VVC Nursing : Spring 2011 General Hospital Orientation

Welcome General Orientation To All High Desert Hospitals SPRING 2011 Presenter: Renate Longoria, RNc, MSN, PHN

Patient Bill of Rights I. Information DisclosureYou have the right to receive accurate and easily understood information about your health plan, health care professionals, and health care facilities. If you speak another language, have a physical or mental disability, or just don’t understand something, assistance will be provided so you can make informed health care decisions. II. Choice of Providers and PlansYou have the right to a choice of health care providers that is sufficient to provide you with access to appropriate high-quality health care.

Patient Bill of Rights ,[object Object]

IV. Participation in Treatment DecisionsYou have the right to know all your treatment options and to participate in decisions about your care. Parents, guardians, family members, or other individuals that you designate can represent you if you cannot make your own decisions.

V. Refuse Treatment or Procedures You have the right to refuse any treatments, medications and/or procedures. ,[object Object]

VII. Confidentiality of Health InformationYou have the right to talk in confidence with health care providers and to have your health care information protected. You also have the right to review and copy your own medical record and request that your physician amend your record if it is not accurate, relevant, or complete.

VIII. Complaints and AppealsYou have the right to a fair, fast, and objective review of any complaint you have against your health plan, doctors, hospitals or other health care personnel. This includes complaints about waiting times, operating hours, the conduct of health care personnel, and the adequacy of health care facilities.,[object Object]

Patient Responsibilities ,[object Object]

You your refusal of treatment prevents us from providing care according to ethical and professional standards, we may need to end our relationship with you after giving you reasonable notice.

You are responsible for being considerate of the rights of other patients and hospital personnel and property.,[object Object]

Violation of Patient Rights Examples: Altering, falsifying, miss-statements of facts or making a material omission on any patient chart … or any other Hospital chart or record. Disclosure of confidential information pertaining to patients, physicians, volunteers, other employees, or any other organization etc., (Up to $ 25.000 in fines to individual and/or hospital; hospital rejects nursing school attendance for clinical). Use of private cell phones while on duty for the purpose of outside communications, taking pictures of patients, co-workers or Hospital property.

Violation of Patient Rights Examples: Negligence or willful in-attention in performance of duties. Soliciting tips, gifts, or other gratuities or favors from patients or their families or accepting gifts with more than a nominal value. Offering unauthorized medical or health advice.

Advance Directives Patient Self-Determination Act of 1991 Health Care Facilities are obligated to: Inform Patients Honor Patients Advanced Directives Advance directives are legal documents that allow the person to convey their decisions about end-of-life care ahead of time. They provide a way for the person to communicate their wishes to family, friends and health care professionals, and to avoid confusion later on.

Advanced Directives A Living Will: tells how the person feels about care intended to sustain life. The person can accept or refuse medical care. Issues that can be addressed, include: The use of dialysis and breathing machines Wanting to be resuscitated if breathing or heartbeat stops Tube feeding Organ or tissue donation A durable power of attorney for health care is a document that names the health care proxy. A proxy is someone the person trusts to make health decisions if they are unable to do so.

Advanced Directives Process: DECIDE – What is important ! – Right to “revoke” at any time What type of care – palliative care, hospice care etc. DISCUSS – With Family, Friends, Physician DESIGNATE – The person you want to make important medical decisions for you if you are unable to make them DOCUMENT – Forms – Your Signature, Two witnesses DISTRIBUTE – Copies to Important Folks -- Bring a copy with you every hospital visit Don’t keep a secret !!!

Customer Service(St. Mary Medical Center) AIDETS Acknowledge Introduce Duration Explain Thank You Survey

Customer Service AIDETS(St. Mary Medical Center) Acknowledge

Customer Service AIDETS(St. Mary Medical Center) Introduce

Customer Service AIDETS(St. Mary Medical Center) Duration

Customer Service AIDETS(St. Mary Medical Center) Explain

Customer Service AIDETS(St. Mary Medical Center) Thank You

Customer Service AIDETS(St. Mary Medical Center) Survey

Customer Services Internal vs. External Customer Answer call lights promptly Intervene to assure patient comfort is achieved – Be proactive rather than reactive: 5 P’s Potty Pain Position Property Problem

Customer Services Respect: Patients Privacy & Confidentiality Diversity – “We may have different religions, different languages, different colored skin, but we all belong to one human race.” (Kofi Annan) Physicians Colleagues Maintain a neat, and clean environment (NOT MY JOB !!!) Patient room, bathroom Nurses’ station

Customer Service ARMC DVD Customer Service for Students

Workplace Violence Healthcare workers are at a greatly increased risk (85%) of being victims of workplace assaults than are private sector workers. Workplace violence ranges from offensive or threatening language to homicide. National Institute of Occupational Safety & Health defines workplace violence as violent acts directed toward persons at work or on duty. This includes: Verbal, written, or physical threats Destroying property Using weapons Robbery Stalking Physical acts such as slapping, punching, kicking

What can you do to prevent Workplace Violence? REMEMBER – violence can happen anywhere. Be aware of warning signs and recognize signs of trouble early. Treat co-workers, patients, and visitors appropriately and with respect. Take all threats seriously. Do not try to handle situations alone.

Recognize the Warning Signs of Violence Use of an angry or threatening tone of voice, shouting, screaming or cursing. Abrupt movement, restlessness or nervous pacing. Unreasonable demands. Postural position tense with clenched fists, tightly gripping objects. Facial expressions usually red face, scowling or frowning with clenched jaws. Verbal threats. Violent gestures, throwing, breaking or pounding on objects. Staggering, slurred speech, irrational speech or other signs of being under the influence of alcohol or drugs.

What should you do when confronted with a violent person? Call a Code “Gray” and maintain self-control. Take immediate action to protect yourself, keep your distance. Leave yourself an escape path. Stay calm and alert, talk calmly and slowly. Listen to the person, this alone can diffuse the situation.

What should you do when confronted with a violent person? Do not try to restrain or disarm the person. Your goal is to prevent harm to yourself and others. Be also aware of “Lateral Violence.” Regardless of how “small” or meaningless the attack may seem, report the incident to your instructor immediately.

Performance Improvement A process that identifies areas of concern in a hospital or on a nursing unit, and the goal is to improve quality of services. Performance Improvement focuses on: What is important to the customers Improving processes -- ongoing Identifying problems Preventing problems The Ultimate Goal: Quality Patient Care

Care Measures As defined by Regulatory Agencies (i.e. JCAHO, HFAP, Medicare) “Core Measures are standardized performance measures that can be applied across health care; they are comprised of precisely defined data elements based on uniform medical language.” Accredited Health care organizations that wanted to keep their accreditations were required to look at their hospital’s performance and report statistical data. The ORYX Performance Measurement Requirements started 1998 – hospitals began to collect and report monthly statistics for specific measures. Medicare and HFAB looking at the compliance percentage – reimbursement to hospitals

Care Measures The HFAP/Care Measures Initiatives covers six focus areas: Acute Myocardial Infarction (AMI) Congestive Heart Failure (CHF) Community Acquired Pneumonia (CAP) Ventilator Acquired Pneumonia (VAP) Surgical Infection Prevention (SCIP) CRBSI Prevention (Catheter-related)

Patient Confidentiality/ HIPAA Health Insurance Portability and Accountability Act (HIPAA) Law was designed to protect the privacy of certain health information Information that relates to the health of an individual and identifies or can be used to identify, the individual There are penalties both civil ($10,000 or $25,000) and criminal for failure to comply with HIPAA requirements.

HIPAA-Student’s responsibilities All discarded paperwork that contains patient information must be shredded, and never placed in the regular trash. If the HIPAA standards are not followed, the hospital is put in jeopardy of receiving a fine. Never discuss patient, or patient health information in public areas such as hallways, cafeterias and elevators.

HIPAA-Student’s responsibilities Never discuss patient or patient health information with your family or friends. Patient’s charts should always be placed in a secured area. Never write name of patient on any of your forms. Use only initials. Never photocopy patient information.

EMTALA Emergency Medical Treatment and Labor Act Patient Anti-dumping Law Hospital must provide appropriate medical screening examination… to determine whether or not a medical emergency exists. If a medical condition exists, the patient must be stabilized before transfer or discharge.

Risk Management Goal To minimize the risk to the institution from an error or problem that could result in legal action or liability. Risk Management: A formal process of identifying, analyzing, treating and evaluating real and potential hazards or pt. issues. It addresses liability and financial losses. Grievance -> departmentally resolved -> report to Charge Nurse and Instructor Include wellness and prevention of injury programs for staff. Risk management is part of continuous performance improvement program.

Environment of Care (EOC) – General Hospital Safety Report any unsafe condition to your clinical instructor or the nurse you are working with. When walking in the halls and stairway, keep to the right and use special caution at intersecting corridors and at door openings. Use a ladder or stepstool to reach items higher than you can reach.

EOC-General Hospital Safety If there is a spill, stay in the area, call for help, then clean or block area until environmental services can get there. Follow “Wet floor” caution signs by walking only on areas that are dry. Remove all defective equipment and furniture from service immediately. Tagging the item as “Defective, Do not use”. Report equipment to the Engineering Department.

EOC-General Hospital Safety Lock all medication cabinets, and supply cabinets when not in use. Student injuries must be reported immediately to clinical instructor. Find out where students should park their car prior to clinical day and comply with facility policy. Patients & Patient’s Families always have the right-of-way.

EOC-Fire Safety R- Rescue A- Alarm C- Contain E- Evaluate/Extinguish Evacuate (only if directed)

EOC-Fire Extinguishers A Trash, paper or wood fires ABC Flammable liquid, trash, wood or electrical fire P- pull A- aim S- squeeze S- sweep Student role when code red is called Help close all doors to patient’s rooms

EOC-Emergency Codes CODE REDFire What do you do if the alarm goes off? CODE GREENEvacuation

EOC-Emergency Codes Code GrayCombative/Disruptive Person G = Go get help Code Yellow Bomb Threat Code Silver Person w/Weapon – Hostage Situation S = Stay away

EOC-Emergency Codes Code BlueMedical Emergency (Adult) Code White Medical Emergency (Pediatrics) Code Pink Infant Abduction Code Purple Child Abduction Code Orange Hazardous Materials Spill

EOC-Emergency Codes Triage InternalInternal Disaster Triage External External Disaster Safe Surrender Site

Electrical Safety All electrical equipment must have a three-prong safety plug. All red electrical receptacles are emergency powered. Patient beds must be plugged into the marked “bed” receptacles. Grasp plug not cord when unplugging equipment from the wall. All electrical equipment brought into the hospital by patient or visitors must have bio-med approval before use. Become familiar with the equipment before you use it.

Many industrial, medical and laboratory operations require the use of compressed gases for a variety of different operations. Compressed gases present a unique hazard. Gases may be: ▬ Flammable or combustible ▬Explosive ▬Corrosive ▬Poisonous EOC-Compressed Gas Cylinder Safety

Careful procedures are necessary for handling the various compressed gases, the cylinders containing the compressed gases, regulators or valves used to control gas flow. EOC-Compressed Gas Cylinder Safety Since the gases are contained in heavy, highly pressurized metal containers, the large amount of potential energy resulting from compression of the gas makes the cylinder a potential rocket or fragmentation bomb.

Gas cylinders must be secured at all times to prevent tipping: ● During Patient transport: Put Oxygen tanks in the appropriate space under the bed or gurney or a properly designed wheeled cart to ensure stability. ● Cylinders should never be rolled or dragged. EOC-Compressed Gas Cylinder Safety

EOC-Radiation Safety Radiation is a part of our natural environment (Cosmic, salt substitutes, fertilizers, pottery). The radiation risk incurred by a person working in a hospital, depends on the magnitude of the radiation dose received. The biggest man-made contribution to radiation exposure in a hospital are from medical x-rays and from radioactive materials for diagnoses and treating diseases.

EOC- Radiation Safety: ALARA Concept To reduce exposure to radiation the “As low as reasonable achievable” concept (ALARA) is followed: Limit time in the area where radiation exposure may occur. Increase your distance from areas where radiation exposure may occur. Use appropriate shielding in radiation areas.

EOC-Radiation Safety Guidelines for students Use protective gear or distance yourself when the portable x-ray machine is activated in a patient room. (stand behind the X-ray technician). If asked to assist during an x-ray you should always wear a shielding apron. Follow all instructions posted on a patient’s door who has a radiation sign, do not ignore the signs.

EOC-Material Safety Data Sheets (MSDS) MSDS are available to you for review on each unit, on computers, or via a 1-800 telephone #. Information on all possible substances that are used What the substance is What danger rating it has Storage guidelines What to do when it enters your body Any necessary phone #s for further information

EOC-Security Personal Safety: Best way to be safe is to remain alert, aware and responsive to your surroundings. Call Security if you see someone that does not belong in your area or is a suspicious person. Always wear your Victor Valley College badge. When you leave at the end of your clinical day use the buddy system to go to yourcar or have Security escort you.

EOC-Security Belongings Safety: Patient Belongings: Dentures, Hearing Aids, Glasses, Money. Student Belongings: Do not bring large sums of money or credit cards to the hospital. If you bring books, purses or other belongings into the hospital find out from your instructor where it would be safe to leave them. Some people do not respect what belongs to you – the less you bring into the hospital the less temptation is there for it to be taken.

EOC-Emergency PreparednessHICS Hospital Incident Command System (HICS) Designated to minimize the confusion and chaos that swirls around disaster During a incident listen and do as assigned Keep your cool and pay attention

EOC-Emergency Preparedness Earthquake Safety During Earthquake Inside Protect yourself first: Take shelter under tables (breathable space), desk, doorways Stay away from windows Do not leave building until safe to do so Outside Step into a doorway (do not hold unto the door frame) or move to an open area After Use phone only for emergency Check on patients and assist where possible Expect aftershocks Do not use elevators

EOC-Emergency Preparedness Bioterrorism Response This is a newer area of terrorism: Hospitals and clinics may be the first opportunity to recognize and initiate a response to a bioterrorism-related outbreak. Hospital staff is trained in decontamination Reporting (Infection Control, CDC, FBI) Potential Agents Anthrax, Botulism, Plague, Smallpox Isolation Precautions – follow directions Psychological aspects of bioterrorism

National Patient Safety Goals National Patient Safety Goals GOAL #1: Improve the accuracy of patient identification: Identify patients with at least two identifiers Name Date of Birth when providing care, treatment, and service. If using armbands, they must be attached to the patient.

National Patient Safety Goals GOAL #2: Improve the effectiveness of communication among caregivers Read back telephone or verbal orders Limit the number of abbreviations, acronyms, symbols: U = write units IU = write international units QD, QOD = write daily, every other day MS, MGSO4, MSO4 = write out morphine and magnesium sulfate 0.1mg = always use a leading zero when using a decimal point Never use a trailing zero 1.0mg write 1mg

National Patient Safety Goals GOAL #2: Improve the effectiveness of communication among caregivers Utilize the SBAR (Situation, Background, Assessment, Recommendation) process for “hand off” communication RN to RN communication. Shift to shift reports. Lunch breaks. Physician calls. Patient Transfers to higher or lower levels of care. SMMC uses a “Ticket to Ride”

National Patient Safety Goals GOAL #3: Improve the Safety of Using High Alert Medications: Remove concentrated electrolyte medications from patient areas, review look-a-like/sound-a-like drugs Medications and solutions labeled even in only one being used. Unlabeled medications/solutions are immediately discarded. Labeling not required if medication / solution is drawn and immediately administered. Preparing two medications at the same time does not meet this definition; therefore each would have to be labeled.

National Patient Safety Goals GOAL #3: Improve the Safety of Using High Alert Medications: Reduce the likelihood of patient harm associated with the use of anticoagulation therapy. All orders for warfarin must include an indication for use. A baseline INR is to be obtained and reviewed before the first dose is given. Dose to be given at 1700 and to be documented on MAR with corresponding INR result.

National Patient Safety Goals National Patient Safety Goals GOAL # 7: Reduce the risk of health care associated infections: Comply with the current Centers of Disease Control and Prevention (CDC) hand hygiene guidelines, prevent HAI’s due to multiple drug-resistant organisms. Encourage your patients to ASK if you have sanitized or washed your hands. GOAL # 8: Accurately and completely reconcile medications across the continuum of care: Compare patient’s current medications with those ordered for the patient while in the hospital, complete list of medications to the patient upon discharge.

National Patient Safety Goals National Patient Safety Goals GOAL # 9: Reduce the risk of patient harm resulting from falls: Fall reduction program – Every hospital has a process in place to prevent patient falls. Morse Falls risk assessment: Once per shift. Any time there is a change is status. Includes a Medication Assessment. Patient / family educated on fall reduction program and individual strategies to reduce fall risk.

National Patient Safety Goals National Patient Safety Goals GOAL # 10: Reduce the risk of influenza & pneumococcal disease in hospitalized older adults: Patients are screened and if they have not received an immunization, with their consent, will receive these vaccinations. GOAL # 13: Encourage patient’s active involvement in their own care as a safety strategy: Patients are asked to report concerns about safety. Condition H or Condition HELP “Speak –Up” Condition H allows for patients and family members to call for immediate help if they become concerned about a patient’s condition.

National Patient Safety Goals GOAL # 14: Prevent Health Care Associated Pressure Ulcers: Every hospital has a process in place to prevent skin breakdown on their patients (No reembursement for Stage III pressure ulcers – is reported to state agencies and will be reviewed). Risk Assessment on every patient on admission and every shift. Skin Breakdown/Decubitus Prevention Protocols Treatment of skin ulcers and/or pressure ulcers Documentation of skin ulcers and/or pressure ulcers

National Patient Safety Goals GOAL # 15: The organization identifies risks inherent in its patient population: Identifying patients at risk for suicide if they are treated for emotional or behavioral disorders. GOAL # 16: Improve recognition and response to changes in a patient's condition: Health care staff can request additional assistance form a specially trained individual when the patient’s condition appears to be worsening. Rapid Response Team

Restraints The use of restraints is considered only after less restrictive means have been attempted and the results of such efforts have been documented. A Dr’s order is required – each order may not exceed 24 hours. Behavioral restraints – patients need to be evaluated by a physician within one hour and re-evaluated every 4 hours. Perform and document ongoing assessment for continued need for restraints and when patient meets criteria for release form restraints.

Patient Safety is everyone's business!

Abuse Reporting Abuse Every Healthcare Worker is a mandated reporter for the following types of abuse: CHILD ABUSE ELDER ABUSE DOMESTIC VIOLENCE REMEMBER: Student Nurses report any suspicion of abuse to their clinical instructor !!!!

Abuse Reporting According to the National Child Abuse and Neglect Data System (1999); of the estimated 826,000 victims of child abuse – 58 % suffered from neglect 21 % were physically abused 11 % were victims of sexual abuse

Abuse Reporting Types of Abuse: Physical Abuse Is intentional injury to a child by the caretaker. It may include but is not limited to burning, beating, kicking, and punching. It is usually the easiest to identify because it often leaves bruises, broken bones, or unexplained injuries. Physical abuse is not accidental, but neither is it necessarily the caretaker’s intent to injure the child.

Abuse Reporting Neglect: Most common type of reported and substantiated maltreatment. Sexual Abuse: “ employment use, persuasion, inducement, enticement, or coercion of any child to engage in, assist any other person to engage in any sexually explicit conduct or stimulation of such conduct for purpose of producing a visual depiction of such conduct.”Any type of touching of a child for sexual gratification. Emotional Abuse: Can be defined as verbal , psychological, or mental abuse in which the damage inflicted leaves lasting emotional scars. It can include blaming, belittling, or rejecting a child; constantly treating siblings unequally; and a persistent lack of concern by the caretaker for the child’s welfare.

Social Services Types of Elder Abuse: Physical -- assault or injury from inappropriate transfers etc. Financial – misusing funds, having an elder sign financial documents they do not understand. Neglect – failure to provide food, clothing, hydration, showers etc. Self-Neglect – the person does not provide for their own care. Emotional –ridicule, taunting. Sexual– any unwanted physical touching, sexual comments, requests or simply glaring at the person’s body.

Social Services Domestic Violence Is the physical assault or threat of doing bodily harm to a spouse, domestic partner, or roommate. Perpetrators can be prosecuted under the domestic violence statute or criminal statutes from assault and battery to attempted murder.

Infection Control: Modes of Transmission ,[object Object]

Direct - physical transfer between a susceptible host and infected or colonized person;

Indirect - personal contact of susceptible host with a contaminated intermediate object;

Droplet - as a result of coughing, sneezing, walking by an infected person;

Vehicle route – diseases transmitted through contaminated items such as water, food, drugs etc.

Airborne route – dissemination of either droplet nuclei or dust particles in the air containing an infectious agent

Vector-borne route – West Nile Virus, Bird Flu, Malaria ,[object Object]

Cover nose/mouth when coughing or sneezing.

Use tissues to contain secretions – dispose in nearest waste receptacle.

Perform Hand Hygiene – after having contact with secretions & contaminated objects/materials.

Hospitals to provide tissues and waste receptacles for used tissue disposal.

Hospitals to provide alcohol-based hand rub dispensers.,[object Object]

MRSA TODAY – It’s faces Slides: Courtesy of Arrowhead Regional Medical Center – Infection Control

MRSA TODAY – It’s consequences Slides: Courtesy of Arrowhead Regional Medical Center - Infection Control

Epidemiology of MRSASlides: Courtesy of Arrowhead Regional Medical Center - Infection Control ,[object Object]

Colonized patients can serve as a source of infection or colonization for others through direct or indirect contact83

Slides: Courtesy of Arrowhead Regional Medical Center - Infection Control The human and financial impact of MRSA is high: ,[object Object]

3.95 MRSA infections occur per 1,000 hospital discharges nationally

1.25 infections per 1,000 discharges at ARMC for 2006-2007, .39 Jan-Sept ‘08

Over 5,000 patients die as a result of these infections annually

Over $2.5 billion excess health care costs are attributable to MRSA infections

Non-reimbursement from CMS for treating healthcare-acquired infectionsOn average, for each patient with MRSA infection this means: ,[object Object]

Over $20,000 in excess cost per case (range $7,000 – $32,000)

4% in excess in-hospital mortality,[object Object]

INFECTION CONTROL PRACTICES help to prevent the spread of infection Slides: Courtesy of Arrowhead Regional Medical Center - Infection Control Hand Hygiene Standard Precautions Personal Protective Equipment Isolation Precautions Proper care of invasive devices Removal of devices when no longer medically necessary Proper care of surgical sites

Infection Control:HAND HYGIENE CDC Hand Hygiene Guidelines: Before patient contact After patient contact Before donning gloves After removal of gloves Hand washing Washing hands with plain soap & water for 15 sec. Antiseptic hand rub agent to all surfaces of hands Surgical hand antiseptic Performed pre-op by surgical personnel with antiseptic hand wash/rub to eliminate or reduce hand flora The CDC recommendation for healthcare workers who have direct contact with patients, food, or patient care equipment not wear artificial nails or natural nails over 1/4” long. Hand hygiene is still the #1 way to stop the spread of infection!

When to perform hand hygiene:Slides: Courtesy of Arrowhead Regional Medical Center - Infection Control ,[object Object]

VVC Nursing : Spring 2011 General Hospital Orientation

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VVC Nursing : Spring 2011 General Hospital Orientation