2013
Student/Resident
Orientation/Reorientation
&
Mandatory Requirements
1
TABLE OF CONTENTS
Requirements
Badges and Parking
Hospital Leadership
Environment Of Care
Risk management
Infection Control
Employee Notification
Management of Information
Ethics and Compliance
Clinical Practice
Patient Safety
Acknowledgement/Quiz
3-4
5
6
7 - 48
49 - 65
66 - 110
110 - 113
114 - 131
132 - 135
136 - 154
155 – 175
178 - 188
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INSTRUCTIONS
Student Requirements
Background Check Requirements:
All staff, residents, students and instructors rotating through JFK Medical Center
must submit an attestation of a background check. The student background
Screening shall include, at a minimum, the following:
Social Security Number Verification
Criminal Search (7 years or up to 5 criminal searches)
Employment Verification to include reason for separation and eligibility for
reemployment for each employer for 7 years
Violent Sexual Offender and Predator Registry Search
HHS/OIG List of Excluded Individuals/Entities
GSA List of Parties Excluded from Federal Programs
U.S. Treasury, Office of Foreign Assets Control (OFAC), List of Specially
Designated Nationals (SDN)
3
Seasonal Flu:
October begins the official Flu season. All staff, residents, students , interns and
instructors rotating through JFK Medical Center October through March will be
required to provide proof of seasonal flu vaccination.
Only a doctor’s note or documentation by the administrator of the vaccination on
official facility letter head will be accepted.
In the case of an individual who refuses vaccination, (for whatever reason) a
signed declination form must accompany the “Seasonal Influenza Vaccination
Documentation” form indicating that the individual understands the risk to self and
others involved in declining vaccination and their understanding of their
responsibility to wear a mask while in the hospital.
4
Student Badges and Parking:
To allow for available parking for our patients and visitors, all staff, residents, students
and instructors, whose rotations are one month or greater, will be required to park in the
garages. An access badge will be needed to enter the parking garages. Those whose
rotations are less than one month will not receive badges and are required to park in
the very last row of the South Parking lot.
Anyone parking outside of their assigned area will be subject to towing at their expense.
To secure an access badge a check deposit will be required at time of orientation and
be returned when the rotation is over and badge is surrendered.
Tobacco-Free Campus
JFK Medical Center is committed to creating a healthy environment for its employees
and visitors and is now a tobacco-free campus. Smoking is not permitted anywhere on
campus property. We ask for your cooperation and understanding to eliminate the
harmful effects of second hand smoke.
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HOSPITAL LEADERSHIP
Mission Statement
The mission of JFK Medical Center is to be the community provider of high quality
and compassionate healthcare that is responsive to the needs of our patients, their families,
and physicians.
Values Statement
Caring – compassionate, competent, committed ethical treatment for all.
Respect – for the worth, dignity, and potential of all individuals.
Responsiveness – to the needs of patients, families, employees, physicians, and members
of the community.
Results – achieving/exceeding clinical, financial, and patient satisfaction outcomes,
ensuring a high level of value in all services we provide.
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ENVIRONMENT OF CARE
AND
“NEW” EMERGENCY CODES EFFECTIVE
NOVEMBER 1, 2010
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Topics Covered:
Manual Location
Emergency Numbers
Emergency Information
Code Information
Hazardous Material Spills
Fire Response
Evacuation Plan
Hazardous Materials/Hazardous Waste
Radiation Safety
Equipment Management
Utility Management
Safety and Security
Transportation
Environment of Care
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Infection Control/Employee Health Manual:
Located in each department, in the Infection Control Office, Employee Health Office,
and in the Meditech MOX Library.
Emergency Operations Manual
Located in each department and in the Meditech MOX Library. This manual includes
disaster, fire, hurricane, bomb threat, and hostage situation information and what your
responsibilities are in the event of these occurrences.
Hazardous Materials Manual
Located in all Hazardous Materials Emergency Response Team members’ offices and
in the Meditech MOX Library.
Manual Location
**All Manuals can be obtained by the Nursing
Supervisor
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Biomedical Waste Plan: Located in the Infection Control Manual in the Meditech
MOX Library.
Exposure to Communicable Disease Follow-up: Located in the Infection
Control/Employee Health Manual in the Meditech MOX Library under Employee
Health Policies and Procedures, “ Exposure to Communicable Disease Follow-Up.”
Nursing Policy and Procedure Manual: Located in each Patient Care Services
Department and in the Meditech MOX Library under JFK Patient Care Manual.
Policies and procedures in the Meditech MOX Library system are the most up-todate and are constantly being revised when rules, regulations, laws and practices
are changed.
Please contact your department manager/supervisor and ask where these policy
and procedure manuals are located within your department.
Manual Location
10
MANUAL LOCATION
Biomedical Waste Plan
Located in the Infection Control Manual in the Meditech MOX Library.
Exposure to Communicable Disease Follow-up
Located in the Infection Control/Employee Health Manual in the Meditech MOX
Library under Employee Health Policies and Procedures, “ Exposure to
Communicable Disease Follow-Up.”
Nursing Policy and Procedure Manual
Located in each Patient Care Services Department and in the Meditech MOX Library
under JFK Patient Care Manual.
Policies and procedures in the Meditech MOX Library system are the most up-to-date and are constantly being
revised when rules,
regulations, laws and practices are changed.
Please contact the department manager/supervisor and ask where these policy and procedure manuals are
located within that department.
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EMERGENCY NUMBERS TO KNOW
MEDICAL EMERGENCY: Code Blue
Dial “33333” and give room number and area
ALL OTHER EMERGENCIES:
Dial “88888” and give room number and area
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IMPORTANT OFFICE NUMBERS
Infection Control: (548) – 3614, located in the Plant Operations Building, second floor.
Hours: 8:00 a.m. – 4:30 p.m., Monday through Friday. After hours or weekends, call hospital operator.
Employee Health: (548) – 3790, located on hallway across from the Library
Hours: 7:30 a.m. – 4:00 p.m., Monday through Friday. After hours or weekends, call hospital operator.
Environmental Services: (548) – 3780.
Hours: 8:00 – 4:30 p.m., Monday through Friday. After hours or weekends, call hospital operator.
Security and Safety: Ext. 44444;
Hours: Security is operational 24 hours per day.
Risk Manager: (548) – 3430, located on administrative hallway
Hours: 8:00 a.m. – 4:30 p.m., Monday through Friday. After hours or weekends, call hospital operator.
Plant Operations: (548) – 3784
Hours: 7:00 a.m. – 3:30 p.m., Monday through Friday. After hours or weekends, call hospital operator.
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Effective November 1, 2010, all color codes are the same across all
hospitals in Florida.
Look on your unit/area for the “Rainbow Ring” for reference
Badge Buddies with the codes will be given to all employees in
January 2011
EMERGENCY CODES
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EMERGENCY CODES
Code Pink
Code Pink Level 13
Code Blue
Code Green
Code Orange
Code Red
Code Black
Code White
Code Yellow
Code Brown
Code Gray
Infant Abduction –New
Child Abduction-Code Adam
Cardiac Arrest -same
Disaster -Code D
Bioterrorism-Code D200
Fire
Bomb Threat /Code Dr. Search
Hostage/Active Shooter
Facility Lockdown
Severe Weather- Hurricane
Security Alert - Code Dr.Strong
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CODE BLUE-RESPIRATORY/CARDIAC ARREST
Code Blue is called for ALL MEDICAL EMERGENCIES that require a rapid
response. When CODE Blue is called, a team of trained personnel will arrive.
If you are not required to stay with the patient, please leave the area immediately.
Activate
Get
the crash cart
Flatten
If
Code Blue, dial “33333” for the PBX Operator, state the code, and your location
the patient’s bed, put the back board or head board under the patient
the patient is pulseless or breathless, begin CPR
Primary
One
nurse must remain to provide information about the patient
staff member must record the events
Notify
Follow
Primary physician and consulted physicians
directions as authorized by the physician or caregiver in charge
Primary
nurse will ensure that the patient’s family is notified of the event and transfer, if it occurs
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CODE GREEN-DISASTER
Code Green - Disaster Plan
This disaster plan was designed to prepare all employees in the event of an external or
internal disaster. We must be able to provide assistance when required to handle a large
influx of victims regardless of the time, size, character, or duration of the emergency.
Report to your department for instructions and remain there until assigned by the Department
Manager or Supervisor
Patient Care Areas are to assess and report the following information:
Current patient census
Number of probable discharges
Potential number of empty beds
Do not use the telephone or elevators unless absolutely necessary
All questions from the media should be directed to the Marketing Department
Visiting hours may need to be canceled and visitors may be asked to leave the hospital. This
will be at the discretion of the Administrator/Designee or Safety Officer.
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CODE RED- FIRE
Code RED
The operator will call “CODE RED” and give the location of the code.
When Code Red has been activated, it will be your responsibility to
remain calm and perform duties assigned to you. You must maintain
control of the situation. Close all doors, inform patients that we are
having a Fire Drill, move all items out of the corridors to allow for clear
passage, make sure visitors remain in rooms, do not pass through
fire/smoke doors unless instructed to do so, and do not use elevators.
Wait for the “CODE RED RECALL” to be announced before opening doors
or returning to routine activities.
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Fire Response
Fires are only possible when fuel, heat, and oxygen are combined in the fire
triangle. Smoke detectors and automatic fire sprinkler systems are used at JFK
Medical Center to assist in detecting fires. When one of these is activated, an
automatic alarm is sounded and a signal is sent to the switchboard who in turn will
contact 911 and activate the Code Red procedure.
Before an incident occurs:
Review your fire safety policy and procedure
know where the exits are in your department
know the location of all fire alarms in your area
know the location of fire extinguishers in your area
Be alert to possible fire hazards and have them corrected immediate
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If you spot a fire before detectors are activated, do the following:
“RACE”
RESCUE the persons from immediate danger
ACTIVATE the fire alarm closest to you
CONTAIN the fire to an area by closing all doors.
EVACUATE the area if the fire or smoke is beyond your control.
Evacuate to the next smoke compartment
EXTINGUISH the fire if you have been trained to use a fire
extinguisher.
Never attempt to fight a fire that is too big for you to handle!
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When using a fire extinguisher, remember “PASS”
PULL pin from handle of extinguisher
AIM hose at base of the fire
SQUEEZE handle to discharge extinguisher
SWEEPing motion with short bursts
Remember that any staff member may shut off medical gases upon
direction from the charge nurse, nursing supervisor, respiratory
therapist, or cardiopulmonary manager
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If a fire alarm is activated and it is not in your area,
do the following:
Close all patient doors. Explain to patients that a fire drill is in progress
and for them to remain in their rooms.
Clear hallways of visitors
Move all equipment out of the corridor. Make sure that passageways in
rooms and in corridor are not obstructed.
Do not open fire doors unless instructed to do so. Stop traffic except for
Code Red and Code Blue Response Teams.
Do not use elevators
Do not call operator to find out if fire is real
Stay alert and await further instructions
Operator will announce “CODE RED RECALL”. You may resume your
regular duties at this time.
22
CODE ORANGE- BIOTERRORISM
Bioterrorism Response:
If bioterrorism event is suspected, immediate notification should be
given to administration,
Non-Emergency Spill Response
The employee discovering the spill shall take the following action:
Evacuate the area of unnecessary patients and personnel
Contain the spill, seal off the area, protect any drains
Identify hazardous material, safely secure source
Get help, notify your supervisor
Consult the appropriate Material Safety Data Sheet (MSDS)
Decide on a plan of action as per MSDS
Use appropriate Personal Protective Equipment (PPE)
Follow prescribed spill and clean up precautions, use spill kit, if
appropriate
Complete an Occurrence Report on any hazardous spill
Inventory and restock any spill kit used
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CODE ORANGE - CHEMICAL DISASTER OR SPILL
Emergency Spill Response:
If the chemical spill is dangerous and deemed too large, or too hazardous by
supervisory personnel for immediate staff to clean up, notify the Hospital’s
HAZMAT Team through the Operator “88888”.
This code is called if there is a chemical spill. In general, if there is a small
chemical spill (one gallon or less), use proper technique as outlined in the Material
Safety Data Sheet for the specific chemical spilled. For large spills (greater than one
gallon), or if a chemical spill is dangerous and deemed too large or too hazardous
by supervisory personnel for immediate staff to clean up, Call the hospital operator
and explain the type of spill and the operator will notify the Hazardous Materials
Response Team who are trained to use the chemical spill kit. These kits are located
in Plant Operations. Laboratory, Oncology, and Radiation Departments have spill
kits specific to their areas and personnel are trained in managing spills.
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CODE YELLOW-LOCKDOWN
A New Policy Related to the Outcomes of Healthcare Violence Events
It is for the ability of the Safety and Security Department (with
assistance from staff and ancillary departments) to secure the
building immediately
Lockdown will occur by security officers at the main entrances
immediately
Areas that may have high risk potential will also be locked down
Administration
Nursery and Pediatric Units ( if apply)
Emergency Department
Intensive Care Units
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CODE BROWN- SEVERE WEATHER
The Medical Center’s Safety Officer will implement this code
The Incident Commander will retain ultimate authority and control over all operations with the hospital for Stage
3, 2 and 1.
In the unlikely event that evacuation of the Medical Center is necessary, the Incident Commander will make that
determination after consultation with the President of the Medical Staff, PBC-EOC, Director of Security, and Safety
Officer.
Director of Plant Operations and others as he deems necessary.
Evacuation will be to other area hospitals, home and/or shelters which may be available.
Staff support to the DCC shall continue as normally as possible until otherwise directed by the Incident
Commander and Safety Officer.
Each Department Head or Unit Manager is responsible to carry out their department specific plans and support
the DCC actions.
The Safety Officer is responsible for all utility systems and structural damage assessments and operations.
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Formerly Code Dr. Strong
Situation where security is needed for combative /violent patient
Any threatening situation can prompt a call
Call Operator (PBX) at “88888”
State that you need a Code Gray
Give name and location or patient room
Police assistance may also be needed as determined by the Security
Department
CODE GRAY –SECURITY ALERT
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Hostage - a person being held by force by one or more individuals.
Hostage situation is a person being held by force, by one, or more individuals
Active
Shooter - an individual or person actively engaged in killing or attempting to
kill people in a confined and populated area
Call 88888
Evacuate
Hide
if at all possible in same place if not safe to relocate
Remain
Protect
If
if immediate threat in your location
as calm as possible
patients
shooter is in the building and not an immediate threat to you, stay in place
CODE WHITE - HOSTAGE /ACTIVE SHOOTER
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This code is activated when a call or note that a bomb has been planted
somewhere in or around the Medical Center is received. The operator will
announce “CODE BLACK – ALL EMPLOYEES RETURN TO YOUR
DEPARTMENTS OR WORK STATIONS”.
If you are the one to receive the threat, do the following:
◦ have someone else call the operator;
◦ keep the caller on the line as long as possible;
◦ listen for background noises, accents, speech patterns;
◦ attempt to determine if the person has knowledge of the Medical Center
◦ ask where the bomb is and when it will explode.
Review your department-specific policy for your duties so you know what to
do when this code is activated.
Code Black- Bomb Threat
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Upon receipt of bomb threat message, the individual receiving the threat should
record all the details of the call.
Try to identify:
•
•
•
•
•
Location of the device
Time set for detonation
Type of device or appearance
How the device can be deactivated
Why the device was placed
Try to identify the following characteristics of the caller’s voice:
•
•
•
Tone: Calm, angry, excited, slow, soft, crying, familiar accent, etc.
Threat Language: Well spoken, foul, irrational, taped, etc.
Background Sounds: Street noises, kitchen noises, voices, PA system, Engines
Dial “88888” and notify PBX who will contact Police and/or Fire Rescue under the
direction of the Administrator/Designee or Safety Officer.
•Staff
in each department may be asked to look in their areas for any unusual objects.
CODE BLACK- BOMB THREAT
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EMERGENCY PREPAREDNESS PLAN
Response to potential emergencies from disruptive to disastrous
Testing the hospital emergency response at least twice a year
Identify hazards, threats, adverse events, and high patient volumes and assess the impact on care, treatment , and services
Know what to do in the event of a disaster or
Six critical elements in every disaster event :
Utilities
Staff Responsibilities
Safety & Security.
Resources & Assets
Patient Clinical & Support Activities
Communications
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Emergency Preparedness Plan
Each department has an individual plan that must be followed.
The employee must know what his or her responsibilities are before the disaster
occurs. This plan will be activated by the “CODE D” announcement upon notification
by the administrator on call, the safety officer, or the nursing supervisor that a
disaster has occurred and a large number of victims are expected to arrive at JFK
Medical Center’s Emergency Department within minutes.
The Emergency Operations Team members will meet immediately upon notification
to set up a command center. All directions will be given from this center to allow
control of the situation.
Hurricane Season: June 1 through November 30 of each year is designated
as hurricane season. Review your disaster plan before hurricane season begins.
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EVACUATION PLAN
The purpose of an evacuation plan is to move patients from a dangerous or
potentially dangerous area to a place of comparative safety. If you have
been instructed to evacuate your area, you will be told what type of
evacuation will be required.
Evacuation (with the exception of PARTIAL EVACUATION) is only done on the
order of the administrator on call, the Safety Officer, or the nursing
supervisor
The following types of evacuation are used at JFK Medical Center.
PARTIAL - moving patients from a dangerous area to safety in another
room
LATERAL - moving patients to another smoke compartment on the same
floor
VERTICAL - moving patients downward from one floor to another
COMPLETE - moving all patients out of the facility
33
HAZARDOUS MATERIALS
Under the Hazardous Communication Act, chemical manufacturers and
distributors are required to evaluate the hazards of their products and provide
the purchasers with the information necessary to ensure safe handling, use,
and storage of chemicals.
When using chemicals in your workplace, review the content label for this
information:
the name of the chemical
who makes or sells it
the address of the maker or seller
why it is hazardous
how exposure to hazard occurs
what conditions would increase hazard
precautions to take while handling substance
what to do if you are exposed to a substance
how to handle a spill or emergency spill
34
HAZARDOUS MATERIALS
Everyone should be aware of hazardous materials in the workplace.
Hazardous Materials information is available on the Poison Control Database
(Poison-Dex) in the Emergency Room (548-3751) and on the TOMES Database
in the Pharmacy (ext. 44260). It is available to all employees’ 24 hours per day.
Hazardous Material Spill Team
If a hazardous material spill occurs, the Hazardous Material Spill Response Team will coordinate all
details.
Minor Spills
Security
Department Ext. 44444
Engineering
Haz-Mat
Department (548)–3784
Coordinator Pager 313-8037 - Office 548-3455
Radiation
Spill Haz-Mat Coordinator Pager 326-1378 Office 548-3455
Administrator
Hospital
Safety
on call
Operator - 0
Officer Office (548)-3700
Security
Supervisor Spectra link - 87340
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HAZARDOUS MATERIALS
Hazardous Waste
Hazardous waste: is material that is no longer in use that is considered
to represent a threat to human life or health. The categories of
hazardous waste with which a healthcare facility must deal with are:
Biomedical waste: any solid or liquid waste that may present a hazard
of infection to humans.
Chemical waste: any chemical that is toxic, flammable, corrosive,
reactive, or “extraction procedure” toxic
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HAZARDOUS MATERIALS
Cytotoxic waste: any waste resulting from the preparation and
administration of medications used in the treatment of cancer or benign
tumors, with few exceptions, themselves mutagens and carcinogens.
Radioactive waste: any waste that contains characteristics of radiological
emissions as defined by the Nuclear Regulatory Commission as being
hazardous to humans, animals, and the environment.
Physical hazard waste: Any objects capable of puncturing or lacerating the
skin such as broken glass, opened cans, etc
37
RADIATION SAFETY
It is important to realize that all of us receive radiation everyday whether we
work in a hospital setting or not. There are many sources of naturally
occurring background radiation (radiation from the sun and elements found
in the earth). In a hospital setting, personnel have the potential to be
exposed to radiation from two primary sources:
One source of radiation within the facility is from fixed or portable x-ray
machines.
38
RADIATION SAFETY
The most important things to remember when working around this type of
equipment or any other type of radiation are time, distance, and shielding.
Time: the less time you are around radiation, the less you are exposed
Distance: the farther away you are from radiation, the less you are exposed
Shielding: if possible, use a lead apron or lead door to stop ionizing rays
39
RADIATION SAFETY
The second source where radioactive materials are normally present is the
department of Nuclear Medicine. The primary function of the Nuclear
Medicine Department is diagnostic, and therefore radiation levels are very
low. Radioactive materials may be found is a nursing unit where a patient
may have a radioactive implant or is admitted for a radioactive iodine
treatment. Instructions are posted in the patient’s room clearly defining the
precautions needed for safe interaction levels for personnel and visitors.
The telephone number of the Radiation Safety Officer is posted in case an
emergency should occur.
40
RADIATION SAFETY
It is important to be aware of the radiation symbol that is magenta or red trefoil
(propeller) shaped symbol on a yellow background. When that symbol is displayed
on a container, package, or door, its purpose is to alert individuals that radioactive
materials are present. Do not handle any radioactive materials unless you are an
authorized user on the state license.
State and federal regulations require healthcare personnel who routinely work
around radiation to wear monitors called film badges. This is a small rectangular
badge worn by personnel in departments such as Nuclear Medicine, Radiology,
Endoscopy, Cardiac Catheterization Lab, CAT Scan, and Outpatient Surgery. Each
month, the badge reports are reviewed by the Radiation Safety Officer to ensure
that all healthcare personnel are keeping within the state and federal guidelines for
radiation exposure.
Contact the Nuclear Medicine Department at ext. 83669 to obtain additional information
concerning the effects of ionizing radiation and matter.
41
EQUIPMENT MANAGEMENT
The Biomedical Department checks all clinical electrical
equipment brought into the Medical Center. Look for the
following items to determine if equipment in your area has
been checked:
Control sticker – this sticker contains information such as
date and technician who checked equipment. If this
information is not on equipment, contact Plant Operations
before using.
“Defective Do Not Use” stickers – used to tag failed units
42
Electrical shocks, burns, or electrocution can be the result of operating
machines improperly or in unsafe conditions. Fire can also be the
result of poor electrical safety habits, including poor maintenance of
electrical equipment. Prevent injuries by following these simple rules:
report any frayed wired immediately
report any broken cords immediately
do not yank plugs from wall sockets
do not work on any electrical apparatus.
ELECTRICAL SAFETY
43
Utility Management
JFK Medical Center has contingency plans for each of our major utility systems.
All staff members need to be aware and know what their departments’
responsibilities are during an interruption.
Utility Failure / Power Failure
If the power fails in your department, immediately check the following:
All life sustaining /critical equipment is plugged into red emergency outlets
Infusion pumps have battery backup – check to make sure it is still functioning properly
If the power fails in your department, contact Plant Operations to see if problem is
facility-wide or local, and reassure patients that they are in no danger and that their care
will not be jeopardized
44
If the water is shut off on your unit, the following will apply:
Notice is sent to all departments if water is to be turned off for any
length of time. If you have not received a notice, contact Plant
Operations immediately to determine cause.
Bottled water is available to all areas if water is to be turned off for only
a few hours.
If, during a hurricane, water will be shut off for a longer period of time,
portable water will be brought in and bottled water and waterless hand
cleaners will be utilized in affected areas.
WATER FAILURE
45
COMMUNICATIONS FAILURE
If telephone systems fail, the following procedure will occur:
Administration and key personnel will utilize hand-held radios
Extra personnel will be on hand to assist with communications
Communications may be continued by using the “SEND MESSAGE
FUNCTION” in the Meditech system (internal only)
Cellular phones may be used only at the direction of the Emergency
Operations Center (EOC)
46
The Safety and Security Department is committed to providing a safe
and secure environment for all persons that interact within the Medical
Center Complex.
Safety and Security Contact Information:
Ext. 44444 for Non-Emergencies, operates 24 hours daily
Ext. 88888 for Emergencies, operates 24 hours daily
Courier Service: Ext. 44444. Provided to Medical Center departments at both on and off
campus locations.
Identification Badges: Ext. 44444. Badges are processed for staff, physicians,
volunteers, contract staff and associates.
Hours of Operation: Monday through Friday, 6:30 a.m. – 7:30 a.m. and 12:30 p.m. – 5:00
p.m. Weekends, 6:30 a.m. – 2:30 p.m.
SAFETY AND SECURITY
47
MAINTAINING A SECURE ENVIRONMENT
Please assist the Security Department in maintaining a safe and secure environment by observing the
following:
Call
immediately if you notice any suspicious behavior or witness an incident.
Secure
all money and purses out of sight or in a locker or locked cabinet.
Observe
Leave
speed limits in parking lots.
parking areas closest to the hospital for visitors and outpatients
Ensure
patients’ valuables are taken home or secured in the Business Office safe. Do not allow patients
to keep valuables in bedside tables or in pillowcases.
Hearing
Have
patient ready before transporter arrives.
Clean
Do
aids, dentures, etc., should be transferred with the patient.
up spills.
not obstruct passageways.
48
INCIDENT REPORTING
PROFESSIONAL LIABILITY
LOSS PREVENTION
PATIENT CONFIDENTIALITY
Risk Management
Section 3
49
A successful Risk Management Program depends on each and every
employee. The following information is provided to assist you in
learning about Risk Management and your role in the Risk
Management process.
Overview
The Risk Management Department of JFK Medical Center is
responsible for managing a program of preventative assessment and
identification of risks as well as handling claims of injury or property
loss
Risk Management also can put procedures in place for responding to
unusual clinical events- Call the Risk Manager if ever in doubt
50
RISK MANAGEMENT
Risk management program is designed to prevent injury and/or loss by
proactively identifying possible exposures that may cause problems and
taking action to eliminate or reduce the possibility of injury or loss due to
that problem. When a loss does occur, it is our responsibility to address the
loss through a thorough investigation and claims management process that
will determine a fair and cost effective manner resulting in settlement with
those individuals who have suffered the loss.
51
RISK MANAGEMENT
The elements of the Risk Management Program include at least the
following:
Reporting of incidents (occurrences, event notifications)
Incident Reporting System that includes investigation and analysis of the
frequency and causes of adverse incidents
Risk management and risk prevention education and training
Analysis of patient grievances relating to quality care
Investigation and management of legal claims and lawsuits
Compliance with Federal, State and local regulations including reporting
requirement to AHCA
52
The goal of hospital risk management is to identify possible risks (hazards)
within the health care setting and plan how to prevent or reduce those risks,
which often cause injury.
MONITORING OF PATIENT RIGHTS AND
CONFIDENTIALITY
53
Risk
The possibility of incurring a loss or an exposure to a loss. A hazardous condition existing
that increases the possibility that a loss could occur.
Loss Control
Risk Management methods used to reduce the frequency and/or severity of losses.
These include Safety Walks, Education, Corrective Action Plans, Orientation as well as
many other Risk Management techniques
Incident
Any occurrence that is not consistent with the routine that results in a potential for or an
actual injury to a patient, visitor or employee, or damage to facility property or reputation.
These can be actual events or potential risks. These are also referred to as “occurrence
reports” or “event notifications”
AHCA (Agency for Health Care Administration)
Licensing and regulatory agency that monitors hospital’s performance and compliance
with regulatory (legal) requirements
IMPORTANT RISK MANAGEMENT
DEFINITIONS
54
Reporting of incidents is done through the Risk Management Module in
Meditech. The exact procedure for this is found in the Administrative Policy
Manual under the Risk Management Section.
INCIDENT REPORTING SYSTEM
(NOTIFICATION EVENTS)
55
Used for reporting any actual or potential events that involve patients
and/or patient property. Examples of incidents that should be reported
using the Patient Notification Event include:
All patient falls
Medication and/or treatment events (actual or potential errors)
Patient personal property loss or damage
Complaints of patient care issues, threats of legal action or other
quality of care issues
Any patient injury including development of pressure sores, major
infections, IV related injuries, etc
Equipment failure causing injury or potential for injury
Treatment or procedures performed without consent
Alteration or loss of medical records
Complaints or allegations or sexual abuse/misconduct
Any significant adverse patient care outcome, regardless of fall
RISK MANAGEMENT
56
NON PATIENT NOTIFICATIONS
Non Patient notification is used for reporting any actual or potential events
related to visitors, volunteers, medical staff and other external entities.
Examples of incidents that should be reported through this notification
include damage to facility or visitor property, visitor falls or other injuries,
narcotic discrepancies, and possible facility hazards identified
Employee Notifications
Used to report employee injuries or illnesses to the Employee Health
Nurse/Injury Coordinator. Examples include employee-related injuries,
falls, or exposure to infectious disease.
Employees report incidents as soon as possible after the event occurs or
when it is first discovered after the event. Early reporting is important
because:
it allows us to take immediate action to remove any risks that can prevent the incident from
reoccurring and take action to reduce or prevent injury or loss to the person.
57
The law requires that the incident and manager investigation findings
be reported to the Risk Manager within three (3) days. The Risk
Manager has the ability to screen incidents immediately after they are
put in the system, however we appreciate a call if you believe the
event is serious and needs immediate attention.
Florida Statue Guidelines
58
EMPLOYEE NOTIFICATIONS
When reporting an incident, important points to remember include:
When in doubt—REPORT
Document the facts—what you observed or quotes of what you were told
directly
Complete all areas on form
Report immediately or as soon as possible after the event occurred or
when you became aware of the incident. Report while the facts are fresh
in your mind.
An injury does not have to occur, just the mere potential is sufficient to
call it an incident. In other words, any unusual event that MIGHT
cause or DOES cause injury is an incident.
59
The loss of glasses, dentures or hearing aids are not only expensive for
the hospital to replace, but can significantly affect the emotional wellbeing, finances, recovery, and satisfaction of our patients. It is important
to inform competent patients and carefully inventory all patient
belongings and encourage any belongings not needed during the
hospitalization to be sent home or secured by the Security Department.
Document if the belongings have been sent home with a family member
and have them sign the valuables form.
PERSONAL PROPERTY CARE AND LOSS
REPORTING
60
LEGAL ISSUES
Claims and Lawsuits
The Risk Management Department is responsible for the investigation and
management of hospital related liability issues. Management of claims
investigation is complex and vital for protection of the hospital and any
individual involved. The legal process for responding to claims is extremely
precise and time specific and therefore must be handled by experienced
investigators and/or attorneys.
61
Subpoenas are delivered by “process servers” or may come
directly in the mail, to the hospital or to your home. When a
process server comes to the hospital to deliver a subpoena,
they are to be directed to Security who will notify the
appropriate receiving department or person.
If you receive a subpoena regarding a hospital-related issue
at your residence, notify the Risk Management Department
(548-3430) as soon as possible for instructions and
assistance in complying with the notice. Do not respond to
the sender without speaking to Risk Management
Do not speak with any attorney concerning JFK matters.
Refer the caller to Risk Management and notify Risk
Management of the contact
SUBPOENAS
62
Hospitalized patients have many rights to protect them. They have the right
to access care for emergencies, the right of privacy and confidentiality.
They have a right to a safe and secure environment.
Patients also have the right to participate in their plan of care, remained
informed of the care they are receiving and the right to accept or refuse any
treatments, procedures, medications or other care as prescribed. Patients
have the right to request restriction of certain uses and disclosures of their
PHI that is contained within their medical record. All requests for
restriction must be made in writing to the FPO (Facility Privacy Official)
PATIENT RIGHTS
63
SAFE MEDICAL DEVICE ACT
The hospital must also be in compliance with the Safe Medical Devices Act
(SMDA). This Federal requirement mandates that medical equipment or
device failures that caused injury or death must be reported to the
manufacturer and the FDA. The Biomedical Department notifies the FDA
and the product manufacturer. Any equipment/device that has
malfunctioned, whether any injury has occurred or not, should be tagged
and removed from the patient care area. Biomedical Engineering should be
notified.
64
DOCUMENTATION
The most important action a health care worker can do to prevent malpractice
suits is provide patient care according to the recognized standard. The second
most important action a health care worker can do to prevent malpractice suits
is to document the care provided to the patient in the patient’s medical record
with clear, factual entries.
This documentation should not only include routine activities such as timely
following physician orders, but ongoing assessments and communication to
appropriate individuals when necessary. Adverse findings should have an entry
to reflect the follow up. If a physician is contacted, the record should reflect a
brief summary of the conversation and outcome of the communication.
65
INFECTION PREVENTION
STANDARD PRECAUTIONS
BLOODBORNE PATHOGENS
HIV TESTING
BIOMEDICAL WASTE
TUBERCULOSIS
Infection Control
Section 4
66
INFECTION CONTROL
Infection Control is the prevention of the spread of infection from one
individual to another and from objects to individuals. It prevents the spread of
infectious diseases in the community and within the health care setting. A
nosocomial, or hospital-acquired, infection is one that develops during
hospitalization and is not present or incubating at the time of admission. The
conditions favored growth of microorganisms and because the conditions were
not changed, an infection occurred.
67
The Infection Control Program at JFK Medical Center is hospital-wide
and includes surveillance, prevention, and control of infection.
Proper procedures decrease:
the patient’s length of stay
cost to the hospital and patient
liability, mortality, and morbidity
the necessity for re-admissions
employee absenteeism
the risk of multiple antibiotic resistant organisms
Everyone is responsible for carrying out infection control
practices and has a role in the hospital-wide Infection Control
Program.
INFECTION CONTROL
68
STANDARD PRECAUTIONS
Adopted by the CDC in 1996: Combines major features of Universal
Precautions and Body-Substance Isolation.
Based on the principle that all blood, body fluids, secretions and excretions
(except sweat & tears) non-intact skin, mucous membranes may contain
transmissible infectious agents.
Standard Precautions applies to all patients regardless of suspected or
confirmed infection
Precautions include: Hand hygiene, glove use, gowns, masks, eye protection,
or face shield depending upon the anticipated exposure.
Equipment or items in the patient environment likely to be contaminated
with infectious bodily fluids must be handled in a manner to prevent
transmission (e.g. wear gloves for direct contact, contain heavily soiled
equipment, properly clean and disinfect or sterilize reusable equipment
before reuse).
69
STANDARD PRECAUTION
Standard Precautions are used in the care of all patients, regardless of
diagnosis or infection status. These precautions are designed to reduce the
risk of transmission of microorganisms from both recognized and unrecognized
sources of infections in hospitals. Standard Precautions apply to blood, all body
fluids except sweat, non-intact skin, and mucous membranes. Personal
protective equipment (PPE) must be used according to the task being
performed.
70
STANDARD PRECAUTION
Wear Appropriate Gloves:
When exposure to blood/body fluids/secretions/excretions is
anticipated
when touching blood/body fluids, mucous membranes, or
non-intact skin of ALL patients.
When handling items soiled with blood/body fluids/body
substances.
71
Wear Appropriate Gloves, Protective Eyewear, and Mask
during any invasive procedure that may generate droplets in the air
(aerosolize)
during any procedure that splash to head/neck could occur
Wear Appropriate Gloves, Protective Eyewear, Masks, and
Fluid-Resistant Gown
during endoscopy procedures
during surgery
when handling cases of severe bleeding from any source
during barium enema procedure, where contact with body fluids may
be anticipated
STANDARD PRECAUTION
72
TRANSMISSION-BASED PRECAUTIONS
Are used when the route(s) of transmission are
not completely interrupted using Standard
Precautions.
Categories:
Contact
Droplet
Airborne
73
CONTACT PRECAUTIONS
Intended to prevent transmission of infectious agents, including
epidemiologic important organisms spread by direct or indirect
contact with the patient or the patient’s environment
Apply where the presence of excessive wound drainage, fecal
incontinence, or other discharges.
Additional consideration for patients with heavy discharges that
create extensive environmental contamination
Single rooms are recommended.
Wearing of gloves and gowns for all interactions that may involve
patient contact with patient or potentially contaminated
environment.
Donning PPE (personal protective equipment) upon entry and
discarding before exiting the patient’s room contains pathogens
Wash hands with soap and water before and after caring for all patients
74
CONTACT PRECAUTIONS
Examples of conditions requiring Contact Precautions:
Multi-drug resistant organisms (MRSA/VRE)**
Scabies/ Lice
Clostridium difficile/GI pathogens
Herpes Zoster (Shingles)
Draining Wounds (drainage cannot be confined to a
dressing)
Masks and contact isolation are required for MRSA/pneumonia
75
DROPLET PRECAUTIONS
Intended to prevent transmission of pathogens spread
through close respiratory or mucous membrane contact
with respiratory secretions.
Special air-handling is not required.
Health care personnel wear a surgical mask for close contact
with patient (3-6 feet)*.
Eyewear/face shields and/or gowns are worn if there is
potential for splashing.
Recommendation for routine use of goggles or face shields.
76
DROPLET PRECAUTIONS
Intended to prevent transmission of pathogens spread
through close respiratory or mucous membrane contact
with respiratory secretions.
Special air-handling is not required.
Health care personnel wear a surgical mask for close contact
with patient (3-6 feet)*.
Eyewear/face shields and/or gowns are worn if there is
potential for splashing.
Recommendation for routine use of goggles or face shields.
77
AIRBORNE PRECAUTIONS
Intended to prevent transmission of infectious agents that remain infectious
over long distances when suspended in the air.
Preferred patient placement in a negative pressure room with (6-12) air
exchanges per hour.
Doors must be closed at all times (exterior hallway and anteroom).
Health care personnel must wear an N-95 NIOSH approved respirator after
fit-testing.
Eyewear/face shield and/pr gowns are worn if there is potential for
splashing
Family/visitors entering the room must wear a blue surgical mask.
If patient must leave room, they are to wear a blue surgical mask, as well
78
AIRBORNE PRECAUTIONS
Examples of infectious organisms
requiring Airborne Precautions:
Tuberculosis
Varicella (chicken-pox)
Rubeola Measles
79
PROTECTIVE PRECAUTIONS
Intended to protect patients from infection while in a neutropenic
state
Neutropenia: Total WBC 1000/m3 or less, neutrophil percentage of
the total WBC is <50%
Patient’s are assigned to a private room.
All visitors will first check with the nurse before entering patient
room. Those with signs of infection will not be permitted in the
patient’s room.
Employees demonstrating signs of illness may not care for patient’s
on Protective Isolation.
80
PROTECTIVE PRECAUTIONS
Environmental Controls:
Change water in pitchers and denture solutions
daily.
Avoid placing fresh flowers/plants in patient’s
room.
Refrain from eating raw unpeeled fruits, raw
vegetables and fruit, home-made or home canned
goods.
Patients are to wear a surgical mask when out of
their rooms.
81
PERSONAL PROTECTIVE EQUIPMENT
For patients on isolation, PPE caddies will be door
mounted and adequately supplied.
Donning PPE is to be performed prior to entering
patient room and removed/discarded before leaving
the room.
Do not wear PPE in common areas: Hallways, nursing
stations, etc.
82
INFECTION PREVENTION RESPONSIBILITIES
Infection Preventions Responsibilities:
Hand Hygiene (know how to perform correctly)
Understanding Precautions
Understanding Isolation Practices
Understanding MRSA and c-diff
Risk Assessment Outcomes
83
INFECTION CONTROL
The most important infection control practice is
to wash your hands before and after patient
care and after using toilet facilities.
84
INFECTION CONTROL
85
BEFORE PATIENT CONTACT
WHEN? Clean your hands before touching a patient when approaching him or her .
WHY? To protect the patient against harmful germs carried on your hands
BEFORE AN ASEPTIC TASK
WHEN? Clean your hands immediately before any aseptic task
WHY? To protect the patient against harmful germs, including the patients own germs,
entering his or her body
AFTER BODY FLUID EXPOSURE RISK
WHEN? Clean your hands immediately after an exposure risk to body fluids (and after glove
removal)
WHY? To protect yourself and the health-care environment from harmful patient germs
AFTER PATIENT CONTACT
WHEN?
WHY?
Clean your hands after touching a patient and his or her immediate surroundings
when leaving
To protect yourself and the health-care environment from harmful patient germs
AFTER CONTACT WITH PATIENT SURROUNDINGS
WHEN? Clean your hands after touching any object or furniture in the patient’s immediate
surroundings when leaving – even without touching the patient
WHY? To protect yourself and the health-care environment from harmful patient germs
INFECTION CONTROL
86
Exposure to bloodborne pathogens (HIV/AIDS, Hepatitis B and C in the
healthcare setting is of great concern to all healthcare workers. JFK has its
own Bloodborne Pathogen Plan that gives you guidance in preventing
occupationally acquired bloodborne pathogen diseases. The Bloodborne
Pathogen Exposure Control Plan is located in the Infection Control/Employee
Health Policy and Procedure Manual found in each unit/department. The
Federal Regulation, “Occupational Exposure to Bloodborne Pathogens Rule” is
available in the Infection Control Office for review by all staff.
BLOODBORNE PATHOGENS AND THE
OSHA BLOODBORNE PATHOGEN PLAN
87
BLOODBORNE PATHOGENS
How Would I Get a Bloodborne Disease?
These diseases are transmitted by:
unprotected sexual contact someone infected with the disease
sharing of contaminated needles
infected woman passes disease to unborn child
needle stick/sharps injuries involving someone who is infected
mucous membrane (eye, nose, mouth) contact with infected material
contact with infected material through broken skin (chapped,
abraded)
88
HIV/AIDS
The Human Immunodeficiency Virus (HIV) is the virus that causes AIDS. It
invades the body, damages the immune system, and allows other infections
to invade the body and cause disease. In many people, the disease of AIDS
does not develop for years, even though the virus is present. The person
may not show any of the following symptoms, therefore, it is difficult to know
if someone is infected with the virus. Symptoms include weakness, fever,
sore throat, nausea, headaches, diarrhea, and other flu-like symptoms.
People with HIV typically will be given medications that attack the virus.
89
HEPATITIS B AND C
There are several types of the Hepatitis virus. The most common ones
transmitted through blood are Hepatitis B and C. These present the greatest
risks to healthcare workers. These viruses attack the liver and can result in
serious liver damage, particularly in cases of chronic infection. The symptoms
of Hepatitis B and C are fatigue, jaundice, loss of appetite, stomach pains, and
nausea.
There is a vaccine available to protect you from Hepatitis B and is offered free
of charge to all employees who are classified “at risk”. Employee Health can
help determine your risk category.
There is no cure or vaccine for Hepatitis C at this time.
90
1. Use Standard Precautions when caring for all patients
2. Use personal protective equipment (PPE) properly when handling all BBF – think ahead
when performing a procedure to decide appropriate PPE to be used
3. Transport specimens in sealed, leak-proof containers clearly labeled with the
biohazardous sign
4. Dispose of sharps in proper containers – do not overfill
5. Do not bend, break, or recap needles
6. Use safety equipment that had been provided
7. Never attempt to remove a safety feature from a device. Always engage the safety feature
after use.
8. Use caution when handling contaminated sharps
9. Do not eat, drink, smoke, apply cosmetics or handle contact lenses in your work area
where there is a risk for occupational exposure
10. Washing your hands thoroughly between all patient contacts or after handling soiled or
contaminated equipment and immediately if contaminated with blood or other potentially
infectious materials, and every time after you remove your gloves. Never wash gloves or
reuse them.
TEN WAYS TO PREVENT BB FLUID EXPOSURE
91
Counseling prior to HIV Testing: It is recommended, but not required, that
HIV testing be preceded by a pre-test counseling session that may include:
the purpose, indications, and limitations of the test
information on how to avoid contracting and transmitting HIV and reducing
high-risk behaviors
potential economic, social, and medical effects of a positive test
availability of support services
Informed Consent: No one should perform an HIV test without obtaining
informed consent, except under special circumstances. Consent doesn’t
have to be in writing as long as there is documentation in the medical
record that the test was explained and consent was obtained. There is a
legal obligation to protect the HIV test result from unauthorized disclosure.
HIV COUNSELING AND TESTING
92
DISCLOSING HIV TEST RESULTS
Below is a list of some of the instances when HIV test results may be
disclosed:
to the patient or legally authorized representative
to anyone designated in a legally effective release of information
to healthcare providers if they have a need to know or are consulting
between themselves to determine treatment
to healthcare staff committees for peer review, monitoring, and evaluation
by court order
when medical or non-medical personnel who have been subject to
significant exposure during the course of professional duties
93
Clostridium Difficile
…..a serious nosocomial problem
94
Clostridium Difficile (c-Diff) is one of the most common organisms to cause
healthcare-associated infections.
C-Diff causes “spores” to form which contaminate the environment – such
as:
over-bed tables, bed rails, toilets, door knobs, etc.
C-Diff spores are not killed with alcohol or other cleaning agents.
What is C- Difficile
95
When the normal gastrointestinal (GI) flora is
disrupted, exposure to C. difficile may result
in C. difficile infection (CDI)
3%–5% of healthy adults and 16%–35% of
inpatients might be colonized
MICROBIOLOGY
96
Appropriate antibiotic selection
Barrier precautions
Compulsive hand hygiene
Disinfection of environment
Executive ownership
The C. Difficile “Bundle”-what do we do?
97
Glove
and gown use
Hand
Private
hygiene
room/barrier
precautions/Isolation
resolve
(until symptoms
or ≥2 days after diarrhea ceases
Dedicated
equipment when possible
Environmental
cleaning; disinfection with
1:10 hypochlorite in epidemic situations
Antimicrobial
stewardship/restriction
INFECTION CONTROL MEASURES
98
Water – as hot as you can
Soap - antimicrobial
Friction - for at least 15
seconds
REMEMBER TO USE
99
If you have questions regarding entering a
patient’s room contact your instructor or unit
charge nurse
Be sure that you understand the Isolation Signs
that are posted so that you can explain them to
visitors and family.
Caution
100
Biomedical waste is any material that is contaminated with blood or
certain body fluids that may present a threat of infection to humans.
This includes, but is not limited to:
absorbent material saturated with blood, blood products, body fluids
that are contaminated with blood or other potentially infectious
materials (spinal fluid, peritoneal fluid, pericardial fluid, vaginal
secretions, semen, amniotic fluid, synovial (joint) fluid, and pleural
fluid) and absorbent material saturated with these fluids which have
dried
Non-absorbent disposable devices that have been contaminated with
the fluids listed above
any fluid that visibly contains blood; human blood and blood products
sharp devices that are capable of puncturing, lacerating, or penetrating
the skin, such as used needles, syringes, scalpel blades, glass, or
plastic
BIOMEDICAL WASTE
101
BIOMEDICAL WASTE
Biomedical waste must be handled, stored, and disposed of differently than
other waste. All bags and containers must be sealed and leak-proof, and
must contain the biohazardous symbol. These containers/bags must not be
given to the public or be allowed off the premises without permission.
Make sure lids are on containers tightly so that the container cannot leak if
tipped and so that the persons handling waste are not exposed to the
contents.
102
BIOMEDICAL WASTE
Do not store bio-hazardous and non-bio-hazardous materials together
Seal the bag at the point of origin. Twist top of bag several times and fold
top over for extra security; tape the top to prevent spillage of contents.
Do not throw items into bags that can penetrate the bag, such as any intact
or broken plastic, needles, glass, or other sharp items. These items are to
be placed in designated hard-sided containers located in utility rooms or
specified areas within your department
At no time is linen to be placed into red bags or containers. Linen is
considered contaminated and does not need special color designation
103
HOUSEKEEPING PROCEDURES
Work surfaces must be decontaminated with a disinfectant when
procedures are completed or when the surfaces become contaminated with
blood or other potentially infectious fluids, and at the end of the work shift.
Blood spills should be cleaned up immediately; wipe up spill with a paper
towel and then disinfect with hospital-approved disinfectant. Gloves must
be worn during the clean-up. If the spill is too large, contact Environmental
Services.
104
What is tuberculosis and how is it spread?
Tuberculosis (TB) is an illness that involves the lungs and other body parts.
TB is spread through the air when someone with active disease coughs,
sneezes, or talks. You can breathe in these TB germs if you have frequent,
close contact with someone with active TB who is not getting proper
treatment. Persons with active disease may cough, feel weak, have a fever,
lose weight, cough up blood, or sweat at night.
Some people do not feel or look sick when infected with TB. They may stay
this way for a short time or for many years; their TB is considered inactive.
The infection may become active due to many reasons and symptoms of
active disease will appear.
TUBERCULOSIS
105
TUBERCULOSIS
A TB skin test (PPD) is used to assess if you have had past exposure to
someone with tuberculosis and to arrange for early detection and treatment.
You will get an injection under the skin and will have the test site checked in
two to three days. Be sure to return for the reading within this time, or test
will need to be repeated. A negative test result means you probably have
not had exposure to TB. You may need more than one skin test to make
sure. A positive result means you may have had an exposure and you
require follow up. If a test is positive, you will not receive another skin test.
106
TUBERCULOSIS
During employment at JFK Medical Center, this test will be repeated at least
annually. If your tests results were previously negative and you become positive
at any time, this is called a “conversion”. If this occurs, you will be referred to a
physician for appropriate follow up.
Unless you are known to have a positive
PPD test result, you will receive a annual PPD skin test. See the Employee
Health Nurse for further details. You should also consider getting a PPD if you
live or have frequent close contact with someone who has active TB; have HIV;
have any signs of active TB disease; abuse drugs; live or work in close contact
with someone with active TB who is not getting proper treatment.
107
TUBERCULOSIS
Most cases of TB can be cured. If you have a positive TB skin test, you
may need to have a chest x-ray and other tests. These tests will tell your
doctor if your TB is active or inactive, if you need medication and what
kind. Medicine can keep the TB from becoming active and can also cure
TB if it is already active. Your doctor may want you to get tested for HIV.
People with HIV are more likely to get active TB and may take a longer
time to be cured.
108
TUBERCULOSIS
TB medication is the only way to cure TB. Be sure to take the medication
for as long as your doctor indicates – even if you feel fine. Tell your doctor
right away if the medicine makes you sick, and keep all doctors’
appointments. If you don’t take your medicine exactly as you are told, TB
may become resistant to the medication you have been given and may not
work (50 – 80 percent of all drug resistant TB are fatal); treatment may
take longer. You may never get well or you could spread TB to others.
Prevention
Avoid contact between susceptible and infectious persons within a
relatively small space. Ensure adequate ventilation and prevent
recirculation of air containing infectious droplets
109
In a Health Care Setting:
Isolate a patient appropriately if the patient is suspected of or has a
diagnosis of TB. Isolation is to remain until there are three negative
sputum smears for AFB to ensure treatment is adequate, or to rule out
the presence of tubercular disease
Wear personal protective equipment which is appropriate for this type
of isolation (N-95 masks – “duckbill) and is provided by this facility.
Get you mask re-fitted by Infection Control if you have experienced a
weight gain or loss of 10-lbs or greater, or if you have had facial or
dental surgery that may affect your facial contour
Be sure to show up for TB testing when required and return for reading
of test.
TUBERCULOSIS
110
EMPLOYEE NOTIFICATION
Employee Health
Section 5
111
If an injury occurs during clinical rotation:
Notify your instructor immediately. Then contact your School and follow
their protocol.
If you have been exposed to blood or body fluids:
1.
Clean exposed area with soap and water. For mucous membrane
exposures flush well with water or saline
2.
Report the exposure immediately to your instructor who should then
contact the Employee Health Nurse or the House Nurse Supervisor in their
absence.
The Employee Health Nurse/Nursing Supervisor will walk you through our
exposure protocol.
STUDENT/RESIDENT NOTIFICATION REPORTING
112
If testing of the patient is required then the student must have labs
drawn.
If lab work is requested, it must be done immediately. A delay in
testing could mean a delay in treatment.
If exposure occurs from a patient with known HIV/AIDS you will be
referred immediately to the ER for treatment.
All post exposure follow up should be done through your school
STUDENT/RESIDENT NOTIFICATION REPORTING
113
INFORMATION SECURITY
DATA SECURITY MEASURES
PATIENT CONFIDENTIALITY AND
RELEASE OF MEDICAL INFORMATION
Management of Information
Section 6
114
MANAGEMENT OF INFORMATION
Information Security in the healthcare industry means protecting employee
and company information, but also includes the patient information
gathered on behalf of the patient during treatment. Practicing good
information security helps insure confidentiality, integrity, and availability of
the information we use, and helps build public trust. It is everyone’s
responsibility to protect sensitive and confidential information generated as
a part of normal day-to-day healthcare business.
115
MANAGEMENT OF INFORMATION
JFK’s Appropriate Access Policies outline these principles
Users will collect, dispose, process, view, maintain, and store patients’
clinical and financial information in an ethical and confidential manner.
Users must access and view only the information that they have a legitimate
“need to know” in order to effectively perform their specific job duties and
responsibilities, regardless of the extent of access provided.
User may not access information on his/her spouse, children, other
relatives, friends, etc unless the user needs the information to perform their
job.
116
MANAGEMENT OF INFORMATION
The user may NOT access his/her own patient information through the
computer system. Typically, employees do not have a “need to know” about
their own information for the performance of their job. Employees may,
however, fill out an authorization form in the Health Information
Management (HIM) Department and obtain a copy of their records.
Although you may use confidential information to perform your job function,
it must not be shared with others unless the individuals have the need to
know this information as well and have agreed to maintain the
confidentiality of the information.
117
MANAGEMENT OF INFORMATION
Access to the system will be restricted to provide the user only those
methods for searching patients necessary to perform job responsibilities.
Access to the Clinical Patient Care System (CPCS) will be continually
monitored through the use of audit trail reports to ensure compliance with
these policies and procedures.
Patient or Confidential information should not be sent through our intranet
or the Internet unless its confidentiality can be assured. If it is necessary to
send patient information to a business associate (i.e., someone outside
HCA), through email, the email must be encrypted. On the subject line type
[encrypt] in brackets. The recipient will receive an email with instructions as
how to open the message.
118
MANAGEMENT OF INFORMATION
Patient Financial Information, Clinical Information, and User Passwords are
all examples of confidential information. A User ID without a password is not
confidential and is frequently included in directories and other tools widely
available.
If you have access to information systems, please keep in mind that your
Logon ID acts as an individual key to our network and to critical patient care
and business applications. It is your identifier for all system access. It must
be protected. Audits for improper access to patient information are
conducted regularly. You will be held responsible for any system activity that
occurs under your Logon ID. Your PASSWORD protects your Logon ID. If your
password is compromised, you must change it immediately. If you need
assistance in changing your password call the HELP desk @4HELP.
119
Information Security Measures
It is part of your job to learn about and practice the many ways that you can
help protect the confidentiality, integrity and availability of electronic
information assets.
Use only your own user ID and Password to access systems/applications.
Always log off the system before leaving the work area.
Create a “hard to guess” password and never share it.
Change your password frequently (upon system request, or if you believe your
password has been compromised – seen, guessed, or disclosed).
Position computer screens away from public view.
MANAGEMENT OF INFORMATION
120
MANAGEMENT OF INFORMATION
Do not turn off JFK computers, but log off instead
Do not put confidential data on removable media unless it is encrypted.
Student’s, Instructors, Residents and Interns are not allowed to copy
anything to removable medic device from JFK computers
Encrypt confidential email if it is sent outside the HCA address book.
Keep sensitive and confidential information in a locked cabinet or drawer
when not in use.
Beware of Social Engineering.
121
"Social Engineers" are individuals who attempt to gain access to systems or
confidential information through manipulation and use it for their own
personal advantage. People who would try to trick others into revealing a
password are good at social manipulation of others.
You can help combat Social Engineering by:
Limiting your conversations in public places.
Being aware of your surroundings and who listens to your conversations.
Identifying as fully as possible anyone asking you for information.
Beware of suspicious emails and only respond to email inquiries from
trusted sources. Never give your password to anyone – verbally, in email,
or on a web page. No one from Security or IT&S will ever ask for your
password.
MANAGEMENT OF INFORMATION
122
Laptop/Portable Device Security
If you use a laptop or portable device: Keep it locked whenever possible –
with a cable lock when in use in your office
in a closed, locked drawer or cabinet when not in use.
If in a car, be sure it is not visible.
Avoid storing confidential information on your device or encrypt it.
If your device is stolen –File a Police Report and notify the FISO (Facility
Information Security Official) or the Director of Information Technology &
Services. The JFK Facility Information Officer is Jane Stewart, she can be
reached at 548-3810. The Facility Incident Response Team must respond
to a theft incident immediately and report to Division and Corporate Security
MANAGEMENT OF INFORMATION
123
Information Security Agreement
At the beginning of rotation/internship at JFK Medical Center, an
Information Security Agreement is signed by each person who has
access to patient information. Some of the points within this
agreement are that:
Confidential information will not be discussed with those who do not
have a need to know.
Confidential information will not be discussed where others can
overhear the conversation.
The user will only access the systems or devices that he or she is
authorized to access.
There should not be an expectation of privacy when using the Company
information systems.
The user will use only the officially assigned ID and password and will
not share these with any other party.
The user will only use approved, licensed software.
There will be disciplinary action if the agreement is violated
124
PROTECTED HEALTH INFORMATION
Ensuring the privacy of Protected Health Information (PHI).
HIPAA regulations require the appointment of a facility privacy official (FPO).
The FPO at JFK Medical Center is Valerie Fuldauer. She can be reached at
548-3461. She oversees and implements the Privacy Program and works to
ensure JFK’s compliance with the requirements of the HIPAA Standards for
Privacy of Individually Identifiable Health Information. In 2009, HIPAA was
elevated to the status of Federal Law. The penalties for breaches are severe
for both the hospital and for individuals. Physicians and their office staffs
are held to the same level of accountability.
125
PROTECTED HEALTH INFORMATION
The FPO is responsible for receiving complaints about matters of patient
privacy. The Facility Information Security Officer is responsible for the
protection of electronic information. Breaches of security of electronic
information such as laptop thefts, password sharing, etc. should be reported
to the FISO at 548-3810. The Facility Privacy Officer and Facility Information
Security Officer work together to insure that all patient information is protected
whether it is verbal, on paper, faxed, emailed, or stored electronically.
126
PROTECTED HEALTH INFORMATION
Patients have the right to access any health information that has been
used to make decisions about their healthcare at JFK. They can also
access billing information. They may review the paper chart (supervised)
or be provided a hard copy. A patient may be denied access to his or her
medical record under certain rare circumstances (e.g., when a person may
cause harm to him or herself or others, or when protected by peer review).
HIPAA provides rights to patients. Those rights are to amend, request
privacy restrictions, to request confidential communications and to obtain
an accounting of disclosures.
127
PROTECTED HEALTH INFORMATION
Any piece of paper that has individually identifiable health information on it
must be disposed of in appropriate receptacles. The paper will be handled
and destroyed securely. The elements that make information individually
identifiable include: name, zip or other geographic codes, birth date,
admission date, discharge date, date of death, e-mail address, Social
Security Number, medical record/account number, health plan id, license
number, vehicle identification number and any other unique number or
image.
128
Confidentiality and Release of Medical Information
All medical records are the property of JFK Medical Center. This includes
all inpatient and outpatient records as well as Wound Care and the Cancer
Center.
Medical records may NOT be removed from JFK Medical Center property
except by authorized personnel in response to a properly executed court
order or subpoena. The patient has the right to expect that records
pertaining to his/her care will be treated as confidential. JFK Medical
Center carries the obligation to safeguard his/her records against
unauthorized disclosure.
Disciplinary action will be taken for unauthorized disclosure (including PCI
access of electronic record) of patient identifiable information.
PROTECTED HEALTH INFORMATION
129
PROTECTED HEALTH INFORMATION
On September 23, 2009 the Health Information Technology for Economic
and Clinical Health Act (HITECH) was signed into law. This act contains
provisions that are required to be followed when certain privacy and security
breaches occur.
A breach is defined in HITECH as the unauthorized acquisition, access, use,
or disclosure of unsecured, unencrypted protected health information which
compromises the security or privacy of information that poses a significant
risk of financial, reputational, or other harm to the individual. If a breach
involves 500 or more patients and 10 of them could not be reached the
facility must post the breach information on their website, notify the
Department of Health and Human Services (HHS) and the media.
130
The key things to remember to avoid a breach are:
Can this information be harmful to the patient, in any way, including
financially?
Does the information contain sensitive information such as HIV, alcohol,
drug abuse, behavioral/mental problems, cancer, etc?
If you are unable to recover the information, and the receiver could use
or re-disclose the information without your knowledge, you must have a
sense of assurance that the information will be destroyed or sent back to
you.
Make sure your fax cover sheet has the confidentiality statement and a
statement asking the receiver to contact you if the information was
received in error. Confirm that your phone and fax numbers are correct.
PROTECTED HEALTH INFORMATION
131
ETHICS AND COMPLIANCE
Section 7
132
PATIENT BILL OF RIGHTS
A Patient Bill of Rights
Are located in the Admissions Packet
Are reviewed with all patients
Can be found on the walls
133
ETHICS AND COMPLIANCE
At JFK Medical Center there is an Ethics and Compliance Program that is
administered by an Ethics and Compliance Officer (ECO). JFK’s ECO is
Valerie Fuldauer and is available to answer any ethics or compliance issues
you may have. You may contact Valerie at (548)- 3461 Our Code of
Conduct “A Tradition of Caring” is available on the HCA Intranet site and is
your guide to carrying out your daily activities at JFK. You may access the
Code using the link:
http://atlas2.medcity.net/portal/site/codeofconduct/
134
ETHICS AND COMPLIANCE
The Code of Conduct states, “we are committed to ethical and legal conduct
that is compliant with all relevant laws and regulations and to correcting
wrongdoing wherever it may occur in the organization. Each colleague has
an individual responsibility to report any activity…that appears to violate
applicable laws, rules, regulations, or this Code.” If you have questions
regarding the Code or encounter any situation that you believe violates
provisions of the Code, you should immediately consult your Instructor, and
any another member of the management team at JFK, or the ECO. The
Ethics Line is 1-800-455-1996. There will be no retribution, retaliation or
punishment for asking questions or raising concerns about the Code or for
reporting possible proper misconduct.
135
POPULATION SPECIFIC
ABUSE AND NEGLECT
BARIATRIC SENSITIVITY
Clinical Practice
Section 8
136
POPULATION SPECIFIC
DEMOGRAPHIC CHANGE
137
Population specific competency ensure that employees possess the knowledge, skills,
ability, and behaviors that are essential for providing care to specific populations.
The goal is to be able to modify patient care to meet the needs of a person in a
specified population and that all staff members are knowledgeable about the specific
care, treatment and services required by certain populations
The needs of the population(s) served may be based on the following
demographic characteristics:
Age
Socioeconomic status
Sex
Race/ethnicity
Disability
Religion(s)
Language(s)
Developmental Stage -Disabilities
Family functionality
Culture / language spoken
Educational level
Illness / treatments to be provided
Health literacy
138
GEARING OUR CARE TOWARD OUR PATIENT POPULATION
Our hospital cares for people from a wide variety of races, cultures, religions as
well as various age groups.
Because every patient’s expectations and needs are influenced by what they
believe, it is crucially important that care-givers have some understanding of the
most common cultural groups utilizing JFK’s facility.
Patient care, treatment, and services may need to be modified for members of a
specific population.
139
GEARING OUR CARE TOWARD OUR PATIENT POPULATION
At JFK we care for a large number of Hispanic/Latino patients but recognize
that there is enormous diversity even within this Spanish speaking group. It is
best to ask, when there are concerns about understanding of directions.
We have come to understand that large numbers of visitors - family, friends,
neighbors, and clergy are thought to be a support to their healing.
We know that this is a group that is likely to be religiously observant. We also
recognize that expressions of pain may vary from stoic to very vocal depending
on country of origin and individual differences.
140
GEARING OUR CARE TOWARD OUR PATIENT POPULATION
At JFK we also care for a significant number of Jewish patients - some of
whom are Orthodox (strictly observant)
Please remember to ask if their language is English and that our
LANGUAGE LINE is available through the telephones to help with
communication.
Our understanding is that their religious belief prohibits casual touching
between caregiver and patients of the opposite gender. Please limit
physical contact to that which is truly necessary.
There are food restrictions which are respected by offering kosher meals.
A prayer shawl or head covering is often worn and should not be removed
unless medically necessary.
141
GEARING OUR CARE TOWARD OUR PATIENT POPULATION
The elderly have different needs and their bodies function a bit
differently than the younger adult.
Vital signs may slow and become irregular, bowel function slows,
hearing and sight may be impaired and skin and bones become MUCH
more vulnerable to injuries and balance problems may lead to falls.
Caregivers are aware of such bodily changes and take extra precautions
to protect our elderly patients.
142
NEEDS THAT VARY BY AGE
Take time to assess for the deficits that often accompany aging, i.e.,
hearing and vision loss, and try to accommodate for them.
Take note of whether the elderly patient has visitors- they may be lonely
and enjoy a few minutes of your time - or a magazine to read.
Making conversation about the day’s news, even the weather, helps
with orientation to time and place.
143
ABUSE AND NEGLECT
144
Abuse and neglect are serious concerns in the United States today. Abuse
and neglect exists here in Florida, right here in Palm Beach County; maybe
on our own street…, or in your patient’s room.
Think about these facts.
•Nearly ¼ of all women will be victims of abuse at some time in their
lives.
•Each year 2 million adults over 60 years of age will be victims
• Every year 2 million children are seriously abused by a parent or
guardian and as many as 1000 die from their injuries.
Pretty frightening statistics…and victims are not always women, children,
or the elderly. Men can be abused and neglected too. Being big and
strong is not always protection.
Anyone you see or meet could have been abused or be in an abusive
situation right now.
Abuse and Neglect
145
Because of the enormity of the problem, every state has strict regulations about
reporting suspected neglect and abuse and every hospital has rules about it as
well.
In fact, The Joint Commission, the agency that oversees all healthcare facilities,
requires that every hospital develop criteria for identifying victims of:
Physical Assault
Rape
Sexual Molestation
Domestic Abuse
Elder Abuse or Neglect
Child Abuse or Neglect
Abuse - physical, emotional, or sexual can leave lasting scars, the kind of scars we
cannot always see…
cycles
But, abuse leads to
of continued violence-where one generation
teaches it to the next. It is a pattern we should all hope to break.
Abuse and Neglect
146
Screening for abuse/neglect must be continuous- beginning when a patient
enters the hospital. Suspected victims must be assessed.
All cases of abuse, neglect, or exploitation must be reported
•Victims of abuse and/or neglect come to the hospital in various ways and from
various places and circumstances.
•The abuse may not be obvious to the casual observer.
•A victim may be unable or reluctant to speak about the abuse.
As Hospital personnel we need to be able to identify signs of abuse and neglect.
We need to be alert.
We must not be afraid to tell what we see.
Even Healthcare staff that does not provide direct patient care (security,
housekeeping, transportation, laboratory, dietary, admitting,
maintenance…everyone) can play an essential role in identifying victims of abuse
and neglect.
Abuse and Neglect
147
All concerns warrant follow-up questions by trained personnel
If the patient discloses abuse-we have trained personnel here that can refer them to
agencies that can help.
However, if the patient denies abuse, we:
1.
2.
3.
4.
Respect their right to not disclose
Inform them of our ongoing support and availability
Offer information and resources for later reference
Reassess (and reassure) them with every contact.
Never think that your observations are not important- you may hear and see
things that others do not.
Unless you are a trained healthcare professional, do not discuss your concerns
with the patient or family member.
Report your concerns to the nurse or a supervisor. It is their legal duty to
provide or offer legal and protective services or resources.
(Outside the hospital refer to the telephone numbers shown on the information
page you have been given)
148
ABUSE AND NEGLECT…IT’S AGAINST THE LAW.
Abuse in any form-physical, emotional or sexual can leave lasting scars,
some of which cannot be readily seen.
But, abuse leads to cycles of continued violence-wherein one generation
teaches it to the next. It is a pattern that needs to be broken.
Wherever you work, whatever your role- if you witness abusive or neglectful
behaviors- you have an obligation to see that it is reported.
149
BARIATRIC SENSITIVITY
150
Obesity is often thought of as a “self-inflicted” condition that could be
easily cured with willpower.
In the U.S. obesity causes approximately 300,000 deaths and costs in
excess of $100 billion dollars annually.
Despite the high cost of obesity in lives lost and dollars spent, the NIH
spends <1% of it’s budget on obesity research.
Obese individuals are often stereotyped as “lazy”, “unattractive”, “dirty”
and/or “out of control.”
Obesity is often viewed as in the same negative category as drug
addiction, alcoholism, and mental illness.
Bariatric Sensitivity
151
Surveyed physicians preferred not to treat obese patients as failure was
expected.
What did nurses list as the most likely reason an obese patient is unable
to lose weight? Non-Compliance.
Obese patients are often stereotyped as:
Lacking self-control
Over-indulgent
Lazy
Experiencing unresolved anger
Practices poor hygiene
Some healthcare employees felt uncomfortable caring for obese patients
and said they would prefer not to care for an obese patient.
Our goal is to raise awareness of the prejudices endured by
the morbidly obese and to better understand their
struggles and fears.
Health Care Provider Bias
152
Obese individuals are often too embarrassed to seek medical care
& often compromise their own well being for fear of being
humiliated in the health care environment.
•Obesity is a chronic illness
•Set the standards high regarding sensitivity
•Be an example to others
•Don’t tolerate discrimination
The bariatric patients’ hospital experience is greatly influenced by
those providing their care.
Understanding the bariatric patients’ unique needs is key to
providing safe and compassionate care.
Attitude/Sensitivity
153
Take time to identify special equipment needs for patients beginning at
the pre-admission appointment. Special equipments include:
Bariatric bed
Bedside commode
Overhead trapeze
Oversized abdominal binders
Large TED hose
Bariatric appropriate equipment is identified throughout the facility with
butterfly stickers. In 2011, new stickers will be implemented into the
identification process. Stickers will state “40” which indicates a 400lb
limit or “50” for a 500 lb limit.
Bariatric Sensitivity
154
FALL PREVENTION
RESTRAINTS
SUICIDE
STROKE
RAPID RESPONSE
Patient Safety
Section 9
155
Fall Prevention Protocol
Identification and ongoing assessment of patient at risk for fall
Establish minimal safety intervention for the patient at risk.
Provide communication of pertinent information
Fall Assessment
On admission and every shift conducted by an RN
Change in patient condition
Immediately after fall
Fall Risk Assessment Tool
Patients who demonstrates any risk signs
Use:
Yellow wristband
Yellow Slippers
Door sign
156
Bed
in lowest position, wheels locked
Call
light within reach
Educate
patient and family about fall hazards and interventions remind
patient to call for assistance
Use
the night light
Round
& Observe: 6 P’s- pain, position, potty, water pitcher, personal
items & phone within reach, peace and quiet.
Pay
extra attention to tethering devices, i.e., foleys, IV’s, nasal oxygen.
Fall Prevention Intervention
157
Obtain education on transfer techniques/safe use of assistive devices
Assure use of Non-slip footwear
2 top side rails up at all times
Bed alarm, floor mats
Use room close to the nursing station
Toileting offered at least q2h while awake.
Keep door open at all times
Bedside table is placed on the non-exit side
Stay in room while in patient in bathroom- if older than 65 years-escort patient
back and forth
Reassess every shift (12 hours) with changes in level of care or condition and
immediately post-fall.
Fall Prevention Intervention
158
RESTRAINTS
159
Any method, manual, physical, mechanical, or material attached or
adjacent to the patient's body which restricts freedom or movement or
normal access to one’s body.
Under this definition, even the following commonly used hospital devices
and/or practices could meet the definition of a restraint:
tightly tucking bed sheets over the patient
pulling up all 4 side rails
Using any device that cannot be easily removed by the patient
physically holding a patient to prevent movement
use of mittens whether they are tied or not, etc.
Restraints
160
Restraints are used as an unusual and temporary
measure when the Physician/Nursing assessment deems it
necessary and other techniques and interventions have
failed. It is also the intent whenever restraints are applied,
that they be removed as soon as possible.
–NOTE
JFK Medical Center DOES NOT USE SECLUSION.
Restraints- Additional points
161
Are applied to prevent interruption of medical therapies and when the
primary reason for their use directly supports medical healing.
Based on the RN’s Clinical judgment, a comprehensive assessment of the
patient must determine that the risks associated with the use of the
restraint are out weighed by the risk of not using it. When a patient is
determined to be at risk for restraint the standardized risk assessment
screens are to be initiated by the RN.
The patient’s health and safety allows for the implementation of preventive
strategies that would be of the greatest benefit to the patient.
The goal of this process is to ensure that the patients who are exhibiting
behavior that places them at risk have alternatives initiated as early as
possible.
Medical–Surgical Restraints
162
SUICIDE
163
Suicide
is the 11th ranking cause of Death
Suicide
is the third ranking cause of death for young people ages 15 to 24.
Women
report attempting suicide during their lifetime about three times
often as men
Suicide
rates increase with age and are “very high” among those 65 years
and older.
Statistical Data
164
Previous attempts on their life
Expresses suicidal ideation
Expresses futility with life
History of alcohol/substance abuse
Chronic Illness or terminal disease
Financial worries
History of depression and psychiatric illness
Recent loss of a job or loved one
Uncontrolled pain
Victims of abuse- sexual/domestic abuse
Who is Most at Risk?
165
Standardized
assessment process performed by
trained staff.
Individuals
who score positively on a suicide screen are
evaluated further.
In
addition, continuous monitoring will be initiated to
assure the patient’s safety.
Clinical Process for Patients at Risk
166
Patient is placed in 1:1 continuous observation
Keep patient in hospital gown- makes it more difficult for them to leave.
Keep all sharp objects out of patient reach, watch closely patient handling
of all materials in room.
Remove shoe laces, belts, tape, soda cans, knives, razors, scissors, lighters,
matches, telephone cords.
Monitor patient’s use of bathroom- keep door ajar, never locked
Restrict/Monitor visitors-educate them about precautions
Suicide Precautions
167
RAPID RESPONSE
168
What Is a Rapid Response Team?
A Rapid Response Team – known by some as a Medical Emergency Team –
is a team of clinicians who bring critical care expertise to the patient bedside
(or wherever it is needed).
The goal:
To prevent deaths in patients who are failing outside intensive care settings.
Why Rapid Response Teams?
People die unnecessarily every single day in our hospitals. The goal is to
respond to a “spark” before it becomes a “forest fire.”
Simply put, the goal of the rapid response team is to prevent deaths in
patients who are failing outside intensive care settings.
Rapid Response
169
What Is the Role of the Rapid Response Team?
Assess
Stabilize
Assist with communication
Educate and support
Assist with transfer, if necessary
What difference can a Rapid Response Team make?
Reduction in non-ICU arrests
Reduced post emergency ICU transfers
Reduction in arrest prior to ICU transfer
Appropriate expectations
Activate the Rapid Response team even when unsure
Have information available for Rapid Response Team
Recognize your role as a member of the team
Rapid Response
170
Mechanism for calling the Rapid Response Team
Dial 33333 from the patient’s room number
If not in a patient room, dial 33333 and give location
In addition to fewer codes and lower mortality, there are other possible
benefits of the Rapid Response Team. Other possible benefits might include:
Better outcomes
Improved relationships
Improved satisfaction
Remember anyone may dial 33333 to activate a rapid response without
it been punitive
Nursing
Physician
Any healthcare worker
Patient
Family members
Rapid Response
171
STROKE
172
JFK is a certified JC Advanced Primary Stroke Center and AHCA
Comprehensive Stroke Center, which means we provide care to patients who
have a stroke or transient ischemic attack (TIA). With early recognition and
treatment we can help to stop the effects of the stroke and/or reverse the
effects of the stroke through early intervention. Our main objective is to
decrease the disability one may endure. One way to decrease the effects of
the stroke is through the administration of the drug TPA to stroke victims.
Here at JFK we have the capabilities to provide interventional treatments
such as the MERCI retrieval which is placing a catheter directly into the brain
and physically removing the clot with a “cork-screw” type device. We can
administer TPA directly at the site of the clot in the brain. JFK is also utilizing
a new device called the “Penumbra” to remove blood clots directly from the
brain.
Stroke
173
STROKE
What are the signs & symptoms of a Stroke?
Sudden numbness or weakness of one side of the face, arm or leg
especially on one side of the body
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden severe headache with no known cause
Early recognition of stroke symptoms is extremely important so our
patients may receive the proper treatment to help reduce the disability
of a stroke.
When should you call a rapid response for a patient who exhibits stroke
symptoms? …..IMMEDIATELY
174
Aspiration pneumonia increases the mortality for stroke patients
Dysphagia screening is done on all patients admitted to the
organization
Dysphagia can lead to aspiration of food, liquids and saliva
which in turn can lead to pneumonia, and increased length of
stay for the patients. (and worse)
Stroke
175
Thank you for taking time from your busy schedule to complete the required
mandatory education.
Please Complete the Quiz in acknowledgement of the Orientation
176
References
Hospitals, Language, and Culture: A Snapshot of the Nation; Retrieved June 28, 2010 from
http://www.jointcommission.org/NR/rdonlyres/E64E5E89-5734-4D1D-BB4D-C4ACD4BF8BD3/0/hlc_paper.pdf
Searight, H. R. & Gafford, J. (2008). Cultural Diversity at the End of Life: Issues and Guidelines for Family Physicians . American
family Physicians.
retrieved from http://geriatrics.uthscsa.edu/tools/CultrualDiversityatEndofLife--Searight.pdf
American Society for Bariatric Surgery. “Rationale for the Surgical Treatment of Morbid Obesity”. November 29, 2001.
Available at: www.asbs.org. Accessed March 25, 2004.
Ferraro, D. R. “Preparing Patients for Bariatric Surgery: The Clinical Considerations”. Clinician Reviews. 2004;14-1:58-62.
Ferraro, D. R. “Management of the Bariatric Surgery Patient: Lifelong Postoperative Care”. Clinician Reviews. 2004;14-2:7479.
Liem, R. www.obesity-surgeon.com
National Institute of Diabetes & Digestive & Kidney Diseases. “Gastrointestinal Surgery for Severe Obesity”. December 2001.
Available at www.niddk.nih.gov. Accessed March 25, 2004.
Voelker, M. “Assessing Quality of Life in Gastric Bypass Clients”. Journal of PeriAnesthesia Nursing. 2004;19-2:89-101.
Institute for Healthcare Improvement
The Joint Commission
177
1.
The recommendation that is made in regard to patient property is to:
a.
b.
c.
d.
2.
Have it locked up by security
Have it kept at the patient’s bedside for easy access
Send it home with a family member
Both a and c
Staff, residents, students and instructors are permitted to park in the parking lot if they have a parking
garage access badge?
True
False
3.
If you have experienced a blood or body fluid exposure, you should:
a.
b.
c.
d.
Wait until the end of the shift to handle it
Wash the affected area immediately with soap and water and contact your Instructor
Go directly to the ER for care without informing anyone
Get the patient tested immediately without telling anyone what you are doing
178
4.
What is the standard for accessing patient information?
a.
b.
c.
d.
5.
If there is a chemical spill in your area you should:
a.
b.
c.
d.
6.
A need to know for the performance of your job
If a physician asks you the diagnosis of the patient
Just because you are curious
You are a relative of the patient
Wipe it up yourself
Call the hospital operator to describe the incident and he/she will then notify the Hazardous
Materials Response Team
Call engineering directly and ask for help
Obtain the chemical spill kit and use it as the directions indicate
In an emergency situation, who may shut off medical gases?
a.
b.
c.
d.
Any staff member, upon direction of a charge nurse, nursing supervisor, respiratory therapist or
cardiopulmonary manager
Any staff member who sees that there is a potential problem
No one may shut off medical gases – except plant operations personnel
None of the above is correct
179
7.
Restraints are used as a last resort only after other methods have been tried and proven to be ineffective.
True
False
8.
Students and residents must complete the Seasonal Influenza Vaccination Documentation form and
provide written proof of their inocculatation.
True
False
9.
There are five opportunities for hand hygiene and include all except:
a.
b.
c.
d.
e.
f.
before patient contact
After using the department desk phone
Before an aseptic task
After a body fluid exposure
After patient contact
After contact with patient surroundings
10. If you wanted to locate the Emergency Operation Manual, you would:
a.
b.
c.
d.
Not worry about where it is, you’ll never need it
Check in your department
Check the Meditech MOX library
Both b and c
180
11. Standard Precautions require that you wear protective equipment that is appropriate for the task being
performed. You need to wear only gloves (no other protective equipment) when:
a.
b.
c.
d.
Performing an invasive procedure where droplets may be generated
During surgery
When handling severe bleeding, from any source
When handling items soiled with blood/body fluids/body substances
12. An example of a fall risk intervention is:
a.
b.
c.
d.
e.
f.
Non-slip footwear
2 side rails up at all times
Bed alarm
Use room close to the nursing station
Toileting offered at least q2h wile awake
All of the above
13. Information that is produced by the manufacturer to describe a product’s identity, hazardous
ingredients, reactivity, health related concerns and proper disposal is called:
a.
b.
c.
d.
Identity label
Material Safety Data Sheet (MSDS)
Ingredient listing
Chemical Safety Sheet (CSS)
14. It is everyone’s responsibility to reduce the risk of patient harm resulting from falls.
True
False
181
15. Biomedical waste is any material that is contaminated with blood or other body fluids that present a
threat of infection to humans. This waste includes:
a.
b.
c.
d.
A band-aid with a spot of blood on the absorbent gauze pad
Absorbent material that is not saturated but contains some blood or body fluid that are contaminated
with blood or other potentially infectious substance
Absorbent material that is saturated with blood
IV bags and tubing with no visible blood on them
16. There will be no disciplinary action taken by JFK Medical Center if patient information is violated
True
False
17. If you experience an injury while on the job at JFK, you should:
a.
b.
c.
d.
Contact the department manager
Notify your Instructor
Follow up with your school and follow their protocol
All of the above
18. If you must call a Code Blue but you are not the patient’s direct caregiver, you should:
a.
b.
c.
d.
Hang around the patient’s room, even if it is getting crowded
Give the operator the room number or area
Leave the area immediately if you are not required to stay with the patient
Both b and c
182
19. The mission of JFK Medical Center is to be the community provider of high quality and
compassionate healthcare that is responsive to the needs of our patients, their families, and physicians.
True
False
20. Health care providers are deemed competent when they are able to understand and respond
effectively to the cultural and linguistic needs brought by diverse patients to health care encounters.
True
False
21. The best way to decrease the amount of radiation that you receive when working around x-ray
machines is:
a.
b.
c.
d.
Decrease the time of exposure, the distance from the machine, and the amount of shielding
Increase the time of exposure, the distance from the machine, and amount of shielding
Decrease the time of exposure and increase the distance from the machine and amount of shielding
Increase the time exposed, decrease the distance from the machine and the amount of shielding
22. Abuse and neglect may be present in which of the following forms:
a.
b.
c.
d.
Physical
Emotional
Sexual
All of the above
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23. Hand-washing is the most effective method to prevent the spread of infection.
True
False
24. If there is a power failure in your area:
a.
b.
c.
d.
e.
Immediately check that all life sustaining equipment is plugged in to red emergency outlets
Wait until plant operations calls to find out what is wrong
Plug all life sustaining equipment into red emergency outlets
Wait for the backup generators to come on-line
Both a and c
25. Patient safety is only the responsibility of JFK Medical Center staff?
True
False
26. Electrical shocks, burns, or electrocution can result from operating machines in unsafe conditions.
These risks can be minimized if you:
a.
b.
c.
d.
Report broken equipment
Do not yank plugs from the wall socket using the cord
Repair equipment yourself
Both a and b
184
27. The best way to prevent exposure to blood-borne pathogens is
a, removing the safety device from equipment if you don’t like it
b. bend the needle after use so that no one else can get stuck
c. washing your hands between patient contacts or after handling soiled or
contaminated equipment
d. allow the needle boxes to fill to save from having to change them so often
28. Understanding the bariatric patients’ unique needs is key to providing safe and compassionate care.
True
False
29. When should you call a rapid response for a patient who exhibits symptoms of stroke?
a.
b.
c.
d.
Immediately
Wait 2 hours to see if the symptoms improve
After your supervisor has been called
After b and c
30. Patient care, treatment, and services may need to be modified for members of a specific population
due to:
a.
b.
c.
d.
e.
f.
Age and socioeconomic status
Sex, race, ethnicity, and religion
Developmental stage – Disabilities
Culture/language spoken
Illness/treatments to be provided
All of the above
185
31. If you see a fire before the fire detectors have activated, which of the answers shown below best
describes the order in which you respond?
a.
b.
c.
d.
Activate the alarm, contain the fire, rescue the people in immediate danger, evacuate to the next
smoke compartment
Contain and extinguish the fire, rescue people in immediate danger and activate the alarm
Rescue people in immediate danger, activate the alarm, contain the fire, extinguish if possible
Activate the alarm, rescue persons in immediate danger, contain and then extinguish the fire
32. Standard Precautions apply to all patients regardless of suspected or confirmed infection.
True
False
33. You can assist the Security Department by
a. leaving valuables in your vehicle in plain sight
b. parking in spaces closest to the hospital
c. returning your badge to Education at the end of your rotation
d. not reporting any suspicious behavior
34. A background check is not necessary in order to begin a clinical rotation or internship
True
False
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35. Proper hand-washing technique includes:
a.
b.
c.
d.
Water – hot as you can
Soap – antimicrobial
Friction – for at least 15 seconds
All of the above
36. All of the following things should be done for a patient identified at risk for suicide EXCEPT:
a.
b.
c.
d.
e.
Keep all sharp objects out of patient reach, watch closely patient handling of all materials in room
Remove shoe laces, belts, tape, soda cans, knives, razors, scissors, lighters, matches, and telephone
cords
Monitor patient’s use of the bathroom – keep door ajar, never locked
Restrict/Monitor visitors – educate them about precautions
Allow the patient to wear his/her own clothes while hospitalized
37. The signs & symptoms of a Stroke include
a.
b.
c.
d.
e.
f.
Sudden numbness or weakness of one side of the face, arm or leg especially on one side of the body
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden severe headache with no known cause
All of the above
187
38. If there is a MEDICAL emergency in your area, you would pick up the nearest telephone and call:
a.
b.
c.
d.
83333
HELP1
33333
88888
39. The Information Security Agreement must be signed by each staff, resident, student and instructor. By
signing it you agree that:
a.
b.
c.
d.
Confidential information will only be discussed with those who have a need to know
The user will only access systems that he/she are officially authorized to use
There should not be an expectation of privacy when using Company information systems
All of the above
40 When the Code Red announcement is made, you should:
a.
b.
c.
d.
Move everything out of the hallway
Close all doors
Wait for the recall announcement to be made before opening doors or allowing people to pass
through
All of the above
188
