1. CITCM Student Clinic Observation January 2014

2. Student Clinic Overview Locations Times

3. Observer Responsibilities Observe You are also there to do. You are expected to do or assist with the following: Be professional in demeanor and attire. Observe complete appointments, this means actual patient treatment and not just patient intake. Be courteous and timely, do not interrupt appointments by going in and out of rooms during the session. Transitioning rooms between patients. (Yes, this means cleaning it, stocking it, helping with laundry if it needs to be done, assisting in the herbal room). A Clinic Supervisor may direct you to perform other Clinic related duties that are necessary to maintain the smooth flow of clinic operation. Patient contact is limited to Tongue Observation and Pulse Taking only. Ensure your clinic observation hours are logged and signed off.

4. Observer Responsibilities cont’d Just a reminder, there are things that Observers don't do: No treatment, of any type. No Patient Interviewing. If you see or hear something you don't understand, write it in your book and remember to ask the Intern or Supervisor when you are outside the treatment room. No recommendations or referrals of any type. Communications about patient treatment or alternative therapies to acupuncture and TCM are the responsibility of the Intern and any referrals that may be made, come through the direction of the Clinic Supervisor. (The Clinic Supervisor may instruct an Intern to advise the patient to seek outside treatment for medical reasons.)

5. Paperwork Hours Checklist Note taking - personal Point notes for review

6. Breaking the Chain of Infection Vulnerable Host – immunization, treatment Infectious Agent –clean/disinfect Reservoir – people, water, equipment Portal of Exit – droplet secretions Transmission –contact (direct, indirect, droplet, airborne) Portal of Entry – wound care, gloves

7. Handwashing http://www.toronto.ca/health/cdc/resources/p df/handwashing_poster.pdf

8. Personal Protective Equipment Gloves (Donning and Doffing) Masks Glasses Lab Coats

9. CITCM and The Flu H1N1 concerns, pandemic strain As of this weekend, there are approximately 1,000 confirmed cases in Alberta. Over 400 in Calgary area with 5 confirmed deaths. At this point, Alberta Health Services is now assuming all cases of the flu are of the H1N1 pandemic strain. We are just at the beginning of the flu season, and can expect to see many more cases. If you are ill with flu like symptoms, you will be asked to leave the school.

10. H1N1 cont’d In the clinic: Infection control is of primary importance. Be diligent with hand washing, the use of hand sanitizer and disinfection of surfaces and areas of contact. If a patient is displaying signs of the flu, have them wear a mask for the duration of the appointment. Prevention is the best defense. Respiratory Etiquette, vaccinations and anti- viral formulas.

11. Common Signs & Symptoms Common Symptoms: Cough and fever that comes on quickly, feeling tired, body ache, sore throat, runny nose, headache, not being hungry. For a child with the flu, also be aware if they are not eating or drinking enough, not waking up and interacting with others, and is irritable, not wanting to be held. Contact Albert Health link ; Toll-free: 1-866-408-5465 (LINK) Edmonton: 780-408-5465 (LINK) Calgary: 403-943-5465 (LINK)

12. Serious Symptoms: Emergency Send to Emergency SOB, rapid breathing, or difficult breathing, chest pain, sudden dizziness or confusion, severe or continued vomiting, high fever lasting more than three days.

13. Cup Cleaning

14. Sharps Disposal Ensure cover is kept at the minimum sized opening. Is locked and sealed at ¾ full. Replaced with a new one Sharps check, floors and other surfaces. (pick up with needle locking forceps)

15. Waste Disposal (blood contact) Waste contaminated by blood Excerpts form the Guidelines for Biomedical Waste in Canada Section 1.1 These guidelines apply to but are not limited to the following facilities: hospitals; nursing homes and extended care facilities; public health units; physicians’ offices/clinics; veterinarians’ offices/clinics veterinary research, teaching and health care facilities; medical research and teaching establishments; health care teaching establishments; clinical testing or research laboratories; facilities involved in the production or testing of vaccines; mortuaries and funeral homes; coroner’s offices; nursing offices; and blood banks and blood collection centres.

16. Waste disposal continued Section 2.1 Defining Biomedical waste “While any item that has had contact with blood exudates or secretions may pose a hazard, it is not usually considered practical or necessary to treat all such waste as biomedical waste. Thus the following items should be considered general waste: soiled dressings; sponges; surgery drapes; lavage tubes; casts, catheters, disposable pads; disposable gloves; specimen containers; lab coats and aprons; and dialysis wastes, such as tubing, filters, towels and disposable sheets.” Therefore, blood waste generated during TCM and acupuncture treatments falls into the category of general waste. However, to promote safe handling and the protection of waste management workers: Gloves; Gauze; Cotton swabs; Sponges; Clean field drapes; or Any product contaminated with blood that is not a sharp; should be contained within a secondary bag prior to disposal in general waste. Any worker who handles waste in a health care environment should be offered the Hepatitis B vaccine.

17. Laundry Quick wash cycle; calculates time based on load. Soap dispenser, ½ fill Bleach dispenser; fill to max line Don’t overload the dryer. Folded linens go in the supply room

18. TDP Lamps Check for safety concerns Turn off Unplug Put away correctly

19. Herb Room Once you have observed and have been trained in poroper herb preparation observers will help in the herb room

20. Other Duties Supervisor and intern requests Down-time list

21. Checklist Review after every appointment Interns will help when time is available, observers will ensure room transition is completed properly.

22. Safety Committee This semester will be starting safety committee. Representatives and Alternates

23. Conclusion Be respectful Be professional Be safe Questions??