1. Health Occupation Student Orientation Module 2: Environment of Care

2. FIRE AND LIFE SAFETY Section 1

3. Safety/Emergency Resources – Fast Facts Fast Facts is a quick reference response guide to  Codes, e.g Code Grey, Pink, Orange  Other events e.g. System Failures, evacuation, disasters, emergency communication systems  Form Samples e.g. bomb threat, abduction record.

4. Emergency Codes TO CALL ANY CODE: SJH Campus: Dial 7111; GH Campus: Dial 811 – activates the overhead paging system Off Site Locations: 9-911 Identify type of code and location Repeat the message. CODE RED Fire CODE BLUE Adult medical emergency Pediatric Code Blue Pediatric medical emergency CODE PINK Infant abduction CODE PURPLE Child abduction CODE YELLOW Notification of a bomb on campus CODE GRAY Combative person CODE SILVER Hostage or weapon CODE ORANGE Hazmat spill or release CODE TRIAGE Internal or external disaster CODE STEMI ST Segment Elevation MI

5. Life Safety – Fire Safety Action to Take for Code Red Department Response Plan You should know the following: Evacuation routes and location of exits and stairs Location of smoke/fire doors Location of fire alarms/extinguishers Look for posted evacuation signage as shown on the next slide.

6. Life Safety - Fire Safety NORTHEAST WINGNORTHEAST WING

7. Life Safety – Fire Safety Action to Take for Code Red R REMOVE all persons in danger A ACTIVATE ALARM use pull station or emergency # 7111 C CONFINE fire close doors and windows E EXTINGUISH the fire if manageable Immediate Response Plan

8. Life Safety – Fire Safety Action to Take for Code Red Student Response When You Hear Code Red Paged: Follow the instructions or your Clinical Instructor or Charge Nurse guidance. Never prop doors open with trash cans, chairs etc – prevents automatic door closure in event of fire.

9. Life Safety - Fire Safety Order of Evacuation Ambulatory / Non-ambulatory patients closest to danger; Ambulatory patients, visitors and staff; Non-ambulatory patients in wheelchairs, Isolettes and cribs; Non-ambulatory patients in their beds Critical Care and ventilator patients using gurneys/beds; Action to Take for Emergency Evacuation:  Move patients beyond nearest fire doors – “area of refuge”  Place an “X “on door with tape  Take meds and medical record with patient  Follow instructions of the Charge Nurse

10. SECURITY MANAGEMENT Section 2

11. Security We have Security / Engineering staff that provides security 7 days a week, 24 hours a day for our facility. We use interior /exterior close circuit monitoring of strategic areas and 2 way communication. Even with these measures, Security cannot be everywhere at all times. You are actually the extra “eyes and ears” of our Security / Engineering staff. The key to providing effective security for our facility is prevention, and prevention begins with you. Your Role in Security Always wear your ID badge Keep personal belongings out of sight Ask for a security escort when leaving after hours - dial 7101, enter 065 at the beep. Main doors are locked between 8p – 5:30a. Use ED entrance during those times. Be alert and observant of people that normally should not be in an area. Report all suspicious activity to the Charge Nurse on your unit.

12. Security Features Warning: Card reader locks as shown at right are installed in the North East Wing. These locks:  Restrict Access to: OR, SSU, PACU, ICU, Cath Lab, Diagnostic Imaging and ED treatment area  Restrict access to med rooms, supply rooms etc Students will receive coded badges enabling limited access. THESE MUST BE RETURNED TO YOUR INSTRUCTOR.

13. Security: EMERGENCY CODES CODE SILVER Hostage or weapon CODE GRAY Combative person CODE YELLOW Notification of a bomb on campus CODE PINK Infant abduction (<1 year) CODE PURPLE Child abduction (<18 years) The hospital has 4 emergency security codes (shown at right) that you need to be aware of. In the event of an emergency, report to your Charge Nurse for direction.

14. Security Management – Hostage / Weapon Situation Action to Take: Staff / students: DO NOT go to announced location This is an extremely dangerous and sensitive situation that should only be handled by local police agencies. Staff / students who see person with weapon: Seek cover/protection; warn others Report “Code Silver” to Operator including location, number of suspects/hostages, number and type of weapons CODESILVERCODESILVER

15. Security Management – Combative Person Action To Take: Student Response: Stay clear of announced location Reassure other patients Follow directions of your Clinical Instructor or Charge Nurse CODEGREYCODEGREY

16. Security Management - Bomb Threat or Suspicious Package Action to Take: Students - IMPORTANT: Do not use radios, pagers or cell phones. If you see a suspicious package, don’t touch it – notify the Charge Nurse Follow the directions of the Charge Nurse. CODEYELLOWCODEYELLOW

17. Security Management - Infant or Child Abduction Action to Take: Staff Response: Go to nearest unmanned exits, stairwell, or parking lot Politely ask for ID of people exiting hospital Do NOT go to area of abduction. Student Response: DO NOT give out any information about a possible abduction. DO note any suspicious activities, persons or vehicles and report to Clinical Supervisor. DO NOT participate in facility wide response. INFANTCODEPINKINFANTCODEPINK CHILDCODEPURPLECHILDCODEPURPLE

18. Security Management - P rotected H ealth I nformation What Must be Protected? an individual’s health information that…  Includes at least 1 of the 18 personal identifiers  Is created, received, or maintained by a health care provider or health plan  Is written, spoken, or electronic Personal Identifiers Name Date of Birth Address Phone Number Email Address Medical Record Number Social Security Number License Number Facial photos Account Numbers And more..

19. Security Management - P rotected H ealth I nformation Steps to ensure Privacy and Security of PHI  Position WOWs and bedside computer screens out of sight of visitors or casual viewers  Lock computer screen or log out when done working  Manage/secure all printed patient census sheets e.g. use cover sheet to hide PHI  Manage/secure all patient identification stickers  Minimize work conversations in elevators, hallways and public areas

20. Security Management - P rotected H ealth I nformation - HIPPA Requirement - Minimum Necessary Standard  This standard provides guidance for use of PHI while maintaining security and privacy  Use / disclose the minimum amount of identifiable patient information needed by your job regardless of access  Applies to all users of PHI in the workplace

21. OTHER EMERGENCY RESPONSE Section 3

22. Emergency Management – CODE BLUE (ADULT) / Pediatric Code Blue Action to Take: Staff Response: Code Team goes to announced location (ED MD & RN, ICU RN, RT, Admin Sup, Compressor, recorder) Unit / department staff bring crash cart If YOU discover the patient: Identify signs/symptoms of cardiac / respiratory distress. Call the code Begin first responder CPR until staff arrive to relieve you. Note: after the first response, students may only observe a Code Blue if first approved by their instructor. CODEBLUECODEBLUE PEDIATRICCODEBLUEPEDIATRICCODEBLUE

23. Emergency Operations Plan - Code Triage Activate CODE TRIAGE Fire Evacuation Code Red Hostage Situation Code Silver Child Abduction Code Purple Natural Disaster Bomb Threat Code Yellow Infant Abduction Code Pink Chemical Radiation Accident Major Utility Failure Each of the Emergency Situations shown at right could result in activation of the Emergency Operations Plan (EOP), Code Triage. The EOP enables us to effectively respond to these emergencies regardless of scope. The hospital adopted the Hospital Incident Command System (HICS) model for its plan.

24. Emergency Operations Plan - Code Triage About the Hospital Incident Command System (HICS) Model The HICS model provides a standardized response to all kinds of emergencies regardless of magnitude. Hospital Command Center (HCC) In the event of a Code Triage, the HCC serves as the clearinghouse for all information and all instructions during the disaster. Incident Commander (IC) The IC is responsible for ALL decisions regarding resources, personnel, patient flow, safety and security issues during the disaster. Action to Take for Code Triage: Students: Follow the directions of your immediate supervisor.

25. UTILITIES / MEDICAL EQUIPMENT MANAGEMENT Section 4

26. Utilities - Utility Failure Action To Take: In the event of a utility failure, follow the directions of the charge nurse on your unit. Emergency power outlets have a RED cover or outlet connections. These receive power from the emergency generator and are used for critical equipment only

27. Medical Equipment – Safety Inspections Patient Care Equipment  Look for inspection sticker with last date noted  OK to use if within 12 mos. of date Non Patient Care Equipment  Look for the “OK to use Sticker) Patient Owned Equipment  Physician order required  Must be inspected by Engineering before use  RCP can inspect respiratory therapy equipment from home

28. Medical Equipment – Safe Use Basics DO NOT plug in any patient care equipment without the third grounding prong in place. DO NOT use extension cords. DO NOT unplug devices by pulling on the cord. DO NOT use wet, damaged or obviously defective equipment. DO NOT use equipment without first being trained Always inspect equipment before using it on patients. Notify the staff of any malfunctioning equipment – describe exactly what the problem is.

29. HAZARDOUS MATERIALS AND WASTE STREAM MANAGEMENT Section 5

30. Hazardous Materials– Your Right to Know Warning Labels on Containers : Material Safety Data Sheets (MSDS) - written information supplied by the manufacturer or distributor of the product. The MSDS lists chemical composition, protective equipment, types of exposure and effects, spill clean up and more. Your Role in HazMat Carefully read and follow warning labels and MSDS. Ask staff for help if you are unclear about what safety measures to take. When in the hospital, you may be exposed to hazardous chemicals. You have the right to know and be informed of these potential hazards. This information is available from 2 sources:

31. Material Safety Data Sheets (MSDS) To Access MSDS Information: Call the toll free number shown at right and have the following information available: Product name and number Manufacturer Name UPC code if applicable Your fax number Emergency requests are responded to within 15 minutes Urgent requests are responded to within 30 minutes. MSDS on Demand 1-800-451-8346

32. Hazardous Materials – Spill Procedure Action To Take: If You Witness a Spill: REMOVE all persons in danger NOTIFY hospital staff immediately Keep others away from spill area DO NOT clean up the spill If You are Exposed: Notify your clinical instructor and hospital staff. Follow emergency first aide measures as directed. CODEORANGECODEORANGE

33. Waste Stream Management Biohazardous wasteRed bags Soiled linenYellow bags Pathology wasteLabeled Red containers Chemotherapy Waste Labeled containers Sharps and broken glass Red sharps containers Pharmaceutical waste Blue and white containers PHARMACEUTICAL WASTE – Any unused medication must be discarded in the pharmaceutical waste containers including narcotics and fentanyl patches oElectrolytes/TPN may be discarded in sink Special attention must be given to disposal of hospital generated wastes. Follow the disposal guidelines listed below.

34. RADIATION SAFETY Module 6

35. Radioactive Materials  Continuously emit radiation.  They are made from radioactive elements. Radiation Producing Devices  Emit zero radiation when they are turned off.  Devices are not a safety concern when they are not being used. Look for the signs shown at right. Radiation – About Radiation

36. Radiation - Radiation Sources Ways To Reduce Your Exposure TIME Spend as little time around radiation as possible. Distance Maximize your distance from radiation. Shielding Shielding yourself behind a wall or high density material can substantially reduce the dose received. LocationRadiation Source RadiologyDevices - X-Ray Machines CardiologyDevices - Portable X-ray SurgeryDevices - Portable X-ray EDDevices -Portable X-ray Cath LabsDevices - X-Ray Machines Nuclear MedRadioactive Materials Radiation Oncology Devices - Linear Accelerator and Radioactive Materials Nursing UnitsDevices - Portable X-ray Radiation sources are present in many areas of the hospital as shown below:

37. Radiation – Radiation Sources When you hear the x-ray tech announce – “X-Ray” – get clear of the room. Only the patient and essential personnel remain in the room. Personnel remaining in the room must:  Wear a lead apron  Not be pregnant  Stay out of the path of the x-ray beam. Portable x-rays are routinely taken on the nursing units. Please observe these precautions:

38. Magnet Safety – MRI No metal items are allowed in the magnet area. Patients must be screened for implanted metal devices prior to this procedure. Do NOT enter with equipment unless you have been screened by MRI staff. Our diagnostic imaging services include Magnet Resonance Imagery (MRI). The magnet in the MRI room is always on so the following measures must be observed at all times for patient and staff safety: