Universal Student Hospital
Orientation
A Collaborative Project of the Nassau
Suffolk Coordinating Council of Nursing
Education and Practice and the
Nassau Suffolk Hospital Council Inc.
Effective Fall 2010
Final Copy/Presented to NSHC
7-16-10
Introduction
• This presentation is to be viewed by all student
nurses in advance of beginning their clinical
rotation annually.
• It in no way replaces the site specific information
that will be covered by faculty and or institutional
personnel upon arrival in the institution.
• Each school will send a letter to the individual
hospitals they are using for student rotation
attesting to the fact that the students have
completed the program and scored an 80 or
better on the post-test.
Topical Outline
•
•
•
•
•
Asepsis/Infection Prevention
Culture
Environmental/Fire Safety
HIPAA/Confidentiality
National Patient Safety Goals
– Medications
– Communication
– Environment
Cultural Competence
Culture
• Shared values, beliefs, customs,
symbols
• Learned and passed on
• Provides meaning for group members
existence together
• Road map/blueprint to comprehend
unwritten rules for living.
Ethnicity
Affiliation with a group often linked by:
• Race
• Nationality
• Language
• Common cultural heritage
Ethnocentrism
•
Belief that own cultural group’s belief and
values are:
–
–
•
Superior
Most acceptable
Stems from lack of exposure or ignorance
Stereotyping
• A fixed and distorted generalization
made about all members of a group
• Has negative results
• No attempt to learn about the
individual
Prejudice
• “An injury or damage resulting from some judgment
or action of another in disregard of one’s rights”
Webster’s Ninth Collegiate Dictionary
• Strongly held opinions about some topic or group of
people
• Stems from:
–
–
–
–
Ignorance
Misunderstanding
Past experience
Fear
Discrimination
• Acting on prejudice
• Denying the other person’s
fundamental right.
Confidentiality
And
HIPAA
Confidentiality
• HIPAA - Health Information
Portability and Accountability Act
• PHI - Protected Health
Information
• EVERY patient’s Right
Ethical Issues in Health Care
• Both legal and ethical principles apply in
the delivery of health care, sometimes
leading to conflicts:
• Government Regulations
– PSDA (Patient Self-Determination Act of
1991) – Federal Law
– Patient Bill of Rights – NYS
– Health Care Proxy Law - NYS
Ethical Issues in Health Care
(cont’d)
• Patient’s rights under the law
– Access to medical record
– Patients with disabilities
– Patient Self-Determination Act
• NYS Health Care Proxy Law
• Patient’s Bill of Rights
• Informed Consent
ANA Code of Ethics for Nurses
• Make explicit the primary goals, values, and
obligations of the profession of nursing. The
code serves the following purposes:
– It states the ethical obligations and duties of every
individual who enters the nursing profession;
– It is the profession’s nonnegotiable ethical standard;
– It is an expression of nursing’s own understanding of
its commitment to society.
Infection Prevention
and
Asepsis
INFECTION PREVENTION
TRAINING REQUIREMENTS
• CDC
• New York State Departments of Health &
Education
• Suffolk County Department of Health
• Joint Commission
• OSHA Blood borne Pathogen Standard
• OSHA Tuberculosis Standard
• EPA
MODES OF TRANSMISSION
• Contact
– direct
– indirect
• Droplet
• Airborne
• Common vehicle
• Vector borne
CONTROL OF THE MODES AND ROUTES
OF TRANSMISSION
Infectious Agent
Susceptible Host
Reservoirs
(Person Likely To
Get The Disease)
(Host of Infectious Agent)
P
Portal of Entry
Portal of Exit
(How Infectious
Agent Enters the
Host)
Means of
Transmission
BREAKING THE CHAIN
OF INFECTION
(How Infectious
Agent Travels)
(How Infectious
Agent Leaves
Host)
Antibiotic resistant organisms
•
•
•
•
•
MRSA
VRE
VISA
VRSA
ESBLs
E.coli
Klebsiella pneumoniae
Organisms with Increasing Resistance
Streptococcal pneumoniae
Pseudomonas-Stenotrophomonas maltophilia
Multiply Drug Resistant TB
Clostridium difficile
• Leading cause of hospital acquired
diarrhea
• Antibiotics major factor
• Spore forming
• Difficult to kill – sterilization needed
• Lasts in environment
• Hand washing – alcohol based gel
ineffective
HANDWASHING
• Single most important
component of an Infection
Prevention program
• Hands must be washed with
soap & water when:
– Before and after contact with patients,
body fluids, specimens, and
contaminated or soiled item.
– Between “clean” and “dirty” procedures
on the same patient.
– After removing gloves.
– Before and after performing invasive
procedures.
– After using the bathroom.
– Before eating.
– When your hands are visibly soiled.
– After coughing and sneezing.
ALCOHOL BASED HAND GEL
• The alcohol based hand antiseptic should
adequately wet hands. Allow to air dry.
Alcohol gel is appropriate for hand antisepsis
before and after patient care, except when the
hands are visibly soiled. Do not use if the
patient has C.difficile.
Nurses Nail Care
• Artificial nails, tips, wraps banned.
• Natural nails ¼ inch long past fingertip
• Intact nail polish-all healthcare workers that
have pt. contact.
• Neonatal nursery in Oklahoma babies died,
PSAE infection, CDC, State DOH –tested staff –
genotype for strain done and found 2 nurses, 1
with artificial nails and the other with long nails
had same strain on nails.
Recommended Hand Hygiene Technique

Handrubs
– Apply to palm of one hand,
Rub hands together covering
all surfaces until dry
– Volume: based on manufacturer
 Handwashing
– Wet hands with water,
apply soap, rub hands
together for at least
15 seconds
– Rinse and dry with
disposable towel
– Use towel to turn off faucet
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.
OSHA BLOODBORNE
PATHOGEN STANDARD
• EXPOSURE CONTROL
PLAN
– The Occupational
Health and Safety
Administration
requires the employer
to protect employees
from exposure and
contamination from the
blood and body fluids
of another person.
– The written Exposure
Control Plan is found
in the Infection Control
Manual.

THE PLAN INCLUDES :
- Standard Precautions
- Housekeeping procedures to ensure
cleanliness and sanitation
- Hepatitis B vaccinations for employees at
risk
- Exposure evaluation and follow-up for
exposure incidents
- Hazardous material container warnings
such as biohazard labels
- Confidential, accurate employee medical
records
- Engineering Controls
- Work Practice Controls
- Selection and use of protective clothing
PRECAUTIONS FOR ALL BLOOD AND
OTHER POTENTIALLY INFECTIOUS BODY
FLUIDS
• Standard Precautions
Applies to all patients regardless of diagnosis or
presumed infection status.
Apply to:
- blood
- all body fluids, secretions, and excretions except sweat regardless
of whether or not they contain visible blood.
- non-intact skin,
- mucous membranes
• Assumes that each person is potentially infectious and
contagious.
To protect yourself from exposure, you must
wear Personal Protective Equipment
(PPE)
• Gloves (vinyl & latex)
• gowns(fluid proof, fluid
resistant)
• protective eyewear
• mask(surgical, non-surgical,
respirator)
• All PPE should be removed
IMMEDIATELY and
disposed of according to
Hospital policy.
SEQUENCE OF Prior to entering the patient’s
PUTTING ON
room:
1. Put on protective garments before
AND TAKING
entering the patient's room
2. Put on mask
OFF PPEs
3. Put on protective eyewear (if necessary)
4. Put on gown, tie at neck and back
5. Don disposable gloves
Leaving the patient’s room:
1. Remove protective garments before
leaving the patient's room.
2. Take off gloves, turning them inside out
when removing.
3. Take off gown, turning back into front
so that inside of gown is on the outside.
4. Take off mask or respirator and eye
protection.
5. Discard in clear waste receptacle.
6. Wash hands.
EXPOSURE TO BLOOD AND/OR BODY FLUID
• Needle stick or sharp object injury:
• Wash the area thoroughly with soap and water
• If blood spills or splashes on your hands:
•
•
•




Wash hands thoroughly with soap and water
If blood spills or splashes in your eyes:
Be aware of location of eye wash station
Flush eyes with large amounts of water
Notify your Supervisor
Complete an incident report
Go to the Emergency Department within 30 minutes
of the incident
National Patient Safety
Goals
Reference Source: www.joint commission . org
National Patient Safety Goals
• The purpose of the National Patient
Safety Goals is to improve patient
safety. The Goals focus on problems in
health care, safety and how to solve
them.
Why Performance Improvement?
• The purpose of the Performance
Improvement Program is to do the right
thing at the right time, and for the right
reasons, for our patients.
• The Interdisciplinary Performance
Improvement Program supports hospital
departments and staff in achieving
standards of “Excellence” and Patient
Safety
Dimensions of Performance
Doing the Right
Thing
• Efficacy – Are we
producing the
desired effect?
• Appropriateness –
Are we doing the
proper thing?
Dimensions of Performance
Doing the Right
Thing Well
Are we doing the
right things
• Timely
• Effectively
• Safely
• Efficiently
• With Respect
and Caring
Patient Safety Facts
• Institute of Medicine reported that 44,000
to 98,000 people die in the US hospitals
each year as a result of medical errors.
Medical Error
• Medical Errors happen when something that
was planned as part of medical care doesn’t
work out, or when the wrong plan was used in
the first place
• They can happen during even the most routine
tasks
• Most errors result from problems created by
today’s complex healthcare system; but errors
also happen when we don’t communicate well
The Good News
• Most medical errors are preventable
Nurses – The Patient Safety “Ace”
A – Advocate
C – Caregiver
E - Educator
Nurses the Patient Safety “ACE”
Advocate
Assure that our policies and procedures
are executed as intended
Report unsafe practices
Speak Up for our patients
Coordinate Care
Communicators
Nurses the Patient Safety “ACE”
Care Giver
Practice within our scope of practice
Assess and communicate effectively
Create effective plans of care
Execute our plans of care
Create safe environments
Nurses the Patient Safety “ACE”
Educator
Teach patients & families to participate in their
care
Inform them about their illness
Infection control practices
Medications
Treatments
Safety Precautions
After Hospital Care
NPSG - Improve the Accuracy of
Patient Identification
• Use two patient identifiers when providing care, treatment or
services (administering medications, handling specimens, during
surgery, blood transfusions, procedures and other treatments).
• It is necessary to know what the institution you are in is using as
their two identifiers. Additionally you must know how the institution
handles those who are hearing impaired or non-verbal.
–
–
–
Ask patient to state name and date of birth
Check information against a source document
Utilize the Surgical & Invasive Procedure Protocol
Perioperative Check List and Verification,
Surgical Site Marking,
Time-out
–
–
Specimen Containers are labeled in the presence of the patient
Two persons verify blood transfusions
Never use the patients room number or physical location as an identifier!
NPSG – Improve the Effectiveness of
Communication Among Caregivers
• Telephone Orders and Test Results are written down
and verified with a “Read-back” – get confirmation!
• Do Not Abbreviate: Morphine, Magnesium, Daily, Every
Other Day, Heparin, Coumadin, Unit, International Units,
Both Eyes, and
• Always Use Leading Zeros, Never Use Trailing Zeros
• Measure and Improve the timeliness of reporting and
receipt by the caregiver of Critical Test Results & Critical
Values.
• Standardize approach to “hand off” communication &
includes opportunity to ask and respond to questions;
verifying information was understood
NPSG - Improve the Safety of
Using Medications
• ‘Look-alike/Sound-alike’ drugs used in the
organization are identified & actions taken to
prevent errors involving the interchange of
these drugs.
• Label all medications, medication containers
(e.g., syringes, medicine cups, basins), or
other solutions on and off the sterile field.
Discard unused liquids.
NPSG - Improve the Safety of
Using Medications
• Reduce the likelihood of patient harm associated
with the use of anticoagulation therapy.
–
–
–
–
–
–
–
–
Defined anticoagulation management program
Use oral unit-dose or pre-mixed infusions
Establish monitoring practices
Use approved protocols
Utilize INR for monitoring
Utilize a food/drug interaction program
Assess baseline and ongoing laboratory testing
Staff, patients and families are educated to anticoagulation
therapy
– Anticoagulation Safety Practices undergo evaluation
Reduce the Risk of Healthcare
Acquired Infections
• Comply with current Centers for Disease Control
and Prevention (CDC) Hand Hygiene
guidelines.
• Manage as sentinel events all identified cases of
unanticipated death or major permanent loss of
function associated with a healthcare acquired
infection.
• Implement evidence-based practices to prevent
– health care-associated infections due to multi-drug
resistant organisms in acute care hospitals.
– central line associated infections.
– surgical site infections
NPSG- Accurately and Completely
Reconcile Medication Across the Continuum
of Care
• Obtain and document patient’s current medications upon
admission/entry
• Compare the list to those ordered and resolve
discrepancies
• Communicate a complete list of the patient’s medications
to the next provider of service when transferred to
another setting, service, practitioner or level of care
within or outside the organization. The next provider
checks the medication reconciliation list again to make
sure it is accurate and in concert with any new
medication to be ordered/prescribed.
• The complete list of medications is provided to the
patient on discharged from the organization.
NPSG – Reduce the Potential of Patient
Harm Resulting from Falls
• Implement a fall reduction program that
includes
• An evaluation as appropriate to the
patient, the setting and services provided;
• patient, family and staff education;
• and program effectiveness
NPSG – Encourage patients’ active
involvement in their own care as a patient
safety strategy
• Define and communicate the means for patients
and their families to report concerns about safety
and encourage them to do so.
• Provide patients and families with information
regarding infection control practices
• Describe to patients the methods used to
prevent adverse events in surgery (Universal
Protocol)
• Encourage patients to report concerns
NPSG – The organization identifies safety
risks inherent in its patient population
• The organization identifies patients at risk
for suicide and addressed the patient’s
immediate safety needs and most
appropriate setting for treatment
• The organization provides information
such as a crisis hotline to individuals and
their family members for crisis situations.
NPSG – Improve recognition and response
to changes in a patient’s condition
• The organization selects a suitable method that
enables healthcare staff members to directly
request additional assistance from a specially
trained individual(s) when the patient’s condition
appears to be worsening.
• The organization empowers staff, patients,
and/or families to request additional assistance
when they have a concern about the patient’s
condition.
• Hospitals developed the Rapid Response Team
(RRT) to attend to patients with a change in
condition.
Universal Protocol to Prevent Wrong Site,
Wrong Procedure, Wrong Person Surgery
• Pre-operative verification – active patient identification
with 2 identifiers and source document
• Utilize the pre-operative checklist
• The person performing the procedure should mark the
operative site for procedures involving right/left
distinction, multiple structures (fingers/toes/lesions), or
multiple levels (spinal surgery)
• Conduct a ‘Time Out’ immediately before starting the
procedure – active communication among all team
members to verify patient, procedure, implant and site.
Safety
FIRE Safety
Everyone’s
Responsibility
Environment of Care
• The environment of care refers to key elements and
issues that are significant in how the hospital operates
related to patients, families, visitors and employees.
• Hospitals have a Safety Management Plan that
addresses all Joint Commission, OSHA and NYS
Department of Health requirements.
•
The objective is to free of hazards and work performed
in a safe manner with the have a physical environment
reduced risk of injuries and hazards. This is
accomplished through the EOC Committee whose
purpose is to identify and reduce safety risks at each
hospital.
Seven Areas of Environment of
Care







Safety Management
Security Management
Hazardous Material and Waste Management
Emergency Management
Fire Prevention Management
Medical Equipment Management
Utilities Management
Safety
• Preventing Injuries is the focus of all Hospital Safety
plans.
• If you are injured while in clinical , you should:
• Notify both your faculty member and manager of unit.
Report to Employee Health Services (EHS) if the injury is
not serious and it is during the week.
• If the injury is serious, report to the Emergency
Department after informing your faculty member.
• You must complete an Incident Report form and any
additional paperwork required by your school and return
it to EHS.
• If the injury or accident involves a patient or visitor:
• You must document the incident on a incident report and
the patient’s Medical Doctor should be notified.
Environmental Security
• The Security Program addresses security issues related
to staff, patients and visitors on the grounds of the
specific hospital. As students you are visitors to the
facility and must adhere to all rules and regulations.
• To minimize security risks:
• All students and faculty are required to wear ID Badges
at all times and the ID badge must be visible.
• Please bring minimal personal belongings to the units
and leave valuables at home or locked in your car.
• The Hospital Security staff is visible on the grounds and
conduct routine patrols.
Emergency Codes
•
•
•
•
•
•
•
•
•
•
Each hospital has different Emergency Codes
Your faculty member will review the following:
Medical Emergency
Fire Drill
REAL Fire
Bomb Threat
Abduction of a child
Decon Hazmat Team (Bioterrorism)
SECURITY EMERGENCIES
Internal/External Disasters
Class of Fires
• Class of Fires: A- B-C
• Class A: Fires are ordinary combustibles
(wood, paper, plastic and rubber)
• Class B: Fires are flammable
liquids/chemicals (grease, oil and
petroleum)
• Class C: Fires are electrical fires (TV,
VCR, computers, etc.)
Types of Extinguishers
Types of Extinguishers
A
pressurized water
BC
dry chemical or C02
ABC multipurpose dry chemical
-
Fire Bells
Your response when you hear the fire bells:
• Listen
• Count bells
• Determine location by checking the alarm chart
located above every alarm box
• Listen to the overhead page
• If the fire is in your location, follow the RACE
plan.
• If your area is above, below or adjacent to the
point of origin, close all doors, remove items
from the corridors, have patients return to their
rooms and listen for overhead pages of status of
situation.
Fire Safety
Remove
Patients from danger
Announce
Confine
- Activate Alarm
Close Doors
Extinguish
With Proper Fire Extinguisher
Fire Safety
Pull Pin
Aim @ fire
Squeeze Handle
Swish side to side
Extinguishing a Fire
•
•
•
•
•
•
•
•
•
•
•
•
•
•
How do you extinguish a fire?
The fire extinguisher is your primary means of extinguishing a small fire, but first you
have to identify the type of fire.
Identify type of fire: A, B or C and Identify the size. Extinguish only the small fires.
Select appropriate type of extinguisher. Be sure it is MRI compatible.
Know how to use the extinguisher
P Pull the pin
The small metal pin located near the top of the extinguisher.
A Aim nozzle at the base of the fire
Aim the extinguisher at the base of the fire
S Squeeze the handle
Holding the extinguisher tightly, squeeze the handle of the extinguisher
S Sweep side to side at the base of the fire
Using a sweeping motion, move the extinguisher from side to side. Stand 6 to 8 feet
from the fire when you start spraying.
Customer Service
General Guidelines:
• Introduce yourself and your role
• Make eye contact
• Greet the patient by their surname
• Explain all procedures and actions
• Ask if any further assistance is needed
before leaving the room
• Smile
Define Our Image
•Professional respect begins with having
self-respect and respecting our own
profession
•Value Nursing and project that image
daily
•Take ourselves seriously and dress the
part
•Recognize and promote the value of
what we do
•Believe in ourselves and our colleagues
Professional Image
How is Image Defined?
•Description
•Portrayal
•Attitude
•Popular Conception
– Usually projected through the
Mass Media
The Essence of Nursing
• Nightingale in her Notes on Nursing, wrote,
“nursing’s most important work is caring” (1859).
• Reading Nightingale one is struck by the
simplicity of her message and its continued
applicability to the health care system of today.
• Enjoy your clinical experience this semester and
your future careers as nurses
Complete the following Post-Test
Complete the 20 question post-test found on
the following Slides 72-76.
Fill in your answers on the separate answer
sheet found on Slide 77.
Print out your completed answer sheet and
submit to your clinical instructor.
Nassau Suffolk Coordinating Council of Nursing Education and Practice
Universal Student Hospital Orientation
Name: ______________________School: ____________________
Date: _______________________
Matching: Cultural Competence
1. Culture
2. Ethnicity
3. Ethnocentrism
Please Use Separate Answer Sheet
A. Belief that one’s own cultural group belief is superior.
B. Acting on prejudice and/or denying the other person’s rights.
C. Injury or damage from some judgment or action of another in
disregard of one’s rights.
4. Stereotyping
D. Fixed and distorted generalization made about all members
of a group.
5. Prejudice
E. Affiliation with a group linked by race, nationality, language,
or common cultural heritage
6. Discrimination
F. Shared values, beliefs, customs and symbols that are learned
and passed on from generation to generation.
True/False
7. Ethical issues in healthcare include legal
principles and governmental regulations, but
do not include the ANA Code of Ethics, which
are optional in the acute care settings.
(True/False)
8. Infection prevention strategies include hand
washing and personal protective equipment.
(True/False)
9. Alcohol based hand gel is appropriate for al
situations.
(True/False)
True/False
10. Standard Precautions apply to all patients,
regardless of diagnosis or presumed infection
status.
(True/False)
11. You should always contact your instructor
immediately if you sustain a needle stick.
(True/False)
12. National Patient Safety Goals focus on problems
in healthcare, safety and how to solve them.
(True/False)
13. The National Patient Safety Goals improve
communication among caregivers via a
standardized approach to hand off communication.
(True/False)
True/False
14. According to the National Patient Safety Goals,
all medications should be labeled. (True/False)
15. Fire Safety is everyone’s responsibility and
response to a fire within the health care system
is facilitated by the RACE acronym. (True/False)
16. Patient confidentiality is every patient’s right
and legislature protecting these rights include
HIPPA (Health Information Portability and
Accountability Act) and PHI (Protected Health
Information).
(True/False)
True/False
17. ACE stands for Advocate, Caregiver and Educator.
(True/False)
18. Preventing injuries is the focus of all Hospital
Safety plans.
(True/False)
19. The nursing professional image is enhanced when
nurses value nursing and project that image daily
and promote the value of the nursing profession.
(True/False)
20. Customer service includes greeting patients by
their first names and referring the patients to support
staff for toileting needs.
(True/False)
Suffolk Coordinating Council of Nursing Education and Practice
Universal Student Hospital Orientation
Post-Test
Name: ______________________ School:
Suffolk County Community College
Date: ___________
ANSWER SHEET
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2.____
3.____
4.____
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6.____
7.____
8.____
9.____
10.____
11.____
12.____
13.____
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