4National Focus on Patient Safety Institute of Medicine report –“To Err is Human” (Nov. 1999)44,000-98,000 deaths due to medical errorsAnnual cost $17B-$29BFederal Mandate and Regulatory Requirements-Presidential directive, The Joint Commission,Centers for Medicare & Medicaid Services,State regulations
5Basics of Patient Safety Actions undertaken by individuals and organizations to protect health care recipients from being harmed by the effects of health care services.
6The Case for Patient Safety Patient safety is a critical component of qualityHealth care is NOT as safe as it should bePeople do not come to work with the intent to hurt patientsWe are human therefore mistakes will occurWhen mistakes do occur we want there to be no harmSpeak-up for patient safety
8Patient Safety First at GSMC! Patient safety is a priority at Good Shepherd Medical Center. Our staff and physicians are committed to improving quality of life and providing safe and healthy surroundings for patients, visitors, and staff. Many procedures are in place to protect the well-being of our patients and to secure the best medical outcome possible.Everyone has a role in patient safety.
10The Patient’s Perspective Don’t hurt meHeal meBe nice to me
11Culture and Safety Culture Behaviors Outcomes is the shared values and beliefs of the individuals in the organization(the way we act whenno one is looking)BehaviorsOutcomes
12Take Action to Reduce Risk Proactive: Monitor patient safety and redesign high-risk processes to prevent an event from occurring.Reactive: Investigate significant patient incidents.
13Culture of Safety Root Cause Analysis Based on findings we: We intensely analyze any error that does occur.Based on findings we:Redesign systemsTest new designsEducate staff on changesFollow-up to see if new design is effective
15Encourage patients, families, staff and physicians to report safety concerns on the hotline Close calls, near misses, share ideasAvailable 24 hours a day, 7 days a weekAnonymousLeave name and number for follow-upIdeas of merit qualify for recognition or rewards
17Rapid Response TeamThe Five Million Lives Campaign by the Institute for Healthcare Improvement encourages healthcare organizations to implement a rapid response team.In 2006 Good Shepherd implemented a rapid response team.The goal is to respond to a “spark” before it becomes a “forest fire.”To prevent deaths in patients who are failing outside intensive care settings.
18Rapid Response Team Call early, Call often Call Rapid Response anytime you are worried about the patient!Clinical and non-clinical staff, patients and families can activate the Rapid Response Team.The team can respond and assist with stabilizing the patient before a cardiopulmonary or respiratory arrest occurs.Call early, Call often
19The Josie King Story Josie King, an 18 month old little girl, died from medical errors in oneof the best hospitals in our country.Josie was the sister of Jack, Relly,and Eva and beloved daughter ofTony and Sorrel. She died as aresult of a series of hospital errorsand poor communication. Throughthe creation of a patient safetyprogram, it is the King family’shope to prevent this from everhappening to another patient.
20Josie King Foundation - Condition “H” (Condition Help) University of Pittsburgh Medical Center - UPMC Shadyside and Children’s Hospital of Pittsburgh worked with the King family to develop the nationally recognized model known as Condition H.Condition H was created to address the needs of the patient/family in case of an emergency or when the patient is unable to get the attention of a healthcare provider in an emergency situation. The call provides immediate help when:they feel they are not receiving adequate medical attention; orif they become concerned with what is happening.The program was designed to be a safety net for patients. In many cases, it is the family who knows the patient better than we do.When Condition H is called, a rapid response team arrivesto the patient’s bedside within minutes.
22Partnering for SafetyWhen patients partner with the health care team, it helps us ensure a safer health care experience for all of us.Patients are encouraged to be actively involved in their own care for safety reasons.
23Involve Patients in Care Our Patients-Our Partners: One Team, One GoalA few ways we involve patients in care…Educate the patient and/or family about hand hygiene, respiratory hygiene, contact precautionsEducate surgical patients about how we prevent adverse events during surgeryInform patients/families how they can report safety concerns by calling Condition H, Patient Safety Hotline (BUZZ), Guest Relations or The Joint Commission
242012 National Patient Safety Goals The purpose of the Joint Commission’s National Patient Safety Goals (NPSGs) is to promote specific improvements in patient safety.The goals are revised on an annual basis and highlight problematic areas in health care and describe evidence and expert-based solutions to these problems.By addressing problems, organizations can promote patient safety and prevent sentinel events.A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury.
252012 National Patient Safety Goals Goal 1 Improve the accuracy of patient identificationGoal 2 Improve the effectiveness of communication among caregiversGoal 3 Improve the safety of using medicationsGoal 7 Reduce the risk of healthcare-associated infectionsGoal 8 Accurately & completely reconcile medications across the continuum of careGoal 15 The hospital identifies safety risks inherent in its patient populationUNIVERSAL PROTOCOL: The organization meets the expectations of the Universal Protocol for Preventing Wrong Site SurgeryNote: Some goals and requirements appear to be misnumbered or missing from the numerical sequence.This in not a typographical error. Some goals do not or no longer apply to hospitals and therefore have not been included.
26Improve the Accuracy of Patient Identification To make sure the right person is receiving the intended care, treatment, and services we must use at least two patient identifiers.NameBirthdateWhen confirming a patient’s name, staff members should not state the name and ask the patient to confirm it. Instead, staff members should ask the patient to state his or her name and birthdate.
27Reduce the Risk of Healthcare-Associated Infections CDC GuidelinesAlcohol-Based Hand Sanitizerwhen hands are not visibly soiledapply to palm of hand and rub hands together covering all surfaces of hands and fingers until hands are drySoap and Waterwhen hands are visibly soiledpatient has Clostridium Difficile (C-Diff)after going to the restroombefore eatingat least a 15-second scrubGlovesthe use of gloves does not eliminate the need for hand hygieneand hand hygiene does not eliminate the need for gloves
29Fall PreventionPatients at risk for falls have a yellow “Fall Risk” armband applied and a magnet placed outside the patient’s door.The patient receives a pair of treaded socks.All efforts are made to move the patient as close as possible to the nurses desk.Family or friends are encouraged to stay with patient, if unable may consider a sitter.Communicate “at risk” patients during patient report and hand off between units.
31Medical Error Reporting The Medical Error Hotline is a voic line available 24 hours a day providing complete anonymity. Employees may use this line to report concerns regarding a medical error was not documented, reported or addressed appropriately.
33Variance ReportingHospital employees and medical staff members participate in a hospital wide variance reporting program.Types of Variance Reports:Falls – Fall Safety ReportMedication Errors – Medication Safety ReportOther occurrences not in the above categories – Variance Report
34Variance ReportingVariance Reports are to be initiated by hospital staff members or employees involved in or identifying occurrence.All questions or sections of the report must be completed.Descriptions should be brief, factual and objective.Patients, visitors and employees who sustain injuries will receive medical attention.On-line system allows anonymousreporting.
35Variance ReportingVariances are reported directly from the occurrence area to the supervisor, manager or director.Managers should investigate pertinent issues reported with a brief summary in the online-systemVariances are routed to Risk Management within 96 hours of the occurrence.Variance Reports will be trended and reviewed by Risk Management.Variance Report Forms are found on GSnetTo Access for – GSnet – Var RptsVariance Reports are never to be duplicated.
36Variance ReportingExamples of occurrences that should be reported on the Variance Report:Mishaps due to faulty/defective equipmentUnexpected adverse results of professional care or treatment – death, brain damage, physical loss or impairment, etc.Unprofessional, threatening or inappropriate conduct of health professionals or employeesPatients leaving against medical adviceThefts, burglaries and vandalism on hospital premises
39Impaired Provider What is impairment? The inability to “practice with reasonable skill and safety” because of:Physical illness or conditionMental disorderAlcohol or drug abuseDisruptive behaviorSexual misconduct/boundary violationsBurnout
40Impaired Provider Examples of disruptive behavior: Bullying or demeaning behaviorSexual harassmentAbusive treatment of patients or staffProfanity or disrespectful languageRepeated violations of rules and policiesPhysical attacks, hitting, pinchingImproper comments/illustrations in medical recordThreatening to get someone fired
41Impaired Provider Healthcare Practitioner Code of Conduct Provides guidance to ensure work is done in ethical mannerAlso referred to as Code of Ethics
42Impaired ProviderReporting impaired practitioners and disruptive behavior:Document specific examples and patterns of disruptive behaviorAnyone may report an impaired provider or disruptive behavior to Executive ManagementComplaints are investigated by Human ResourcesExecutive Management may identify involved practitioners to the Committee on Physician Health (CPH)Identity of reporting individual kept anonymous unless individual gives permission to discloseRetaliation against reporting individuals isgrounds for immediate referral to theExecutive Committee for correctiveaction.
43Safety Sense: Occupational Injury Benefit Plan Rev
44What is SAFETY SENSE?Good Shepherd Health System (GSHS) DOES NOT have workers’ compensation insurance coverage for work-related injuriesGSHS is a “non-subscriber” to workers compensation, and does provide medical, death, dismemberment and wage replacement benefits to employees who sustain injuries or occupational diseases in the course and scope of their employment.The GSHS plan is called SAFETY SENSE
45New Plan Effective Aug. 17, 2009Our new plan was effective 8/17/09 and provides similar benefits to workersMedical care for injured employees will be provided at the GSMC Occupational Medicine Clinic. GSMC Emergency Dept. is for true emergencies.Injuries must be reported within 24 hours of occurrence using the Accident Investigation ReportA urine drug screen is required for injuries that need medical treatment.
46SAFETY SENSE: Benefits Available Medical care at Occupational Medicine, specialty referrals, therapy, and diagnostic testing, as needed, through Occ Med provider.Light duty accommodations for employees placed on restricted dutyWage replacement at 75% of salary for employees taken off of work after 32 hours of lost time.
47Acknowledgement of SPD A Summary Plan Description (SPD) of the SAFETY SENSE Occupational Injury Benefit Plan is provided to you by clicking the link on GSNet under “Work-Related Injury” in the Policies section. Spanish and English versions of the SPD are available on GSNet.Please review the plan, print a copy, if you like.If you are unable to print a copy and desire a copy, one can be provided to you by calling the phone numbers given below.You have been provided with information about the GSHS SAFETY SENSE plan and agree to comply with the Plan.Please contact Beth Chrismer - (903) for questions.
49Patient RightsWhen and where are patients informed of their rights? At the time of RegistrationRights include:Considerate and Respectful CareAdvance DirectivesConfidentialityHospital Policy & ProceduresPatient Complaint Process
50Patient RightsNotice of Patient Rights posted in Registration area and available onEthics Committee – Good Shepherd Medical Center Ethics Committee’s goal is to facilitate ethical reflection and decision making by persons involved in the case, focusing on the patient’s values and wishes versus imposing a decision. Their role is consultative in nature rather than decision making. (consent/refusal to treatment, withholding life support, DNR)Chaplain, nurse, physician and others convene to render decision.Decision can be accepted or deniedContact your Supervisor to convene the EthicsCommittee
52Contact Tina Collins: Medication Safety (3612) Chris Bland: Safety Manager (5163)
53Environment of Care Disciplines of the Environment of Care Safety SecurityHazardous materialsEmergency ManagementFire SafetyMedical EquipmentUtilities
54Environment of CareThe Safety Management Plan at Good Shepherd Medical Center provides a process to effectively manage and reduce safety-related risks to patients, staff, and visitors.
55Environment of Care Safety Management Goals Comply with all safety-related regulatory requirements.Provide a safe, secure, and therapeutic environment for patients, staff, and visitors.Integrate safety practices into daily operations.Identify opportunities to improve performances in the safety management program.
56Environment of Care This facility has an Environment of Care Committee (EOCC) that monitors training and competence of staff and assesses physical and operational conditions of the infrastructure and grounds and equipment through building inspections, environmental rounds, safety inspections, and various performance improvement initiatives.
57Healthcare Security Functions of security include the following: To protect staff, patients, visitors, and property.To investigate and record incidents, thefts, disturbances, vandalism, accidents, and traffic accidents.To provide special services including escorts, battery boosts, and lock and unlock doors.To respond to emergencies such as fire, disaster, and bomb threat.
58Healthcare Security Phone numbers for Security Security: ext. 3376/2196FAX: ext. 1153If you are inside the hospital, you may dial “0” and ask the operator to call Security on the radio. (Preferred method)
59Healthcare Security Secure your valuables Lock valuables in work areas.Keep valuables out of sight in your car or trunk.Weapons – No weapons (firearms, clubs, knives with long blades) may be carried on property.Escorts and Parking Lot Safety– always try to walk with a group, rather than alone, to your vehicle. Use the “Buddy System.”
60Healthcare Security Badges – always wear your ID badge. Badges must be either worn on the upper left chest by being attached to a collar, lapel or shirt pocket or attached to a GSHS approved lanyard.Badges are that are damaged due to misuse, wear and tear or are lost will be replaced at a charge of $5.00 to the employee.Badges are also to be used as access cards for the employee parking lots.Suspicious persons or activities – Report any suspicious persons or activities immediately by calling “0” and alertingthe operator or call security at x3376.
62Fire Safety General Guidelines To report a fire, call 3000 and report CODE REDEnforce “no smoking” rules.Use only approved extension cords.Keep flammable materials away from ignition sources.Enforce policies about unauthorized appliances and equipment.Keep general housekeeping in order.Report or correct any fire hazards.
63Fire Safety Extension Cords Use only approved extension cords. Cords must have a grounded plug.Use the correct cord for the load and protect the cord from traffic.Be sure extension cords are in good working condition.Do not overload electric sockets or extension cords.
64Fire Safety Flammable Materials Keep flammable materials away from ignition sources.Class A fires involve normal combustibles such as wood, cloth, paper, rubber, upholstery, and plastics.Class B fires are related to flammable liquids, gases and greases, such as oils, paints, and gasoline.Class C fires are related to electrical equipment such as fuse boxes, circuit breakers, machinery, and appliances… computers, televisions and mechanical equipment.
65Fire Extinguishers Fire Safety All extinguishers in this hospital are rated forClass A, Class B, or Class C fires.Good Shepherd uses the PASS method of operating a fire extinguisher:Pull the pinAim at the base of the flameSqueeze the handleSweep from side to side
66Fire SafetyGood Shepherd uses the RACE method of dealing with a fire: Rescue (Move Patients past 1st Fire Door) Alarm (Pull Station or Call Operator) Contain Fire Extinguish/Evacuate
67Emergency Preparedness Code WordsEmergency number 3000 use for all emergenciesOperation Baker – Emergency EvacuationCode Gray – Bomb ThreatCode Adam – Abduction in the hospitalCode Yellow – Bioterrorism eventCode Black – TornadoCode Red – FireCode Blue – Cardiac ArrestCode Pink – Neonatal ResuscitationCode Stroke – Reponse to Stroke PatientOperation Able – Mass CasualtyCharlie Brown – Combative individualDuress Word – ADVICE
68Operation Baker - Evacuation Operation Baker is the implementation of strategic or urgent evacuation of patients and other persons from the Medical Center or grounds. Assist all patients and visitors out of the building. Be aware of all evacuation routes in your area.
70Bomb Threat – Code GrayEmployees in the immediate area of the bomb should remember:Search for and report any suspicious objects. DO NOT move, jar, or touch the object or anything attached to it.Check public access areas, such as restrooms, telephone booths, ER, lobby, and patient rooms first.DO NOT turn lights on or off.Turn off all two-way radios, cell phones and pagers.
71Abduction in the Hospital - Code Adam Denotes an abduction from the hospitalIf an employee suspects an abduction, they should call 3000 and report Code Adam with a description of the person who was abducted (age, sex, race, etc.)All employees should search the area and detain visitors until an all clear is announced.NATIONAL CENTER FOR MISSING AND EXPLOITED CHILDREN says“Prevention is the best defense against infant abductions”HUGS Infant Security System
72Bioterrorism - Code Yellow A substantial influx of patients with illnesses that are uncommon in nature should be suspect. Code Yellow will be called when it is determined these illnesses are a result of a bioterrorist event (such as anthrax, etc.). Infection control should be notified immediately, and all personnel in areas that provide initial treatment to patients should be aware of department specific treatment protocols.
73Code Black can be proceeded by : Operation Weather Watch Tornado - Code BlackA tornado has been spotted within a five mile radius of the Medical Center. Patients should be moved to inside corridors and away from windows until an all clear is announced.Code Black can be proceeded by :Operation Weather Watchmove to state of readinessalert visitors to weather conditionsreview Code Black procedures
74Fire - Code RedFire or smoke situation which requires activation of the fire response plan. Respond to a fire by calling the emergency number 3000 or activate the fire pull in your area. Locate all exits and evacuation plans for your work area to be prepared for an emergency.
75Cardiac Arrest - Code Blue Code Blue is called when a patient suffers cardiac arrest. This code is called by calling 3000 and stating Code Blue and the location or patient room. The Code Blue team reports to the location announced and starts resuscitation efforts.
76Mass Casualty – Incident Operation Able Hospital expects large number of patients to be treated due to the incident. Major Disaster Response Plan will be implemented upon announcement of “Operation Able”. All departments should implement their department-specific response plans for appropriate action.
77Combative Individual – Code Charlie Brown Charlie Brown alert is issued for a combative individual with security responding to subdue the individual. Employees should balance or offset the person’s behavior with a helpful, calming response.If the behavior becomes violent, call the emergency response team by contacting 3000, stating “Charlie Brown” and giving them the location of the event.
78Emergency Response Team The staff member initially involved with the combative person and the Charge Nurse become team leaders. Uses the least force necessary to physically quiet or restrain combative individual. Notify treating physician or ER physician to secure order for restraint and/or medication.The team leader or their designated staff notifies the hospital operator of the situation and location by calling “Charlie Brown” to x3000.
79Duress Word – “Advice”Hostage situation – The duress word to alert the operator of a hostage situation is ADVICE. All calls should include the word ADVICE and the CEO’s name with as many details possible – number of people, weapons, number of attackers, etc.(Example: This is Mr. Williams. I am in the Personnel Office with four people. Please contact Mr. Banos. I need his Advice. Have Mr. Banos contact me at this phone number, 2130, with the advice.)
80Hostage SituationsImmediately notify appropriate department to report situation and its location.Remove people from the area if it can be done in a safe manner without drawing attention to the hostage taker.Assist in preventing other staff, visitors, and/or patients from entering the area.Identify number of hostages and any suspects.DO NOT call out the emergency code. Call Executive Management and use code word ADVICE.
81Electrical SafetyWhen normal power is interrupted, and emergency power system takes over.The system is powered by diesel-fueled generators.The emergency power system comes online within 10 seconds when normal power is interrupted.Plugs for emergency power are to be easily seen. (red-outlets)Ivory outlets: Normal power-general purpose.
82Utilities ManagementUtilities at Good Shepherd are protected by back up provisions in case they fail.Emergency Power System – takes over when normal power is interrupted. Emergency system is powered by seven generators – four in the hospital and two in the Medical Plaza and one in the Customer Service Center. Plugs for emergency power are either red or labeled appropriately.
83Utilities ManagementWater Outage – follow the Emergency Water Supply Plan in your Safety Manual to minimize the impact on patients.
84Utilities Management Fire Detection System The Plant Operations Department has a fire detection system that is computerized and monitored 24 hours a day. These systems are routinely inspected and tested annually.On the individual unit or floor, you have a:Pull stationSmoke detectorFire extinguisherChiming light or horn and lightFire doors
85Other Utilities-Elevators 30 Elevators in use in the facilityElevators are a very safe mode of transportationAlways practice proper elevator etiquette.
86Medical Equipment Management Know where the shut-off valves and zone valves are located when working with oxygen, vacuum, and medical air.Be prepared to shut off valves as instructed during a fire.
87Safe Medical Device Act Medical Equipment ManagementSafe Medical Device ActA means for reporting equipment that could or has caused or contributed to the death or permanent injury to a patient. When discovered, immediately notify supervisor and/or the Risk Manager. The equipment must be reported to the FDA within 10 days.
88Medical Equipment Management If there is any chance the equipment has harmed a patient in any wayremove the item from service immediately, with accessories.label it as defectivecomplete an incident report.DO NOT try to repair it yourself, and do not allow it to be worked on or examined by someone else.Immediately report malfunctioning equipment to BioMed at x4532.
89Medical Equipment Management All equipment is inspected periodically by Bio-Medical Services.The Biomed Shop contains a library of operator and service manuals for equipment and spare parts for critical life support equipmentCALL x45327:00 a.m. to 4:30 p.m. M-FAfter hours, On-Call BMET is available by calling the operator
90When are Interim Life Safety Measures Taken? Construction areasLocations near constructionAll buildings that do not meet current life safety codesImplemented if construction restricts, impedes or changes personnel emergency exit routes or affects fire detection/suppression systems.
91Hazard CommunicationAll hazardous materials have a Material Safety Data Sheet (MSDS) available through your department, your supervisor or on GSnetRight to Know assures employees are aware of possible exposures in their work environmentAll hazardous materials must have a label naming the chemical and have adequate hazard warning. Report any unlabelled containers to your supervisor.
92Hazard Communication The National Fire Protection Association’s (NFPA) placard system provides a simple system of hazard identification.The placard is diamond in shape.(blue, red, white, yellow)Color coded for type of hazard.Number coded for severity of the hazard.
93Hazard CommunicationKeep disposable empty compressed gas cylinders separate from other trash and secured in the proper location for your area.Cylinders should be chained or secured when not in useDispose of cylinders as directed at your facility.
95Spills or Leaks of Known Hazardous Substances Hazard MaterialsSpills or Leaks of Known Hazardous SubstancesTake the following actions for spills or leaks of a known substance:Immediately secure the areaRequest assistance from Environmental ServicesEnvironmental Services has trained personnel to clean spills – hazardous and unknown.They will obtain special equipment (spillkits, mops, towels, etc.
96Spills or Leaks of Unknown Substances Hazard MaterialsSpills or Leaks of Unknown SubstancesFor spills or leaks of an unknown substance, you should:Isolate the area from public and all non-essential persons.Secure the areaRequest assistanceDetermine the nature of the materialContain the spill or leak
97Hazardous Material Response Team The team is responsible for responding to all spills housewide 24 hours a day. The team is comprised of: EVS Personnel Safety Manager Security Lab Plant Operations (if spill is on grounds) Other Personnel as needed
98Hazardous Material Response Team Good Shepherd has policies on GSNet in the HazMat Manual on hazardous materials and spills.Nursing has policies on GSNet regarding chemotherapy safe handling and usage.
99HOW DO CHEMO SPILLS AFFECT ME? Environmental Services -Cleans spills greater than 5ccNursing - Cleans spills less than or equal to 5 cc & reports spills greater than 5cc by calling 3000.
100Blood or Body Fluid Spills Hazard MaterialsBlood or Body Fluid SpillsMinimize your risk of exposure by containing, removing, and disinfecting all blood or body fluid spills as quickly and effectively as possible.Wear gloves and other appropriate Personal Protective Equipment (PPE).Use a dry absorbent material toSolidify larger fluid volumesTransform them into an easily handled semi-solid state
101Hazard Materials Eyewash Station Employees who may be exposed to hazardous corrosive chemicals should know how to use emergency eyewash equipment.If the spill is on protective equipment, remove the equipment (gloves, glasses, goggles, clothing) after the eyewash is activated.Rinse away chemicals remaining on the equipment.
102Radiation Safety Distance and Shielding Two techniques for reducing dose rate areDistanceShieldingMobile units - six feetMaximizing the distance between the source and the worker decreases exposure significantly.
103Radiation Safety Dosimeters Leave the badge at work in a specified location at the end of each day. (one month wear)Use dosimeters only for measuring an occupational dose.Do not wear the dosimeter if you are receiving medical or dental exposures as a patient.Protect from extreme temperature changes, humidity and chemicalsDo not expose to water or liquid
104Body MechanicsInjuries on the job can be prevented by using the Five Principles of Body Mechanics.1. Posture – keep your chin level and slightly tucked, keep chest up but not out, stomach muscles tight, knees not locked2. Keep objects close to your body3. Face the object4. Symmetry – use both sides of your body equally, use both hands whenever possible5. Wide base of supportStanding – Legs should be at least shoulder-width apart.They can be either side to side or one in front of the other.Sitting – Keep weight evenly distributed.
107Contact Joey Sutton: Care Direct Coordinator (3612) Jeanie McKay: Director of Organizational Development (5276)
108Cultural DiversityGood Shepherd Medical Center represents a diverse population of people from our staff to our patients.You will be asked to take a new look at the population served by learning about cultural values, beliefs, norms, and practices of particular cultural groups.
109Cultural Diversity Keys to Success: Communication Styles – be sensitive to body language when addressing patients:Facial expressions – frowning, smiling, etc.Gestures – pointing, hand signals, etc.Example: American people widen their eyes to show anger, Chinese people narrow theirs. Some cultures view making eye contact as rude versus being polite.Personal Space – be aware of the dynamics of your impact on:Distance - backs a wayTouch – May want or not want to be touchedExample: American culture expects people to stand about an arm’s length apart when talking, Hispanics favor being closer and moving away might be perceived as being “cold.”Relevance of TimeImmediate versus laterRecognize that differences in time consciousness may be cultural and not a sign of laziness or resistance.
110Cultural Diversity GSMC supports Cultural Diversity by: Religion -Chaplaincy services available for all denominationsLanguage – Cyracom telecommunication for over 300 languages, ASL, interpreters.Food Requests – Special diets available on request.
111Cultural DiversityAll people are NOT alike regardless if they are of the same culture.Avoid stereotyping people.
113Population Specific AGE GROUPS: Neonates - birth – 6 months Infants – 6 months – 12 monthsToddlers – 1 year – 4 yearsPreschooler – 4 years – 6 yearsSchool age – 6 years – 12 yearsAdolescent – 13 years – 18 yearsAdult - 19 years – 65 yearsGeriatric – 65 years old and beyond
114Population Specific Neonates: birth – 6 months Smile Follow objects with eyesMaintain head control
115Population Specific Infants: 6 months – 12 months Increased development of the arms and legsBabies become familiar with their bodies by putting hands and feet in mouth
116Population Specific Toddlers: 1 year – 4 years Significant people are parentsMay appear afraid of strangersVery activeUse play to learn
117Population Specific Preschooler: 4 years – 6 years Short attention spans and a lot of energyCurious and imaginativeAfraid of being in hospital, the dark, and pain
118Population Specific School age: 6 years – 12 years Knows the difference between fantasy and realityHave a strong need to follow rulesAct younger than they are
119Population Specific Adolescent: 13 years – 18 years Do not like to ask questions for fear of appearing “stupid”Can react with anger when frustratedPeer identity is very important
120Population Specific Adult: 19 years – 65 years Early Adulthood – Manages a household, rears children, develops careerMiddle Adulthood – Accepts physical changes, maintains a healthy lifestyle, plans for retirement
121Population Specific Geriatric: 65 years old and beyond Bones become more fragile and fracture more easilyMay have decreased vision and hearingMay be depressed related to a decrease in their physical abilities
122Population SpecificPopulation specific skills are the skills used to give the care and attention that meets an individual’s needs.Each individual has his or her own likes and dislikes, feelings, thoughts, beliefs, life experiences and abilities.Experts have determined that these qualities are similar according to a person’s age or stage of life.When we understand these stages of life, we improve the care and attention given to patients, families, and visitors.
124Offered to all patients, families, staff and volunteers: Spiritual CareOffered to all patients, families, staff and volunteers:Non-denominational spiritual counselor providing spiritual support and counselingBereavement supportSacramentsOn-call clergy available for pastoral careStress managementServices for special occasionsChapel – First floor, across from Waiting area
125Offered to all patients, families, staff and volunteers: Spiritual CareOffered to all patients, families, staff and volunteers:Pre-operative patients and family membersPatients who have religious/spiritual requestsPatients, families and/or staff experiencing emotional/spiritual distress
126Spiritual Care A spiritual care consult can be obtained by: Physician OrderEmployee/Volunteer requestPatient/Significant other requestConsult the Chaplainthrough phone extension 2636,Pager #OrThrough the hospital operator
128Palliative CareStarts in the initial phase of the disease process, and continues through this process until cure, remission, or death occurs. In palliative care, no specific treatment is excluded, from curative treatments to resuscitation; however, emphasis remains on comfort care of the patient and the needs of the family dealing with a life-altering disease process.
129Hospice CareHospice is primarily a concept of care, not specific place of care. Hospice emphasizes palliative rather than curative treatment; quality rather than quantity of life. Professional medical care is given, and sophisticated symptom relief provided. The patient and family are both included in the care plan and emotional, spiritual and practical support is given based onthe patient’s wishes and family’sneeds.
131Abuse, Neglect & Exploitation As a skilled caregiver your responsibility includes:To know when you see a victim of abuseTo offer the care neededTo report:Social ServicesNursing SupervisorTexas Department of Protective Services
132Abuse, Neglect & Exploitation Forms of AbuseSelf – does not care for basic needs , unfilled prescriptions, does not eat properly or has poor grooming habitsCaretaker – Neglect or dependent child/adultEmotional –Spoken threats, aggressive behaviorPhysical- Hitting, kicking, throwingSexual – Sexual harassment, sexual assaultExploitation – Taking advantage of or misuse of patients personal belongings, including finances
133Abuse, Neglect & Exploitation Signs of NeglectPoor hygieneBody liceDehydrationUnfilled prescriptionsMalnutritionFailure to thriveBasics – necessities of life, housing, clothing, nutrition, medical care, needs supervisionMunchausen Syndrome by proxy
135ViolenceCycle of ViolenceTension BuildingPhaseHoneymoonPhase
136Domestic Violence A Healthcare Issue 25-30% of women presenting to the ER are current or formerly battered women2.2 – 3.1% of patients (700,000 – 1.1 million)in the ER present with abuse related traumaAbused woman account for 64% of all female psychiatric inpatients18 – 32% of pregnant women are abused
137ViolenceAll adult patients in the ED and in the Inpatient Units are screened for domestic violenceVictims are offered the resources of the Women’s Center and Shelter or the Texas Department of Protective Services.
138Violence in the Workplace Health care and social service workers face an increased risk of work-related assaults stemming from several factors, including:The prevalence of handguns and other weapons among patients, their families or friends.The increasing number of acute and chronically mentally ill patients now being released from hospitals without follow-up care, who now have the right to refuse medicine and who can no longer be hospitalized involuntarily unless they pose an immediate threat to themselves or others.
139Violence in the Workplace Additional risk factors of work-related assaults, include:The availability of drugs or money at hospitals, clinics, and pharmacies, making them likely robbery targets.Situational or circumstantial factors; the increasing presence of gang members, drug or alcohol abusers, trauma patients, or distraught family members, long waits in the ED, all leading to client frustration.
140Violence in the Workplace Why is workplace violence prevalent in healthcare?Healthcare workers deal with people on a daily basis who:Are scared – they do not know what is happening or they know that what may happen will be unpleasantAre feeling loss of personal power – they need to show that they are still in control and can act as an individualAre angry – they are angry at the situation which has placed them in the healthcare workers’ care; they are angry that their loved ones are hurting or are ill or dyingAre in pain or are sick
141Violence in the Workplace Workplace Violence PreventionGSMC is committed to the prevention of all forms of violence in the workplace, and to providing a safe and secure work environment for all employees.Report warning signs of potential violence as soon as possible to a security officer or supervisor.
142Violence in the Workplace Workplace Violence PreventionPractice Non-Violent Crisis InterventionRecognize the signs of someone in an agitated stateStay in control of your own behaviorDo not handle crisis alonePractice tension reduction and therapeutic rapport
144Contact Deb Stewart: Mgr. Privacy Officer (2684) email@example.com Compliance Hotline:
145Background: Federal Privacy Protections Health Insurance Portability and Accountability Act of 1996 (HIPAA)Applies to:Hospitals, physician practices, and other providersHealth insurance companiesProtects the confidentiality of health informationGives patients certain rights with respect to their health information
146Background: State Privacy Protections State laws and regulations also protect patient privacyState laws may apply to information about sexually transmitted diseases, HIV, genetic testing, or other conditionsProviders must comply with both federal and state laws
147Background: Protected Health Information (PHI) HIPAA is designed to protect information that:Identifies individual patients, including demographic informationRelates to the past, present, or future physical or mental health of a patientRelates to the past, present, or future payment for a patient’s healthcare services
148How the HIPAA Privacy Regulations Impact Our Daily Practices Rev
149Dr. Jones’ office contacts the hospital to schedule an admission for Mr. Smith. He will be admitted for surgery to repair a fractured ankle.The Hospital Must:Provide a notice of Privacy Practices if this is the patient’s first admission.Make a “good faith” effort to obtain a written acknowledgment from the patient that he has received the Notice of Privacy PracticesTell him that information will be put in the facility directory and allow him an opportunity to object.
150A few weeks after his discharge, Mr A few weeks after his discharge, Mr. Smith returns to the hospital and requests a copy of his records.Under HIPAA, patients have the right to access their records in designated record sets and obtain copies of them. This right extends for as long as the hospital keeps the records.Designated record set for providers includes:-Medical Records-Billing Records-Diagnostic images such as X-Rays, EKGs and scans
151A few weeks after his discharge, Mr A few weeks after his discharge, Mr. Smith returns to the hospital and requests a copy of his records.May charge a reasonable cost-based fee for making copies and for postage. May not charge a fee for retrieving records for review.Most providers do not charge for copies sent to other providers or given to the patient for continued care.
152Mr. Smith wants to know to whom the hospital has released information from his records. Individuals have the right to request an “accounting of disclosures” of PHI for six years prior to the request.Exceptions:Payment, treatment, or operationsTo the patient or someone authorized by the patientTo those involved in the patient’s careFor national security or intelligence purposesTo correctional institutions and law enforcementBefore April 2003
153Patients have the right to request an amendment: After reviewing his records, Mr. Smith finds information he believes is incorrect. He asks to have the record amended.Patients have the right to request an amendment:In a designated record setFor as long as the hospital maintains the recordsMost providers require a written request with rationale.Providers have 60 days to act (with a possible 30-day extension).If the request is granted, the hospital must:Notify patient that amendment was acceptedInform relevant persons identified by patient.Amendment requests in our facility must bereferred to the privacy officer.
154Many deny request if PHI: After reviewing Mr. Smith’s request, Dr. Goodcare denies the amendment.Many deny request if PHI:Was not created by the hospital (unless the originator is no longer available)Is not part of the designated record setWas not available for inspectionIs accurate and complete
155If the request for amendment is denied: The hospital must give written notice to the patient, explaining:Reason for denialRight to submit written statement of disagreement or have request included with future disclosuresIndividual’s right to complain to the privacy officer or HHS
156Mr. Smith’s wife requests a copy of his recors. She says Mr Mr. Smith’s wife requests a copy of his recors. She says Mr. Smith wants to send it to another doctor who is treating him.The patient’s written authorization is necessary to give his wife a copyThe records could be sent to another healthcare provider upon request, because this is covered as part of treatment, payment, and healthcare operations.
157A few months later, Mr. Smith comes back for a follow-up visit A few months later, Mr. Smith comes back for a follow-up visit. As he’s leaving, he overhears two staff members discussing his case in the hallway. Visibly upset, he returns to the information desk and says he wants to file a complaint.Patient discussions should never occur in a public area, where they may be overheard by othersPatients have the right to file complaints if they believe their privacy has been violated, and we take these complaints very seriouslyThe privacy officer should speak privately with the patient to better understand the situation and express concern
158Penalties for Violations We will take corrective action up to and including discharge of an employeeIndividuals may also be subject to criminal and prison time, for intentional violations
159Guarding Ethics: False Claims and Corporate Compliance Rev
161Federal and State False Claims Laws Laws to prevent and detect fraud, waste and abuse in federal and state health programs, such as Medicare and Medicaid.Civil lawsuits may be filed to recover damages and penalties from healthcare providers who submit false claimsAny person may file a lawsuit who has knowledge of false claims
162Federal and State False Claims Laws Healthcare provider that commits fraud and abuse against Medicare/Medicaid may be fined $ $11,000 for each false claimMay be liable for payment up to three times the government’s damagesMay be liable for payment of costs of civil action against the healthcare provider
163Federal and State False Claims Laws Individuals are encouraged to report misconduct under the “whistleblower” provisionIndividuals may bring a civil lawsuit on behalf of the US Government to recover funds paid by Medicare/Medicaid false claimsGovernment may determine if the lawsuit has merit and may or may not join the lawsuit“Whistleblower” may receive reasonable expenses for attorney’s fees and percentage of amount recovered
164Federal and False Claims Laws “Whistleblower” discovered to be involved in false claims, the share of the recovered amount may be reduced“Whistleblower” convicted of criminal conduct related to the submission of the false claim will be dismissed from the lawsuit with no compensation“Whistleblowers” are protected from employer retaliation“Whistleblowers” subjected to retaliation may bring civil lawsuit in federal court and will be entitled to:Reinstatement of job with same seniorityTwo times the amount of back pay with interestAdditional damages such as attorney’s fees
165Federal and State False Claims Laws What is Fraud?Fraud is knowingly and willfully executing, or attempting to execute, a scheme to defraud any federal or state health care program or obtain by false means or fraudulent pretenses any money or property owned by or under control of federal or state health care programs.
166What is Abuse?Abuse may directly or indirectly result in unnecessary costs to Medicare/Medicaid, improper payments, or payments for services which fail to meet professional standards or care or that are medically unnecessary.Abuse involves payment for items or services when there is not legal entitlement payment, although the provider not knowingly or intentionally misrepresented facts to obtain payment.
167Examples of Health Care Abuse Collecting more than the coinsurance or deductible allowed by Medicare/Medicaid.Using procedure or revenue codes that describe more extensive services than those providedRequiring a deposit or other payment from a Medicare beneficiary as a condition for admission, continued care, or provision of serviceBilling for services grossly in excess of those needed or required by the patient (EX: Billing for complete lab profiles when only a single diagnostic test is necessary)
168Reporting Compliance Issues Good Shepherd asks and encourages anyone to report suspected problems or issues dealing with fraud, waste and abuse in federal and state health care programs.Good Shepherd Compliance policy has detailed information for your use regarding these circumstances available on
169Reporting Compliance Issues Call the Compliance Officer: Ken CunninghamPlace an anonymous call to the GSHS Compliance Hot Line (24/7)Send a letter to:Compliance Officer, Good Shepherd Health System700 East MarshallLongview, Texas
170Reporting Concerns Through Joint Commission The Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) is an independent, not-for-profit, national body that oversees the safety and quality of healthcare and other services provided in accredited organizations.Employees and the public may report concerns about safety or the quality of healthcare being provided at GSHS to the Joint Commission atConcerns regarding accreditation and the accreditation performance on individual organizations can be obtained through the Joint Commission website at
172Corporate ComplianceEnsures that Good Shepherd operations are conducted in compliance with its’ policies and procedures in an ethical mannerEmployees are expected to conduct themselves in accordance with the highest ethical standard and avoid wrong doing
173Corporate Compliance Compliance is everyone’s job! Examples of compliance policies are explained in your handbook, such as:Do not discuss cost of services with other hospitalsDo not use GSHS tax-exempt status to purchase or for personal benefitDo not take equipment or supplies without authorization
174Corporate Compliance Hotline: (903)315-5053 Employees should: Receive a copy of the Compliance Handbook (yellow) upon hireRead, sign and acknowledge compliance with policiesReport any compliance issuesHotline: (903)
175Corporate Compliance Handbook Employees should:Complete the 2010 Compliance Handbook CBL and acknowledgement test on GSLSReport any compliance issuesHotline: (903)
177Contact Terry Smith: Infection Control Nurse (5166) Cheryl Herbert, Infection Prevention Director (2662)
178Goal of Infection Prevention Prevent healthcare associated infections (HAI) through education, surveillance, observation and monitoring of infections/communicable diseases.Infection prevention applies to everyone, including patients, visitors, healthcare workers, volunteers, contract employees, physicians and others as needed.Infection prevention extends from inpatient care to outpatient, rehab, skilled care, home care…anywhere a patient receives care.
179Basic Principles of Infection Prevention Infections cause by bacteria and viruses can be transmitted between patients & healthcare workers. To avoid infection comply with these practices:Hand hygiene – no artificial nailsCare & cleaning of equipmentStandard precautions and use of PPETransmission based precautions (isolation)ImmunizationsReporting needle sticks or blood/body fluid exposuresPrevention is the key!!
180Basic Principles of Infection Prevention Infection can be spread in the following ways:Direct contact: spread of infection or germs is person-to-person by direct touch or contact.Indirect contact: Spread of disease or germs is cause by the environment, or by equipment and medical devices that are not cleaned properly or become contaminated by improper handling.Airborne Route: Spread of disease by germs in the air.
181Standard PrecautionsAre intended to reinforce well established infection prevention principles such as hand hygieneReduce the risk of spreading or acquiring bloodborne diseases such as HIV or Hepatitis BApply to all patients and healthcare workersFood and drink should be in appropriate areasUse barriers to prevent transmission of germs (pathogens) from:Excretions (like stool) -- BloodAll body fluids --nonintact skinSecretions (except sweat --mucous membranes (mouth, eyes)
182Standard Precautions Gloves Wear prior to touching blood, body fluids, secretions, excretions, contaminated items, and when performing vascular access procedures (IV catheters)Use clean gloves to touch mucous membranes and non-intact skinChange gloves between tasks and remove promptly after procedures to prevent environmental contaminationAlways perform hand hygiene before and after glove use
183Standard Precautions Linen: Environmental Control: Clean and disinfect environmental surfaces, beds, bed rails, bedside equipment, bathrooms and other frequently touched surfaces daily and when soiling occursClean all blood spills with an appropriate disinfectant per the Exposure Control PlanLinen:Contain and transport all linen in water-proof bagsA second bag is required if outside contamination of the first bag occursSoiled linen must never be placed on the floorDo not overfill the bag (more than 2/3 full for convenience of handling and proper closureBags must be securely closedBagged linen should be placed in specially designated areasfor pick up. Environmental services will remove linen perprocedure.
184Standard Precautions Trash Contain regular trash in a clear plastic bagUse the red biohazard bag or other designated biohazard container for items that are soiled with blood, that cannot be emptied of blood (e.g. chest tube bottles or blood transfusion bags), or that are caked with blood that could flake off. When in doubt, use a red bagA second bag/container is required if outside contamination of the first bag/container occursTrash is placed in special containers in designated soiled locationsEnvironmental Services will remove trash per procedure.
185Standard Precautions Sharps Laboratory Specimens: Disposal containers are designated for proper disposal of needles, syringes, and scalpels. Never dispose of sharps in the regular trashDo not bend, recap, resheath, shear, or break used needles or other sharps; activate safety mechanism where applicableDo not overfill sharps containerSafety devices (resheathing IVs, safety syringes and scalpels, etc) must be discarded in sharps containers! Safety mechanism must be activated prior to disposalLaboratory Specimens:All specimens are to be considered infectious at all timesTransport in a clear plastic bag labeled with the biohazard symbolA second bag/container is required if outside contamination of the first bag/container occursSecure specimens appropriately for Pneumatic Tubetransport
186OSHA Standard on Bloodborne Pathogens Bloodborne diseases like HIV or Hepatitis can be spread when infected fluids enter the body through:Needle stick or sharps injuryCuts, scrapes or other breaks in the skinSplashes of blood or body fluid in the mouth, nose or eyesOral, vaginal or anal sexSharing used needlesBaby through birth processHIV (Human Immunodeficiency Virus)May start with mild flu-like symptoms and progress; will then weaken the immune system which increases the risk of infections or cancer and may eventually cause deathCan lead to AIDS (Acquired Immunodeficiency Syndrome)Can be carried in the blood stream without symptoms –the person doesn’t know that they are infected
187Bloodborne Diseases HBV (Hepatitis B Virus) can cause: Active Hepatitis B: a flu like illness that can last for many monthsA chronic carrier state: the person may have no symptoms, but can pass HBV to othersCirrhosis, liver cancer and deathConsider the HBV vaccine. It is your best protection against Hepatitis B and is provided free of charge in Employee HealthHCV (Hepatitis C Virus):The HCV also attacks the liver and is similar to HBV. There is currently no vaccine available to protect youPatients may not have symptoms of the disease, but can still transmit the infection. The only way to consistently protect yourself is to follow Standard precautions (face protection, gloves, gowns, mouth-to-mouth resuscitation device) every time you expect to have exposure to blood or body fluidsA copy of the OSHA Standard on Bloodborne Pathogens is available on request by calling Infection Prevention at x2662
188Transmission-Based Isolation Precautions Transmission-Based Isolation Precautions are used for patients who have highly contagious diseases/conditions. In addition, these precautions can be used “empirically” based on signs/symptoms of disease before a firm diagnosis is madeIt is very important to be consistent with hand hygiene, use of gloves, care of the environment, and cleaning of equipment.Germicidal wipes are available for use on surfaces such as keyboards, stethoscopes, and electronic thermometersThese additional precautions are necessary to interrupt the chain of transmission.
189Transmission-Based Isolation Precautions Airborne Isolation PrecautionsUsed for diseases that are transmitted through the air by tiny particles that can travel long distances on normal air currents.Examples of airborne disease include tuberculosis (TB), rubella (measles), and varicella (chickenpox)Patients who are suspected of or are diagnosed with these diseases are placed in a private, separately ventilated, negative pressure room
190Transmission-Based Isolation Precautions Airborne Isolation Precautions (cont’d):The door must be kept closed to maintain negative pressure (air in the room won’t flow out)Anyone entering the room must wear a N-95 respirator as respiratory protection. These are not regular surgical masks, but rather a fit-checked respirator required by CDC – annual fit testing and medical evaluation requiredIf the patient must be transported, place a surgical mask on the patient or provide tissues to cover coughSupplies outside the room would include a posted Airborne Isolation sign, a box of small and regular sized N-95 respirator masks and germicidal wipes to disinfect small pieces of equipment coming out of the room
191Transmission-Based Isolation Precautions Droplet Isolation Precautions:Used for diseases which are transmitted by large respiratory dropletsCoughing, talking and suctioning create these droplets. They are so large, they “rain down” (fall out of the air) within 2-3 feet of the patientExamples of droplet spread diseases include the flu, meningitis caused by Neisseria meningitis, pertussis (whooping cough) and streptococcal respiratory diseaseA private room is necessaryA negative pressure room is not indicatedWear an isolation mask(ear loop) when entering the roomThe patient should wear a surgical mask during transport and cover coughSupplies outside the room would include a posted Droplet Isolation Precaution sign, a box of isolation masks (yellow ear loopmasks) and germicidal wipes to be used to disinfect smallpieces of equipment coming out of the room
192Transmission-Based Isolation Precautions Contact Isolation PrecautionsUsed for diseases/conditions which are transmitted by physical contact with the patient or the patient’s environmentExamples of contact spread diseases or conditions include MRSA, VRE and RSVA private room is necessaryWear gloves when entering the roomWear a gown when entering the room for contact with the patient or environmental surfaces/patient care equipmentRemove the gown and gloves before leaving the room and perform hand hygieneSupplies outside the room would include a posted Contact Isolation Precaution sign, a cart to store the gowns,gloves and germicidal wipes to disinfect small piecesof equipment coming out of the room
193Transmission-Based Isolation Precautions Contact Special Isolation PrecautionsUsed with patients known or suspected to have Clostridium difficle (C. diff)This organism is spread through contamination of the environment by C. diff spores or by unwashed hands of healthcare workersA private room is necessaryWear gloves when entering the roomWear a gown when entering the room for contact with the patient or environmental surfaces/patient care equipmentRemove the gown and gloves before leaving the room and wash your hands with soap and water. Hand sanitizer does not kill C. diff spores
194Transmission-Based Isolation Precautions Contact Special Isolation Precautions (cont’d):Environmental Services will clean these rooms with a special cleaning solution to help kill the sporesSupplies outside the room would include a posted Contact Special Isolation Precaution sign, a cart to store the gowns, gloves and germicidal wipes to disinfect small pieces of equipment coming out of the roomA reminder sign will be posted in the room at the door, to remind you to wash your hands with soap and water before you leave the room
195Transmission-Based Isolation Precautions Multi Drug Resistant Organisms (MDRO):Several common germs or bacteria like Methicillin Resistant Staphylococcus Aureus (MRSA) and Vancomycin Resistant Enterococcus (VRE) have become resistant to many antibiotics. This means the usual antibiotics prescribed will not kill these germs and so they are called Multi-Drug Resistant Organisms (MDRO). While these germs should not cause an illness in healthcare workers, if a patient gets an infection from one of these resistant organisms, the doctor may not be able to cure the infection.MDRO can be spread by direct contact from the hands of a healthcare worker to a patient. Contact Isolation precautions, when used correctly, will prevent the patient-to-patient spread of MDRO.
196A Healthy Workplace Cover Your Cough Cover your mouth and nose with a tissue when you cough or sneeze ORCough or sneeze into your upper sleeve, not your handsPut your used tissue into the trashClean your hands by washing with soap and water or by using hand sanitizerGet a flu shot every yearProtect yourself and our patients!Notify your supervisor prior to beginning work shift of any potentially infectious conditions.Non-intact skin / skin infectionsGI illnessFeverRespiratory illness
197Influenza: Protect Your Patients. Protect Yourself. Common Flu Symptoms:Fever (usually high)HeadacheTirednessCoughSore throatRunny or stuffy noseBody achesInfluenza Transmission:Flu spreads person to person in respiratory droplets when people who are infected cough or sneezeHealthy adults may be able to infect others 1 day before getting symptoms and up to 5 days after getting sick.
198Influenza: Protect Your Patients. Protect Yourself. Healthy Tips to Prevent the Flu:Wash your handsDon’t cover sneezes and coughs with your handsDon’t touch your faceClean your ‘shared spaces’Get enough sleepDrink more waterContinue a moderate exercise programEat healthyLimit alcohol intakeListen to your body
199Tuberculosis Symptoms: Tuberculosis (TB) is a serious lung infection caused by a tiny germ called a mycobacterium. When an infected person sneezes, coughs or speaks, the germs are expelled into the air and can be inhaled by another personSymptoms:Severe, prolonged cough (may cough up blood)Fever and night sweatsTirednessWeight loss
200TuberculosisTB can be easily controlled by following these guidelines:Initiate Airborne isolation Precautions as described earlier under Transmission-Based isolation PrecautionsUse caution when doing cough inducing procedures, like suctioning or bronchoscopyA portable air treatment machine is available for use in areas without a separately ventilated, negative pressure room. Refer to the Infection Prevention Manual for directions in obtaining the unit, if needed.New employees receive a skin test called a TST (Tuberculin Skin Test). A small amount of fluid (PPD) is injected under the skin on the forearm. A raised, red area on the forearm where the test is placed means the test is positive and you may have been exposed to TB. A thorough physical examination including a chest x-ray would be done to check for infection.
201Infection Prevention and Patient Safety Initiatives Hand HygieneReducing drug resistant organismsEliminating bloodstream infections caused by central lines (large catheters inserted close to the heart)Eliminating urinary bladder infections caused by cathetersReduce and eliminate infections from surgery
202Remember:Infection prevention is important for you and particularly for our patients. Everyone is responsible for following the basic principles for hand hygiene, cover your cough, standard precautions and transmission-based isolation precautions.Report any exposure concerns and Infection Prevention will communicate any exposure issues.If you need more information, please refer to the Infection Prevention Manual (available online on GSnet) or contact the Department of Infection Prevention at x2662.