1. Student Orientation 2013
Our Mission Statement
Above all else, we are committed to the care and improvement of
human life. In recognition of this commitment, we will provide
exceptional healthcare to our expanding communities with
compassion and integrity pursuing excellence in all we do.
Helping, Healing, Giving HOPE.
• During
the time you are completing this module, you may call 8023382 for any questions. Also the Infection Prevention Nurse is here
Monday through Friday 8-4:30 at ext. 4969. Questions that you have
at night or on the weekends may be directed to the House Supervisor
at 3037.
1

2. Vision Statement
As the Nationally recognized tertiary care provider of
the largest healthcare system in NW GA, Redmond will
support and engage our medical staff, expand and
modernize our facilities, grow our Primary Care,
Occupational Health, and EMS networks, and enhance
our community presence. We will promote staff
development and deliver exceptional patient care every
time. Our reputation for success will be recognized
through service line growth, increased market share,
exceptional clinical outcomes, and superior patient,
physician and employee satisfaction.
We are Redmond.
2

3. Values


With
Excellence

Compassion
Accountability
Respect &
Ethics...

We are Redmond!



3

4. Ethics and Compliance

Redmond and HCA have a comprehensive, values-based
Ethics and Compliance Program, which is a vital part of the
way we conduct ourselves. Because the Program rests on
our Mission and Values, it has easily become incorporated
into our daily activities and supports our tradition of caring
– for our patients, our communities, and our colleagues. We
strive to deliver healthcare compassionately and to act with
absolute integrity in the way we do our work and the way
we live our lives. All work must be done in an ethical and
legal manner. It is your responsibility and your obligation to
follow the code of conduct and maintain the highest
standards of ethics and compliance.
4

5. Ethics and Compliance


If you have questions or encounter any situation which you
believe violates the provisions of the code of conduct or the
corporate integrity agreement, you should immediately
consult your supervisor, another member of the
management team, the Human Resources Director (Patsy
Adams ext 3023), the Ethics and Compliance Officer
(Deborah Branton ext 3036), or the HCA Ethics Line (1800-455-1996).
Each employee and volunteer is required to attend two
hours of initial code of conduct training and a one hour
annual refresher training session. Leaders and individuals
in key jobs have additional annual education requirements.
5

6. Georgia False Claims Laws




There is a federal False Claims Act, and there are also
Georgia laws that address fraud and abuse in the Georgia
Medicaid program.
Any person or entity that knowingly submits a false or
fraudulent claim for payment of funds is liable for
significant penalties and fines.
The False Claims Act has a “qui tam” or “whistleblower”
provision. This allows a private person with knowledge
of a false claim to bring a civil action on behalf of the US
Government. If the claim is successful, the whistleblower
may be awarded a percentage of the funds recovered.
For additional information, please see the Georgia False
Claims Statutes Policy.
6

7. EMTALA


The Emergency Medical Treatment and
Active Labor Act is commonly known as
the Patient Anti-Dumping Statute.
This statute requires Medicare hospitals to
provide emergency services to all patients,
whether or not the patient can pay.
7

8. EMTALA



When a patient comes to the emergency
department (emergency can be located on any
part of the hospital campus), the hospital must
screen for a medical emergency.
If an emergency medical condition is found, the
hospital must provide stabilizing treatment.
Patients with emergency medical conditions
may not be transferred out of the hospital for
economic reasons.
8

9. Medical Ethics:
End of Life Care

Palliative Care


The goal of palliative care is not to cure the
patient. The goal is to provide comfort.
Understand the importance of addressing all
of the patient’s comfort needs near the end of
life. This includes psychosocial, spiritual,
and physical needs.
9

10. Medical Ethics:
End of Life Care

End-of-Life Decisions



Patients have the right to refuse lifesustaining treatment.
Respect this right and this decision.
Withdrawing Life-Sustaining Treatment

Withdrawing and withholding life-sustaining
treatment are ethically and legally equivalent.
Both are ethical and legal when the patient
has given informed consent.
10

11. Pet Partner
Animal Visitation Program



Animal visitation is a short term intervention to help
improve the patient’s well being and reduce loneliness. Pets
provide opportunities for patients to display affection and
emotion, practice social skills, and have positive experiences.
The visit is determined by the patient’s needs at a particular
time. Pets used for animal assisted activity are not patient’s
pets. The adult dogs or cats brought to this facility will be
certified through Delta Society (www.deltasociety.org).
Animal must be appropriately restrained with identification.
Identification will include a Redmond picture ID Badge
attached to the animal’s vest or collar.
Pet Partner Volunteer will contact the charge nurse on the
floor of the patient on the day of the visit.
11

12. Pet Partner
Animal Visitation Program

Staff Responsibility



Ensures that patient meets criteria for an animal visit.
Animals are restricted from food preparation service
areas, and other high risk areas including: any patient
with a decubitus, surgical patients, open wounds or
burns, open tracheotomy, immune-suppression, all
isolation precautions rooms, critical care area patients,
patients with tuberculosis, salmonella, campylobacter,
shigella, streptococcus A, MRSA, ringworms, giardia,
and amebiasesis are excluded from this program.
In the event that a patient receives a bite or scratch, the
patient’s nurse will complete an occurrence form about
the incident. The nurse will notify the patient’s
physician and the Infection Prevention Director.
12

13. Teamwork: A cooperative effort by members of a
group trying to achieve a common goal.
To make teamwork happen…
Communication
is a necessity.
Must have interaction with others even
when things are not going as planned.
Get Feedback from other staff members
and managers.
Share the responsibility.
13

14. Skills for Teamwork:






Listening
Questioning
Respecting and supporting ideas
Helping
Sharing
Participation
14

15. Teamwork



People who work in a hospital situation know how to
manage high-stress situations, but frustrations can build.
Working as a team will reduce situations where a staff
member feels overwhelmed by his/her workload or the
temperament of an unpleasant staff member.
Compassion and common courtesy are appropriate not
only when communicating with patients; they are also
vital in how you treat your coworkers.
If everyone does his/her job in an efficient manner and is
aware of the needs of other staff members, he/she can
contribute to the overall morale.
15

16. Ergonomic Safety


Ergonomic Safety is adapting the equipment,
procedures and work areas to fit the person in order to
help prevent injuries and improve efficiency.
Musculoskeletal disorders (MSDs) affect muscles,
nerves, tendons, ligaments, joints ,or spinal discs.
Injuries can include strains, sprains, and repetitive
motion injuries.
Signs and symptoms: pain, tingling, numbness,
swelling, stiffness, burning sensation, etc. May
experience decreased gripping strength, range of
motion, muscle function, or inability to do everyday
tasks. Risk factors: repetition, forceful exertions,
awkward postures, contact stress, and vibration.
Common MSDs: Carpal tunnel syndrome, rotator cuff
syndrome, trigger finger, tendonitis, herniated spinal 16

17. Ergonomic Safety


Apply these tips to your job: Adjust chair height and
backrest (feet should be flat on the floor, knees level
with hips, and lower back supported). Sit an arm's
length away from the computer screen. Keep wrists
straight and elbows at right angles. Alternate tasks.
Use proper body mechanics when lifting, transferring,
etc. Avoid reaching and stretching overhead.
You may recommend ways to reduce the chance of
developing musculoskeletal disorders to your
supervisor. Your work space may be evaluated for
ergonomic safety by notifying Rhonda Culp at ext.
4968. Your departmental safety representative may
assist with body mechanic in-services. Report signs,
symptoms, illnesses ,and injuries to your supervisor,
complete an occurrence report, and obtain medical
17
treatment in Employee Health Services.

18. Ergonomic Tips

The best way to avoid the discomfort of
MSDs is:

Change body positions frequently/Set up work
stations to fit your body/Stretch every 45 minutes
to an hour/Perform stretches that are designed to
decrease discomfort for job specific tasks
Decrease
Warm-up
Fatigue
exercises
Interrupt sustained postures
Proper ergonomics
Appropriate work methods
Limited overtime
Increase
Recovery
Physical
fitness
Proper nutrition
Good sleeping postures
Ice after activities
Avoid smoking
Alternative job placement
18

19. Eligible






All Redmond Employees
Spouses/Dependents
insured thru HCA
Occupational Health
EMS
IT & S
Shared Services


PAS
Supply Chain - Materials
Not Eligible


Redmond Spouses/Dependents
not insured thru HCA insurance
HCAPS


Team Health





Family Care Centers
Anesthesia
ED Providers
Surgery Center (ASC)
Volunteers
Contractors (i.e. Sudexo,
Securitas, etc)
19

20. Employee Safety and
Workers’ Compensation




Our facility’s commitment is to you.
We have programs in place to make our facility as
safe as possible for you, our patients, and visitors!
We will work in your best interest to ensure
accidents are handled properly and you get the
medical care you need.
With your help, our program will be effective!
20

21. Employee Safety Committee




Consists of members from key departments
within this facility.
Meets bi-monthly to review injury statistics
and address prevention needs.
Completes quarterly hazard surveillance
rounds to identify and correct hazards.
Progress is monitored by Senior
Leadership.
21

22. Area’s of Concern 2013






Compliance with all policies & procedures.
Timely hazard reporting.
Timely accident reporting.
Always wear appropriate Personal
Protective Equipment.
Slip, trip & falls prevention.
Patient management.
22

23. Compliance with all Policies and
Procedures

Employees are responsible for following current
RRMC policies and procedures and notifying their
supervisor for identified safety hazards.
Wear Personal Protective Equipment

Employees are responsible for wearing the
appropriate personal protective equipment for
isolation precautions (see Infection Prevention
slides for details).
23

24. Timely Hazard Reporting




Hazards will ultimately injure one of our staff, a
patient, or a visitor.
We are all responsible for ensuring hazards are
eliminated.
Report potential hazards to Clay Callaway, Safety
and Security Officer and/or Rhonda Culp,
Employee Health Services.
Discuss potential hazards during staff meetings.
24

25. Timely Accident Reporting



If you are injured on the job you should report the
accident to your supervisor immediately!
The appropriate medical care will be coordinated
for you. Contact Employee Health Services for
panel physician authorization.
A post-accident investigation will be performed by
your manager to determine what, if anything, can be
done to prevent a similar occurrence from
happening again.
25

26. Slip, Trip, & Fall Accident Prevention




A slip occurs when there is too little traction or friction between the shoe and the
walking surface. Some common causes of slips are wet surfaces, occasional
spills, weather hazards, and loose rugs.
A trip occurs when a person’s foot contacts an object in their way or drops to a
lower level unexpectedly, causing them to be thrown off-balance. Common
causes of trips are obstructed view, poor lighting, clutter, wrinkled rugs,
uncovered cables or cords, bottom drawers not being closed, and uneven walking
surfaces.
A fall occurs when you are too far off balance. This can occur as a same level fall
or a fall to a level below the one you are walking on. Falls from elevations such
as ladders, stairs, and loading docks can be much more severe.
There are numerous personal factors that may increase an individual’s risk of a
slip, trip, or fall. These include age, body shape or mass, gait dynamics (the
particular way an individual walks), physical condition, perception (an
individual’s ability to see and their awareness of their surroundings), and
26
psychological and psychosocial factors (stress and distractions).

27. Slip, Trip, & Fall Accident Prevention
Here are some simple ways to alter your behavior and help avoid slips, trips, or falls:

Watch where you are going while walking – pay attention and look for slip, trip, and
fall hazards

Walk, don’t run – make sure you give yourself enough time to get where you are going

Don’t engage in activities that may be distracting – for example: reading or texting
while walking

Use handrails when climbing or descending stairs

Check that your walkway is clear and that your view is not blocked before you lift
anything

Don’t carry a load that you can’t see over or around while carrying

Walk carefully and slowly when transitioning from one walking surface to another

Slow down and take small steps if the walking surface is cluttered, narrow, uneven,
slippery, or at an angle

Wear stable proper fitting shoes with non-slip soles – avoid backless shoes to help
decrease your risk for slips, trips, or falls

When entering a building on a wet day, remove as much water from your shoes as
possible – walk carefully as the floors may be slippery
27

28. Patient Management Accident Prevention

Patient Transfers - Bed to Chair






Make sure everyone involved knows their role and expectations for the
transfer
 Call for assistance if the patient is a mod or max transfer
 Call for assistance if the patient has required more than one person in
the past
 Call for assistance if you are unsure how the patient will do
Make sure that the surface you are leaving and the surface you are going to
are close and that all brakes are applied
If one side is weaker, it is best to transfer to the stronger side
Ensure the patient is wearing proper foot wear
Transition the patient from supine to sitting edge of bed
Give the patient time to adjust to this position to ensure they do not get
dizzy or lightheaded
28

29. Patient Management Accident Prevention
Continued…







Help the patient scoot to the edge of the bed so their
feet are resting on the floor for balance and support
Place a gait belt around the patient
Position yourself for the transfer
Have patient rock with you and stand on the count of
three to ensure everyone is assisting at the same time
Pivot to the chair
Have patient reach for the surface/arm rests of the
surface they are transferring to
Remove gait belt
29

30. Patient Management Accident Prevention
Continued

Patient Transfers – Bed to Bed or Bed to Stretcher
 Make sure everyone involved knows their role and expectations
for the transfer
 Ensure sheet is adequately under the trunk and buttocks of the
patient
 Ensure enough people are present for the size of the patient
 Those on the side being transferred to, kneel on the bed to pull
the patient half-way
 Make sure patient keeps their arms folded across their chest
 One person takes charge and counts to three for everyone to go
 Patient is transferred halfway, then the people receiving the
patient get off the bed onto the floor and the people sending get on
the bed for the remaining half
 Ensure everyone is ready and the lead counts to three again .
30

31. Patient Management Accident Prevention
Continued



Patient Transfers – Repositioning in Bed
 Use gravity to assist if able and place the bed in Trendelenburg
 Have the patient bend their knees to assist with the push
 Have them place their arms across their chest
 Ensure the pad/sheet is adequately under them
 Ensure everyone knows their role
 One lead counts to three for patient to push with their legs and
those assisting to pull
 Make sure you move with the transfer and do not twist or torque
your body, rather move your feet and step
For all transfers, know your precautions: Cardiac, Total Hip
Precautions, Lumbar Precautions following surgery, Hemiparesis, etc…
Contact our Rehab department as needed for questions.
31

32. Safety: A Shared Responsibility


Redmond’s responsibility is to provide a
safe work environment that facilitates safe
work procedures.
Each employee’s responsibility is to
practice safe work skills that incorporate
proper body mechanics and work
procedures while keeping their body well
and fit for their work tasks.
32

33. If you are Injured on the Job



Report the injury to your supervisor IMMEDIATELY!
Workers’ Compensation benefits may apply to your
injury, please follow up with Employee Health Services.
Workers’ Compensation provides the following benefits:

Medical - Follow-up after emergency treatment and
evaluation by authorized providers is coordinated
through Employee Health Services.

Lost Wages – The state has limits on the amount of
lost wages you may receive if you miss time from
work.
33

34. Direct Cost of Injuries




Inability to continue working
Impact on your wages
Disruption of your family life and routines
YOUR CAREER
34

35. Set Good Examples


Be proactive in the identification of hazards and
prevention of injuries.
Report injuries timely and work with Employee
Health Services throughout the rehab process.
Maintain Communication


Maintain contact with your department Director.
Contact Employee Health Services with any issues
related to your injury!
35

36. Transitional Duty



Light-duty or transitional duty may be accommodated if a
department has a need and is able to utilize an employee for
job duties that fall within the employee’s treating physician job
restrictions and charge these hours to their department without
going over productive staffing targets or creating overtime as a
result of accommodating light duty.
This will be reviewed and approved on a case by case basis by
the department director, Employee Health Services, and the HR
director as needed.
If the department becomes no longer able to provide these job
duties without going over productive staffing targets, then
light-duty work will not be an available option.
36

37. Employee Health Services (EHS)
Non-work Related Illness or Injury





EHS stocks many over-the-counter medications; these are
available for employees as needed.
EHS also provides free blood pressure checks, weight
checks, and basic first aid.
You will report to EHS annually for your required health
update and Respirator Fit test (if appropriate for your
job).
For conditions requiring prescription medications, labs, xrays, and that require the attention of a nurse
practitioners, Rome Redmond Wellness Center or West
Rome Family Care Centers can provide those services.
Employees may be referred to their Primary Care
physician for further evaluation, treatment, and/or follow-
37

38. Blood Borne Pathogen Plan



A copy of our plan is available on the RRMC intranet site.
The plan explains the processes we have in place to
minimize exposures, and what to do if there is an exposure
to a blood or body fluids.
Potentially infectious fluids: blood, semen, vaginal
secretions, cerebrospinal fluid, synovial fluid, pleural fluid,
peritoneal fluid, pericardial fluid, amniotic fluid, or any
other fluid that is visibly contaminated with blood and all
body fluid where it is difficult or impossible to differentiate,
saliva in dental settings, tissue and organs that are not fixed
other than intact skin (from any human living or dead), HIV
containing cell or tissue cultures or organs, and tissue from
experimental animals infected with blood borne pathogens.

39. How to Reduce Transmission of Blood
Borne Pathogens?



Observe engineering controls; needle-less systems, safety
devices, sharps disposal containers, biohazard waste
containers, needle boxes at appropriate height.
Observe work practices; never recap needles, perform hand
hygiene, use appropriate PPEs, do not bend or break needles,
do not eat or drink in areas where there is potential for
exposure, do not store food or drinks in a refrigerator that is
used to store blood or other potentially infectious material
(OPIM), use red biohazard bags for disposal of infectious
wastes.
Know the job tasks in your department that may involve
exposure to blood or OPIM and wear appropriate PPEs. Ask
your leader for a list of tasks in your department and the
required PPE.

40. What Can You Do To Prevent Sharps
Injuries?
Be Aware





Keep the exposed sharp in view.
Be aware of people around you. Stop if you feel
rushed or distracted.
Focus on your task.
Avoid hand-passing sharps and use verbal alerts
when moving sharps.
Watch for sharps in linen, beds, on the floor, or in
waste containers.
40

41. What Can You Do To Prevent Sharps
Injuries?
Be Prepared




Complete your Hepatitis B vaccine series and
titer in Employee Health Services free of charge.
Organize your work area with appropriate sharps
disposal containers within reach.
Receive training on how to use sharps safety
devices.
Wear gloves if you expect to come in contact with
blood or body fluids.
41

42. What Can You Do To Prevent Sharps
Injuries?
Follow Policies
 Don’t recap needles.
 Never use needles with the needleless IV
system.
 Be responsible for every device you use.
 If you identify a sharps without a safety
device, discuss this with your supervisor
and/or Employee Health Services.
42

43. What Can You Do To Prevent Sharps
Injuries?
Dispose of Sharps with Care
 Don’t remove contaminated sharps with your hands
unless medically required (i.e. caps off used
needles, scalpel blades). If necessary, use a
mechanical device or forceps.
 Always activate safety devices immediately after
using a sharp. Never remove safety devices. Keep
your hands behind the needle at all times.
43

44. Disposal of Sharps With Care




Place all used sharps in biohazard
containers, see policy IC-45.
Securely close biohazard containers when
¾ full and notify Environmental Services
to change the sharps container.
Do Not overfill sharps containers.
Do Not reach by hand into containers
where sharps are placed.
44

45. Additional Sharps Injury Prevention
for the OR




Use a neutral zone when passing sharps
instruments. Pass sharps on a tray, not directly to
another individual. Use verbal alerts when moving
sharps.
When suturing, use blunt sutures for muscle and
fascia.
Stay focused on your task. Stop if you feel rushed
or distracted.
Use mechanical devices such as tongs to handle
contaminated reusable sharps. Do Not use your
hands.
45

46. Hepatitis B





Hepatitis B is a contagious blood borne disease
affecting the liver
Can be mild lasting a few weeks or a serious lifelong
illness
Symptoms may include jaundice, fatigue, fever,
nausea, and abdominal pain
Spreads when infected blood and body fluids enters
the body of a person who is not infected
Exposures may occur with needle-sticks/sharps
injuries

47. Needle Stick/Sharps Injury
What is the risk of infection after exposure?

HBV



Healthcare personnel who have received
hepatitis B vaccine and developed immunity
to the virus are at virtually no risk for
infection.
Hepatitis B vaccines are free.
For a susceptible person, the risk from an
exposure can range from 6 – 30% and
depends on the status of the source
individual.
47

48. Needle Stick/Sharps Injury
Treatment For The Exposure

HBV


Hepatitis B vaccine for all healthcare
personnel who have a reasonable chance of
exposure to blood or body fluids.
Hepatitis B immune globulin (HBIG) alone
or in combination with vaccine (if not
previously vaccinated or no immunity
developed after vaccination).
48

49. What is Hepatitis C?




Hepatitis C is another contagious blood borne disease
affecting the liver.
Can be a mild illness lasting a few weeks to a serious
lifelong illness that attacks the liver.
It is primarily spread through contact with the blood
of an infected person .
HCV infection often occurs without symptoms or
with mild symptoms. The symptoms are very similar
to those of Hepatitis B.
49

50. Needle Stick/Sharps Injury
What is the risk of infection after exposure?

HCV


The average risk for infection after a
needlestick exposure to HCV infected blood
is approximately 1.8%.
There is a small risk associated with
exposure to the eye, mucous membranes, or
nonintact skin.
50

51. Needle Stick/Sharps Injury
Treatment For The Exposure

HCV


There is no vaccine against hepatitis C and
no treatment after exposure that will prevent
infection.
Following recommended control practices to
prevent percutaneous injuries is imperative.
51

52. What is HIV?




Human immunodeficiency virus (HIV) is a virus that can
lead to acquired immune deficiency syndrome (AIDS).
HIV damages the immune system and makes a person
with AIDS more likely to get serious infections and other
diseases.
It may be transmitted by contact with an infected
person’s blood or body fluids which enter the body of a
person that is not infected.
Within a few weeks of being infected with HIV, some
people develop flu like symptoms that last for a week or
two, but others have no symptoms at all.
52

53. Needle Stick/Sharps Injury
What is the risk of infection after exposure?

HIV



The average risk of infection after a
needlestick exposure is 0.3% (or about 1 in
300).
The risk after exposure of the eye, nose, or
mouth is about 0.1% (1 in 1,000).
The risk after exposure to nonintact skin is
less than 0.1%.
53

54. Needle Stick/Sharps Injury
Treatment For The Exposure

HIV




There is no vaccine against HIV.
Postexposure prophylaxis (PEP) with
retroviral drugs is recommended for certain
occupational exposures that pose a risk of
transmission of HIV.
PEP is not recommended for exposures with
low risk for transmission of HIV.
PEP should be started as soon as possible
after exposure, preferably within 2 hours.
54

55. What is an Exposure?







Contact with another person’s blood or OPIM such as in needle
sticks/sharps exposures, mucus membrane exposure, or exposure
to non intact skin.
If you are exposed to blood or OPIM, you should clean the skin
injury site with soap and water. If it is a mucous membrane
exposure, flush the area with water.
Inform your supervisor or the designated charge person and go to
Employee Health Services (may go to the Emergency Room
during other hours) to be evaluated.
Complete occurrence form.
You will receive risk information, be evaluated by the ER
physician or the Nurse in Employee Health Services, be informed
of recommendations of treatment, and receive care.
You should follow up after your initial evaluation the next day with
Employee Health Services.
You will receive a written opinion for any future recommended
follow up in approximately 15 days.
55

56. Bloodborne Pathogen Exposure


Report to Employee Health Services or the E.R.
immediately after a Bloodborne Pathogen Exposure. If
you go the E.R., then follow-up with Employee Health
Services as soon as the office opens.
Following a bloodborne pathogen exposure, the risk of
infection may vary with factors such as:





the pathogen involved
the type of exposure
the amount of blood involved in the exposure
the amount of virus in the patient’s blood at the time of exposure
The following factors were associated with an increased
risk of HIV seroconversion:




deep injury (deep puncture wound)
visible blood on source patient device causing injury
procedure involving needle placed in a vein or artery of source
patient
endstage AIDS in source patient
56

57. Biohazards

Biohazard Labels


These labels are warnings that the
contents of the container are possibly
infectious materials.
Linens

Use standard precautions when handling
linens. Linens are treated as if potentially
infectious. Linens removed from isolation
rooms should be taken to the laundry
chute.

58. Biohazardous Waste Management

It is VERY important that hazardous medical waste be placed in
the appropriate disposal system. The following are considered
hazardous waste and must be disposed of properly:






Chest tubes — Place in red bags
Anything “wet” with blood or body fluid (gauze, disposable
towels, etc.) — Place in red bags
Suction canisters — Use isolyzer and place in red bags
Blood bags after infusion completed — Place in red bags
All used syringes — Sharps containers (needle boxes)
All sharps (needles, scalpels, suture needles, etc.) — Sharps
containers (needle boxes) *Always activate the safety device

59. Five Questions OSHA might ask
about Blood Borne pathogens:



What is standard precautions? All blood and body
fluids are treated as if potentially infectious by
wearing appropriate PPE when dealing with them.
What do you do when there is a blood spill? Wear
PPE, locate spill kit, follow directions, dispose of
properly in red bag and disinfect area where spill
occurred.
What do you do with contaminated sharps and
laundry? Used sharps go in designated sharps
containers made of hard plastic that are puncture
resistant, linen goes in the dirty linen hamper or is
taken to linen chute.

60. Questions continued


Have you been offered the hepatitis B
vaccination free of charge? Yes, by employee
health services (all employees have opportunity
to receive the vaccine).
Where is the Bloodborne pathogen plan? On the
intranet under IC policies, in the nursing office,
or can be obtained through employee health
services.

61. If you have questions about Bloodborne
Pathogens, contact Employee Health at
ext 4968, or Infection Prevention ext 4969
8:00am – 5:00 pm
Monday through Friday
If EH or IP is not available, contact your
Department Leader or the Nursing
House Supervisor.

62. Pandemic Influenza





A pandemic is an infectious event that has
a global impact (such as those in 1918,
1958, & 1968).
The impact on society will be huge!
Respiratory Hygiene/Cough Etiquette
 Learn it, live it, teach it!
All staff must either get an flu vaccine or
wear a mask in designated areas while at
work
For more information, visit:
www.pandemicflu.gov

63. Prepare Your Family





Have a plan for your family
Review your Personal Preparedness Planning Kit
Make sure you have a plan for pets
You will be required to work
If you have special needs, let us know



Special needs adult or children and no other adult
to care for them
Military obligations
DMAT, other volunteer organization

64. How would Redmond handle an
influx of infectious patients?


If a large number of infectious patients
suddenly presented to the hospital, we
would activate our emergency
preparedness plan.
This plan addresses staffing, supplies, and
other issues that might occur as a result of
the increased patient load.

65. INFECTION PREVENTION

Our goal is to reduce risks
and prevent infection in our patients.
Why all the fuss about hand hygiene?
 Most common way to transmit bacteria is hands.
 Hand hygiene is very effective in reducing
transmission of infections. Two products can be
used:
 Soap and water –lather hands using friction for
15-20 seconds, rinse under running water. Use
soap and water if hands are visibly soiled or in
case of tier 2 (high rate or outbreak) for c
difficile.
 Alcohol based product –Cover all surfaces of
hands and fingers and rub together. Once dry,
your hands are safe.

66. Indications for Hand Hygiene


Before:
–Patient contact or contact with environment
–Donning gloves when inserting a CVC
–Inserting urinary catheters, peripheral vascular
catheters, or other invasive devices that don’t require
surgery
After:
–Contact with a patient’s skin, body fluids or excretions,
non-intact skin, wound dressings
–Contact with patient’s environment
–Removing gloves

67. Nails: Direct Patient Care Givers



Natural nail tips should be kept to ¼ inch in
length
Artificial nails are not to be worn (includes a
few non clinical departments)
Nail polish may be worn in most departments
as long as it is not chipped
Check with your department leader if you have questions about
whether you can wear polish or artificial nails while at work

68. Standard Precautions



Assume that every person is potentially
infected or colonized with a bacteria that
can be transmitted to others. Applies to
another person’s blood or body fluid.
Wear appropriate Personal Protective
Equipment (PPE) when you anticipate
contact with blood or body fluids.
Remove PPE before leaving patient’s
room.

69. Transmission Based Precautions:

Used in addition to Standard Precautions
 Contact Precautions (gown, gloves, and
sometimes mask)
 Airborne Precautions (wear N 95 mask)
 Droplet (wear regular mask)

Enhanced Droplet Precautions (wear regular
mask except a N 95 mask must be worn when
doing aerosol generating activities)

70. Transmission Based Precautions
Contact Precautions





Used when patient has a bacteria
transmitted by direct patient
contact or by indirect contact by
touching environmental surfaces
in patient room.
Gowns and gloves must be worn
and sometimes a mask.
Private room for patient or
placed with patient with the
same bacteria.
Before leaving the room, patient
should put an isolation gown
over their attire, and wash
hands. If patient is bed bound,
place the gown on the end of the
bed with the chart on top of it.
Notify Environmental Services
to terminal clean room when
patient is discharged.
Airborne Precautions





Used for illnesses transmitted
by airborne droplets.
Patient is placed in a negative
air flow room.
Patient wears a regular mask if
they need to leave the room.
Staff must wear N 95 mask
when entering room (staff who
have not been fit tested may
not go in this room).
Visitors are instructed on how
to wear an N 95 mask by the
nurse.

71. Transmission Based Precautions
Droplet Precautions





Used for illnesses transmitted by
large droplets.
Staff wear regular mask.
Patient is placed in a private
room, may be placed in room
with another patient with same
pathogen.
Patient wears a regular mask
when leaving room.
Visitors wear regular mask in
room.
“Enhanced” Droplet Precautions




Applies when patient has
influenza.
Staff wear regular mask, EXCEPT
wear N 95 mask if performing
aerosol generating activity (move
patient to negative air flow room
when feasible).
Ask visitors to step out of room
when aerosol generating activities
are being done.
Keep patient on precautions for 7
days after onset of illness or until
24 hours after the resolution of
fever and respiratory symptoms
which ever is LONGER!

72. Personal Protective Equipment (PPE)
Gloves





Wear gloves when contact
with blood or other
potentially infectious
materials is possible.
Change gloves when going
from dirty area to a clean
area.
Remove gloves after caring
for a patient and wash hands.
Do not wear the same pair of
gloves for the care of more
than one patient.
Do not wash gloves for reuse.
Gowns



Wear a gown to protect skin
and prevent soiling or
contamination of clothing
during procedures and
patient-care activities when
contact with blood, body
fluids, secretions, or
excretions is anticipated.
Remove gown and perform
hand hygiene before
leaving patient
environment.
Do not reuse gowns.

73. Multi Drug Resistant Organisms (MDRO’s)

Methicillin-Resistant Staphylococcus Aureus (MRSA)

MRSA is a staph bacteria resistant to some antibiotics.
MRSA can be transmitted by direct contact with the patient or their
environment.




Colonization with MRSA –means it is present, but does not cause
the person to be sick.
Infection with MRSA-causes the person to be sick.
High risk patients admitted to our hospital are screened for MRSA
upon admission. If their test is positive (meaning they have MRSA
in their nose), they are placed on contact precautions. This is why
you are seeing more patients on contact precautions.
Redmond has a very low rate of MRSA acquired at our
hospital!

74. MDRO’s

Vancomycin Resistant Enterococcus (VRE)






Bacteria that has become resistant to certain antibiotics.
Contact Precautions should be used.
High risk patients are screened for VRE on admission.
Most patients who have VRE are colonized, not infected
with VRE.
Redmond had zero VRE infections acquired at our
hospital last year.
Carbapenum Resistant Enterobacteriaceae


Most common – Klebseilia Pneumoniae Carbapenemaic
(KPC)
Contact Precautions should be used.

75. Clostridium Difficile (C diff)





May develop due to prolonged use of antibiotics.
Causes diarrhea and more serious intestinal conditions.
Can be transmitted by hands.
Recently released information allows hand hygiene with
alcohol gel or soap and water in non outbreak situations.
In case of tier 2 (high rate or outbreak) of c difficile, soap
and water is required. Infection prevention will inform
staff of tier 2 recommendations.
Environmental services cleans room at discharge using
bleach wipes or bleach.

76. Preventing MRSA, VRE, and C Difficile







Wash hands before and after contact with patient or
environment.
Disinfect medical equipment between patients (this
includes your stethoscope).
Staff wear gown and gloves upon entering room (Contact
Precautions).
Encourage visitors to wash their hands.
Education sheet to patient/visitors.
Visitor may decide for themselves whether or not to wear
a gown or gloves. Exception: if the visitor is visiting other
patients they must wear a gown and gloves in a contact
precaution room.
Use disposable equipment, such as B/P cuffs and
stethoscopes when possible.

77. Transporting Patients on Contact Precautions:






Notify receiving department that patient is on contact precautions.
Patient should wear isolation gown over their attire if transported by
wheelchair, if bed bound place folded gown over end of bed and
chart on top of gown, and wash patients hands prior to transport.
Transporter washes hands and dons isolation attire upon entry to
room.
Transporter assists patient on stretcher or in wheelchair.
Transporter removes isolation attire and washes hands.
 If transporter anticipates they might have contact with patient’s
blood or body fluid while transporting patient, the transporter
can don new attire after washing hands prior to transporting
patient out of room.
 A second person, not wearing isolation attire, should assist with
transport of the patient. The second person performs all the
environmental contact during the move such as opening doors
and pressing elevator buttons.
Transporter will don new isolation attire (gown and gloves) before
helping patient off stretcher or wheelchair at destination.

78. Preventing Surgical Site Infections (SSI)






Surgery patients may be given a special product to
use to bathe or shower before surgery
Hair is removed by clippers NOT razors
OR staff perform hand scrub prior to case
Special attire is worn by OR staff during surgery
Antibiotic is given before surgery
Antibiotic is discontinued within 24 – 48 hours
depending on the surgery

79. 

~250,000 Blood stream infections occur every year in the
U.S.
Why Aim for Zero
 Many blood stream infections related to central lines
are preventable.
 Bundle practices help prevent blood stream
infections.

80. 
Insertion Bundle Practices:
 Wash hands prior to
inserting and handling
line.
 Provider (and assistant)
inserting line wears sterile
mask/gown/gloves, and
cap.
 Patient is covered with a
large drape.
 Patient’s skin is cleaned
with a special skin prep.

Maintenance Bundle Practices:

Assess need of line daily.
Perform hand hygiene before
touching line or dressing.
Use CHG unless contraindicated for
site care and dressing changes.
Change gauze dressings every 2 days
or clear dressings every 7 days unless
soiled, dampened, or loosened.
Replace tubing and connectors per
policy.
Scrub the hub for 10-15 seconds
before accessing device.






81. Preventing Ventilator Associated Event




Head of bed up 30 degrees unless
contraindicated
Daily “sedation vacation” and daily
assessment of readiness to extubate
Peptic Ulcer Disease Prophylaxis
Deep Venous Thrombosis Prophylaxis
(unless contraindiated)

82. Preventing Foley Related Urinary Tract
Infections





Hand hygiene prior to inserting a foley
Only staff who have completed competency
may insert catheters
Insert catheters only when necessary
Assess need daily, ask physician for order to
remove when no longer needed
Keep bag below the level of the bladder at all
times

83. Tuberculosis (TB) Update






Spread person-to-person by air
droplets
Symptoms: greater than three
weeks of cough, unexplained
fever, weight loss, and night
sweats.
Active TB is contagious.
Airborne Precautions with
negative air flow room required.
Door must remain closed at all
times except when entering and
exiting the room.
N 95 masks are worn when
entering the room.



A person can have a positive
PPD skin test without active
TB. Clinician must determine
whether active or not.
Associates with active
tuberculosis can not work until
cleared by the health
department and employee
health.
RRMC is a low risk facility for
TB. Annual PPD skin tests are
not required except for staff in
microbiology and histology.

84. Respirator and Fit Testing to
Prevent Transmission of Airborne Illnesses

N-95 Respirator
 Designed to provide respiratory protection for the wearer.
 Filter efficiency level of 95% or greater against
particulate aerosols free of oil.
 Reduce the wearer’s exposure to certain airborne particles
in a size range of 0.1 to 10.0 microns, including those
generated by electrocautery, laser surgery, and other
powered medical instruments.
 The masks are designed to be fluid resistant to splash and
splatter of blood and other infectious materials.
 These masks are not designed for industrial use.

85. Respiratory Fit Testing
Fit Testing



Employees with a possibility of
exposure to airborne illness will be
fit tested with one of the masks
available here at RRMC before
they can wear a respirator.
 3M 1860 Regular and Small
(blue mask)
 Tecnol Fluidshield Regular and
Small (orange duck-bill)
Compliance with OSHA standards
requires fit testing completion with
hire and repeat fit testing annually
thereafter.
Fit testing will be completed in
Employee Health Services during
month-of-hire annual evaluation.
Medical Evaluation



A medical evaluation questionnaire
is required for all employees
wearing a respirator in the
workplace.
This evaluation will determine
whether or not an employee is
medically able to wear a respirator.
All employees may not pass this
evaluation.
Employees who do not pass the
medical evaluation cannot wear a
respirator and should not enter
rooms were a patient is on airborne
precautions.

86. Respirator

Mask





Every employee fit tested for a respirator is responsible
for knowing what size mask they wear.
A sticker is placed on back of ID badge with mask brand
and size at the time of fit testing.
Employee Health Services and department supervisors will
have documentation of mask size for employees that have
been fit tested.
The mask must be discarded if it becomes soiled or at the
end of your shift. Masks are stored in the ante room in a
open plastic bag labeled with staff name.
Concerns

Any employees with medical problems, respirator
problems (such as fit seal difficulty), or any concerns
should contact Employee Health Services.

87. Latex Allergies

Latex allergies pose a serious problem for nurses, other
health care workers, and for 1% to 6% of the general
population. Anaphylactic reactions to latex can be fatal.
Health care workers’ exposure to latex has increased
dramatically since universal precautions against
bloodborne pathogens were mandated in 1987. Latex can
trigger three types of reactions: irritant contact dermatitis,
allergic contact dermatitis, and immediate hypersensitivity.
Many medical devices contain latex that might trigger
serious systemic reactions by cutaneous (skin) exposure.
There are some diagnostic tests to determine if a person
has an allergy to latex. If a patient tells you they are
allergic to latex, use the latex free supplies located in the
green bin in your supply room. Need more information?
Contact the Nursing House Supervisor at ext. 3037. For
associates with latex allergies, contact Employee Health
87

88. Performance Improvement
(PI)

Performance Improvement means simply doing
things a little bit better tomorrow than we did
them today. Redmond is accredited by The Joint
Commission which requires that we have an
improvement plan in place. To make our
improvement efforts as visible as possible,
Redmond uses a tool called FAST-PDCA to
document our improvement projects.
88

89. Performance Improvement

High quality organizations make continuous efforts to improve
their services and products. Opportunities to “do things better”
exist in all departments of our hospital.

Performance improvement occurs the fastest when every employee
asks themselves, "Is there a better way to do this?" or "Why are we
doing this at all?” You know when a process is broken because
you have to work with it every day. FAST-PDCA allows us to test
a new or better idea, fine tune it if needed, then implement it.

Another way for patient care departments to improve their care
delivered is to implement evidence-based medicine that has
already been determined to be the best way, or best practice, to
deliver medical care. Healthcare delivery changes constantly due
to new innovation and continuing research. We have the
responsibility to know what constitutes best practice and to see that
it is implemented at Redmond. Please contact your manager or
quality department when you hear, see, or read of best practices
implemented at other facilities.
89

90. Performance Improvement


Core Measures, which are a series of evidence-based best
practices, are an integral part of how we deliver patient care
at Redmond.
They are not optional for a couple of reasons:





They represent best care.
How well we adhere to Core Measures is compared to every other
hospital in our region and state, as well as across the United States,
as an objective way for consumers to compare how well we deliver
care.
Medical charts are audited continuously to determine our
adherence to the Core Measures.
When we fail to adhere to them, an opportunity exists to
improve our processes. If you were involved in a missed
opportunity, the Quality Department will reach out to you to
help determine how to improve our care delivery.
Nurses should commit to memory the next 8
slides on Core Measures, it’s that important!
90

91. CORE MEASURES:
Myocardial Infarction
•
•
•
•
•
•
•
Beta blocker at discharge or document a reason if withheld
Document LVSD or Ejection Fraction (EF)
ACEI or ARB for EF<40% or document a reason if
with-held
ASA for chest pain/or MI on arrival and discharge or
document reason if with-held
PCI within 90minutes for STEMI or LBBB
LDL within 24hrs of admit
LDL >100 discharged on statin or document a reason if
with-held
91

92. CORE MEASURES:
Congestive Heart Failure



Document LVSD or EF
ACEI or ARB for EF<40% or document a
reason if with-held
Discharge instructions must include:




Activity & Diet & Follow-up visit
Worsening symptoms
Weight monitoring
List medications as found on Med Reconciliation
Form
92

93. CORE MEASURES:
Pneumonia

Blood cultures before antibiotics

1st antibiotic in ED within 6 hrs of arrival

Flu vaccine given – October–March
(Must be
current season – Remember to document)

Appropriate antibiotic selection
93

94. CORE MEASURES:
Surgical Care (SCIP)

Prophylactic antibiotic 1 hour prior to incision (2 hours for
vancomycin)

Appropriate antibiotic

D/C antibiotic within 24hr (48 for CABG) after surgery end
time or document reason for continuing antibiotic

Clip hair only/never shave
(continued)
94

95. CORE MEASURES
Surgical Care (SCIP)
(continued)

Continue beta blockers (never stop abruptly and document
received the day before surgery and/or the day of surgery as
well as POD 1 or POD2!)

VTE (clot) prevention within 24 hours before surgery to 24
hours after surgery

6am blood sugar on Day 1 and Day 2 for CABG and valve
patients

D/C foley by POD#2 or document reason
95

96. CORE MEASURES
Venous Thromboembolism (VTE)


NEW CORE MEASURE FOR 2013!
Documentation required for:



VTE prophylaxis for ALL inpatients OR
“Patient at low risk for VTE, no prophylaxis
needed”
If VTE prophylaxis is not built in to an order
set, there is a new universal order set for VTE
prophylaxis
96

97. CORE MEASURES
Immunization Measure


NEW UNIVERSAL MEASURE FOR 2013!
Pneumonia vaccine status:


vaccines must be given, refused, or medically
contraindicated due to allergy or current active
chemotherapy
Influenza vaccine status:

Oct 1-March 31 – If received prior to admission, it
must have been for the current flu season

98. CORE MEASURE
Stroke Core Measure


NEW CORE MEASURE FOR 2013!
Venous Thromboembolism Prophylaxis


Antithrombotic Therapy:




by the end of hospital Day 2
for ischemic stroke patients by end of
hospital Day 2
Discharged on statin medication
Assessment for Rehabilitation
Stroke Education

99. Opportunities for Improvement


If you want to learn more about Performance
Improvement or feel you have a better way of
doing things at Redmond, please see your
manager or Jon King, Quality Director (located
in the Lower Level near Human Resources at
extension 3155).
Thank you for all you do!
99

100. 2013 Hospital
National Patient Safety Goals

The purpose of the National Patient
Safety Goals is to improve patient safety.
The Goals focus on problems in health
care safety and how to solve them.
100

101. Identify Patients Correctly


Use at least two ways to identify patients. For
example, use the patient’s name and date of
birth. This is done to make sure that each
patient gets the medicine and treatment meant
for them.
Make sure that the correct patient gets the
correct blood type when they get a blood
transfusion.
101

102. Improve Staff Communication


Get important test results to the right staff
person on time.
Critical results from lab, radiology, or
cardiology must be reported within 30
minutes to physicians. Time can be a
factor when addressing these issues for
patient health.
102

103. Use Medicines Safely



Label all medicines that are not already labeled. For
example, medicines in syringes, cups and basins.
Take extra care with patients who take medicines to
thin their blood. Educate the family and the patient.
Record and pass along correct information about a
patient’s medicines. Find out what medicines the
patient is taking. Compare those medicines to new
medicines given to the patient. Make sure the
patient knows which medicines to take when they
are at home. Tell the patient it is important to bring
their up-to-date list of medicines every time they
visit a doctor.
103

104. Prevent Infection





Use the hand cleaning guidelines from the Centers
for Disease Control and Prevention or the World
Health Organization.
Use proven guidelines to prevent infections that are
difficult to treat.
Use proven guidelines to prevent infection of the
blood from central lines.
Use proven guidelines to prevent infection after
surgery.
Use proven guidelines to prevent infections of the
urinary tract that are caused by catheters.
104

105. Prevent Mistakes in Surgery



Make sure that the correct surgery is done
on the correct patient and at the correct
place on the patient’s body.
Mark the correct place on the patient’s
body where the surgery is to be done.
Pause before the surgery to make sure that
a mistake is not being made.
105

106. Identify Patient Safety Risks



Find out which patients are at risk for
committing suicide, or are abused or
neglected.
Keep the patient safe and notify the
physician.
Make sure these patients are referred for
appropriate care and are kept safe in our
hospital.
106

107. I-Privilege

If you are un-sure if a physician is
credentialed to perform a service here at
RRMC you can use I-Privilege to look
up his/her credentials.

From our home page click on the IPrivilege link in the right hand column

Then on the left of the screen that is
pulled up click on I-Privilege again

Then use our COID -31052 for your
User ID and Password
107

108. Guidance Document: Tubing and Line
Safety using I-TRACE
Behavioral expectations
I: Illuminate the patient care area whenever invasive medical lines and tubes are
manipulated (initiated, accessed, maintained, or discontinued).
T: Perform hand hygiene. Touch the line or tube and trace it from the insertion point on
the patient back to the point of origin.
R: Perform a cognitive review.
•
•
•
What is the purpose/expected outcome of the line/tube intervention about to
occur? Visualize the actions planned; take time to ensure the planned actions will
deliver the expected outcome.
Has a 2 point patient identification been carried out?
Has BCMA been utilized to the fullest extent possible for the intervention about to
occur (e.g. medications; TPN)?
A: Act if any mismatch between the planned activity and desired outcome is discovered,
either through BCMA alerts, independent double checks, or a cognitive review.
C: Clarify and correct. Concerns expressed by primary caregivers, colleagues, patients, or
family member are valid and sufficient reasons to seek clarification before proceeding with
a task involving lines and tubes. Correct any discrepancies before proceeding with the
intervention.
E: Expect to use the ITRACE process: each time a line or tube is accessed, manipulated, or
discontinued and when care is handed-off to another clinician or care team.
108

109. Do Not Use
Abbreviations, Acronyms, and Symbols
Abbreviation
Preferred Term
U
Unit
IU
International Unit
Q.D. & Q.O.D.
daily & every other day
Trailing zero (X.0 mg)
Lack of leading zero (.X mg)
X mg
0.X mg
MS, MS04, & MgSO4
morphine sulfate or
magnesium sulfate
µg
Mcg
T.I.W.
3 times weekly
c.c.
Ml
ii, etc. (apothecary symbols)
2 or two
109

110. Rapid Response Team

The purpose of the Rapid Response Team is to provide
critical decision making and intervention at the first
sign of patient decline; to prevent arrest situations,
and save patient lives. The utilization of a Rapid
Response Team will bring critical care expertise to the
patient bedside before a crisis situation results in a
cardiac/pulmonary arrest.
 The call is initiated by dialing (706) 233-5625 and
entering the patient’s three digit room number.
 Hospital staff or patient's family/visitors may initiate.
110

111. Rapid Response Team

The role of the Rapid Response Team
(RRT) will be to:
Assess the patient and the situation.
 Assist with stabilizing and transporting, if needed,
to a higher level of care.
 Assist with organizing information to be
communicated to the patient’s physician using the
SBAR tool.
 Educate and support the nursing staff.
 The RRT does not “replace” calling the primary
physician – but supplements, organizes, and
expedites information to the physician.
 Family members and visitors can also call the
RRT.
111


112. FALL RISK
Nursing staff will assess the patient for safety/fall
risk at the time of admission, and as indicated by
the unit assessment/ reassessment policy and with
each change in condition: Identify problem as
potential for injury related to fall risk on the
care plan/problem list.
Safety rounds (with a purpose) are completed
and documented Q 1 hour until 10pm, then Q
2 hours through 7am and also PRN.



For example, explain that you are there to assist
the patient to the bathroom.
112

113. FALL RISK
Fall Reduction Activities







Place a yellow sign at the head of the bed.
Place a yellow bracelet on the patient.
Place yellow socks on the patient.
Place fall risk magnetic stickers on the patient’s doorframe.
Educate the patient and family about the risk of falling and
to call for help.
See if family members can stay when patients do not follow
instructions. If they are not able, outside resources may be
hired by the family.
Frequently round for pain, potty, proximity of patient needs,
and position.
113

114. Hand-off Communication Process


The hand-off communication process for
Redmond is based on the SBAR
communication format.
SBAR stands for
S – Situation
 B – Background
 A – Assessment
 R – Recommendation

114

115. Hand-off Communication Process

The tools used in the hand-off process
include:




Direct face-to-face communication.
Phone report.
Reports printed from Meditech - SBARD.
Communication is a factor in more than 90%
of Sentinel Events reported to the Joint
Commission.
115

116. Patient rights





Patients and healthcare workers need to understand patient
rights and responsibilities to ensure that quality care is provided
and that the patient can participate fully in their treatment and
care.
How are patients informed of their rights?
 Patient Hand Book
 Patient Bill of Rights
 Signage in all areas of the hospital.
Patients have a right to an advocate to stay with them during
their hospitalization as long as it does not infringe upon other
patient’s rights or interfere with clinical care or pose risk.
Patients must be asked about what language they prefer to
receive their healthcare information. The hospital is responsible
to provide information in the requested language.
A patient or an advocate who is participating in their care must
have the opportunity to use a competent translator in the
preferred language. If a patient or family member refuses to
utilize the provided interpreter, a waiver must be signed.
116

117. Patient rights

What is your role in patient rights?





Everyone is involved in protecting the rights of
patients. For example, the right to confidentiality
means not telling your friends or relatives when
someone you know has been a patient.
We provide privacy for patients by always knocking
before entering a patient or procedure room.
Patients have a right to a secure environment. Know
how to respond during a disaster or fire.
Patients are informed of their right to establish
advance directives or to change their current advance
directive status.
Patients also have a right to file a grievance. You can
assist with the investigation and response by contacting
Risk Management at ext. 3950 or Administration at
ext. 4100 should you have a question.
117

118. Patient rights

Where can you find a list of
patient rights?

In facility Policy RI-04 Rights and
Responsibilities of Patients, the Patient
Handbook, posted beside the elevator in
the front lobby and at outpatient services,
and on Redmond’s Intranet site.
118

119. Patient rights



Access the Ethics Committee and the Ethic Resolution Process.
Phone: 706-802-3037.
Any concerns over patient safety may be reported to the Joint
Commission. Phone: 800-994-6610.
Access the grievance process. Express complaints or concerns
regarding care or services, including discharge.

Facility contact: 706-802-3950
Independent Agency:
Office of Regulatory Health
2 Peachtree Street N.W., Suite 200
Atlanta, Georgia 30329
Telephone: 1-404- 657-5726

Peer Review Organizations:
Georgia Medical Foundation [Medicare]
57 Executive Park South, Suite 200
Atlanta, Georgia 30329
Telephones: 1-800-282-2614
1-404-982-0411

Humana Military Healthcare
Services, Inc [Champus]
931 South Semoran Blvd., Suite 218
Winter Park, Florida 32702
Telephone: 1-800-658-1405
119

120. Pain Management

Four major goals of pain management





Reduce the incidence and severity of patients' acute
postoperative or posttraumatic pain.
Educate patients about the need to communicate
unrelieved pain, so they can receive prompt evaluation and
effective treatment.
Enhance patient comfort and satisfaction.
Contribute to fewer postoperative complications and in
some cases, shorter stays after surgical procedures.
Effective pain management has additional benefits for
the patient ,e.g., earlier mobilization, shortened hospital
stay, and reduced costs.
120

121. Unanticipated Adverse Events and How to
Report
Occurrence Reporting

An occurrence is an event that is unusual, significant or
notable.

Categories include: Patient, Non-Patient (visitor, MD,
volunteer, student, facility, equipment) or Employee
Examples include: Near Miss, Fall, Medication, Treatment
and/or Testing, Adverse Effect, Equipment, Property,
Assault (abuse or harassment), Error, Failure to follow
policies & procedures, Failure to follow MD’s orders,
User/Operator error, Defective or malfunctioning
products, Incorrect action/activity, Inappropriate
action/activity, Omission, Delay, Complications, Loss or
theft of personal belongings, or Auto events with facility
vehicles.

Occurrences should be documented in Meditech during
the working shift or definitely within 24 hours. The
department manager or house supervisor should be
notified at the time of the event. Please notify the Risk
Manager of all serious and potentially legal situations. 121

122. Occurrence Reporting

Meditech Reporting
 Log onto Meditech - Select 500
Occurrence Reporting - Select Facility Select Category - (If patient) At prompt
type A# then the account number - (If NonPatient or Employee) Type N into the first
field to create a new report (For employee
type in last name and press the look-up key)
- If no previous Occurrence report exists for
this patient , you will receive a message “No
available notifications for this patient.
Create a new one? “ Answer Y (Yes) Answer all questions in field - Input will be
by free text or pull down menu selection Enter all the information you know or can
122
obtain.

123. Occurrence Reporting







Look-up key (F9 ) displays a pull down menu.
Previous field key (F6) allows you to backup.
The enter key allows you to move forward one field.
Magic or file key (F12):
This key will provide the menu for selection.
You MUST FILE to save your work.
Exit key (F11):
Caution exit does not save your work.
Text fields require typing from keyboard.
An occurrence report is a confidential facility report that
should not be referenced in documentation on the
patient’s record.

If you have any difficulties, please don’t hesitate to contact
RISK MANAGEMENT at 3950.
123

124. Sentinel events

A sentinel event is an event which results in
unanticipated death or major permanent
loss of function, not related to the natural
course of the patient’s illness or underlying
condition. Also, suicide; infant abduction or
discharge to the wrong family; rape;
hemolytic transfusion reaction involving
administration of blood or blood products
having a major blood group
incompatibility; a health-care associated
infection; and surgery on the wrong patient
or wrong body part are all sentinel events.
Please secure all information and items
related to the event. If you have any
124

125. Reportable Events

State (Georgia) Reportable Events:

The following type events should be reported to
the State of Georgia Office of Regulatory Services:





1. Any unanticipated patient death not related to the
natural course of the patient’s illness or underlying
condition;
2. Any surgery on the wrong patient or the wrong
body part of the patient;
3. Any rape of a patient which occurs in the hospital.
We report all deaths where the patient has been
in restraints within the previous 24 hours to CMS
or if a restraint was implicated in the cause of
death
Report to the appropriate department leader and
Risk Management at 3950 or Regulatory
Compliance at 3038 in the event that any of the
above situations occur . The situation is reviewed
and reported to the Office of Regulatory Services 125

126. Suspected Impairment of Licensed
Independent Practitioner


All healthcare workers including physicians and
nurses should be competent and able to carry out
their patient care responsibilities free of any
impairment(s) that adversely affect their judgment
or clinical performance.
A licensed independent practitioner (LIP) is defined
as any individual permitted by law and the hospital
to provide care, treatment, and services without
direction or supervision (e.g., doctor).
126

127. Identification of an Impaired LIP

An impaired LIP is defined as one who is
unable to provide care, treatment, or
services with reasonable skill and safety to
patients because of a physical or mental
illness, including deterioration through the
aging process, loss of motor skill,
excessive use or abuse of drugs including
alcohol.
127

128. Signs and Symptoms of
Impairment

Signs and symptoms of potential impairment
include, but are not limited to:









Personality changes/mood swings
Loss of efficiency and reliability
Increasing personal and professional isolation
Inappropriate anger, resentments
Abusive language, demeaning others
Physical deterioration
Memory loss
Increase in tardiness, absenteeism, illness
Lack of empathy towards others
128

129. Reporting a LIP Suspected of
Impairment

If any individual in the hospital has a
reasonable suspicion that a LIP (or any
other healthcare workers) may be impaired
and this impairment may adversely affect
patient care and safety, take immediate
action by notifying your supervisor, and
following the appropriate Chain of
Command listed in policy LD 05.
129

130. ADVANCED DIRECTIVES







Advance Directives include Living Will and Durable Power of
Attorney (DPOA) for Health Care.
Living Will only applies to terminal conditions.
DPOA for Health Care allows a person to name an agent to speak
on the person’s behalf, when the person cannot speak for their
self.
Inside the hospital, the attending physician must be present when
the patient names an agent. An agent can speak for the patient
concerning any condition.
Patients should be asked at the time of admission if they have an
advance directive. If the patient has a copy, obtain a copy for the
chart BY CONTACTING HIM or BEDBOARD.
Patients should initial and date a copy of the directive(s) and the
hospital staff should place it inside the current medical record.
Social Services can assist by answering general questions and
providing blank forms.
130

131. Emergency, someone
call FOR HELP!!!




Question: What do you do in the hospital when you
need help in a hurry?
Answer: Call extension 4000. The switchboard will
answer your call immediately. This extension should
be used the same as if you needed “911”. It is designed
for emergency situations, not just to get through to the
switchboard in a hurry. For example, this line could be
used for a Code Blue or if a visitor was seriously hurt.
NEVER use this phone line for anything other than
emergencies!
When you hear a code announced do not call PBX!
 They do not know what you are supposed to do
– they only know what they are supposed to do!
 Call your supervisor or leader.
131

132. Emergency Preparedness





Designed to provide a safe environment for all.
Drills are used to improve effectiveness.
Resource guides and manuals are available to assist
you.
Don’t wait for an emergency to learn what you
should do.
RRMC utilizes an all hazards approach.
132

133. Environment of Care

Defective Equipment


Security Related Incidents
Any incident requiring Security assistance (i.e.
theft or suspicious activity), contact security by
dialing 0 and asking PBX to page a member of
Security.
Please refer to the Environment of Care section of the
policy manual for in-depth information on these
133


Defective equipment should be reported to
BIOMEDICAL Services via Meditech or at Ext. 4962
if equipment removal constitutes an emergency.
Equipment will be tagged. Tag will say “danger
defective equipment”.

134. Environment of care

EMERGENCY PREPAREDNESS CODES
 Code Red—Fire
 Code Gray—Bomb Threat—Notify
Switchboard
 Code Blue—Adult Cardiopulmonary Arrest
 Code Blue PEDS — Pediatric
Cardiopulmonary Arrest
 Code Pink – Pediatric Abduction
 Code White – Adult Patient Elopement
 Code Green— Hostage Situation
 Code Orange—Hazardous Material Event
 Code Silver —Active Shooter
 Code Black - Structural damage to facility
134

135. Environment of care

EMERGENCY PREPAREDNESS CODES





Code Triage - Provides guidelines for
operations in the event of an emergency
Code 900 - Show of force
Code 1000 - Visitor, associate, family member
needs assistance
Code Manpower – Lifting assistance
Tornado – Tornado warning for Floyd County
135

136. Environment of care

CONTACTS









Extension 4000— Emergency line to
Operator/PBX
Labor Pool Location — Classroom C (Ext.
2273)
Facility Privacy Officer — Santrell Marsh
Facility Information Systems Officer —
Angie Turner
VP Quality, Risk, Ethics and Compliance —
Deborah Branton
Patient Safety Officer – Edma Diller
Risk Management – Kathy Shapiro
Facility Safety Officer — Clay Callaway
Infection Prevention Director — Terri Aaron
136

137. Mass Casualty Event

Code Triage

Standby: An event has occurred – facility must
decide if we can meet demands or utilize extra
resources





Develop a plan with the department
Call your immediate family
Activate: Initiate the disaster plan – activate your
department response
Stand-down: Begin recovery and return to normal
operations
Know your role!
137

138. Code Manpower


Associate should call for lifting assistance for any patient
that has lifting restrictions; is in position which prevents
safe lift; patient lift would allow for injury of associate or
may injure patient.
All associates should respond immediately to assist. Upon
assessing the situation, the Nurse providing initial care
and the Charge Nurse should develop a plan with the
Physical Therapy associate to lift the patient without
injury to the patient or themselves. Any patient requiring
being placed on backboard should call EMS at 4911 and
request a unit to respond to assist with equipment.
138

139. Code Gray

There has been a bomb threat





If you get the call, notify the switchboard at ext.
4000
Look for packages or people that should not be in
your area
Only if there is a legitimate reason would we
evacuate
Take direction from Incident Command or law
enforcement
Leave lights alone!
139

140. Code Blue & Code Blue PALS

Code Blue




Adult cardiac or respiratory event.
Don’t forget the Rapid Response Team (Call for
the Rapid Response Team when you feel a
patient’s clinical status is in decline).
Know how to call a code and where your supplies
are located.
Code Blue PALS


Pediatric cardiac or respiratory event.
ED Nurse will respond to assist with running the
code.
140

141. Code Pink

Pediatric Abduction


Patient Care Coordinator






Call ext. 4000
Give gender and age
Building must be locked down
Each department has a response
PBX will announce: Code Pink b or g and age
Try to detain, but do not put yourself in harm’s way


Can be a patient or visitor
Get a good description of person, vehicle, tag, etc.
Make sure unoccupied rooms and areas are checked
141

142. Code White


Patient Elopement
Patient Care Coordinator






Call ext. 4000
Give gender and age and clothing description
Building must be locked down
Each department has a response
PBX will announce: Code White m or f and age
Make sure unoccupied rooms and areas are checked
142

143. Code Green

Hostage situation is occurring



Lock down your area
Do not try to negotiate
Police should be alerted to enter in an area
distant from the hostage situation
143

144. Code Silver “Active Shooter”





Lock down your area immediately. Move any
patients, family members /bystanders or staff to safe
area.
Call ext 4000 to report threat if safe and then call
(9) 911 on in house lines or 911 on cell to report
issue to 911.
Assist by describing any features of the event or
shooter to Police.
Provide care to injured as possible, but do not enter
“hot” area until danger is removed.
Code triage will not be called until all areas are
safe.
144

145. Code Orange






Hazardous Material Event
Haz Mat Team will respond
If someone who has been contaminated
walks in – don’t touch them – take them
back out the way they came in
Stay uphill and upwind!
Decon is in ED or outside
Don’t forget your PPE’s
145

146. Code Black

Associates will call operator at extension 4000
to report physical or structural damage which
would occur from either natural or man-made
disaster. Admin rep, Security, Maintenance,
Plant Engineer, and EMS to respond to area
and additional resources to be called as needed
through HIC. No associate should attempt to
enter unstable area for rescue unless trained to
respond, wearing appropriate PPE, and having
recovery assistance.
146

147. Code 900





You are in a situation in which you are
threatened verbally or physically
Show of Force
All males respond
No physical contact
DO NOT USE THIS CODE FOR
LIFTING HELP!!
147

148. Code 1000

Visitor or family member is ill or injured

Stay with person and have someone call ext. 4000
to report the incident

ED Nurse and House Supervisor will respond

Call 4911 ONLY if “packaging” is required
148

149. Tornado Warning
Tornado warnings are announced by PBX as tornado
warning. This way both staff and visitors will be aware of
the severe weather potential.
 The announcement will be, “Attention, Attention,
Attention. Floyd County is currently under a tornado
warning”.





If a Tornado Warning has been reported in our area
 Close patient doors
 Get everyone out of halls and away from glass
 Discourage visitors from leaving
Turn beds to inside walls
Clear area of anything that can become a projectile
Instruct family members & ambulatory patients to go into the
bathrooms and cover themselves
149

150. Inclement Weather




Each leader will review staffing and
supplies for the anticipated period.
It is your responsibility to get here!
We will provide housing.
Transportation may be provided.
150

151. Evacuation

Move from unsafe to safe area



Horizontal Evacuation


Floor to floor
Full Scale


Room to Room, Wing to Wing
Vertical Evacuation


Ambulatory first
Sickest last
Triage and transport area will be established
Make sure you account for all patients
151

152. Bio-terrorism Update



Healthcare facilities may be the initial site of recognition
and response to bio-terrorism events. All patients in
healthcare facilities, including symptomatic patients with
suspected or confirmed bio-terrorism-related illnesses
should be managed utilizing Standard Precautions . For
certain diseases or syndromes (smallpox and pneumonic
plague), additional precautions may be needed to reduce
the likelihood for transmission. For more in-depth
information on this topic, please refer to the
Bio-Terrorism Readiness Plan policy.
A quick reference guide is posted in the Emergency
Department
For further information visit www.ready.gov
152

153. Eye Wash Stations






Know where they are located
Do not block access to the station
Flush eyes for 15 minutes unless MSDS indicates
different flush time for the substance involved in the
exposure
Water should be temperate (not too hot or cold)
Weekly checks and flushes must be performed for
each eye wash station
Eye wash stations must be available everywhere
corrosive materials are used or stored
153

154. Eye Wash Station Locations














Employee Heath
Outpatient - Med Room and Room 24
Decontamination ER
Outpatient Oncology – 5th Floor
Lab (3)
Pharmacy
Radiology
Cardiology
BioMed
Maintenance – Boiler Room
Maintenance - Chiller
Housekeeping
CCA Housekeeping
OR
154

155. O2 Tank Storage


O2 tanks are considered empty when they
have less than 500 psi
A cylinder should never be left standing on
the floor unsecured.
155

156. Hazardous Material and
Waste
Read Container Labels—Before handling any chemical container, always read the label.
Warnings may be in words, pictures, or symbols.
Consult the Material Safety Data Sheet (MSDS)– A MSDS gives more detailed
information on a chemical and its hazards. It also gives you specific precautions for
protecting yourself from dangerous exposure. Your department should have a
notebook with a list of the chemicals used in your area.
Use Proper Handling Techniques– Always wear proper personal protective equipment.
Dispose of Chemicals Properly– Carry and store chemicals only in approved, properly
labeled, safety containers. Never dispose of chemicals in containers used for ordinary
waste. Never pour them down sewers or drains. Always consult the MSDS sheet for
approved method of disposal.
Contact Mike Stewart in the Lab at ext. 3117 or 4050
if you have questions.
156

157. FIRE SAFETY

Make good housekeeping part of your work routine.
 Keep passageways and exits clear.




Know your area.


Don’t let furniture or equipment block stairways, halls, or
exits.
Keep floors clear of waste and spills.
Make sure exit paths and doors are well-lit and clearly
marked.
Where are the fire pull stations and extinguishers
Know how to extinguish


Cover and smother
Be careful to not fan the flames
157

158. FIRE SAFETY

Check fire doors.



Make sure nothing is blocking them.
Never wedge or prop them open.
Dispose of trash safely.


Put waste in approved containers.
Keep these away from heat
sources.
Put flammable substances in
approved metal cans or containers.
158

159. FIRE SAFETY

Prevention is the best defense
against fires.


To prevent fires related to electrical
malfunction remove damaged or
faulty equipment from service and
submit malfunctioning equipment
for repair.
To prevent fires related to
equipment misuse do not use any
piece of equipment you have not
159

160. FIRE SAFETY
It's easy to use a fire extinguisher if you can remember the acronym
PASS, which stands for Pull, Aim, Squeeze, and Sweep.




Pull the pin.
This will allow you to discharge the
extinguisher.
Aim at the base of the fire.
If you aim at the flames (which is frequently
the temptation), the extinguishing agent will
fly right through and do no good. You want to
hit the fuel.
Squeeze the top handle or lever.
This depresses a button that releases the
pressurized extinguishing agent in the
extinguisher.
Sweep from side to side
until the fire is completely out. Start using the
extinguisher from a safe distance away, then
move forward. Once the fire is out, keep an
eye on the area in case it re-ignites.
160

161. IF YOU DISCOVER A FIRE –
REMEMBER:
 RACE




R - RESCUE anyone
in immediate danger
A - Activate the
ALARM
C – CONFINE or
CONTAIN the fire
(close the door)
E - EXTINGUISH
small controllable
fires/or EVACUATE
161

162. All Foam and Gel Hand Cleaners

Foam and gel hand cleaners are becoming very popular for hand
cleaning in the healthcare environment. For them to be effective,
they must contain more than 60% alcohol. That makes the hand
cleaners FLAMMABLE. It is not unsafe to use the hand cleaners,
but you should be aware of the following information each time the
hand cleaner is being used:




After applying the gel or foam, the alcohol on the hands should be
allowed to evaporate for 30 seconds. You could wave your hands in the
air to accelerate the evaporation.
The solution on your hands is flammable until the alcohol evaporates.
If a flame or spark is near your hands before the alcohol evaporates, a
fire could occur. There have been reports of healthcare workers whose
hands caught on fire from a spark or from static electricity after using
an alcohol based hand cleaner.
Alcohol burns very clean and the flame is almost clear.
162

163. Organ Donation

Timely referrals of potential organ donors
is critical.


Healthcare professionals are required to
identify and refer all deaths and imminent
deaths (brain deaths) to the Donation Referral
Line at (800) 882-7177.
Timely referrals preserve the option of
donation for families of medically suitable
patients.
163

164. Heart Disease Remains #1 Cause of Death in the U.S.
164

165. Heart Attack Facts
Each year, approximately 1.2 million Americans
suffer a heart attack, and nearly one-third of these
individuals die…many before they reach the
hospital.
About every 26 seconds an American will suffer a
coronary event, and about every minute someone
will die from one.
Hundreds of thousands of Heart Attack victims
survive, but are left with a damaged heart.
165

166. Heart Attack Facts
A heart attack occurs, in most cases, when
a blood vessel supplying the heart muscle
becomes completely blocked. The vessel has Blocked artery
become narrowed by a slow buildup of fatty (before treatment)
deposits made mostly of cholesterol. These may
crack open, forming a clot.
Same blocked artery
(with restored flow after
treatment)
When a clot occurs in this narrowed
vessel, it completely blocks the supply of
blood to the heart muscle. That part of
the muscle will begin to die if the
individual does not seek immediate
medical attention.
166

167. Heart Attack Facts
The best way to stop the heart attack process is to
detect the symptoms early, before damage to the
heart muscle occurs.
It is critical for those who experience any chest
discomfort or heart attack symptoms to call 9-1-1
and quickly get to the Emergency Department.
It is just not the heart attack itself that kills; it is also
the time wasted when one is trying to decide whether
or not to go to the hospital.
167

168. Time Wasted =
Muscle Lost!!
Delays in time result in loss of
heart muscle.
It is important to note that 85% of muscle damage
takes place within the first hour. This is often referred
to as the “golden hour.” It is within this timeframe
that the blocked heart vessel needs to be opened.
Complete destruction of the muscle being supplied by
the blocked vessel continues over a six-hour period.
168

169. Time
Wasted….Why?!
People often dismiss heart attack warning signs, such as
chest pain, thinking they merely have heartburn or a
pulled muscle. The unfortunate conclusion is that
many people wait too long before getting help.
Because every minute counts when having a heart
attack, it seems that getting to the ED as quickly as
possible would be everyone’s first choice.
Unfortunately, more than 50 percent of all patients
experiencing chest pain walk into the ED rather than
calling 911.
169

170. What You Need to Know
Know the frequent signs of a heart attack

Chest discomfort. Most heart attacks involve discomfort in
the center of the chest. The discomfort lasts for more than a
few minutes or it may go away and come back. The
discomfort may feel like pressure, squeezing, fullness, or
pain.

Discomfort in other areas of the upper body. This may
include pain or discomfort in one or both arms, the back,
neck, jaw, or stomach.

Shortness of breath may occur with or before chest
discomfort.

Other symptoms may include breaking out in a cold sweat,
nausea, or light-headedness. Treatments are most effective
when they occur in the early stages of chest pain.
170

171. What You Need to Know
Know that heart attacks are NOT just a man's problem! More women
in the United States die of heart disease each year than men. Women
often experience signs and symptoms that are different from men. Or
signs in women may go unnoticed altogether.
Heart Attack Signs/Symptoms in Women include:









Unusual fatigue
Upper abdominal pressure or discomfort
Nausea or Vomiting
Lower chest discomfort
Dizziness
Unusual shortness of breath
Back pain
Light-headedness, fainting, sweating,
Pressure, fullness, squeezing pain in the center of the
chest, spreading to the neck, shoulder, jaw or arm
171

172. What You Need to Do

Be able to recognize the early symptoms of a heart
attack. Educate others in early heart attack care.

Be an advocate for the exceptional heart attack care
coordinated by Redmond EMS and Redmond Regional
Medical Center.

Inform others that our 911 dispatchers and Emergency
Medical Services (EMS) are trained to recognize heart
attack symptoms. Our EMS units transmit EKG’s
directly to our ED from the scene so that by the time
the patient arrives, the ED, Cardiologist and Cath Lab
team are ready to assist.
172

173. What You Need to Do
Know the signs of a heart attack
Call 9-1-1 to get to the hospital
immediately if you are concerned
Know your risk factors
Be an advocate for your own health
Consider healthy lifestyle changes
Get off the couch- begin exercising
20 minutes per day, 4-6 days per week
Stay active physically, mentally and socially
Build social relationships through family, church,
even pets
Eliminate stress by finding a hobby
……and always……REMEMBER REDMOND………….
FOR COMPLETE HEART CARE!
173

174. We at Redmond take the
“Golden Hour” Seriously!

The speed of opening the
blocked artery is measured in
door-to-balloon (D2B) time.

The National goal for D2B
time is less than 90 minutes.
Redmond’s goal is 60 minutes!

The time starts when the
patient enters the hospital and
ends when the clot causing the
blockage is removed in the
Cardiac Cath Lab.

In 2012, Redmond’s
average D2B time
was 55 minutes!

Our new focus in 2013 is on
teaching the community to
recognize symptoms and get to
the hospital sooner!
We are Redmond!
174

175. And We Have the Awards to
prove it!
Redmond’s Chest Pain program is accredited by the Society of
Cardiovascular Patient Care and by The Joint Commission for
Cardiovascular and Disease Specific Heart Attack care.
The accreditation philosophy is based on process improvement. It
Encourages us to improve our quality by standardizing care processes
across departments, including EMS, provide outreach education, and
improve patient, physician, and staff education.
We promote EHAC (Early Heart Attack Care) which is a public
awareness campaign to educate the public about signs of an impending
heart attack AND that these signs and symptoms can occur days or
weeks before the actual event.
175

176. Heart Failure Facts




Heart failure is the leading cause of morbidity
(ill health) and mortality (death) in the U.S.
The most common reason for admission to the
hospital in the age group 65 years and older!
1 in 5 people diagnosed with Heart failure die
within 5 years of diagnosis.
Many people can lead a full and enjoyable lives if
Heart Failure is managed with lifestyle changes,
education, diet, and medications.
176

177. What is Heart Failure?
A condition resulting from the heart’s inability to
pump an adequate amount of blood to meet the
body’s needs.
It can be sudden, but usually develops over time.
Basically the heart can’t keep up with the body’s
workload.



It
Does Not mean your heart is going to STOP
beating.
It
Does mean the heart pump is weak.
177

178. What Causes Heart Failure?
Anything that can damage the heart!!
• High blood pressure.. Common cause
• CAD and Heart attack….Most common cause
• High cholesterol and arrhythmias
• Damage to heart valves
• Diabetes & Obesity
• Viruses, drugs, excessive alcohol
• Advancing age or congenital heart defects
• Heart muscle disease
• Etc.
178

179. When your heart is damaged

At first the weakened heart tries to make up for it’s
inability to meet the needs of the body by:



Enlarging to contract more strongly
Beating faster (got to get that oxygen to the cells!)
Blood pressure increasing to perfuse the organs
These temporary measures mask the problem of
heart failure, but they don’t solve it. Heart failure
continues and worsens until these substitute processes
no longer work, and you start seeing signs of heart
failure.
179

180. Warning signs of Heart Failure






Shortness of breath
Swelling in feet,
ankles, stomach
Weight gain from
FLUID (not fat
weight)
Fatigue, tiredness
Increased heart rate
Coughing when lying
down
180

181. Prevention of Heart Failure








Lose weight (weight causes increased work)
Stay active (exercise helps everything)
Quit smoking (and avoid second hand smoke)
Keep your BP under control
Eat healthy (low fat …low SALT)…lower your
Cholesterol
Limit alcohol (If you drink alcohol, do so in moderation.
This means no more than one or two drinks per day for
men and one drink per day for women)
Control your Diabetes
Routine MD checkups and immunizations
181

182. Treatment of Heart Failure








Treat the underlying cause (BP, CAD, etc.).
Weigh daily… looking for fluid build up.
Heart healthy 2 GM Sodium diet …no added salt.
Limit fluid intake (less than 2 liters).
Medications for heart failure and BP control….Be
compliant!
Lifestyle changes…(weight loss, exercise, smoking,
etc.).
Limit stress.
Know the signs of heart failure.
182

183. Redmond Regional


Maintains Advanced Certification for the
treatment of Heart Failure with the Joint
Commission. Our goal is to improve the
lives of individuals with heart failure and
decrease the incidence of heart failure in
our community.
Redmond has Gold Plus Achievement
with American Heart Association in the
treatment of Heart Failure.
183

184. Facts About Stroke
3rd leading cause of death in the United States.
Risk increases with age, but people of any age
can have a stroke.
Leading cause of adult disability in the U.S.:

Without treatment, 62% of people who have
a stroke will have moderate to severe
impairment.
184

185. What is a stroke?
It’s not an “accident.”
A stroke occurs when
something happens to
interrupt the steady
flow of blood to the
brain.
Old Term: CVA or
Cerebrovascular
accident.
Bad term because stroke
is preventable and
treatable.
New Terms: Stroke,
TIA
185

186. Three Types of Strokes



Mini-Stroke or Transient Ischemic Attacks
(TIA) – brief episodes of stroke symptoms.
Ischemic Stroke is caused by blood clot. The
clot blocks flow of blood to brain.
Hemorrhagic Stroke is caused by bleeding.
Results from burst or leaking blood vessels in
the brain.
186

187. Stroke Symptoms: Remember
“FAST”
Only one
symptom
is
necessary
to indicate
stroke
187

188. F = Face
Ask person
to smile
• Droops on
left or right
side
• Sudden
drooling
• Numbness
A = Arms
• Look for difficulty
Ask person to
raise both arms
holding things or
putting on clothing
• Numbness
• One arm drifts down
or won’t go up
• May have trouble
walking
188

189. S = Speech
Ask to
repeat
phrase
or name
object
T = Time
At any sign,
Call 9-1-1
• Slurred speech
• Doesn’t make
sense
• May not
understand what
other people are
saying
• Forgets how to
read or write
• Time lost is
brain lost
• Save time
and brain
cells
• Go in an
ambulance
189

190. Stroke Prevention: Know your Risk
Factors and develop a lifestyle to
decrease you risk







High Blood pressure
Tobacco use
Diabetes
TIAs
Carotid or other artery
disease
Atrial Fibrillation or
other heart disease
Certain blood disorders








High blood cholesterol
Physical inactivity and
obesity
Excessive alcohol
intake
Illegal drug use
Increasing age
Gender
Heredity and Race
Prior stroke
190

191. “Stroke Alert”


EMS and Emergency Department play key role
in coordinating care of stroke patients admitted
to our hospital
What if the patient is already here and starts
having signs and symptoms of a stroke????
Call our Rapid Response Team at:
706-233-5625
Redmond Regional Medical Center
is certified by The Joint Commission
as a Primary Stroke Center.
191

192. Sexual Harassment

The following is prohibited:


Unwelcome sexual advances, requests for sexual favors,
and all other verbal or physical conduct of a sexual or
otherwise offensive nature.
Behavior that engenders a hostile or offensive work
environment will not be tolerated. These behaviors may
include but are not limited to: offensive comments, jokes,
innuendoes and other sexually-oriented or culturally
insensitive/inappropriate statements, printed material,
material distributed through electronic media or items
posted on walls or bulletin boards.
192

193. Sexual Harassment



You should promptly report the incident to your
supervisor, who will investigate the matter and take
appropriate action, including reporting it to the Human
Resources Department.
If you believe it would be inappropriate to discuss the
matter with your supervisor, you may bypass your
supervisor and report it directly to the Human Resources
Department which will undertake an investigation.
Or you may call our Ethics and Compliance Officer,
Deborah Branton, at 3036 or the Ethics Line at 1/800455-1996. The complaint will be kept confidential to the
maximum extent possible.
193