Kaiser Medical Center
Volunteer Training/Competency
Pet Therapy
Sample Volunteer Competency List
Name: ______________________________
Date: __________
Age specific Population:
The Volunteers in this service area encounter following check- marked populations
X
pediatric (1 – 12 years)
X
adolescent (13 – 17 years)
X
adult (18 – 64 years)
X
senior (65 years or over)
Task
Date Competency
Observed (O) or
Informed (I)
Trainee’s
Initials
Trainer’s
Initials
i.e. 01/01/09 (O) or (I)
General Tasks
Arrives and leaves at assigned time.
- Varies and when requested. Notifies MOB or Hospital Site
Coordinator regarding changes in availability.
- Sign in and out of the Volunteer office, prior to and after all
visits.
- Check Pet Therapy mailbox and PT log for patients
requesting a visit.
- Document areas visited and requested visits on logs.
Dresses in KP uniform - Polo shirt with ID badge.
Dog wearing KP vest with ID badge.
Door codes:
Reviews and understands procedure for time off and illness.
- Absence line:
- Calendar in Volunteer Workrooms
Safety Locations:
 Identify locations of fire extinguishers, pulls and routes
 Locates the Environment of Care Binder/MSDS sheets
(Volunteer offices and Intranet)
 Locates meeting place if a disaster occurs.
Timecards (changed every six months, Jan. – June, and July –
Dec.)
 Identifies the location of timecards.
 Reviews and understands the procedure for completion of
timecard(s). Use pencil only.
1
Work Place Safety Information
 Monthly Safety Topics/Drawing in Volunteer workrooms
 Process for reporting injuries
Task
Date Competency
Observed (O) or
Informed (I)
Trainee’s
Initials
Trainer’s
Initials
i.e. 01/01/09 (O) or (I)
Etiquette
 Avoids receiving tips and gum chewing.
 No food or beverage allowed during duty in patient/member
areas
 Avoids use of cell phone, texting, iPod during shift
 Pet Therapy dogs should access patient care areas utilizing
stairwells whenever feasible.
 Dogs are to be relieved in areas outside the hospital footprint
with minimal member visibility. Dogs are to refrain from being
relieved in the following areas: MOB Courtyard, near the main
entrances of both the MOB and hospital, all courtyards within
the hospital footprint on any floor.
 Respects confidentiality
Cultural considerations
 Respects member cultural and religious beliefs in providing
volunteer services.
 Avoids patients, visitors and staff who react fearfully to dog.
 Reports any occurrences to RN Unit manager and Volunteer
Services manager immediately and completes a Responsible
Reporting Form (RRF).
 Uses interpreter services as necessary (e.g., AT&T Language
Line Services or Qualified Bilingual staff found on the Intranet –
QBS I or II)
2
Service Standards
 Smiles, introduces self, makes eye contact
 Speaks in appropriate volume
 Upholds patient confidentiality
 Engages in positive, appropriate interactions and conversations
throughout medical facility to maintain optimum representation
of Kaiser Permanente.
Task
Date Competency
Observed (O) or
Informed (I)
Trainee’s
Initials
Trainer’s
Initials
i.e. 01/01/09 (O) or (I)
Infection Control:
 Volunteer washes/degerms hands before and after each visit.
Reminds patient to use gel too.
 Checks with the nurse to ensure visitation of appropriate patients
and any patient wounds are covered prior to the dog entering the
patient’s room.
 Restricts the pet from any areas where there is food preparation,
medication preparation, and/or cleaning supplies.
 Provides clean up supplies/equipment and immediately cleans
up animal waste during each animal visit. Contacts EVS
X14949 for any follow-up cleaning.
 Provides clean hospital gown over current patient’s gown when
dog is requested to sit on patient’s lap.
 Provides a clean sheet, towel or appropriate cover to be placed
on bed prior to allowing dog on the bed. Dispose of the cover in
the appropriate receptacle after visitation.
 Refrain from pet visitation if dog has any illness (diarrhea, open
wound, infection, or in heat.
3
Codes

















Team Alert – STAT medical attention
Code Blue – cardiac or respiratory arrest
Code Pink – Infant/child abduction
Code Red – fire: use RACE procedure
Code Orange – Chemical spill (ID if known)
Code White – Computers are down
Code Yellow – Bomb Threat
Code Gray – Security STAT
Code Silver – Security STAT, weapon or hostage involved
Code Dry – Implement emergency H20 supply
Code Wet – H20 spill
Code C – Emergency C-section
Heart Alert – STEMI heart attack
Stroke Alert – Stroke
Triage I and II – Disaster
HCC – Hospital Command Center
Labor pool location
Task
Date Competency
Observed (O) or
Informed (I)
Trainee’s
Initials
Trainer’s
Initials
i.e. 01/01/09 (O) or (I)
4
Duties:
Reads service description and discusses the following guidelines:
 All visits by pets will be coordinated with hospital personnel
(i.e., charge nurse, manager, and supervisor or unit designee).
 Nursing staff will supervise the Pet Visitation Program visit to
ensure all volunteers and dogs are in compliance with
departmental policies and procedures.
 Pet Therapy volunteer must be in control and in attendance with
dog at all times during every visit.
 Dogs are the only pets allowed in the Pet Visitation Program.
 Dogs must remain on leash at all times.
 Ensures the requirement that the dog must be registered with a
hospital-approved organization (i.e. TDI, Therapy Dogs
International, Inc.).
Incident Reports: verbalizes the following guidelines for incident
reports:
 Hospital personnel will immediately report any incident as a
result of the pet visitation to the supervisor/manager and
complete a Responsible Reporting form.
Supervisor/manager receiving any incident report must notify
Volunteer manager and forward associated RRF.
Patient Safety:
 Provides proof of current vaccinations from the veterinarian/TDI
for all visiting pets. Submits proof of vaccinations from the
veterinarian to the Volunteer Manager on an annual basis.
 Remains with the pet at all times.
 If patient has roommate, checks with the nurse prior to the
animal visit for permission to avoid potential issues/concerns
such as pet allergy or contraindication to the roommate and
his/her medical condition.
 Refrains visitors and patients from feeding the dog while
volunteering.
Communication via e-mail and Internet
 Any and all e-mails sent to PT volunteers regarding requests
for patient visits will only include 4 digit room numbers.
 All communication between PT volunteers will comply with
HIPAA and Confidentiality Regulations.
 Any photos taken within the medical center, prior to
distribution or posting, must be approved through KP’s
Public Affairs department.
 Patients and families may take photos within patient rooms
but must not contain any staff without their consent.
Task
Date Competency
Observed (O) or
Informed (I)
Trainee’s
Initials
Trainer’s
Initials
i.e. 01/01/09 (O) or (I)
5
Patient Communication/Interaction
Demonstrates good listening skills. Able to explain the benefit of
Pet Therapy (i.e., lowering blood pressure, recovery) to visitors, pts,
and staff.
For pediatric patients (1 – 12 years):
 Uses familiar terminology to communicate at the child’s level
when communicating and interacting with the child.
For adolescent patients (13 – 17 years):
 Avoids authoritative approach when communicating and
interacting with the adolescent.
For adult patients (18 – 64 years):
 Speaks clearly and calmly when communicating and interacting
with the adult patient.
For senior patients (65 years and over):
 Faces the senior member and speaks slowly and audibly when
communicating and interacting with him/her. Allows times for
the senior member to respond or ask questions. Repeats as
necessary to ensure clear communication.
Comments:
I have completed the above service orientation and feel comfortable to proceed alone.
Signature: ______________________________________________Date: __________
Validator’s Signature:
Title: ___________
Date: __________
6