcare agency
policy
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Emergency Codes
Please Note:
Each healthcare agency has identified specific
emergency codes and terminology. Please refer
to each specific healthcare agency’s orientation
material for codes, alerts, and emergency
telephone numbers.
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Emergency Codes
Fire
4 steps to respond to a fire:
R escue anyone in immediate danger.
A ctivate the alarm and call the emergency number.
C lose doors and windows.
E xtinguish if possible. Evacuate if necessary.
4 steps for using an extinguisher--“PASS”:
1
2
3
4
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Emergency Codes
Fire
Oxygen tanks and other compressed gas cylinders can explode.
They must be handled with extreme care – it’s federal law!
 Secure with a chain or in a rack when stored
 Use only an approved carrier during transport – an
approved carrier is designed for this purpose.
 Store in limited quantities
 Full and empty tanks must be stored separately and
clearly labeled for easy identification.
74
Emergency Codes
Radiation Safety
• Only properly trained individuals may handle or administer
radioactive materials.
• Signs must be posted in rooms where radioactive materials
are stored or used.
• Do not enter without proper supervision.
• You may not eat or store food in these areas.
• When unattended, materials must be secured.
75
Emergency Codes
Bomb Threat
In response to a bomb threat announcement,
each person should:
• Immediately check your department or area for any
items (boxes, backpacks, computer cases, etc.) that
don’t belong.
• Call Security to report anything found that could be
related to the threat.
• Refer to specific healthcare agency policy for further
information or talk with your area supervisor for
specific directions.
• Prepare to evacuate if directed.
76
Emergency Codes
Disaster Codes
Disaster means something has happened that changes the way we will
deliver services, and may mean a large number of casualties.
For example:
• An outbreak of infectious disease.
• A large plane crash.
• A weather-related disaster.
• Sudden increase in patient census.
 Be ready to respond!
 Review your healthcare agency’s disaster plan.
 Remain in your location – you will be contacted if needed.
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Emergency Codes
Security Alert Codes
What is security alert?
• Response to an incident of civil or emotional unrest within
healthcare agency that threatens the safety of patients,
visitors and staff.
• Potential reasons to activate security alert include, but are
not limited to:
– Heightened emotional or behavioral
response, even after de-escalation attempts.
– Visible weapons.
– Physical altercations.
– Hostage situations.
– Communication of threats.
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Emergency Codes
Active Shooter Guidelines
When an active shooter is in your vicinity follow
your healthcare agency’s specific policy/procedure
– HIDE
• Hide in an area out of the shooter’s view
• Block the entry to your hiding place, lock doors, turn out
lights
• Call security or 911 for help
• Silence mobile devices
• Wait for the “all clear”
Emergency Codes
Active Shooter Guidelines
– Follow Directions given by law enforcement officers
•Remain calm, and follow officers’ instructions
•Put down any items in your hands (i.e., bags, jackets)
•Immediately raise hands and spread fingers
•Keep hands visible at all times
•Avoid making quick movements toward officers such as
holding on to them for safety
•Avoid pointing, screaming and/or yelling
Adapted from homeland security publication How to Respond to An Active Shooter at http://www.dhs.gov/activeshooter-preparedness, March 24, 15.
Emergency Codes
Infant or Child Abduction
When an infant or child is missing everyone’s help is
needed to locate an infant or child.
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Emergency Codes
Missing Infant or Child
 Be familiar with agency policy if you are
working with infants and children.
 The first few minutes are critical. Quick,
decisive action may result in finding the infant.
• Stop : Unless you are involved in a life-saving
procedure, immediately stop where you are and what
you are doing to search the immediate area.
• Secure : All entrances and exits.
• Search: Look for suspicious persons with bundles,
bags, and/or carrying infants. Report suspicious
persons or items to the organization’s security or law
enforcement.
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Banding Together for Patient Safety
Some healthcare agencies are participating in a
North Carolina statewide program to implement
standardized armband colors for improved safety.
Check each agency’s orientation material for
participation and use of the colored bands or
other method of identification.
83
Patient Safety
• Annually, patient safety goals are determined for
healthcare agencies. Various accrediting bodies
establish the goals for various practice areas like
the Joint Commission (TJC), & the Accreditation
Commission for Health Care (ACHC), etc.
• Healthcare providers are responsible for knowing
and implementing these in patient care.
• Click on the link below and read the required
patient safety focus and goals for assigned
clinical area(s):
http://www.jointcommission.org/standards_information/npsgs.aspx
84
Patient Safety
REFLECTION:
According to the National Patient Safety Goals, how many patient identifiers
are required prior to administering medication:
A. 1
B.
2
C.
3
A. 4
To go back to the NPSG link click here
85
Patient Safety
• Good attempt! This is incorrect.
• Please try again Slide 84
86
Patient Safety
• Correct response.
• Good job! Slide 87
87
Cultural Diversity
To demonstrate the values of outstanding customer
service, integrity and a caring spirit, honor individual
differences by treating everyone with respect, courtesy
and sensitivity to their unique needs, concerns or beliefs.
About 32% of the U.S.
population belongs to ethnic
or racial minority groups:
12% African-American; 9%
Hispanic; 4% Asian; and 2%
belong to other groups.
(CiNet Healthcare Learning: EDA 450-0069)
88
Cultural Diversity
Assumed Similarity:
Thinking that everyone else sees
the world the same way you do.
Example: Healthcare provider
assumes that the patient can read
a brochure because (s)he can read it.
Not all people learn the same way. A patient may
understand spoken English but not be able to read it. Use
multiple approaches when teaching patients and families.
89
Cultural Diversity
Comfort with the
Familiar:
We are often drawn to others
who look, act, or think the
way we do.
Example: People from
a specific unit will tend to eat with other members from their
same department because they are familiar.
A new person may feel more comfortable eating with someone
they met during orientation.
90
Cultural Diversity
Anxiety and Tension:
These emotions can happen
when you feel uncomfortable
around people who are different
than you. The key is how you
handle those emotions.
Example: A new person eats
with people from another department; co-workers or fellow
students can invite him or her to eat with them.
How the co-workers treat the new person will affect
everyone – it will either add to or cut down on the anxiety
and tension.
91
Cultural Diversity
Ethnocentrism:
The belief that one’s own culture
or ethnic group is better than
others. Differences are
often viewed as inferior.
Example: If a new person
thinks of boldness as a good thing, he or she may feel free
to ask questions and debate issues with instructor/boss.
If the instructor/boss is from a different culture that values
harmony over boldness, he or she may think the new
person is bossy or rude.
Before taking offense, put yourself in the other person’s
place. Think about their cultural norms.
92
Cultural Diversity
Stereotyping:
A stereotype is an exaggerated
belief about a person based
on his or her background.
Example: Thinking that all
Healthcare workers from other countries are poorly
trained.
Judge a person based on what he or she actually
does. Do not judge based on what you think that
person will do.
93
Cultural Diversity
Prejudice:
Prejudice is a hostile attitude toward
people who do not fit in with your group.
Example: Treating a co-worker/student from another
country as if he or she is not smart.
Language often can be a big problem for staff/students
from another country. The medical terms are different, and
medications have different names.
A co-worker/student with limited English communication
skills often mentally translates words before responding.
94
Cultural Diversity
Patients from Different
Cultures:
It is possible to tailor your
speaking style to the
needs of the patient.
The more you know about
your patient’s culture and values, the more likely you are to
get your point across.
Interpreters are available at most agencies. Contact your
department supervisor for more information.
95
Cultural Diversity
Patients from Different Cultures: (continued)
Ask about the patient’s culture as it relates to treatment:
• Some patients may have special dietary
needs.
• Explain to the patient what to expect in the
way of treatment.
• Explain how the treatment may differ from
what the patient expects.
Asking questions about a patient’s culture will add to your
ability to see issues from his or her point of view.
96
Cultural Diversity
Communication:
• Pay attention to how the patient answers questions
• A person who values boldness may think it is polite to make
eye contact.
• Watch how close the person stands to you and gestures.
Also note the tone of his or her voice.
• In some cultures, standing close when speaking is a sign of
respect.
• If you accidentally offend someone, apologize.
• Smile, speak in a friendly tone of voice, treat others fairly and
respectfully.
• Don’t forget that about 90% of communication is non-verbal.
97
General/Miscellaneous Information
Chain of Command
For any Concerns,
Questions or Issues
• Speak with your Instructor
or Healthcare Provider, first
and as appropriate.
• The Instructor /Healthcare
Provider will guide you
further as needed.
98
General/Miscellaneous Information
Palliative Care
The comprehensive care and management of the
physical, psychological, emotional, and spiritual needs
of patients (all ages) with chronic, debilitating, life
threatening illness and their families.
Palliative Care Focus
•
•
•
•
Pain management
Symptom management
Hydration / Nutrition
Holistic approach & support
99
General/Miscellaneous Information
Transplant Safety
• Only Trained Personnel from an Organ
Procurement Organization (OPO) is
permitted to offer families the option to
donate, recover donated organs, and
distribute in an equitable manner
• Refer questions to your clinical
instructor, preceptor or agency liaison.
See the Healthcare agency’s Policy and
Procedure regarding Organ Donation
100
General/Miscellaneous Information
See specific healthcare
agency guidelines for details.
Libraries
Student Parking
Many agencies encourage
carpooling and parking areas
are agency specific for students.
Meals
101
General/Miscellaneous Information
Personal Electronic Devices/Valuables
• Personal electronic devices – see Healthcare
agency policy.
• Storage is limited for personal belongings.
• Valuables cannot be secured.
• No photography is allowed in the clinical
setting.
102
General/Miscellaneous Information
103
General/Miscellaneous Information
E-Cigarettes
are also
prohibited
104
Core Orientation Test
Now that you have completed the core
orientation, please return to your
school’s website to take the orientation
test if it is required.
If you have questions, contact your
school coordinator.
105