Transcript DON`T

River Oaks Hospital
OUR MISSION
The mission of River Oaks Health System
is to provide the highest quality patient
care through a genuine commitment of
service and safety to our customers
PARKING
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Place parking permit on dash
Park in the North parking
lot behind the River Oaks
Professional Center
Resource
Building
Education
North Lot
River Oaks Professional Building
River Oaks Professional Building
HIPAA is a broad law dealing with the
privacy and security of health information:
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The Privacy Rule tells hospitals and physicians when and
how they can use or disclose patient health information.
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The Security Rule tells hospitals and physicians how to
protect health information from being inappropriately
accessed, edited, or destroyed.
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The first essential element
of HIPAA: PHI

Protected Health Information (PHI) is ALL
PERSONAL HEALTH, BILLING AND
DEMOGRAPHIC INFORMATION, IN ANY
FORMAT (Oral, Paper, Picture or Electronic)
CREATED OR HELD BY A COVERED
ENTITY (hospital or physician, payer)
 (includes past, present and future
healthcare)
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Minimum Necessary or
“need to know”
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All members of the workforce contribute to the care of
the patient. That doesn’t mean everyone needs to see
health information about patients.
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If you do not need to know confidential information to
provide care (clinical or financial) you are NOT
permitted to access it. This includes your PHI.
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Our #1 Biggest Risk:
Nosy Associates
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A co-worker accesses information. The only
reason was for curiosity regarding:
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A co-worker who is a patient
A physician who is a patient
A neighbor who is a patient
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Actions that could cause a
HIPAA violation
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Taking pictures of any patient’s image, body part or X-ray with
personal cell phone cameras (this will be grounds for termination)
Unauthorized access of sensitive health information (HIV, Abuse,
Psych records)
Access of the associate’s own “patient” record in the computer system
Sharing or stealing another co-worker’s password for the computer
systems
Not verifying who you disclose patient information to (financial or
clinical) and not confirming that the person requesting the information
is authorized to receive it
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Steps you should take to protect
patient privacy include:
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Respect the patient’s information and condition the same way
you would expect others to respect and care for yours.
Close treatment room doors or use privacy curtains when
discussing the care of a patient.
Ensure that medical records are not left where others can see or
gain access to them.
Keep laboratory, radiology and other test results private.
Make sure computer screens containing PHI are not visible to
others not involved with the patient.
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Destruction of paper containing patient
information
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Shred all patient information when it is to be discarded.
Do not place anything with a patient’s name or identifiers
in the regular trash.
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Patient name bands
Telemetry strips
What about IV bags with med labels?
If you can, peel off label. Label must be shredded or
blacked-out with a marker.
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Visitor Identification
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All associates should question visitors or other persons who
are in restricted areas and are not escorted by an associate
of the facility or are not displaying proper identification.
Vendors and contractors will be wearing their company ID
in addition to hospital identification noting that they have
permission to be in the building.
All associates, volunteers and other workforce members
must wear their identification badge as issued by the
hospital.
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Notification to Patients
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Federal law now requires us to tell patients if someone
has snooped into their information protected by HIPAA.
We must also notify patients any time their protected
health information was inappropriately disclosed outside
of the facility, or if it was stolen or breached.
We are required to notify the patient in writing and
report all breaches of PHI to the Federal Government.
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Who do we need to notify if a breach of PHI
is detected?
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All of the affected patients.
The Federal Government.
Local media if 500 or more patients in
the same area are affected.
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Examples of Breaches
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Lost laptop or PDA
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PHI left behind in the cafeteria, lounge, or public area
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“Snooping” in patient records without a need to know the information
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“Cell phone pictures” taken by associates that identify a patient or
characteristics of a patient (x-ray or body part)
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PHI faxed to the wrong fax number, or emailed to the wrong address
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Information intended for one patient handed to another patient (not
verifying your work).
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Increased HIPAA enforcement actions
could directly affect you!
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If you are found to be responsible for any type of a
HIPAA violation that the State Attorney General
believes has threatened or in some way harmed a
patient who is a resident of your State, you can be held
responsible for your actions.
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The State Attorney General can bring a civil action in
federal court against you!
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Conclusion
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We must all remember to protect the privacy and security
of patient information at all times.
We are all patients from time to time. How would you feel
if your own health information was used or disclosed in a
way that was harmful to you or your family?
If you have a question about HIPAA, ask your supervisor
or your Privacy Officer.
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Corporate Compliance
The purpose of the Compliance program is
to ensure that the Hospital
• Conducts all business in compliance with
all applicable federal and state statutes,
regulations and healthcare program
requirements
• Adheres to the highest ethical standards in
all actions
If you become aware of a violation, questionable
conduct, or questionable practice violating the
Compliance and Ethics Program, you should
immediately report the concern to one of the
following:
Your instructor
• The nurse manager or CNO
• The Hospital Compliance Officer (HCO)
• The Divisional Compliance Officer (DCO)
• The Director of Compliance or VP of Compliance
• The General Counsel
• The Compliance Helpline or Compliance Post Office
boxtraining
•
Compliance Helpline notices are
prominently displayed throughout the
hospital. Calls to the Helpline go
directly to an outside company who
generates a report to forward to the
Home Office Compliance Department.
The Compliance Program strictly
prohibits retaliation against any person
who has reported a suspected violation.
Compliance Risk Areas
Submission of inaccurate claims
• Outpatient procedure coding
• Billing errors in admissions and discharges,
• Improper relationships between the hospital
and physicians
• Violations of the EMTALA legislation
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CUSTOMER SERVICE
PROVIDING EXEMPLARY CARE AND
SERVICE TO OUR PATIENTS
Who are our Customers?
• Physicians
• Patients
• Family Members
• Visitors
• Employees
• Other Departments
• Vendors
• Community
LEGENDARY
SERVICE
TREAT EVERYONE AS IF
HE OR SHE IS THE MOST
IMPORTANT PERSON IN
OUR FACILITY!
Communication with Patients
5 Steps
A
I
Acknowledge the patient by name
D
Duration (length of time to expect
for test or procedure)
E
T
Introduce yourself (credentials,
experience)
Explanation (of test or procedure
details)
Thank the patient for choosing River
Oaks
HOURLY ROUNDING FACTS
Every employee is responsible for patient rounding
Each patient room has a white board to list:
Date
Names of caregivers
Plan of care for the day
Before leaving the room,
every caregiver should ask
the patient:
“Is there anything else I can
do for you?”
Patient Safety assessment
includes patient access to:
Water (if allowed)
Tissue
Call System
Telephone
TV Remote
Trash Can
Why do hourly rounding?
Research demonstrates that hourly rounding:
Decreases call light usage
Increases patient satisfaction
Decreases patient falls
Develops trust
Anticipates a patient’s needs
Every employee
Is
responsible for rounding!
5 components of hourly rounding:
Personal Needs
Pain
Position
Patient Safety/Environmental Plan
Plan of care
Bedside Reporting
Bedside reporting means that conversations are moved from outside the
room or at the nurses station to the bedside with the patient actively involved
in the report of care. Bedside report should happen at any transfer from unit
to unit and at the change of shift.
Advantages for the Patient:
•Perception that they are a priority, not the staff schedule or staff comfort
zones
•They see and hear from the team of professionals providing care
•They are reassured that each shift of caregivers are getting the necessary
information about what is going on with their care
•Improved communication
•Reduced alone time during shift change
Advantages for the Staff:
•Improved communication
•Allows staff to be better prepared about the patient’s condition
•Keeps report to items related to patient condition/care
•Accountability increases for the care provided
•The off-going nurse can use “hands-on” to show the oncoming nurse
how to operate special equipment or how special orders are
being handled
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We believe that a patient
entering River Oaks
Hospital has the right to
expect the highest quality
of care necessary to aid
him/her in regaining or
maintaining a maximum
level of health.
Code of Conduct
The Code of Conduct policy states that disruptive and
inappropriate behavior will not be tolerated.
Examples include:
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Verbal outbursts, yelling, profane/angry language
Refusing to perform assigned tasks
Name-calling, ethnic jokes, unnecessary sarcasm
Eye-rolling, making faces, inappropriate gestures
Intimidating physical behavior, physical threats
Failure to keep confidences
Starting, repeating or spreading rumors about others
Criticism of healthcare professionals in front of patient or
other professionals
Sexual harassment
Disruptive Behavior
Includes Physicians And Other Independent
Practitioners
Policy
It is the policy of CHS that all individuals within its
facilities be treated courteously, respectfully, and
with dignity. To that end, CHS empowers the Board
of Trustees of each facility to require that all
individuals, employees, physicians, and other
independent practitioners conduct themselves in a
professional and cooperative manner while in the
Hospital or while involved in Hospital business.
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Definition Of Disruptive
Behavior
Disruptive behavior is any inappropriate
and/or abusive behavior that may disrupt
hospital operations, create a hostile or
dangerous work environment or which
may negatively impact patient care.
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DO YOU KNOW?
Patient Bill of Rights
 Patient has the right to
refuse students if they so
desire.
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PROFESSIONALISM
Remember that you represent
your profession and your
school
 Be quiet and respectful
 Silence cell phones
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DRESS CODE
Wear your name badge
or student ID at all times
 Wear your uniform or lab
coat over street clothes
 Avoid perfumes, heavy
make-up, or jewelry
 Keep fingernails trimmed
and neat
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STOP
ROH
DID YOU REMEMBER TO LEAVE ALL PATIENT
INFORMATION IN THE HOSPITAL?
Check your pockets for any patient data!
• All patient information must remain in the hospital!
• This is a privacy and confidentiality issue!
• Remember to use the paper shredder box! DO NOT put any
identifying patient information in the trash cans, including IV
bags
•
EVERY BODY WANTS THE
CHART!
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Avoid shift change times
for getting patient info
Take chart out to counter
instead of sitting at
nurse’s desk
Put the chart back where
you got it when you are
finished
DISASTER CODES
DIAL 444
 GIVE
TYPE OF CODE
TO BE CALLED AND
LOCATION
 REPEAT
INFORMATION
THREE TIMES
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A telephone call notifying the hospital of an
anticipated influx of casualties will be relayed to
Senior Administration or nursing supervisor/Security
Dispatch… (mostly ROH unless transferring from
other hospitals)
It could also be an internal disaster with staff
casualties.
CEO or Administrator on call will be notified…
decision to implement CODE YELLOW will be made
based upon the incident….
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Nursing units—will have staff
members collect wheelchairs and
stretchers which will be placed on
standby on the unit.
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Unit staff will report back to their
department for assignment
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All available associates report to their
departments for assignments.
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Department directors will issue
assignments to their associates and
coordinate and distribute resources.
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Directors will receive overhead pages or
runners informing them of meeting times
and locations for updates from the
hospital command center.
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HORIZONTAL TO THE NEAREST
SMOKE COMPARTMENT
VERTICAL TO NEXT FLOOR DOWN
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TOTAL EVACUATION OF THE
HOSPITAL
Suites Building Evacuation – Southwest
corner of property
Vision Building – Southwest corner of
property
Main Hospital – East side of property beside
the ED parking area
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Be prepared! Keep a bomb threat
report form by your telephone in
order to obtain important
information.
Remember to remain calm and try to
get as much info as possible from the
caller.
Directors will then go back to their
departments and form the initial search
teams while police and fire are contacted
by administration/security
If the location of a suspicious package is
known, do not touch or move the object!
Inform the hospital command center!
ALL 2-WAY AND CELL Evacuation will be considered.
PHONE TRAFFIC
If the location of the bomb is
CEASES! Regular
unknown…administration may initiate a
telephones are all right Code Yellow and/or an evacuation
to use however!
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Fire somewhere inside one
of the buildings or outside in
a parking lot
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KNOW FIRE DOORS/WALLS
LOCATION
KNOW EVACUATION ROUTES
KNOW YOUR SPECIFIC
DEPARTMENT DUTIES
In a Code Red DRILL:
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Respond exactly like you
would in a real fire
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Pull the fire alarm pull station
and follow R.A.C.E.
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Pediatric Security:
Be vigilant on the Pediatric
Unit…. Ensure all staff wear
their badge and secondary
badge at all times!!
Remember to watch for
anyone acting suspicious!!
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CHILD/INFANT
ABDUCTION (Could also be
used for an adult patient if
appropriate, e.g. Down’s
Syndrome patient)
Know your department’s
responsibility for exit doors associates go to assigned exits
and do not let anyone in, or
anyone out. Also ask to see
inside all bags.
Security will report to area
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A combative, disruptive
person in the area
Dial 444 to report location
Code white team will
respond
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Person with possible deadly force (serious threat or weapon)
Dial 444 if safe to do so
Get out of area/building if possible and if safe
Stay away from area
Lock & barricade the doors to your area
Hide behind furniture, and turn out lights and cell phones
Security will respond and assess the situation
Flowood police will be contacted
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Code Black Watch will be called
when conditions are right for
severe weather
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Code Black Warning will be called
for severe inclement weather or
tornado
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ANNOUNCED BY OPERATOR
OR SECURITY
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Move patients, visitors, employees into hallway away
from outside of building
Close all doors
Know location of EOC manual or how to access it on
the intranet
Know when normal duties resume
What is a Rapid Response Team?
A team of clinicians who are available to assist in the
rapid evaluation, assessment, and stabilization of
any patient who appears unstable or acutely ill.
Rapid Response Teams (RRTs) are a part of the
Institute for Healthcare Improvement’s 100,000 Lives
Campaign
How do I call the Rapid Response Team?
When the assistance of the
Rapid Response Team is needed:
Dial 444
Give operator location of patient
Operator will page the RRT to
patient location
When do I call the Rapid Response Team?
Criteria includes but is not limited to:
 Bad feeling about patient
 Chest pain
 Acute change in heart rate <40 or >130 bpm
 Acute change in BP <90 or >200 mmHg
 Respiratory distress or acute change in rate
 Acute change in oxygenation <90% despite O2
 Acute changes in mental status
 Acute change in blood glucose <60 or >500
 Acute change in urine output
 Seizures
 Acute significant bleeding
How will calling the Rapid Response Team
help me?
Help my patient?
Opinion
Second
STAT
Think of the rapid response team as a way to get a
“Second Opinion STAT”! If you are worried about your
patient or just feel something is not right…call the RRT
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Code team will respond to the room or area
CPR, ACLS, PALS, NRP as needed
All others stay out of area
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Nurse Manager
Staff Nurse
Nursing Supervisor
ER Physician
ER & ICUnurse
Respiratory Therapy
Radiology Tech
Laboratory Tech
Security
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This is used for lifting help
All available employees will go to the
area to assist with lifting
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A CODE PURPLE should be called for any spill of a
hazardous material.
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DO NOT CALL A CODE PURPLE FOR A MINOR
BLOOD SPILL.
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Do not attempt to clean up an unknown substance.
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Leave the area, close the doors and wash hands with
soap and water. Post staff at doors to warn people who
may be trying to enter the area.
CALL 444 AND REPORT A CODE PURPLE!!!
APPROPRIATE PERSONS SHOULD BE NOTIFIED!
SDS SHEETS MAY BE
OBTAINED on the Intranet
under Services– MSDS Online
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Ensure all doors with an exit sign are
NOT BLOCKED
Also make sure that all medical gas
panels and electrical panels are NOT
BLOCKED with equipment
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Ensure all hallways are clear of
equipment and items not currently in
use. “In use” means you are near the
equipment actively using it.
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Lock All Known Exits
This code will be called on authority of
Administration or Incident Commander
CODE ORANGE
Code Orange will be called in the
event of a radiologic disaster
ELECTRICAL SAFETY
It’s everybody’s responsibility!
 Avoid using extension cords
 Never bend or break off the
ground plug
 Don’t use the “cheater plugs”
that change 3-prong plugs into
2-prong plugs
 Don’t roll equipment over cords
More electrical safety tips:
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Keep areas around electrical
equipment and cords free from water
or wetness
Keep cords away from grease, oil,
sharp objects and heat
Make sure the switch is OFF before
plugging a piece of equipment in
Do not use water on an electrical fire
Grasp a plug firmly and pull to
remove from a socket—never pull by
the cord
EQUIPMENT SAFETY…..
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If a piece of equipment gives you a tingle
or shock, blows a fuse, stalls, sparks or
trips a circuit breaker…
Take it out of service
Tag it with the orange label
Place a work order for repair via bio-med
LOCK OUT/TAG OUT
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Maintenance will secure
electrical disconnect or
piping valves while
conducting work on
equipment.
Do not remove or tamper
with device that has been
locked or tagged.
HAND HYGIENE……
…..THE SINGLE MOST EFFECTIVE WAY
TO PREVENT INFECTIONS!
Alcohol foam – more effective than
handwashing except for C difficile infections
USE IT!
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Handwashing:
Wet hands using warm water
Work up a lather with soap
Scrub for at least 15 seconds
Clean under nails
Rinse well – fingertips down
Dry hands well & use dry paper towel to turn
off faucets
STANDARD
PRECAUTIONS
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Exceeds universal precautions
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Avoid contact with any body
fluid except sweat
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Personal protective equipment – available
in all patient care areas
ISOLATION…..
STOP before you enter…
3 types of isolation at
ROH:
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Droplet precautions
Contact precautions
Airborne precautions
Check the sign on the door for
necessary PPE before entering!
Isolation is based on the 3 basic ways
germs spread in hospitals
Isolation Works
This Way
1. Contact – must be picked up by
contact with hands or clothes to be
spread.
2. Droplet – uses large droplets from
sneezing and coughing to spread
3. Airborne – uses very small particles
floating in the air to spread.
Contact Isolation uses Gloves and Gowns as a barrier between the
germs and your skin or clothes to prevent you from carrying the germs
you could pick up from patients to another patient or yourself. We always
use Contact Isolation for MRSA, VRE, C.Diff and other MDROs
With Contact Isolation you are required to put gloves on before entering
Contact:
the room, and wear a gown if you are going to touch the patient, the bed
Green Sign
on door
or other equipment in the room. You must remove both the gloves and
gown before leaving the room. Don’t forget to Wash Your Hands.
Each person in Contact Isolation should have their own
stethoscope, BP cuff and thermometer as well as a bottle of
Hibiclens in the room.
Droplet Isolation uses Masks, Eye Protection and Face Shields as a
barrier between the germs and your eyes, nose and mouth. These
germs are spread by spraying out of droplets when the patient coughs
and sneezes. We always use Droplet Isolation for Influenza, both
seasonal and H1N1, and Bacterial Meningitis.
Droplet:
Gold Sign
on door
With Droplet Isolation you are required to put on a mask before entering
the room. You may need to wear eye protection or a face shield if the
the patient is not using Respiratory Hygiene. In addition a gown and
gloves may be needed because the droplet spray may spread the germs
on the bed linen. You must remove all the barriers used before leaving
the room. Don’t forget to Wash Your Hands.
RESPIRATORY HYGIENE
Patients should cover their nose and mouth with tissues to contain
respiratory secretions when coughing and sneezing, discard when used
and perform hand hygiene.
If Patients are in an open area waiting for care they should wear a mask.
Each person in Droplet Isolation should have their own
stethoscope, BP cuff and thermometer as well as a bottle of
Hibiclens in the room.
Airborne Isolation uses HEPA (N95) Masks as a barrier between the
germs that are floating in the air and your lungs. These germs are so
small that they spread by floating in the air after patients cough, sneeze
or talk. Other patients and health care workers come along and breath in
the germs. We always use Airborne Isolation for TB, Chickenpox,
Disseminated Shingles and Measles.
If you are not immune to Chickenpox or Measles – you should not
care for these patients. If you do not know if you are immune,
check with Employee Health.
With Airborne Isolation you are required to put on a HEPA mask before
entering the room. It provides a high filtration barrier between the floating
germs and your lungs. You need to be fit tested and evaluated by
Employee Health before you can wear a HEPA mask and care for patients
in Airborne Isolation. You are allowed to re-use your HEPA mask for your
entire shift unless it is damaged. You should remove the HEPA mask after
leaving the room. Don’t forget to Wash Your Hands.
Airborne
Pink Sign
on door
HAZARDOUS
WASTE
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Infectious waste other than sharps must
be placed in red bio-hazard bags.
All needles, scalpels and other sharp
instruments or devices must be disposed
of in “sharps containers”
Bio-hazard bags and sharps containers
are placed in “BIOHAZARD” bins.
BACK INJURY PREVENTION
PROGRAM
The Safe Patient Handling Program, an important
ERGONOMIC solution for clinical staff, includes
the following:
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Safe Patient Handling Policy
Mechanical Lifting devices
Friction Reducing devices
Gait Belts
FRICTION REDUCING
DEVICES (NOW AVAILABLE)
ErgoSlides
To be used when patient needs assistance to
move up in bed or repositioning
 Lateral Transfer Slides
To be used when patient needs assistance
moving from bed to another bed or stretcher
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What Is Risk Management?
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An on-going systematic process for loss
prevention & control
A means to minimize risks for patients, visitors,
and personnel by providing a safe environment
A process that supports, maintains, and enhances
the quality of patient care by
preventing/decreasing the frequency and severity
of adverse events
The process of reducing loss to the hospital
PURPOSE
To maintain a safe and effective health care
environment for patients, visitors, and
employees, thereby preventing or reducing
loss to the organization.
WHO is responsible for Risk
Management?
EVERYONE
Steps to Take When an Event
Occurs
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First and foremost: make sure the patient
receives any medical care necessary.
Notify the physician if
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the patient is injured
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there is a need for a physician examination or
new treatment orders
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there is any patient fall, with or without injury
Complete an Event Report and review it with
your supervisor
Notify the Risk Manager of the event
What Should Be Reported?
Any event or condition which:
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May result or has resulted in an injury to a
patient or impairment of patient care
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Reflects a deviation from hospital policy,
procedure, or practice
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Is an unusual occurrence that is outside
the norm of daily activities
Examples Of What Should Be
Reported
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Medication variance
Unanticipated outcome
Patient or Visitor fall
Hazardous Material spill
Security Issue
Equipment or medical device failure
Procedure variance
Refusal of treatment
AMA
Property loss or breakage
Safety Issue
Event Report Completion
DOs
&
DON’Ts
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DO document the details
of the incident in the
medical record
DO document the facts
DO document follow-up
treatment and/or action
taken
DO fill in all the blanks,
sign and date the report
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DON’T record in the medical
record that an event report was
completed
DON’T place the event report
in the medical record
DON’T document your opinion
DON’T tell patient/family a
report has been written
DON’T make a copy of the
event report
DON’T discuss an event except
when authorized by the Risk
Manager
Recognizing and Reporting
Abuse
The responsibility of the health care
worker when any abuse is suspected is to
notify the physician and Social Services
Child Abuse
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We are required by law
to report suspected child
abuse
Report is confidential
We are immune from
liability for reporting
Signs of Child Abuse
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Unexplained bruises,
welts, lacerations,
burns, fractures
Internal injuries with
symptoms of nausea,
vomiting, blood in urine
Physical indicators of
sexual abuse such as
lacerations and bruises
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Behavioral indicators,
such as hostile behavior
toward adults, running
away, bedwetting
Sleep/Speech disorders
Habit disorder such as
rocking
Consistent hunger, poor
hygiene
Listlessness
Vulnerable Adult Abuse
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We are required by law to report suspected abuse
of a vulnerable adult—any adult unable to care for
themselves.
Any patient in the hospital can be considered
vulnerable
Could be physical, emotional, financial, or sexual
abuse or neglect
Report suspected abuse to the physician and the
Social Service Department
Domestic Abuse
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Domestic violence is the leading cause of injury in
women ages 15-44.
Occurs in approximately 33% of pregnant women
25-30% of women treated in the ER are there for ongoing abuse
Men as well as women can be victims
Domestic violence cannot be reported to the police
without the victim’s permission
Notify the physician and Social Services of concerns
about domestic violence
Our Performance Improvement (PI) Methodology
is based on the PDCA model for improvement.
Plan
Do
Act
Check
What is PDCA?
Plan –
 Decide what to improve and analyze existing information to
plan and design a change which should result in improvement.
Do
 Test out the design change and measure the results.
Check
 Use measures to determine if the design implemented was
effective.
Act
 If the change was effective, make the change permanent
On-Going Measure of Effectiveness
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Sustained improvement is important to maintaining the highest
quality care / service and in achieving our Mission.
What are the Focus Areas for our PI Priorities?
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Satisfaction
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Patient Safety
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Patient
Physician
Employees
Ensuring a safe environment for our patients, visitors, volunteers,
our staff and physicians.
The Joint Commission’s National Patient Safety Goals drive our
safety goal initiatives.
Core Measures

River Oaks –
 SCIP -Surgical Care Improvement Project (inpatient and
outpatient)
 CHF
 AMI
 Pneumonia
 VTE Prevention
Core Measures
The monitoring of core measures provides a way for
hospitals to standardize performance measures
across the nation and identify opportunities for
improvement.
Core measures are monitored because they are
considered high volume and/or high risk for
patients.
Hospital Ethics Committee
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Purpose: To direct staff in appropriate actions
for the discussion and resolution of ethical
issues
Members: Medical staff, clergy, community
representatives, hospital employees
Ethics Committee (cont’d)
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A meeting of the Ethics
Committee may be
requested by a physician,
patient/family, or health
care provider
Meeting is confidential
Ethical Behavior can be described as
doing the right thing.
Cultural Considerations
Culture: “The values, beliefs, and
practices shared by a group”
Healthcare workers need cultural competencies – these are skills
you use to work well with patients of all cultures.
The first step toward cultural competence is simply
being aware of your own cultural beliefs
Cultural Tidbits
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Avoid stereotyping
Take cues. Avoid eye
contact, sitting close,
etc., if patient avoids
these
Ask about proper
practices if you are
unsure
Discuss one topic at a
time
Avoid using medical
jargon or slang
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Ask about ways of
showing respect such as
how the patient wants to
be addressed
Use words the patient
understands
Approach a new patient
slowly
Don’t be too casual or
familiar
Focus on showing
respect
Learn about cultural differences!
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Direct eye contact is considered impolite or
aggressive in many American Indian, IndoChinese
and Arab cultures
Hispanic patients may keep their eyes downcast
as a sign of respect to others
Some Asian-Americans consider touching a
person’s head to be impolite because they
believe the spirit resides there
A hurried attitude on your part could offend
Hispanic or Asian patients who value politeness
or American Indian patients who value an
unhurried approach to communication
Language
River Oaks has access to language
interpreters through the Language Line.
The phone to access this service is kept in
the nursing supervisor’s office.
 River Oaks is contracted with interpreters
for the deaf to help communicate with the
hearing impaired
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Bariatric Patients
Sensitivity Training
What do you feel
when you see
these patients?
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Empathy: Identification with and
understanding of another’s situation,
feelings, and motives.
Synonyms: compassion, understanding,
insight, appreciation.
What about this patient?
ap·a·thy (ă p’Ə -th ē)
1. Lack of interest or concern, especially
regarding matters of general
importance or appeal; indifference.
2. Lack of emotion or feeling;
impassiveness.
Don’t they know that they’re fat?
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Do you think you’re the first person to stare at or
make fun of them?
Remember, this person gets up everyday and the first
person they see each day is themselves.
No one knows better than the patient that
they have a weight issue.
 They live with the discomfort and social
isolation everyday
 Sometimes, their worse critics are
themselves
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Do….
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Monitor facial expressions
Plan ahead
 Communicate size requirements with other
departments so equipment can be on hand upon
patients’ arrival.
 Anticipate the needs of the patient…they may be
too intimidated to ask for it
Ask the patient how they do ______ at home.
 Toileting
 Ambulating
 Dressing/undressing
 Personal hygiene
Do…
Assess psychological well-being and
motivation
What support do they have at the hospital?
Who will be there when they get home?
 Touch the patient!
 Obese patients reported less physical
touching by the caregiver than the nonobese patients
 Nurses’ attitudes about obesity can
hinder good nursing care
 Treat the patient the way you would want
your loved one treated
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Do Not….
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Call bariatric equipment ‘Big Boy’, ‘Heavy
Duty’….
Make loud, public requests for extra lifting
help
Publicly announce the patient’s weight
Roll your eyes when you first visualize your
patient…they can see that.
Act exasperated when they ask for
assistance
Make verbal/non-verbal expressions of
disgust when you have to get special or extra
equipment
Student Injury
If injured during clinical experience, notify
immediately:
- your instructor
- the nurse manager
- the supervisor
- the employee health nurse
 Hospital protocols will be followed
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MEDICATION ADMINISTRATION
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Standard times – see “Fast Facts”
MAR Worksheet – take to bedside
Two patient identifiers: Name, DOB
Look alike/sound alike drugs – posted
in unit medication room
Now doses – as soon as possible after
the order is written
Stat doses – with highest priority after
the order is written
New orders – must be verified by staff
Accudose access via instructor
Narcotics: nurse, instructor &
student
Basics of Documentation
 Write legibly
 Use only black ink
 Never erase or use correction fluid, tape, magic markers
 Do not skip lines or leave blanks
 Chart in chronological order
 Corrections
- single line through incorrect entry (do not obliterate)
- make correct entry
- initial, date and time correction
 Late entries
- Date and time of entry
- Statement: “late entry for _____ (date entry should have been made)
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Review of basics….cont’d
 Use only hospital approved abbreviations and symbols
 Do not use “Unapproved Abbreviations” listed in any
patient chart
 Be sure patient identifying information is on each page
 Date each page, especially of a bi-fold or tri-fold form
 Record the date and time of each entry and event
 Document when events occur
 Do not document anything in advance of its being done
 Sign per hospital policy – each entry should be signed
 Do not document for someone else without proper
notation: ex: foley catheter inserted per J. Doe, RN
109
Basics of Documentation (Cont’d)
 Document
outcomes of nursing interventions to
show effectiveness of patient care
 Document the patient’s refusal of treatment
and/or your teaching about the need for treatment
and possible consequences of refusal
 Don’t insert information in the margins
NEVER, NEVER, NEVER
alter a record
110
FOOD DRUG
INTERACTIONS
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Patient brochures on
nursing units
Document education on
patient education sheet
FOCUS
DOCUMENTATION
Used on MedSurg nursing units
 D—DATA
Assessment
 A—ACTION
Intervention
 R—RESPONSE
Outcome
D----DATA
ASSESS THE PROBLEM
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Your assessment
What the patient
tells you
Significant lab
values, vital
signs, etc.
A=ACTION
YOUR NURSING INTERVENTIONS
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What you do
Who you call
What you report
PRN medications
Comfort measures
R=RESPONSE
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Patient’s response to your
interventions
What you see
What the patient states
Changes in measurements
TIME FOCUS
10:00
PAIN
10:15
IV
10:30 PAIN
D-DATA
A-ACTION
R-RESPONSE
D- Pt c/o pain in R hip. States pain is “8” on intensity scale
Describes pain as throbbing. States pain gets worse when he
turns to R side.---------------------------------------------N.NURSE RN
A- Tylox 1 given p.o. Assisted patient to reposition to L side
D. IV in R hand swollen, infiltrated. Pt c/o discomfort at
site.-----------------------------------------------------------N.NURSE RN
A. Discontinued intact 18 gauge angiocath from R hand, no
redness or drainage at site. Restarted IV in L forearm with 16
gauge angiocath using sterile technique, sterile transparent
dressing applied.--------------------------------------------N.NURSE RN
R. D5W infusing at 75cc/hr L forearm without s/s infiltration
States pain is now a 3 on intensity scale. ---------------N.NURSE RN
My patient is in pain….
Pain is a FOCUS
Use the appropriate pain scale
Check for response
Do pain assessment every shift and as needed
Pain Documentation
MINIMUM OF EVERY
SHIFT on the flow sheet
 USE appropriate pain scale
 Document response to
interventions for pain
 How do we measure pain?
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Falls Prevention - Assessment
Assess your patients for falls on admission using the
Morse Fall Risk Assessment tool.
Reassess your patient every 12 hours and additionally
if the patient falls or his condition changes.
Document your assessment according to policy.
120
Falls Prevention – Interventions
Educate patient and family on fall safety and document.
Hourly Rounds should be made but patients should not be
awakened for rounding assessment
Components of Hourly Rounds
Potty (toileting assistance)
 Personal Needs – items in easy reach
 Positioning
 Pain
 Plan of Care
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Falls Prevention - Interventions
Environmental interventions
 Side rails up – but remember, having 4 side
rails up is considered a restraint.
 Bed in lowest position with wheels locked
 Remove any clutter / obstructions in room
 Call light and personal items within reach
 Night light working
 Secure, non-skid footwear
 Bed alarm, as applicable
When a fall occurs
Ensure patient safety
 Ask patient about injury, pain
 Do not move patient until potential injuries are
identified and safety assured
 Assist patient to bed in safest manner
 Ask patient how the fall occurred
 Assess vital signs
 Assess environment for safety issues
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Notification of the fall:
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Notify the shift supervisor
Notify the physician
Notify the family as soon as possible
Notify the risk manager by phone immediately in the
event of a serious injury
Documentation of the fall:
 Complete Event report for any fall or assisted to floor event.
 Document specific facts in nursing notes
 Document preventive measures initiated
 Update fall prevention assessment and fall prevention plan
of care.
THE NURSING CARE PLAN
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The “Plan of Care” is
part of the patient
care record
Document nursing
interventions
Resolve problems
DVT Prevention
Flowtron Pumps
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Thigh, Calf, or Foot Wraps
Inspect every SHIFT
Report any s/s skin
irritation to physician and
Wound Care nurse
Keep heels off bed
Remove and inspect with
any c/o pain
RESTRAINT
SHOULD BE
USED AS THE
LAST
ALTERNATIVE!
 Alternatives first!
 Review Restraint policy
Be alert for s/s of physical
distress in the restrained
patient….
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Dyspnea
Flushed face
Tachycardia
Diaphoresis
Cyanosis
Hypertension
IV THERAPY
1 attempt per student, then
seek assistance
 No lower extremity sites
 Site/tubing changes q 72 hr
 Hyperal tubing q 24 hr
 Central lines – review policy
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National Patient Safety Goals
Goal 1: Identify patients correctly
Use 2 patient identifiers ( Name and DOB for
adults, Last Name and account # for infants)
 Eliminating Transfusion Errors – requires a (2)
person check at the patient’s bedside
 Label blood and specimen containers in the
presence of the patient
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130
National Patient Safety Goals
Goal 2: Improve the effectiveness of
communication among caregivers.

Report critical results of tests and diagnostic
procedures on a timely basis
131
National Patient Safety Goals
Goal 3: Improve the safety of using
medications
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Label all medications, medication containers (syringes, medicine cups,
and basins), and other solutions on and off the sterile field in
perioperative and other procedural settings.
Take extra care with patients who take medicines to thin their blood.
Record and pass along correct information about a patient’s medications.
Find out what meds they take at home and compare those to new meds
given in the hospital. Make sure the patient knows which meds to take
when they go home. Tell the patient to take an up-to-date list of meds
every time they go to a doctor.
132
National Patient Safety Goals
Goal 6: Use Alarms Safely
Make improvements to ensure that alarms on medical
equipment are heard and responded to on time.
National Patient Safety Goals
Goal 7: Prevent infection
A. Meeting hand hygiene guidelines
B. Using proven guidelines to prevent:
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Multi-drug resistant organism infections
Central-line associated blood stream infections
Post-op infections
UTI from Foley catheters
134
National Patient Safety Goals
Goal 15: Identify patient safety risks.
A. Risk Assessment to be performed on any
patient expressing suicidal ideation.
B. Provide patient and family members with
information on the crisis prevention hotline if
identified at risk for suicide.
135
National Patient Safety Goals
Prevent Mistakes in Surgery
Follow the Safe Procedure Review:
A. Assure the correct surgery is done on the correct
patient and at the correct place on the patient’s body
B. Mark the procedure site
C. Perform a Safe Procedure Review just prior to
procedure to make sure a mistake is not being made
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THE END