To be completed by all New Hires, Volunteers, Contractors, & Students Policies and Procedures Human Resources Policies & Procedures are located online in I-REPP ◦ I-REPP is the best place to find information regarding unit and hospital practices, policies and procedure. Do NOT discriminate on Race Color Religion Sex/Wages National Origin Disability Age Disability Status Genetics Employees Hired based On ◦ ◦ ◦ ◦ Experience Skills Aptitude Ability to fit into JVMC and WVC culture Equal Opportunity Employer Orientation period ◦ First 90 days of employment you should receive an evaluation. Director should review with you your progress during and at the end of the 90 day orientation period. ◦ Skills Check list and department orientation Must be completed by 90 days Ask department director if you do not have a 90 day orientation and Skills Check List ID Badges ◦ ◦ ◦ ◦ ◦ ◦ Must wear at ALL times Worn above the waist Human Resources creates the badges Used for timekeeping and security doors Glucometer If LOST or STOLEN replacement badge cost $20 Dress Code (HR-A-7) ◦ Hair should be clean, well-groomed and controlled, and appropriate to the job. ◦ Uniforms are to be worn if department requires them ◦ Open toed sandals are not appropriate in Clinical areas ◦ Flip-Flops/Sandals are never appropriate ◦ Jewelry must be conservative, non-offensive, and worn in moderation. Two piercings per ear is allowed, all others must be removed. ◦ All cosmetic products (including fragrances) should be worn in moderation ◦ Tattoos are to be covered Clothing ◦ The following types of pants/skirts are not appropriate: Denim pants Leggings Shorts (including walking shorts). Sweat pants Mini skirts ◦ The following shirts are inappropriate : Tank tops T-shirts Sweatshirts without collars Souvenir T-shirts or sweatshirts (excluding Jordan Valley Medical Center or Jordan-West Valley) Problem Solving Procedures 1. Address issues or grievances with A. B. C. D. Supervisor or Manager Human Resources VP over your department CEO 2. Or IASIS Alert Line 1-877-898-6080 or www.alertline.com Employment Status ◦ ◦ ◦ ◦ ◦ Full Time 36 hours/week - eligible for all benefits 30-35 hours/week - eligible for medical, dental, vision and small amount of PTO Accrual Part Time Less than Part Time/PRN Less than 30 hours/week - no benefits Registered Nurses only. Higher rate of pay, no benefits Per Diem 7 on 7 off Lab (MT’s only) All benefits, no accruals Employee Conduct and Work rules (HR.401& IASIS Standards of Conduct) ◦ IASIS expects employees to follow rules of conduct that will protect the interests and safety of all patients, employees and the facility. Conduct that is offensive to patients or fellow employees, discredits the company, interferes with business operations, or any other conduct which in the facility's judgment is adverse to the company's interest will not be tolerated. Examples of unacceptable behaviors Fighting, intimidating or threatening violence in the workplace Boisterous or disruptive activity in the workplace. Insubordination or other disrespectful conduct. Sexual or other unlawful harassment or discrimination Sexual Harassment (HR.402 & HR.401) ◦ Is unwelcome sexual advances, requests for sexual favors and other verbal or physical conduct of a sexual nature. ◦ When submitting to or rejecting this conduct, the individual’s employment or work performance is clearly affected. The result of sexual harassment is an intimidating, hostile or offensive work environment. IASIS is committed to providing a work environment that is free of discrimination and unlawful harassment. Actions, words, jokes or comments based on an individual’s sex, race, ethnicity, age, religion or any other legally protected characteristic will not be tolerated. It applies to all employees, including supervisors, managers and department heads, directors, physicians and vendors, whether or not employed by IASIS. Under certain circumstances, the policy would apply to agents and non-employees who interact with IASIS employees. What is the Company’s responsibility? Act immediately and take every complaint seriously Conduct a thorough investigation Keep accurate documentation of the events and any action taken Ensure non-retaliation What should the victim of sexual harassment do? It is helpful for the victim to directly inform the harasser that the conduct is unwelcome and must stop. The victim should use the employer’s complaint process or grievance system in place. • Non-Soliciting Policy (HR Policy HR.109) ◦ Employees shall not engage in solicitation for any reason during his or her work time or to another employee on their work time. ◦ The only exception will be for events sanctioned by the hospital. ◦ The hospital’s electronic mail system is a business system and not a personal communications network or bulletin board. ◦ Off-duty employees of IASIS, or of an on-site contractor who works at the hospital, are not permitted access to any non-public working areas of the hospital including the emergency area. Tobacco Free Environment (EOC-E-23) ◦ Jordan Valley and Jordan-West Valley prohibit smoking or tobacco product use wile on any Jordan Valley or Jordan-West Valley campus Tobacco use is defined as the burning of any type of tobacco product, as well as the use of oral tobacco products. The policy applies to All employees, Patients, and Visitors • Staff Rights Policy (HR.112) ◦ A way to address your rights not to participate in certain aspects of patient care if it conflicts with your cultural values, ethics, or religious beliefs. ◦ Notice Upon Hire Examples • End of life treatment • Blood transfusions • Organ donation ◦ Not Accepted Reasons Refusal to treat patients based on: • • • • • Nationality Religion Creed Color Sexual orientation • Family Medical Leave Act (FMLA) ◦ Eligible after one year with 1250 worked hours ◦ Job Protected to: • Care for child after birth or adoption • Care for family member with Serious Health Condition Up to 12 weeks leave • Military Leave ◦ 30 day Advanced notice if possible ◦ Apply for FMLA with Matrix Absence Management • Information can be found on the intranet underISO Forms/Department Forms/ Human Resources • Call 1.877.202.0055 • Website www.matrixeservices.com Lunch Breaks ½ Hour deducted after five hours worked No lunches must be approved by Manager Hospital must pay for missed lunches Lunches – must be at least 30 minutes of uninterrupted time ◦ Must punch out if you leave the hospital ◦ If you don’t have 30 minutes of uninterrupted time for a lunch, you much punch a “no-lunch” when you clock out at the end of your shift. ◦ If you forget to clock a “no-lunch,” you must turn in a “no-lunch” form and enter a “nolunch” in API. ◦ ◦ ◦ ◦ Overtime ◦ Paid at 1.5 times average rate of pay ◦ Average rate of pay includes shift differentials Direct Deposit Takes up to three pay periods to activate Sign up at any time Deposits in bank normally on Thursday Any bank or credit union that has checking On your check stub it will read “NON-NEGOTIABLE” on signature line ◦ Overtime is based on a 40 hour workweek ◦ ◦ ◦ ◦ ◦ API ◦ Timekeeping system Track your own hours Log in and sign off on your hours each pay period Request PTO ◦ Must use badge to punch Benefits o Benefit eligible employees have 30 days from their hire date to enroll in benefits. o To enroll in benefits you can: o Call Melissa at 801-601-2361 for help o Enroll online through Lawson on the intranet o Fill out an enrollment form if online is not working Attendance and Punctuality “Scheduled Absences” ◦ A scheduled absence occurs when an employee has arranged at least 24 hours in advance and has been granted supervisory approval to be absent from work. Unscheduled Absences” ◦ Any absence not requested and approved 24 hours in advance (e.g. call-in sick). No Shows ◦ Two consecutive shifts missed – hospital will assume employee has quit Caring Commitments • • • We recognize that our talented and dedicated employees are our greatest assets. All patients, visitors, staff members, physicians and contractors are encouraged to submit a STAR recognition card to recognize any deserving individual within the organization. The STAR Performance Recognition Program recognizes individuals for demonstrating STAR behaviors. STAR behaviors can be found within “Our Caring Commitments” & “It’s the Right Thing to Do” pamphlet. • • • • • • I Commit to service through I Commit to accountability through Providing compassionate care. Responding promptly to your needs. Listening carefully to you. Providing clear explanations. Accepting ownership Providing exceptional customer service • • • • • • I Commit to teamwork through Working well with others Promoting a positive attitude I Commit to respect through Being sensitive to the diversity of others Treating everyone with respect and dignity Acting with integrity Respecting your time Chris Rock Risk Manager Overall claims against nurses or that involve nurses continue to rise (CNA data) 60% from Med/Surge setting Average paid settlement around 160K Most frequent claims involve death (38%), infection/sepsis (6.5%). Most severe claims involve birth injury and paralysis events Claims involving wrong medication route have the highest settlement among medication claims. We failed to adequately advocate for the patient. We failed to sufficiently disclose and discuss while here to resolve the concern. Studies have shown that patients sue providers and hospitals they don’t like more than ones they like, probably based on their perception of how their concerns were addressed. Who reports: Any individual (staff) at all locations who witnesses or discovers and incident or unusual occurrence. What is reported: Events where there is an unexpected outcome: falls, medication errors, T/T/P (complications, delayed, missed order), equipment failures, security threats, blood complications, behavioral problems, skin integrity, etc. Why Report: To predict future risks and protect patients, visitors, and staff To identify where P&Ps need updates To educate staff on potential risks To prevent & defend against lawsuits Do file incident report after pt. stable and w/in end of shift. Do record in the patient’s medical chart a factual account of any outcome with pt. injury. Do Not route incident reports through other departs (okay notify your manager/sup). Do Not indicate in the patient’s medical record that a UOR was filled out (liability protection). Do Not assign blame, be judgmental, or admit liability verbally or on the UOR report. Stick to facts. EMTALA (EM) concerns Sentinel Events (unanticipated death or major permanent loss of function) Damage to IASIS property Loss of Patient property Birth related injury Significant complaints (Customer Service Champion or Risk Manager). Goal is to try to resolve the patient’s concern (while in-house, if possible), and before it becomes a major risk issue. Right Right Right Right Right Patient Route Dose Time Medication Right Documentation Standard Precautions Estimated 1.5 million harmed each year; 7000 deaths/year. High Risk Medications: Heparin, Insulin, Opiates, etc. Familiarize yourself with medication dosages, side effects, warnings, contraindications. Know how to obtain current reference materials, or contact pharmacy when available. Adverse Drug Reactions Communication: read back TOs, etc. Document all medications administered and response. Document any wasted medications in compliance with hospital Policy. Resolve all narcotic discrepancies. Document all errors as a UOR. A new study shows that as the number of distractions/interruptions increases, so do the number of errors and the risk to patient safety. For instance, four interruptions in a single drug administration doubled the likelihood that the patient would experience a major mishap. Small lapses can lead to big mistakes! Read back TOs and labs Make sure pt identifiers are correct/consistent Follow SBAR Does the procedure sounds right for the diagnosis? Follow procedures for critical values reporting Call the physician, to clarify if the order is not legible or unclear! 24 hour nursing chart checks, important safety net! Failure to document conversations with patients. Failure to document medication response. Abnormal VS documentation and follow-up. Failure to notify physician of changes in condition. ◦ Failure to indicate that the new nurse was made aware of significant changes in patient condition at shift change. ◦ Other mistakes include: ◦ ◦ ◦ ◦ Illegible handwriting Generalizations Overuse of abbreviations, or do not use Spelling errors Recording assumptions Medicare will not longer pay for following HAC “never events” Retrieval of retained surgical devices left in patient Falls (Avg. cost of fall with injury = $4233, prob more) Blood Incompatibility Pressure Ulcers, hosp acquired III and IV (Stage II = $1119, Stage II and III = $10,185 SSI after CABG ($15-40K) Incompatible blood or air embolism Catheter associated UTIs Vascular catheter-associated infections Manifestation of poor glycemic control Surgical site infection DVT Additional proposals in works (gov and private) SCIP DNR - Purple We have adopted the color PURPLE for the Do Not Resuscitate designation with “DNR” embossed/printed on the wristband or label. Do we still need to look in the chart? – – Yes!; and Code designation can and does change during a patient’s stay. Calling CODE BLUE! • • • Recommended in the Standardized Hospital Emergency Code for the State of Utah. If Utah selected the color blue for the DNR wristband, the potential for confusion exists. “Does blue mean I code or I do not code?” Allergy - Red We have adopted the color RED for the Allergy Alert designation with the word “Allergy” embossed/printed on the wristband or label. Associated with other messages such as STOP! DANGER! Easy Implementation The transition to red for Allergy Alert should be easily achieved since the majority of hospitals use a wristband for allergies already use red for Allergy Alert. Fall Risk - Yellow We have adopted the color YELLOW for the Fall Risk Alert designation with the words “Fall Risk” Associated with “Caution” or “Slow Down” for example: stop lights and school buses; American National Standards Institute (ANSI) designates yellow for tripping or falling Falls account for more than 70% of the total injury-related healthcare cost among people 60 years of age and older. Color-coded “Alert” Wristbands Risk Reduction Strategies =============================== 1.Use wristbands with the alert message pre-printed (such as “DNR”). 2.Remove any “social cause” colored wristbands (such as “Live Strong”). 3. Initiate banding upon admission, changes in condition, or when information is received. 4.Educate patients and family members regarding the wristbands. 6. Educate staff to verify patient colorcoded “alert” wristbands upon assessment, hand-off of care, and transfer. Preventing Patient Falls! 1 in every 3 adults over 65 fall each year. Proportion increases to 1 in 2 by the age of 80 ◦ (“Falls Prevention Interventions in the Medicare Population” available at cms.gov) Falls exceed automobile accidents as the number one cause of accidental death or persons over 75. Thirty percent of hospital falls will result in injuries, including 5% serious trauma such as hip fractures. Thus, there are about 52,500 serious injury falls per year in U.S. hospitals Falls with injury and can have a large financial impact and risk to the hospital & patient. The hospital employs a comprehensive Fall Prevention Program aimed at reducing patient and visitor falls. The following interventions are important components of the Fall Prevention Program for patients identified at risk: ◦ Utilize the CareView virtual bed and chair rail system where available and according to protocol. ◦ Complete a fall risk assessment upon admission, every shift, and anytime there is a change in status. ◦ Communicate fall risk levels during shift report and during other hand-off communications. ◦ Utilize additional prevention tools such as yellow bracelets & signs, bed alarms, side rails, lap belts, no slip socks, walkers, etc. ◦ Check the Four P’s during hourly rounding: Pain, Potty, Position, and Placement. ◦ Place the patient in a room close to the nursing station. ◦ Make sure the call light and other items the patient may need are placed and left within easy reach of the patient. ◦ Educate the patient and family about fall risk, and remind patients to call for help prior to getting up, particularly for toileting needs. ◦ If the patient is confused or wandering, discuss concerns with the family and where appropriate evoke their assistance with in room patient watches. ◦ After a patient falls, re-evaluate what changes are needed to prevent repeat patient falls. Cause of Inpatient Falls, May 12 through Dec 12 25 100% 90% 80% 70% 15 60% 50% 10 40% 30% 5 20% 10% 0 Cause of fall % of Total Tioleting Confused patient 21 7 5 5 2 1 51% 68% 80% 93% 98% 100% Environment Slip and fall Therapy related Syncope episode 0% % of Total # of Falls 20 A restraint is defined as: Any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely. Chemical: A drug or medication used to control behavior or restrict a patient’s movement and is not the standard treatment or dosage for a patient’ s condition. Note that PRN drugs is only prohibited if med meets definition of drug. If all 4 side rails are up, or if belts are being used to keep a patient in bed or from getting up. Patient’s have right to be free from restraints, including when necessary only and not as coercion, discipline, convenience, or Medical = NV/NSD (non-violent, non-self destructive) ◦ Prevent pulling lines Behavioral = V/SD (violent, self destructive ◦ Danger to themselves or others, after least restrictive alternatives attempted. Forensic restraints: handcuffs, shackles, or other restrictive devices by law enforcement. Orthopedic devices: surgical dressings, bandages, protective helmets, etc. Protective equipment: padded side rails, padded mitts, etc. Does not include methods that involve the physical holding of a patient for the purpose of conducting routine physical examinations or tests (crying child for example) Restraints or seclusion can only be used when less restrictive interventions have proven ineffective & they are needed to protect the patient, staff, or others! Alternatives to undertake first: These interventions must be documented! Promote a safe environment; fall precautions, assist devices, alarms, adjusting light/noise, patient location, 1:1, toileting. Promote cognitive, psychological, and physiological well being; orientate patient, ask family to help/stay, eliminate unnec equip, medication assessment, toileting, re-position, physical assessment to identify medical problems causing beh change, diversion activities. Promote functional mobility; wear glasses, contacts, hearing aids, strengthening activity, provide pain or other comfort meds Americans with Disabilities Act (ADA) is a Federal Law that prohibits discrimination against those with disabilities. The ADA includes those with hearing impairments/deaf ◦ Assume nothing, take extra time to make sure understanding is clear) ◦ Maintain good eye contact ◦ Be sensitive to visual environment – avoid bright lights that create glare or make it difficult to read lips ◦ Some deaf people do not read lips; consider and use other methods to communicate. ◦ Family members/friends cannot reliably interpret medical terms and procedures Interpretation machine is housed in the ER/ED department The nurse follows the procedure for start up (laminated help sheet with the machine Interpreter will ask for needs (desired services needed language/physician etc.) Connection is completed within minutes to begin effective communication Keep machine plugged in so battery does not drain. Contact Supervisor if you encounter problems. Local sign language interpretation is available as back-up. TDY if needed. Packets (resource materials) from State Office Other Languages (Medvix phone number with code, >100 languages). Meeting Needs of Disabled Patients ◦ Handicap stalls, ramps, other assist devices ◦ Increased risk for falls, interventions as noted. Hospitals must abide by ADA Laws! If you encounter issues, you may use the Hotline Number to call in the event: x3662 Sara Phillips Quality Director Sara Phillips Director Quality Management Quality Like Beauty is in the Eye of the Beholder. We must meet the needs of the 20 year old as well as the 90 year old. Quality means different things to different people. They key to quality lies in communication and standardization. The most frequent complaint from patients relates to the lack of communication from staff and physicians. Treat every patient the same way you would your family member (connect with the patient, show them they are not just a number) ISO is a set of standards that drive our Quality Management System. We use them as our Quality management system. The Core element is standardization. McDonald’s Hamburgers are the same all over the world because they have “work instructions” for how to cook a hamburger. We have Standards, Forms, and Policies. These three things provide directions on how to perform certain processes. Patient/Client’s Satisfaction - Service Quality Patient/Client’s Outcomes – Quality of Care (Do the right thing, for the right patient, at the right time) ◦ Both of these elements now affect our payments. Processes – Quality of Design Staff and Physician Satisfaction – Quality of Service, Design, and Care Quality Improvement Designed to improve outcomes or processes Quality Assurance – Designed to keep things the same. Decreasing the Number of Code Blue Cases by Implementing Rapid Response Teams that respond to emergency situations before the patient’s breathing or heart stops. Decreasing the Number of Nosocomial MRSA Infections by Implementing Strong Hand Washing Programs. Define the Customer, their Critical to Quality (CTQ) issues, and the Core Business Process involved. Define who customers are, what their requirements are for products and services, and what their expectations are Define project boundaries the stop and start of the process Define the process to be improved by mapping the process flow Measure the performance of the Core Business Process involved. Develop a data collection plan for the process Collect data from many sources to determine types of defects and metrics Compare to customer survey results to determine shortfall Analyze the data collected and process map to determine root causes of defects and opportunities for improvement. Identify gaps between current performance and goal performance Prioritize opportunities to improve Identify sources of variation Improve the target process by designing creative solutions to fix and prevent problems. Create innovate solutions using technology and discipline Develop and deploy implementation plan Control the improvements to keep the process on the new course. Prevent reverting back to the "old way" Require the development, documentation and implementation of an ongoing monitoring plan Institutionalize the improvements through the modification of systems and structures (staffing, training, incentives) From GE's DMAIC This is the Process Tool Our Teams Use Airlines do a great job of error proofing. They use three redundant systems for every critical element of the airplane. Healthcare usually uses one – the person performing the task. Airline Flights 4000 X 365 = 1460000 A 1% error rate equals 14600 crashes Annually there are normally 2 – 3 crashes a year. Healthcare What is our error rate? (We often consider 99% to be excellent.) How do we error proof our processes? (We need to learn to standardize what we do and use technology to prevent harm to patients.) According to the Joint Commission's president, these "never events" are becoming more common because of growing time pressures. He notes that wrong-site errors have proven "more complicated to eradicate than anybody thought" because it requires changing hospital culture and ensuring that physicians collaborate and follow standardized protocols. Peter Pronovost, the medical director of the Johns Hopkins Center for Innovation and Quality Patient Care notes that physicians' "ritualized compliance" is a key contributor to high wrong-site surgery rates. According to KHN/Post, several wrong-site procedure studies have found that physicians routinely fail to participate in pre-surgery timeouts. For example, in a 2010 study of 132 wrong-site and wrong-patient cases reported by Colorado physicians between 2002 and 2008, 72% of error cases did not include a timeout to confirm case details before the procedure. The clinical director of the Pennsylvania Patient Safety Authority says physicians who confirm details with patients before they are moved into the OR are less likely to make an error. Similarly, physicians avoid mistakes when they stop to ask team members if they have concerns. "There's a big difference between hospitals that take care of patients and those that take care of doctors," he says, adding, "The staff needs to believe the hospital will back them against even the biggest surgeon." We are fallible human beings. We live in an inherently risky world where we create risk and cause undesirable outcomes. Fallibility vs. Culpability The reckless driver model: The drunk driver who kills someone is culpable, the driver who kills someone who runs out in front of him is fallible. And the moral is: Follow hospital standards and policies. National patient safety Goals were developed as a result of harm to patients. They are all important! Staff must know and follow these standards. Your Unit Director will review all of them with you. Three of them and the reasons for them are listed below on the next slide. Improve the safety of using medications - standardize and limit the number of concentrations – look alike, sound alike – physically separated, reduce risk associated with anticoagulation therapy. Reason: Patients were harmed and some died when the wrong medication was injected. Concentrated potassium accidently injected causes immediate cardiac arrest. Improve the accuracy of patient identification patient name and date of birth Reason: Patients were permanently harmed when the wrong procedure was performed, the wrong medication given, the wrong blood given, or laboratory tests labeled and reported incorrectly. Improve the effectiveness of communication between caregivers – read back – do not use abbreviation – timeliness of reporting critical values – hands off communication Reason: Patients were harmed or died as the result of being treated for an incorrectly recorded laboratory result. Questions? Contact Sara Phillips x3163 Mary Jordan Infection Prevention/ Employee Health Nurse New Hire Orientation 4-30-2013 Varicella (chickenpox) MMR Tdap Hep B - if working in a clinical area TB test – 2 step method Flu shot – every year Protects against acute and chronic Hepatitis B disease, the associated liver cancer & cirrhosis 3 shots and a titer Very safe vaccine, only 1: 1,000,000 have a serious complication Best of all IT IS FREE for employees! This is required for clinical areas. OSHA requires annual fit testing Fit testing is offered in clinical areas. Your director will tell you how it is done on your unit. It means that you’ve been exposed to TB some time in the past. It does not mean that you have active TB. It does mean that you will have to visit with the Employee Health Practitioner If you have a positive TB skin test Do NOT receive future TB skin tests Monitor for signs of active TB Night sweats Cough that lasts for weeks Coughing up blood Unexplained weight loss Unusual (for you) tiredness If any of the signs are apparent, contact Employee Health immediately. Work Practice Controls Food and drinks in the workplace. Refrigerators (food and specimen) Specimens handling Spills PPE Hand Hygiene Infectious Waste Can be found in I-REPP in Infection Prevention Policies. You can get a copy from Infection Prevention if you do not want to pull one off of I-REPP. Employee Health is available to answer any questions you have about the plan. It may be Yellow, Orange, or Red. Do not put regular trash in the Biohazard (Red) Trash. Do not put Biohazard trash in the regular trash. Do not store clean supplies in a Biohazard bag. Do not put a Biohazard bag in the regular trash even if there is nothing biohazardous in the bag Bulk Blood? Micro/Lab Waste? Urine? Other Body Fluids? Sharps? Contaminated or Saturated Dressings? OSHA does not allow food or drinks in any area specimens may be. Food and specimens may not be in the same refrigerator. Staff food may not be stored in the patient food refrigerator. Breast milk is a body fluid and may not be stored in a food or specimen refrigerator. Patient food must be dated and the name of the patient attached before it is placed in the refrigerator. Ask where you may keep your drinks during unit orientation. What do I do? Who do I tell? Do I go to the ER? ER admitting at both campuses has separate packets for Injury and Exposure. The injury packet is also on the intranet under HR forms. Fill out all forms entirely! The drug screen must be done before you leave from the shift on which you were injured. Notify your supervisor and Employee Health Report injury to supervisor and Employee Health. We can help determine whether medical care or simple first aid is needed. Report to ER admitting and get packet for Workman’s Comp or print it off the intra-net. Report to Lab for drug screen. You need to report an exposure incident to employee health or the house supervisor immediately. Time is of essence in testing and/or starting prophylactic treatment. You will have tests for Hepatitis B, C, and HIV. Source patients and staff will have to sign a consent for HIV testing. There is no charge to the patient or staff member for postexposure testing. Healthcare workers are at risk for exposure to bloodborne pathogens including Hepatitis B and C and HIV. Certain populations of Healthcare workers are more at risk than others. Those at high risk include staff who are directly involved in patient care (physicians, nurses, nurse’s aides, therapists, EMT’s), patient testing (lab, cath labs) and environmental services personnel. The most common type of bloodborne pathogen exposure comes from needlesticks or puncture and laceration wounds from an object contaminated with an infected patient’s blood. Other exposures include splashes, splatters, or sprays of blood that is contaminated with HIV, Hepatitis B or C. Hepatitis B is the most common pathogen that HCW’s (Healthcare Workers) could potentially be exposed to. The average risk from a single needlestick or cut is 6-30% and depends on the immunity of the individual exposed and the amount of the virus in the source patient’s blood. Hepatitis C carries a risk level of about 1.8% for infection after an exposure while HIV carries a risk of infection after exposure of about 0.3% (1 out of 300). For HIV infection risk after exposure to the mucous membranes, the risk drops to 0.1% (1 in 1000) and the risk of infection after exposure to a non-intact skin surface (such as a scrape or open skin lesion) is less than 0.1%. The level of risk varies with such factors such as whether or not a pathogen was present in the blood and what that pathogen is, the type of exposure, the amount of blood involved in the exposure, how deep the exposure was into the skin (percutaneous exposures) and the amount of the virus in the patient’s blood at the time of the exposure. Do not recap syringes. Do not bend, break or shear needles Handle sharps with medical devices such as forceps when possible Use only an approved sharps container to dispose of sharps. Take care not to toss in patient trash. Use appropriate barriers such as gloves, masks with eye shields and non-permeable gowns when contact with blood is anticipated. Close and seal sharps containers when they are 2/3 full. NEVER force a sharp into a container!! Consider receiving the Hepatitis B vaccination series for protection against Hepatitis B virus. Note: This vaccination series will not protect you against Hepatitis C or HIV. Report the exposure incident to your supervisor immediately!! Time is of essence to obtain tests and start prophylactic medication. Notify Employee Health Nurse immediately. Go to Emergency Department and get exposure packet from NURSING. You will go to the LAB, give a drug screen and have blood drawn for baseline Hepatitis B and C and HIV. If the source patient is known, they will be interviewed for risk factors and asked to sign a consent form and blood will be drawn from them for these viruses also. For some exposures the physician may opt to give you immunoglobulin to help protect you against these viruses if you have no immunity to Hepatitis B, or start you on oral medications prophylactically until the lab test results are returned. For the first 6 weeks after an exposure to HIV, it is suggested that you not donate blood or other body fluids or be considered as an organ donor. Use condoms with sexual intercourse. If you are a breast-feeding mother, stop breast-feeding in the follow-up period. HIV can be transmitted through blood and body fluids such as breast-milk or semen. HIV usually poses no risk of transmission from sweat, tears or from skin-to-skin contact. Testing for follow-up will be done on initial exposure (baseline), again varying with the type of exposure. How would you feel if a co-worker became infected with HIV, Hepatitis B or C and it was due to your carelessness? How would you feel if you were infected as a result of someone else’s carelessness? Must be done before you leave from the shift in which you were injured. If you do not do this you will be asked to return for the drug screen. Only current medications prescribed for you are permitted. What is Formaldehyde? Formaldehyde is a colorless, flammable, strong-smelling chemical widely used to make resins, plywood, particle board, pressed wood products, glues and plastics. It is also used as a preservative in medical laboratories, mortuaries and veterinary clinics. It is mixed with water to make a liquid called “formalin” which contains 37 % formaldehyde and 6% - 13% methanol. Only the lab may store formaldehyde Regulated areas shall have danger signs posted at entrances and access ways Go to the lab to get the Formalin to be used that day. All formalin that is not used must be returned at the end of the day. 10 2 Exposure routes ◦ Inhalation Sore throat, coughing, shortness of breath Sensitization of respiratory tract 25-30 ppm: pulmonary edema and pneumonitis ◦ Ingestion Severe abdominal pain, violent vomiting, headache, diarrhea, unconsciousness and death Methanol used to stabilize the formaldehyde solution poses additional toxic hazards Skin contact Irritation from vapors, pain, blurred vision May cause irreversible damage if splashed in eyes Irritation and/or burns; cracking, scaling, white discoloration Can be absorbed through skin ◦ Eye contact May cause irreversible damage if splashed in eyes Irritation from vapors, pain, blurred vision 10 3 Engineering controls: 1. Always use formalin in a properly functioning chemical fume hood or in a properly ventilated area 2. Use the smallest amount of formalin necessary Protective clothing (lab coats, aprons, suits): 1. Tychem® CPF2, SL, CPF3, F, CPF 4, BR, LV, Responder, TK, or Reflector all have breakthrough times >480 min Gloves (required when using >1% formaldehyde): 1. Nitrile (>360 min) is the best choice 2. Neoprene (105 min), or PVC (100 min) are ok 3. Rubber or Neoprene/rubber are ok for short use (10-15 min) 4. PVA gloves are not recommended Eye protection 1. For working with formaldehyde at any concentration greater than 1%, splashproof eye protection is required Volunteers may not transport formaldehyde 10 4 Specimens in Formaldehyde Cerebral Spinal Fluid Specimens that are not tightly sealed Notify Employee Health An assessment of the workstation will be obtained and suggestions for improvements discussed. Take time to stretch. If your position requires extended computer time, rest your eyes. Look away and focus on something on the opposite wall. Test the load before moving an object. Use assistance if necessary. Plan the move. Check the path of travel to be sure that it’s clear. Use a wide balanced stance with 1 foot ahead of the other. This reduces the likelihood of slipping and jerking movements Keep the lower back in it’s normal arched position while lifting. Bend knees or hips. Bring the load as close to the body as possible. Keep head and shoulders up as lifting begins. This keeps the natural arch in your back. Tighten stomach muscles as the lift begins. Lift with the legs. Stand up in a smooth, even motion. Move the feet (pivot) if a direction change is necessary. Communicate if two or more individuals are involved in the movement. The CDC has included alcohol hand rubs in their Hand Hygiene Guidelines for Health Care Workers. Use of the alcohol hand rubs has proven to be an effective measure to improve hand hygiene and decrease the spread of organisms within a healthcare facility. You must wash hands using alcohol based hand cleaner or soap and water before and after patient care. You must wash hands after touching something dirty on a patient before touching something clean. You must wash hands after removing gloves. You must wash hands after using the restroom. A Reminder About What You Already Know Use soap and warm water Scrub hands for 10-15 seconds (pick a little song) Don’t forget the backs Don’t forget between your fingers The thumb is the most forgotten digit Scrub fingernails in the palm of your hands Dry hands Turn off faucet & open door with paper towel No artificial nails Natural nails must be kept short and clean No large, bulky jewelry Protect Yourself and Your Patients For patients with TB, measles, chickenpox, and shingles. Patient must be in negative pressure room at all times, with the door closed. Staff must wear special N-95 mask and must be fit-tested before use. Droplet Precautions • Use for patients with influenza, RSV and respiratory illnesses • Wear a regular surgical mask when within 3 feet of the patient Contact Precautions • Use for patients with open wounds with drainage, skin infections EXCEPT drug resistant organisms. • Wear gown and gloves • Wear mask with eye shields if splashes might occur VISITORS Report to nurse before entering Patient Placement Private Room with door to remain closed Gloves and Gown Must be donned before entering the patient’s room. No Exceptions! Must be removed before leaving the patient’s room. No Exceptions! Remove PPE in a manner so as not to touch skin, clothes or environmental surfaces. Mask with eye shields Must be donned before entering the patient’s room if infective material can be splashed or splattered into eyes or mucous membranes. Must be removed before leaving the patient’s room. No Exceptions! Wash Strict Hand washing mandatory. May use Alcohol Hand Rub Patient Transport Limit transport out of room to essential purposes only Place clean linen between patient and wheelchair, stretcher or lift. Communication to receiving departments re: precautions is mandatory. Patient Care Equipment Dedicated or disposable equipment only. If using wheelchair, stretcher or lift, etc. thoroughly disinfect equipment after patient use. VISITORS Report to nurse before entering Patient Placement Private Room with door to remain closed Gloves and Gown Must be donned before entering the patient’s room. No Exceptions! Must be removed before leaving the patient’s room. No Exceptions! Remove PPE in a manner so as not to touch skin, clothes or environmental surfaces. Mask with eye shields Must be donned before entering the patient’s room if infective material can be splashed or splattered into eyes or mucous membranes. Must be removed before leaving the patient’s room. No Exceptions! Wash Strict Hand washing mandatory. USE SOAP AND WATER Patient Transport Limit transport out of room to essential purposes only Place clean linen between patient and wheelchair, stretcher or lift. Communication to receiving departments re: precautions is mandatory. Patient Care Equipment Dedicated or disposable equipment only. If using wheelchair, stretcher or lift, etc. thoroughly disinfect equipment after patient use. Remember the best defense is PROTECTING YOURSELF by strictly following Standard Precautions and Transmission Based Precautions. The use of personal protective equipment is MANDATORY. Gowns Gloves Masks Eye shields Shoe Covers Others Everyone must know & do this! Read the following policy carefully! Cleaning of Equipment Terminal cleaning of equipment left in room. ◦ ◦ Equipment cleaned and left in the room shall be identified as clean. Equipment that needs to remain plugged in will be cleaned, positioned as close a possible to the power source, the slack in the cord will be wrapped and tied with a blue zip tie. Cleaning of equipment that does not remain in the room after patient discharge. ◦ Housekeeping will clean the equipment, wrap the power cord and secure it with a blue zip tie. The clean equipment will then be placed in the equipment room or other designated place. Cleaning of equipment that travels room to room. ◦ ◦ Gait belts, BP cuffs and SVO2 probes that are reusable or disposable will remain in a single pt room, and be cleaned upon patient discharge. Blood pressure machines, thermometers, Xray plates etc. that move room to room shall be cleaned by the staff member using the equipment upon leaving a pt’s room. Rental Equipment ◦ ◦ ◦ ◦ ◦ All rental equipment will be cleaned upon arrival to the facility. It is the responsibility of the staff member receiving the equipment to clean or to arrange for cleaning of the equipment, prior to its being placed into use. Equipment that is used immediately after cleaning does not need to be marked. If use of the equipment will be delayed after cleaning, the power cord will be wrapped and tied with a blue zip tie. Cleaning of broken equipment that may be removed from the room. A work order will be generated and attached to the broken equipment. The equipment will be placed in the soiled utility room. Nursing staff will clean the equipment, wrap the power cord and zip tie it with a blue tie. The clean equipment with the attached work order will be placed in the equipment room, in a spot marked for broken equipment. Biomed will pick up the broken equipment and repair it. Biomed will re-clean the equipment and mark it with a blue zip tie. It will then be returned to service. Broken equipment that can not be unplugged. ◦ ◦ ◦ This equipment will be grossly decontaminated. A work order will be attached, identifying it as broken. Biomed will handle this equipment as bio-hazardous. Housekeeping will clean the repaired equipment, mark it with a blue zip tie and return it to service. Broken equipment that may be unplugged and has disposable or bio-hazardous pieces. The equipment will be grossly decontaminated and placed in a clear bag. A work order will be attached to the bag. The equipment will then be placed in the soiled utility room for pick up or taken to Biomed. Questions? Call Infection Prevention at 801.562.4266 Life Safety Orientation This program covers safety information related to… Fire Safety Electrical Safety Security/Personal Safety Life Safety & Environmental Safety IF YOU TAKE AWAY ANY OF THESE ELEMENTS, FIRE CANNOT EXIST There are four elements of fire… FUEL: Any combustible material – solid, liquid or gas. Most solids are liquids become gas or vapor before they will burn. OXYGEN: The air we breathe is about 21 percent oxygen. Fire only needs the atmosphere to contain 16 percent oxygen HEAT: The energy that causes the fuel to produce vapors which, in turn, allows ignition to take place. CHEMICAL REACTION: When fuel, oxygen and heat come together in the proper amounts and under the right conditions, a chemical chain reaction takes place and causes rapid oxidation to occur. This rapid oxidation results in fire. How to Prevent Fires… Electrical fires are the most common fires in healthcare settings Use only UL-rated electrical equipment Keep electrical equipment and motors cleaned and properly maintained Check wiring and electrical fitting for wear or damage. Report any wear or damage to your supervisor Never overburden electrical outlets or piggyback electrical cords Do not use extension cords or tack cords to wall or run under carpet Investigate any unusual odors coming from electrical device How to Prevent Fires… Keep storage and maintenance areas free of trash and clutter Keep combustible materials well away from any source heat Store gas cylinders away from patient area Do not store cleaning fluids near any source of heat, such as equipment electrical closets Keep flammables away from any spark-producing source Use flammable liquids only in well-ventilated areas A fire in any area of the hospital(s) is an emergency, which must be resolved quickly. Employees and students are required to know and implement the four basic steps in the event of a fire using R.A.C.E. R escue A larm C onfine E xtinguish Rescue the patient(s) from danger. Disconnect oxygen from the wall outlet only for the patients in immediate danger from the fire. Close the door behind you. R escue A larm C onfine E xtinguish Activate the nearest alarm box and call the Medical Center operator at extension “ 0 ” or 4444. Give the exact location of the fire by floor and room number and the extent of the fire. Remain on the line until the operator has verified information given. Never hesitate to sound the alarm with ANY suspicion of fire. R escue A larm C onfine E xtinguish Close all doors and windows in the area of the fire. This will limit oxygen supply to the room. R escue A larm C onfine E xtinguish Extinguish only very small easily controlled fires, or fires that prohibit the removal of patients. Proper use of Fire Extinguishers… Use PASS method P A PULL the pin AIM the nozzle at the base of the flames S SQUEEZE the trigger while holding the extinguisher upright S SWEEP the extinguisher from side to side covering the area of the fire Use of fire extinguishers can save lives and property by putting out small fires before they spread General Response of Employees… Familiarize yourself with location of fire alarm pull stations and fire extinguishers Close all windows and doors Reassure patients and visitors that everything is under control Prepare to evacuate if ordered by Fire Department/Security Stay close to the floor. Most fire deaths are caused by smoke-related carbon monoxide poisoning Evacuation… Evacuate only if directed to do so Evacuate ambulatory patients first to reduce confusion and create more room Move patients horizontally, out of their rooms, through next set of fire doors If you can’t move horizontally, work your way down to the next level Do not use elevators Bring patient record When NOT to Fight a Fire… The fire is spreading beyond the point where it started Smoke or flames threaten patients’ safety You do not have proper equipment to extinguish the fire Flames are threatening to block your path of escape Fire Drills… In an effort to provide on going fire safety education, the Engineering Department conducts monthly fire drills throughout both hospitals and campus buildings. Immediately following these drills, staff are asked to participate in a fire safety test & review. This test is a useful tool to identify areas where more education may be needed. An employee from each department is required to complete the Code Red Report Form (located on Intranet) following a drill or actual event. This information is required by DNV and is a useful tool to identify any life safety issues that need to be corrected. Everyone has a role in keeping the hospital a safe place. Hospital security staff has the responsibility to protect staff, patients, visitors & property Employee Responsibilities… Report any suspicious activity or perceived threats Always be aware of your surroundings Do not prop open doors When leaving a secure area, do not allow people to enter Keep valuables out of sight. Do not leave purse, phone, wallet out in areas where people have access For a security escort, please contact the hospital operator and ask for security Parking… Employees may park in stalls lined in white. Yellow parking places are visitor only Do not leave valuables in your car Security Codes… CODE BLUE– MEDICAL EMERGENCY ◦ Call 4444 ◦ Operator pages “Code Blue” overhead three times ◦ Operator initiates group pages to Respiratory, Lab, Pharmacy, Radiology, House Supervisor ◦ All personnel return to your department if code blue in your area ◦ Responding personnel: bring crash cart begin CPR if qualified Patient's nurse to remain in room Bring patient’s chart. In-patient area, bring patient’s chart up on the computer Provide support to family Security Codes… CODE RED- FIRE RESCUE patients in the immediate area Sound the ALARM. Pull the alarm box or dial 4444 CONFINE the fire Close all windows and doors Shut off portable fans Ensure automatic smoke doors are closed If unable to move patient, place wet towel at bottom of door EXTINGUISH the fire if it is small and easily controlled or prohibits the removal of patients Security Codes… CODE GREEN – SECURITY/SHOW OF FORCE A situation that has the potential of becoming out of control and requires security or assistance to prevent injury to patients, visitors or staff. Dial hospital operator at 4444 and designate the area and problem Hospital operator will page “Code Green” and location overhead three times Responding personnel will use non-threatening measures to defuse situation If further assistance is needed, the hospital operator is to notify appropriate police departments Complete Occurrence Report Security Codes… CODE ORANGE – HOSTAGE SITUATION If you identify a hostage situation you should: ◦ Dial 4444, request a Code Orange, give the location and stay on the line, Operator will call 911 ◦ Secure the immediate area and remove all personnel to an area that is safe and secure ◦ Write down everything, keep a log ◦ Do not talk with media ◦ Follow instructions from police, once they arrive Security Codes… CODE YELLOW – BOMB THREAT The person receiving the bomb threat should: Keep the person talking Stay calm Get another employee to dial 4444 and tell the operator to announce overhead three times “Code Yellow” Give location Ask: Where is it? What time is it set to go off? What does it look like? What is the explosive? Where was it placed? Why was it placed? Security Codes… CODE PINK – INFANT ABDUCTION There is a Security System (HUGS) in place and newborns are banded at birth. Should a newborn be removed from the unit without the band being deactivated, an alarm will automatically trigger and the hospital operator will call a “Code Pink”. Nursing staff will immediately obtain a head count of all babies Question mother of the missing baby regarding possible location Hold all personnel until released by law enforcement Other staff will go to their pre-assigned areas to watch and check all people attempting to leave the hospital Security Codes… CODE PINK – INFANT ABDUCTION Cautiously detain individuals: (continued) Carrying a baby With large bags Wearing baggy coats or anything else that could hide a baby If person insists on leaving, observe them from a distance noting their description, direction of travel and description of car and license number. Give this information to the police or hospital security Security Codes… CODE ADAM – MISSING CHILD When a parent or guardian notifies an employee that this/her child, either a pediatric patient or pediatric visitor, is missing in the hospital ◦ Obtain a detailed description of the child including: Name and age Hair and eye color Weight and height What the child is wearing, including shoes, as abductors don’t usually change shoes if they redress the child ◦ Location where child was last seen ◦ Operator will announce “Code Adam” overhead three times Security Codes… CODE ADAM – MISSING CHILD ◦ Staff will: (continued) Completely search their immediate area and adjacent area Monitor pre-assigned doors to make sure the child does not exit hospital Other hospital staff will begin searching the other areas of hospital ◦ Cautiously detain individuals who have a child fitting the description Ask person to wait for management to arrive If person insists on leaving, observe them from a distance noting their description, direction of travel and description of car and license number Give information to police and hospital security Security Codes… CODE GREY – SEVERE WEATHER The Safety Officer or designee will call the code when information is received that severe weather is approaching ◦ Staff will do the following: Draw blinds Pull all drapes and curtains Provide patients with pillows Assist patients to safe areas Move all visitors and other staff to interior hallways Security Codes… CODE SILVER - ACTIVE SHOOTER/KILLER How to respond when an active shooter/killer is in your area: Evacuate. Have an escape route and plan in mind. Leave your belongings behind and keep your hands visible Hide Out. Hide in an area out of the shooter’s view. Block entry to your hiding place and lock the door. Silence your cell phone Take Action. As a last resort and only when in imminent danger, attempt to incapacitate the shooter/killer. Act with physical aggression and throw items at the active shooter/killer Upon arrival of law enforcement: Immediately raise your hands and spread your fingers Allow law enforcement to take control of situation Security Codes… CODE BLACK – DISASTER Code Black may be called if it is anticipated patients will be arriving at the hospital in sufficient numbers or with injuries of such magnitude that their care cannot be handled within the context of normal hospital functions A Code Black will be determined by Administration, House Supervisor, ED Director or Charge Nurse Dial 4444. Operator will announce overhead “Code Black” three times Unit Directors, Supervisors or Charge Nurse report to command center Prepare for evacuation Security Codes… CODE PURPLE – STROKE PATIENT If you suspect stroke with a patient, look for the following: ◦ Facial droop – Ask patient to smile and look for unevenness or drooping of one side of face ◦ Arm drift – Ask patient to lift both arms at shoulder level, if one arm is hanging lower or drifts downward ◦ Inappropriate speech – Watch for confused garbled speech or slurring of words ◦ Dial 4444, request a “Code Purple” ◦ Operator will announce overhead “Code Purple” and initiate Group pages to team members Security Codes… CODE STEMI – STEMI STEMI stand for ST segment elevated MI. This code is called from anyone coming into the ED (or inpatient) having a myocardial infarction. Because time is of the essence with these patients, when a code STEMI is called, a designated team is notified. ◦ Dial 4444, request a “Code STEMI” ◦ Operator will announce overhead “Code STEMI” and initiate Group pages to team members Security Codes… Refer to the Disaster Reference Cardex in each department for all code definitions. Definitions can also be found on the back of employee badge. Check with your department director to know your role in each code. Equipment and Electrical Safety… Grounding is the single most important principle in electrical safety Never use a piece of equipment that is not equipped with a ground plug Never use electrical equipment when the ground prong is loose or broken. Frayed or damaged electrical cords should not be used All electronic devices & equipment should be visually inspected for any damaged cords or parts If a “tingle” or shock is felt, unplug the equipment and report to your supervisor or the Engineering Department When disconnecting electrical cords from wall, grasp the plug and gently pull. NEVER grab the power cord and yank it Arrange equipment cords and cables away from foot traffic Protect cords and cables from liquids and sharp objects Red electrical outlets provide emergency power. Ensure critical equipment is plugged into the RED emergency outlets All hospital medical equipment is maintained by the hospital’s Clinical Engineering Department All hospital mechanical equipment such as HVAC, generators, electrical, plumbing, stretchers and wheelchairs are maintained by the Maintenance Department To avoid patient harm, suspected problems with equipment should always be reported Never use water or a water fire extinguisher to fight an electrical fire Hospitals are challenged with maintaining a safe building and environment. Employees play a vital role in keeping the hospital safe. Employees Responsibilities: Keep hallways free of clutter and equipment Do not use space heaters Boxes are not to be stored on floor Storage is to be kept at least 18” from ceiling Dress for the weather to avoid slip and falls Live trees and natural wreaths are not allowed in hospital Jordan Valley Medical Center/Jordan-West Valley’s administration and staff members recognize the health hazards caused by tobacco products. As a healthcare campus, JVMC/WVC is committed to the establishment and enforcement of a healthier, tobacco-free environment. Initial Inspection of Equipment ◦ Includes ALL equipment that is used on a patient, regardless of ownership. Physician Owned Rentals Leases Demonstration Patient Owned Medical Equipment ◦ We Perform Electrical Safety checks to protect you and the patient During Preventive Maintenance Checks, we: ◦ ◦ ◦ ◦ Inspect for damage Inspect for proper operation Calibrate the equipment Replace worn parts Perform Repair Services ◦ Common problems can include: Equipment is unplugged Equipment is turned off User does not know how to use it Using Bad probes and/or accessories Equipment is actually damaged The Magnet is always on To report a Broken Piece of equipment: ◦ Use Web Link and/or ◦ Inform your supervisor ◦ Call the Service Coordinator (JVMC x 4213) or Biomed (WVC x3801) with: Biomed Control Number or Asset Number YOUR name, so we can ask you questions Description of the problem. “Broken” causes delays Location of the equipment, where we will find it If you move it, we will come, but cannot fix it. Clinical Engineering Users Responsibilities: ◦ Verify equipment does not need to be inspected. Should have label: ◦ Inspect unit before use: Frayed cables Missing/Broken accessories Proper operation Clinical Engineering Users Responsibilities: ◦ Inform supervisor/Director if a problem is found. ◦ Call Biomed (x3153 or x3801), if in doubt. Clinical Engineering Equipment Failures: ◦ If there is patient harm caused by failed Medical Equipment, it MUST be sequestered Leave unit plugged in, if possible Disconnect from patient, and keep any disposables used Put sign on it “Do Not Use” Inform your supervisor Call the Service Coordinator (JVMC x4213) or Biomed (WVC x3801) immediately ◦ An investigation of the state of the equipment will be made Clinical Engineering Electrical Safety: ◦ EVERYONE is susceptible ◦ Frayed, Damaged cords can cause serious harm ◦ Requires periodic inspections The Magnet is ALWAYS ON!!! When in Doubt, Call Biomed! Klay Kunz Regional Compliance Director IASIS’ Compliance Program It is every employee’s responsibility and duty to report possible or suspected wrongdoing that violates the IASIS’ Standards of Conduct or any regulation that governs our organization. IASIS’ Compliance Program [DATE] GC.009, Duty to Report Potential Compliance Violations, supports an environment that encourages an obligation to immediately report wrongdoing through the Chain of Command or IASIS AlertLine. Individuals are protected from retaliation and retribution when reporting potential compliance violations. IASIS’ Standards of Conduct We relate to people ethically and responsibly… IASIS’ Standards of Conduct Relating to fellow employees: Treat others with respect and dignity No tolerance for sexual harassment Communicate honestly Avoid discrimination in hiring practices Adhere to Standards of Conduct Follow appropriate chain of command Relating to communities: Relating to patients: Provide compassionate, prompt and professional care Provide high quality healthcare indiscriminately Treat all emergency medical conditions Protect patient confidentiality Uphold patient advance directives Relating to vendors: Provide health education & resources Treat objectively, honestly & fairly Volunteer in community activities Select for objective business reasons Represent IASIS accurately & honestly Adhere to terms and conditions of contracts; keep information confidential Refrain from fraudulent activities or improper practices IASIS’ Standards of Conduct Examples of Gross Misconduct Socializing with prospective, current or former patients Abusing a patient emotionally or physically Engaging in sexual activity Using abusive or provocative language in the presence of the patient and/or family members Using a form of restraint not physicianprescribed Failing to maintain confidentiality Accepting from or exchanging gifts with a patient Offering unprescribed drugs or alcohol to a patient Challenging physician orders or criticizing physician care in the patient’s presence IASIS’ Standards of Conduct When to get help: Where to get answers: Is the action legal? Is it the right thing to do? If I do it, will I feel bad? Will it have a positive impact on our patients, co-workers, or the company? Would I be proud to tell others what I did? How will it look in the newspaper? Read our Standards of Conduct Get on-line at iasishealthcare.com Talk with your Supervisor Talk with your facility’s HR personnel Talk with your facility’s Regional Compliance Officer Contact the Corporate Compliance Officer @ 615.844.2747 Contact the IASIS Legal Department @ 615.844.2747 Call the AlertLine @ 1.877.898.6080 Employees and personnel will not be subject to retaliation or retribution for asking questions, expressing concerns or sharing information about situations that may be in violation of the IASIS Standards of Conduct. Anyone who engages in a deliberate act of retaliation or retribution will be subject to disciplinary action, including termination if warranted. A review of HIPAA Privacy, ARRA, and HITECH What is HIPAA, ARRA & HITECH? • HIPAA is the Health Insurance Portability and Accountability Act of 1996 (HIPAA). – April 14, 2003 – federally mandated deadline for privacy regulation compliance • ARRA is the American Recovery and Reinvestment Act of 2009 – Signed into law on February 17, 2009 • HITECH is the Health Information Technology for Economic and Clinical Health Act – Title XIII in the ARRA A Covered Entity may not use or disclose protected health information (PHI) unless HIPAA allows it ◦ A patient’s individually identifiable health information is protected ◦ PHI may be oral or written or in any form ◦ Information that identifies an individual and relates to Physical, mental health or condition of the patient Care provided to the patient Payment for healthcare A Business Associate may not use or disclose PHI unless it is permitted by the terms of its business associate agreement with a Covered Entity A Covered Entity may use and disclose protected health information for treatment, payment and healthcare operations purposes without obtaining a patient’s written authorization Otherwise, a Covered Entity must: ◦ Have a signed authorization, or ◦ Meet a HIPAA exception HIPAA Privacy • Our hospitals, including employees and physicians, must continue to comply with the HIPAA privacy rule Breach Examples • Inappropriate access of patient information – Accessing paper or electronic records which are not required to perform your job – Accessing more than is required to perform your job – Applies to employees, physicians, business associates, etc. • Inappropriate use of patient information – Uses which are outside of one’s job scope • Inappropriate disclosure of patient information – Misdirected faxes containing sensitive information sent outside of the facility – Incorrect PHI provided to a requestor or patient – PHI removed or stolen from an office, briefcase, etc. Timely Notification • Appropriate notifications must occur within specific timeframes; therefore, it is very important that employees promptly report a known or suspected HIPAA violation to any the following: – Supervisor / Manager (chain of command) – Regional Compliance & Privacy Officer – IASIS AlertLine Higher Civil Penalties Violation category – Section 1176(a)(1) Each Violation All such violations of an identical provision in a calendar year Covered entity did not know $100 - $50,000 $25,000 Covered entity had reasonable cause $1,000 - $50,000 $100,000 Covered entity acted with willful neglect, corrected $10,000 - $50,000 $250,000 Covered entity acted with willful neglect, not corrected $50,000 $1.5 million Criminal Penalties Apply to Employees • Criminal penalties – Now apply to individuals (including employees), not just the hospital or covered entity HIPAA Privacy Practices • Never obtain, access, or disclose patient information unless you are authorized to do so. – Being a hospital employee does not mean you are “authorized” to access patient information – you must have a valid business reason – If you need access to your own patient records, you must go through the same routes as any other patient of the facility (request records from the H.I.M. Department or Business Office, as applicable) – Accessing or reviewing patient information without a valid reason is a breach of the patient’s privacy – If you are authorized to obtain, access, or disclose patient information, do not share this information with unauthorized individuals (hospital peers who do not have a “need to know” or family members, friends, etc.) – “Snooping” in a patient’s medical record is not tolerated by IASIS and will be promptly addressed with strict corrective actions, which may lead up to or include termination HIPAA Privacy Practices • Alleged abuse of any IASIS system is grounds for suspension of an employee and deactivation of systems access until a thorough investigation is completed • Confirmed abuse of any IASIS system is grounds for permanent loss of access and/or other immediate disciplinary actions, as deemed appropriate • In all cases, we must limit the amount of protected health information we use, disclose or request to the minimum necessary required to perform the task Disciplinary Action • You are personally responsible for the access of any information using your login and password • You are in violation of IASIS policies and subject to disciplinary action if: – you access information that you do not need to perform your job, or – allow someone else to access information using your login information whether they are authorized to view that information or not, or – you fail to immediately notify the Regional Privacy Officer or your Facility’s Information Security Officer / I.S. Director if you are asked to share login or password information How Can You Protect Patient Privacy? • Don’t discuss confidential patient information with coworkers in public areas (elevators, cafeteria, etc.) • Do hold conversations with patients and families in private areas, when possible • Don’t assume someone else will report a known or potential HIPAA violation…it is each employee’s responsibility to report • Do file medical records or patient information, in patient care areas, in such a way to avoid observation by patients, visitors, or unauthorized staff How Can You Protect Patient Privacy? • Don’t position computer monitors where the information may be seen by visitors • Do remember to lock your computer screen when it will be left unattended • Don’t leave confidential patient information on an unattended printer, a copy machine, or a fax machine • Do use limited patient information on departmental white boards • Don’t toss any paperwork containing patient information in the regular trash, including reports, handwritten notes, lab reports, patient labels, etc. -- dispose of this information in a designated shredding bin How Can You Protect Patient Privacy? • Don’t release a patient’s medical record or medical information unless you are authorized to do so • Do check forms to be sure they contain the name and other information pertaining to the correct patient for which they will be used • Don’t discuss confidential patient information with your spouse, your neighbor, or your friends – what happens in your facility, stays in your facility • Do report misuse of confidential patient information to your Supervisor, to the Regional Compliance & Privacy Officer or to the IASIS AlertLine How Can You Protect Patient Privacy? • Don’t forget, it is your responsibility to maintain patient confidentiality and privacy at all times (not just when you are in the facility) – Sharing information, descriptions, or pictures of patients, their family members, etc., on Facebook, Twitter or other social media is inappropriate and will result in appropriate sanctions How Can You Protect Patient Privacy? • HIPAA violations or breaches may be prevented if employees will use caution when appropriately accessing, using, or disclosing protected health information (PHI) • Additional HIPAA / HITECH information will be presented by your Regional Compliance & Privacy Officer in the near future, as we are currently awaiting several updates from the federal government • Do your part to protect our patients’ privacy…it’s the right thing to do! Information Security Information Security, HIPAA Security, HITECH H.B. 300 2012 Protection of the Confidentiality, Integrity and Availability (CIA) of sensitive and critical data against unauthorized access, modification and destruction Personal information such as names, addresses and social security numbers could be at risk Patients trust us to protect their health information Our reputation is on the line It’s the Law – HIPAA/HITECH, Sarbanes Oxley, PCI, etc. …Corp. agreed to pay $1 million and take corrective action in a pair of settlements with HHS' Office for Civil Rights involving violations of the privacy provisions of HIPAA …Corp. agreed to pay $2.25 million in HIPAA privacy violations Regulators fined a Hospital $250,000 for failing to keep unauthorized employees from snooping in medical records The HIPAA Security Rule establishes national standards to protect individuals’ electronic personal health information that is created, received, used, or maintained by a covered entity. The Security Rule requires appropriate administrative, physical and technical safeguards to ensure the confidentiality, integrity, and security of electronic protected health information. Our Hospitals must protect: ◦ Computer hardware, software and medical equipment ◦ Buildings/areas that house computer hardware, software and medical equipment ◦ Storage and disposal of data and the back-up of data ◦ Who has access to data Special care and attention must be administered when using medical equipment, computing systems, and all portable media during and after accessing patient information (i.e., Physician Portal, Star, HPF, etc.) HITECH extends the complete Security Provisions of HIPAA to business associates of covered entities ◦ Extension of civil and criminal penalties Provides new breach notification requirements ◦ requires HIPAA covered entities to report data breaches affecting 500 or more individuals to HHS and the media, in addition to notifying the affected individuals Unauthorized access to any system containing ePHI Providing ePHI to non-workforce individuals without proper authorization Sending ePHI to your personal email account (i.e., gmail, yahoo, etc.) Stolen unsecured laptop storing unencrypted ePHI on hard drive Stolen unsecured external media (i.e., PDA/Smart Phones, Magnetic tapes, CD/DVD’s, USB External Flash (thumb) Drive, Compact Flash/Secure Digital, etc.) storing unencrypted ePHI Criminal penalties now apply to covered entities and workforce members! Electronic Protected Health Information (ePHI) is PHI created, received, stored or transmitted electronically, such as: Digital Radiology Electronic Medical Record Electronic Billing Information The HIPAA Security Rule covers all electronic media including, but not limited to: ◦ ◦ ◦ ◦ ◦ ◦ ◦ ◦ Computer networks Desktop computers Laptop computers PDA/Smart Phones Magnetic tapes CD/DVD’s USB External Flash (thumb) Drive Compact Flash/Secure Digital PCs, mobile devices such as PDAs, Smartphone's, laptops, digital cameras, flash drives or other devices containing confidential information or electronic PHI must be kept secure ePHI must be removed from these devices as soon as the need to perform a required job function is complete All confidential information is best kept on network storage space provided by Information Technology (IT) and accessed only when needed Encryption and passwords must be used to protect ePHI Personal devices are NOT approved for use in transmitting patient information (i.e., texting between employees or physicians, taking photographs of patients, etc.) Contact your local IT department for assistance Portable media with confidential information, such as: ◦ Laptop computers ◦ PDA/Smart Phones ◦ CD/DVD’s ◦ USB storage media (i.e., compact flash, multimedia, secure digital, etc.) Must be kept with you or locked up in a safe location (e.g., locked drawer or file cabinet) If you MUST leave any of these items in your car, your trunk is your best choice (store items prior to reaching your destination) Choosing a compliant password and keeping it secure are two of the most important steps you can take to protect electronic information Passwords should be: ◦ A minimum of 7 alpha (upper & lower case) & numeric selection ◦ Includes symbols or special characters when possible ◦ Based on something besides personal information so that it cannot be easily guessed or obtained Do not use names of family members or pets Do not use any word in the dictionary Keep your password private Do not share your password with anyone Do not write your password on a sticky note Do not reuse old passwords Do not use your company passwords on web sites (e.g., bank accounts, shopping, etc.) Do change your password every 90 days If you believe someone has inappropriately used your user ID or password, change your password immediately and notify your FSO or Information Systems (IS) department If you notice other security policy violations contact your FSO or IT department A incident is the act of violating an explicit or implied security policy, such as: ◦Unauthorized access of sensitive information ◦Unapproved file modification ◦Critical files deleted Report any real or suspected security incidents to your FSO or IT Department immediately You are personally responsible for the access of any information using your user ID and password You are in violation of IASIS policies and subject to disciplinary action if you: ◦ access information that you do not need in order to perform your job, or ◦ allow someone else to access information using your user ID and password information whether they are authorized to view that information or not Limit the amount of patient information included in e-mails to the minimum necessary Incoming and outgoing e-mail, plus attachments, are scanned for malware prior to delivery Keep in mind: ◦ Be suspicious of messages appearing more than once in your mailbox ◦ Be cautious about opening email and attachments, giving out personal information, or altering computer configurations based on message content ◦ Never respond to spam (do not try to unsubscribe!) as this only verifies your email address as active and more spam will be delivered ◦ Delete spam and other questionable email IASIS installs virus protection software on all computers Do not bypass or disable the virus protection software Do not open e-mail attachments with a suspicious file extension or from anyone you do not know Do not download software from the Internet to your computer If you detect or suspect malicious software or a virus on your computer, immediately notify your FSO or IT Department Is essential so that others cannot use the computer under your user ID and password. This can result in unauthorized access to confidential information, such as, ePHI. (remember, you are responsible for all access and activity logged to your user ID) When leaving a computer unattended, you must: ◦ Use “ctrl / alt / delete” and select “Lock Computer” or “Log Off”, or ◦ Use the “Lock Workstation” icon on the desktop IASIS computer systems must be physically secured at all times Rooms housing computer servers must be kept locked (badge strike and biometrics locks provide entry auditing capabilities) Server location should be evaluated according to risk associated with unauthorized access and environmental threats and hazards (e.g., flooding, hurricanes, tornadoes, etc.) Electronic PHI, and other confidential information, on computer system hard drives and external storage media (including copier, fax, scanning devices) must be removed before hardware or external media is disposed of or made available for re-use Contact your local IT Department regarding additional information on ePHI data removal and disposal of computer-related equipment Do lock portable media in a secure receptacle with limited access to those with a need to use in performing their job duties Do keep your laptop with you or lock it in a secure receptacle Do keep your password a secret (only known by you) Do lock your workstation when leaving your work area Do notify the IT department prior to using your personally owned computing device Do ensure that the email address or fax number is correct when sending sensitive information Do protect and handle ePHI as if it were your own Do report security incidents to your FSO (IT Director) Do Not allow other individuals to utilize your user ID and password to access the network and applications Do Not allow unauthorized individuals to watch over your shoulder while you are logging into the network or working with ePHI Do Not leave your laptop visible in your vehicle (put it in the trunk PRIOR to arriving at your destination) Do Not allow physical or logical access to ePHI by unauthorized individuals YOU and your actions are the most important part of keeping our sensitive information secure! Security & IT policies and procedures are located on the I-REPP policy management system under “IASIS Corporate Division” within the “Security” & “Information Systems” manuals If you have any questions regarding your part in information security, contact your FSO or IT Department Thank you for your time and assistance! Keith Poulsen Radiology Director Time – quicker exposure means less radiation Distance – the greater the distance equals less radiation Shielding – lead aprons, thyroid shields NRC Regulatory acronym for “as low as reasonably achievable,” which means making every effort to maintain exposures to ionizing radiation as far below the dose limits as practical. Dosimeters – Badges that record radiation exposure Monthly/Annual reports Pregnant workers – Fetal badges Fetus is very radiosensitive Education/Awareness Warning Signs in MRI No metal objects in restricted area Ask the MRI Tech to answer any questions or concerns Scott Croft Laboratory Director Jordan Valley Medical Center and Jordan-West Valley are working hard to protect you against the dangers of hazardous materials. In addition the Occupational Safety and Health Administration (OSHA) have issued the “Hazard Communication Standard.” This rule states you have a “Right to Know” what hazards you may face on the job and how to protect yourself. Infectious substances Flammable liquids and gases Radioactive materials Toxic Chemicals Hazard communication starts with the chemical manufacturer. Each company that makes or imports chemical must evaluate the possible physical and health hazards of each substance they make. This information is found in two places: 1. The container labels, and 2. Material Safety Data Sheets (MSDS), information which can be accessed by calling the phone number listed on each phone through out the hospital. There is one master copy of the MSDS for each facility kept in the clinical laboratory departments. The Laboratory Director is also the Hazardous Materials Coordinator for the facilities. The name of the chemical. The name, address and emergency phone number of the company that made or imported the chemical. The physical hazards. Storing or handling instructions. Identify the chemical or substance that was spilled. Secure the area as much as possible until security can arrive. Call the MSDS Faxback Service telephone number 1-866-990-2522, to obtain a MSDS and contain the spill following the directions on the MSDS. Alert the hospital operator who will notify members of the Spill Assessment Team who will assist with exposures and spill clean up. members of the team will be contacted accordingly: - Security Officer: anytime weekends and holidays - Department Director where spill occurred: M-F 0700-1900 - House Supervisor: 1900-0700 M-F, and anytime weekends and holidays - Housekeeping: anytime weekends and holidays - Hazardous Materials Coordinator (Lab Director): anytime - Safety Officer (Facilities Director): anytime Remove patients and personnel exposed to hazardous materials and assist them to the Emergency Department if necessary. Evaluate how to appropriately clean up the spill as directed by the MSDS using appropriate personal protective equipment and items from the spill cart. Contact the Hazardous Materials Coordinator and the Safety Officer to obtain additional help for spills unable to be cleaned up using the items on the spill cart. Dispose of the substance as directed by the MSDS. Document the incident on a Chemical Spill Report Form and send the report to the Hazardous Materials Coordinator. Physical Neglect Emotional or psychological Sexual Exploitation – Dishonest use of person’s resources such as money or property Children Domestic partners both male and female Elders Other vulnerable adults (Those with mental or physical impairments.) More than 3,114 men, women, and children entered shelters in FY 11 to escape domestic violence There has been an increase in the number of days and the length of stay in shelters. . Of the total number of Child Protective Services cases (CPS) that include an allegation of domestic violence in the presence of a child, 33% are substantiated/supported cases Of the substantiated/supported CPS cases, domestic violence is the most supported allegation at 33% and sexual violence is the second most supported allegation at 22% . *Statistics from www.nomoresecrets.utah.gov. Recent trauma history Bilateral or multiple injuries Unexplained injuries Delay in seeking medical care Physical injury during pregnancy especially on breasts and abdomen Behavioral cues such as depression, suicide ideation, anxiety, sleep disorders panic attacks, symptoms of posttraumatic stress disorder, substance abuse problem Overly protective, controlling partner, or a partner who refuses to leave patient Direct or indirect references to abuse Defensive wounds such as bruises/lacerations on back of forearms, and, etc. Strangulation Injuries caused by sexual violence Patient displays extreme fear or apprehension De-emphasizes the extent of the injury Infants: Disrupted feeding routines Failure to thrive Developmental delays Excessive screaming School-aged: Become aggressive Poor school performance Behavior problems Have somatic complaints Preschoolers: Regressive behaviors Clingy and anxious Decreased willingness to exert their independence Adolescents: Feel shame Become aggressive Exhibit high risk behaviors Run away from home Truancy Lose impulse control Persons who report suspected cases of abuse, in good faith, are protected from civil or criminal liability in the State of Utah. Reporting in “good faith” means the reporting person has reason to suspect, to the best of their knowledge, that the person in question is a victim of abuse. Report to immediate supervisor or appropriate authorities based where you work. Find out your specific departmental procedure for reporting. Healthcare providers are classified as mandatory reporters of abuse by the state of Utah Child abuse – a mandatory reportable crime Commission of domestic violence in the presence of a child is considered child abuse and must be reported Elderly/disabled person abuse – a mandatory reportable crime Any assault (call local law enforcement or 911) If an adult patient presents with an injury inflicted by another person with a weapon , they are required by law to report to the authorities HIPAA permits covered entities to disclose protected health information about whom the covered entity believes to be a victim of abuse, neglect, or domestic violence After a report is made, health care providers are mandated by HIPAA to inform the patient of the report UNLESS in their professional judgment, they believe informing the individual would place them at risk of serious harm. Detailed description of persons involved Findings – photos - take photos of all injuries- must obtain consents Label the photos with the patient's name, location of the injury, date, time, and your signature. Body maps are used to accurately document bruising, scars, red marks, and other injuries. When completing a body map, provide as much detail as possible, such as the size and color of the injury. Referrals made including to which Dr. Treatments given Reasons for suspecting abuse Name and badge # of officer bringing in Direct quotes from patient or family better than subjective opinions • Have the patient memorize a domestic abuse hotline number or ensure that she has it readily available. • Help establish a safe place to go and a plan for how to get there. • If the patient is living with the abuser, discuss how she can prepare to leave home quickly when ready or when necessary. • Tell the patient where medical care can be obtained if she is injured or experiences pain after being attacked. • Encourage the patient to notify police when subjected to dangerous circumstances or domestic abuse. • Instruct the patient on how to obtain a restraining order or a protection from abuse order and to always have a copy of the order readily available. • Advise the patient to have the locks at home changed and to have additional locks installed if extra security is needed. • Notify your supervisor and the proper authorities, following the protocol established by your facility and your state laws, if you suspect that abuse has occurred. Routinely screen female patients for abuse. Intervening on behalf of women is an active form of preventing child abuse Ask direct questions Document your findings Assess safety of victim and children. Help the patient reduce the danger to herself and her children when the patient is discharged. Review options and referrals. Take time to talk about options available to the patient and the patient’s family. Give the victim written information if she feels that it is safe to do so. Lippincott’s Nursing Procedures and Skills www.nomoresecrets.utah.gov. At Jordan Valley Medical Center and Jordan-West Valley, we care for and interact with people of all ages. Although needs and abilities vary from person to person, there are some commonalities in the various age groups. Knowing what these are and understanding them will be helpful in more fully meeting the needs of the patients we serve, regardless of what job is performed at the hospital. Infants like: Touch Talking Musical Toys Peek-a-boo/Patty Cake (6 months-1yr) Being read to (6 months-1 yr) Music (6 months-1yr) Diet: Breast milk or formula 6-8 times/day or on demand Begin solid foods at 4-6 months Teething begins by 6 months Doubles birth weight by 6 months At risk for dehydration Pain: Remember painful experiences after 6 months of age Need to be medicated for pain when appropriate Have faster metabolism so pain medications work more quickly Major Fear: Separation Anxiety Encourage parents to stay with infant Bring infant’s favorite toy/blanket to hospital. Newborn infants can generally be soothed with gentle touch and sound Interventions/Health Maintenance: Holding infants during feeding provides warmth and comfort. Physical contact is very important at this age. Teach the parents the importance of immunizations. Encourage parents to seek well child check-ups from their Health Care Provider Childproof hospital room Instruct parents to childproof home Instruct parents on the importance of knowing CPR, the Poison Control phone number, 911 The tongue is the most common airway obstruction. Place infant on back to sleep to prevent SIDS Car seats – place child facing rear of car until they reach 20 pounds. Car seat placed in back seat Observe for signs/ symptoms of child abuse and report to Child Protective services when appropriate Toddlers like: Push/pull toys Dolls Trucks Being read to Music Videos/TV To play by themselves Don’t like to share Diet: Pain: Drink from cup Like finger foods Are finicky eaters Like small frequent meals/snacks Like to feed self Are at risk for dehydration Remember painful experiences Need to be medicated for pain when appropriate Major Fears/Anxieties: Loss of control. Separation/Abandonment Body mutilation. Allow the child as much choice and control as is safe and possible. Maintain home routine Keep normal daily routine if possible. Teach parents the importance of immunizations Encourage parents to seek well child checkups from their Health Care Provider Childproof hospital room Instruct parents to childproof home Instruct parents on the importance of knowing CPR, the Poison Control phone number, 911 Instruct parents in use of car seats placed in back seat Pre-School Age Child likes: Group play Music Videos/TV To dress self Vivid imagination Diet: Like finger foods Like to choose own food Are finicky eaters Like small frequent meals/snacks Are at risk for dehydration Pain Management: Can verbalize pain Distraction techniques Use Smiley Face Scale to determine pain severity. Fears/Anxiety: Separation/Abandonment Body mutilation Dark, monsters Loss of control Health Maintenance: Involve patient in planning and carrying out selfcare activities. Set realistic limits. Teach parents the importance of immunizations Encourage parents to seek well child check-ups from their Health Care Provider Instruct parents on the importance of knowing CPR, the Poison Control phone number, 911 Seat belts while in car Bicycle helmets School Age Child likes: Board/Video games Books Music Art Videos/TV Friends To maintain home routine while in hospital Independence Diet: Allow school age child to choose food according to preference. Interventions/Health Maintenance: Involve patient in planning and carrying out self-care activities. Give sincere praise. Set realistic limits Provide time for school work Wear seat belts, booster seats up to age 8 Wear helmets safely Instruct about: Illicit drugs Abstaining from smoking Protection from firearms Fears/Anxiety: Bodily injury and mutilation Loss of control Failure to meet expectations of important people. An adolescent likes: Increased sleeping/eating during growth spurts To fit in with peer groups. To develop own identity To choose own values To be very independent Privacy Is self-conscious about physical appearance Diet: Reinforce good food choices Fears/Anxiety: Self image Acceptance Loss of control Failure to meet expectations of important people. Intervention/Health Maintenance: Involve patient in planning and carrying own self-care activities Give sincere praise when accomplishes a task or responsibility Provide time for school work If a child is out of school for more than 2 weeks contact school for home tutoring Assess for and instruct in: Auto safety Sport/helmet safety Alcohol, smoking and drug abstinence Depression/Suicide Eating disorders Self esteem issues The Adult has: Multiple roles, look for signs of stress Teach stress management Diet: Reinforce high fiber, low cholesterol diet Fear/Anxiety: Family Loss of control Health Maintenance: Women: Cervical Cancer screening; Breast exams and mammography. Men: Monthly selftesticular exams and PSA Both: Cholesterol checks, Colorectal cancer screening; Sexually transmitted disease, Alcohol in moderation, abstaining from smoking and illicit drug use The Elderly may have: Poor skin turgor Sensitivity to heat and cold Slower cognition Short term memory loss Decreased hearing and visual acuity Diet: Balanced diet with attention to food taste and texture. At risk for dehydration Health Maintenance: Continue to seek guidance from their health care provider Assist with chronic disease management, with special attention to medication The Elderly may have difficulty adjusting to: Changes in family roles; adjusting to retirement and income constraints Death of spouse or friends Their own chronic illness. Fear/Anxiety: Ability to live independently Financial concerns Loss in health, independence, friends, and family How We Communicate… 2012-2013 Compliance Training What is the purpose of Cultural Diversity training? To learn how to communicate with different races, religions and backgrounds To learn what is normal behavior for others unlike ourselves What is the purpose of Cultural Diversity training? To know the importance of treating co-workers, patients, family members and visitors with respect To understand the beliefs, values and faiths of others What is the purpose of Cultural Diversity training? To learn how cooperation and patience can improve the work environment To become sensitive to others and help them feel accepted and welcome To begin working as a team that supports and encourages our differences What is the purpose of Cultural Diversity training? To include and acknowledge everyone and put them at ease To encourage the retention of employees by our inclusiveness What is the purpose of Cultural Diversity training? To maintain a calm environment that treats everyone equally To encourage creativity using everyone’s talents and abilities What is the purpose of Cultural Diversity training? To focus on individual attitudes that impact the well being of patients and family members To accept the differences in behavior patterns and respond What is the foundation for Cultural Diversity? As little children, we were taught The Golden Rule in a variety of settings: “Do unto others as you would have them do unto you.” REMEMBER: This shared value is quoted in countries all over the world in many different languages and dialects and forms the basis of countless religious doctrines. It speaks to us from the world’s point of view. Promoting Cultural Diversity help us in the hospital setting… Cultural Diversity is NOT about promoting ourselves. Cultural Diversity is about showing respect for others. * Every culture is important to our society. Promoting Cultural Diversity helps us in the hospital setting… If each of us treats everyone we meet with kindness and respect, we will all have a part in improving our workplace and changing lives for the better…and that’s good healthcare. We may be different from co-workers, patients, visitors and caregivers in: What we believe What we eat What we say and express What we think about healthcare What we do when a loved one dies Although our differences are more noticeable, there are also subtle ways that we’re alike. We have basic beliefs. We enjoy familiar comfort food. We thrive on relationships and social time. We think family and friends are important. We want to be healthy. Working in a culturally diverse environment requires open communication, sensitivity and a willingness to accept our differences. Summary Regardless of your job, YOU and only you are responsible for your attitude and actions towards co-workers, patients, families and visitors. It is important that each of us becomes more mindful of the feelings of others and more accepting of their beliefs, customs and social behaviors so that we can work together and serve each other within a culturally diverse environment. Cultural Diversity in the Workplace The following web-sites may be helpful: 1. Tanenbaum Center for Interreligious Understanding www.tanenbaum.org 2. Society for Human Resource Management www.shrm.org 3. Race Matters and America’s Religious Diversity www.racematters.org 4. Bahai News: Cultural and Religious Diversity www.uga.edu/bahai/News A culturally diverse environment depends on our communication… Managing Workplace Violence 2012-2013 Compliance Guidance The National Institute for Occupational Safety and Health defines workplace violence as violent acts, including physical assaults and threats of assaults, directed towards persons in the workplace. It is the responsibility of healthcare professionals to recognize a potential for workplace violence, risk factors, preventative measures and techniques for managing situations. HEALTHCARE IASIS The most common forms of workplace violence: Verbal and/or written threats Body language used to threaten or intimidate Physical attacks, either planned or impulsive Use of weapons Hospital areas that are high risk: Emergency Departments Waiting rooms Behavioral Health Units Chemical Dependency Units Gero-Psych Units IASIS HEALTHCARE Risk factors that may contribute to workplace violence: 1. 2. 3. 4. 5. 6. 7. 8. Working with persons that have history of violent behavior, mental health problems or chemical dependency Inadequate security Understaffed; working alone Poor lighting or workplace design, facility and grounds Unrestricted public access to buildings Crowded waiting rooms; long waiting times Patients, family members and visitors carrying handguns or other weapons Lack of trained staff to prevent, respond and report IASIS HEALTHCARE These are warning signs of suspect behavior: Past history of workplace violence and/or domestic violence Discontent or disrespect for authority; angry comments or body language Sudden withdrawal; socially isolated Poor hygiene Paranoid; fanatic behavior Resistance to change; negative Poor attendance; chronic tardiness Fixation with weapons and violent acts Appears to stalk others; enjoys intimidation IASIS HEALTHCARE There are methods recommended to diffuse or resolve potentially dangerous situations: Avoid sudden movements or speaking aggressively Keep a safe distance, allowing physical space for person Suggest a move to quieter area Lay the ground rules – calmly relate consequences of violent behavior Move and speak calmly Use relaxed posture; stand at right angle - not directly facing Encourage conversation Focus attention on the person; appear interested; listen patiently Acknowledge the person’s feelings IASIS HEALTHCARE The goal is to remain calm in all potentially dangerous situations. Consider the following suggested responses to an encounter: Remain calm at all times; avoid expressing anger or impatience Encounter should be close to accessible and unobstructed exit Position yourself at an equal level with person; either sitting or standing, etc. Never give orders or commands, fight or argue Reassure person; point out choices When complaint is true, accept criticism positively When complaint is unwarranted, ask questions for clarification Ask for recommendations to resolve the complaint IASIS HEALTHCARE It’s important to recognize signs that a situation is escalating beyond the control of persons involved. For the safety of all concerned, know how and when to react to prevent harm and ensure everyone’s immediate safety. Obtain assistance from Security or Police, particularly if weapon involved If physically attacked, call for help as loudly as possible If being pushed, pulled or dragged, drop to floor and roll Activate security or fire alarm Send a bystander for help or provide specific instructions IASIS HEALTHCARE Employees and visitors are entering and leaving facility property at all hours of the day and night. IASIS further protects the workplace from any form of violence by providing physical security measures: Separate, secure restrooms for Monitor processes to decrease employees with locks Adequate lighting – inside and outside facility, parking lots, etc. Curved mirrors at intersecting hallways and concealed areas Sign-in procedures with visitor passes; visiting hours policy waiting times Adequate training for Security Officers Ensure all hospital units are staffed appropriately Develop formal process for reporting all incidents IASIS HEALTHCARE Our Human Resources policy, HR.807, defines “workplace violence” as any intentional conduct which is sufficiently severe, offensive or intimidating to cause an individual to reasonably fear for his/her personal safety or for others present in the work environment. Employees should do their part by reporting such acts to an immediate Supervisor, to Security Staff, Human Resources or Administrative Staff as appropriate in the situation. IASIS HEALTHCARE IASIS will make the sole determination of whether, and to what extent, the company will act upon threats or acts of violence. IASIS HEALTHCARE Our STANDARDS of CONDUCT supports IASIS’ commitment to ensure a safe workplace and communicates this responsibility to every employee: Immediately report any violence or threats of violence against a patient, visitor, employees or other person Refrain from possession of firearms or any other type of weapon on company property or any other locations where we may be present in relation to our work Refrain from reporting to work impaired by drugs or alcohol, including drugs prescribed by a physician and over-the-counter medications Refrain from using, selling, purchasing, transferring or possessing illegal drugs or misusing legal drugs while on our property or while performing company business Refrain from inflicting violent acts or making threats, either physical or verbal, to co-workers, patients, visitors, vendors or others on or off our property Do your part to maintain a safe work environment. It’s everyone’s responsibility. IASIS HEALTHCARE Through its response procedures, training, and facility resources, IASIS strives to protect its employees, patients, visitors and others on facility property from all forms of workplace violence. IASIS’ strategy is firmly in place: Written, formalized program for Prevention of Workplace Violence Goals and objectives for prevention provided to employees Management’s communication of zero tolerance for workplace violence Analyze worksite for greatest areas of risk and risk factors and review security measures in place Provide metal detectors Maintain alarms and security devices; periodically test equipment Minimize stress in waiting rooms by designing comfortable, non-crowded areas Create two exits in all counseling areas Jordan Valley Medical Center Jordan-West Valley Campus The Language of Caring ©2010; Wendy Leebov. All rights reserved. www.quality-patient-experience.com Heart-to-Heart Head-to-Head Feeling, Caring, Empathetic Thinking, Doing, Explaining, Fixing When you speak heart-to-heart: Patients and families feel important, cared for, and understood They can hear the head-to-head part much better When you speak head-to-head: The patients and family get valuable information They appreciate your answers and solutions Busy-ness and pressure make people mainly task-oriented. Most communication is from the HEAD, much less from the HEART. The result: Patients and families may view us as uncaring and not tuned in. X “I’m in terrible pain. I want more medicine NOW!” • “I’m so sorry you’re in pain. I want to help.” • • “Let me talk to your doctor and see if there’s something that might work better for you.” “I really want to ease your pain.” 1. 2. 3. 4. 5. 6. 7. The practice of presence Acknowledging the person’s feelings Showing caring nonverbally Explaining positive intent The blameless apology The gift of positive regard The caring broken record It is critically important to quiet your all other thoughts and focus fully on the patient or family member. Acknowledge the patients’ feelings and build concrete skills in communication with empathy and responsiveness to people’s emotion, anxieties and concerns. Nonverbal behaviors can ease or increase anxiety, earn trust and demonstrate caring. Nonverbal behavior speaks louder than words. We do what we do in order to have good patient outcomes. Shows how you can express sincere regret as a way to demonstrate your caring – without taking blame or blaming anyone else. Reinforce the power of expressing thanks, appreciation and admiration to patients and other customers who are stressed, frustrated, anxious or uncomfortable. Handle a difficult, stressful interaction with caring – without becoming defensive or rigid and without losing our composure. Combine the skills into one powerful caring message, leaving our patients feeling safe, relaxed, and willing to communicate, engage and cooperate with their care. Even though we are caring, the people we serve don’t know it unless we COMMUNICATE it. By communicating our caring, we ease patient and family anxiety and enhance their experience. If you had a bank that credited your account each morning with $86,400-with no balance carried from day to day-what would you do? Well, you do have such a bank…time. Every morning it credits you with 86,400 seconds. Every night it rules off as “lost” whatever you have failed to use toward good purposes. It carries over no balances and allows no overdrafts. You can’t hoard it, save it, store it, loan it or invest it. You can only use it – time. Spend it wisely…….. Your patient doesn’t care how much you know, until they know how much you care .
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