River Oaks Hospital STUDENT ORIENTATION.

River Oaks Hospital STUDENT ORIENTATION

OUR MISSION The mission of River Oaks Health System is to provide the highest quality patient care through a genuine commitment of service and safety to our customers

PARKING Place parking permit on dash
Park in the North parking lot behind the River Oaks Professional Center

River Oaks Professional Building
Resource Building Education North Lot River Oaks Professional Building River Oaks Professional Building

What is HIPAA? (Health Insurance Portability & Accountability Act of 1996)
HIPAA is a broad law dealing with the privacy and security of health information: The Privacy Rule tells hospitals and physicians when and how they can use or disclose patient health information. The Security Rule tells hospitals and physicians how to protect health information from being inappropriately accessed, edited, or destroyed. 5

The first essential element of HIPAA: PHI
Protected Health Information (PHI) is ALL PERSONAL HEALTH, BILLING AND DEMOGRAPHIC INFORMATION, IN ANY FORMAT (Oral, Paper, Picture or Electronic) CREATED OR HELD BY A COVERED ENTITY (hospital or physician, payer) (includes past, present and future healthcare) 6

Minimum Necessary or “need to know”
All members of the workforce contribute to the care of the patient. That doesn’t mean everyone needs to see health information about patients. If you do not need to know confidential information to provide care (clinical or financial) you are NOT permitted to access it. This includes your PHI. 7

Our #1 Biggest Risk: Nosy Associates
A co-worker accesses information. The only reason was for curiosity regarding: A co-worker who is a patient A physician who is a patient A neighbor who is a patient 8

Actions that could cause a HIPAA violation
Taking pictures of any patient’s image, body part or X-ray with personal cell phone cameras (this will be grounds for termination) Unauthorized access of sensitive health information (HIV, Abuse, Psych records) Access of the associate’s own “patient” record in the computer system Sharing or stealing another co-worker’s password for the computer systems Not verifying who you disclose patient information to (financial or clinical) and not confirming that the person requesting the information is authorized to receive it 9

Steps you should take to protect patient privacy include:
Respect the patient’s information and condition the same way you would expect others to respect and care for yours. Close treatment room doors or use privacy curtains when discussing the care of a patient. Ensure that medical records are not left where others can see or gain access to them. Keep laboratory, radiology and other test results private. Make sure computer screens containing PHI are not visible to others not involved with the patient. 10

Destruction of paper containing patient information
Shred all patient information when it is to be discarded. Do not place anything with a patient’s name or identifiers in the regular trash. Patient name bands Telemetry strips What about IV bags with med labels? If you can, peel off label. Label must be shredded or blacked-out with a marker. 11

Visitor Identification
All associates should question visitors or other persons who are in restricted areas and are not escorted by an associate of the facility or are not displaying proper identification. Vendors and contractors will be wearing their company ID in addition to hospital identification noting that they have permission to be in the building. All associates, volunteers and other workforce members must wear their identification badge as issued by the hospital. 12

Notification to Patients
Federal law now requires us to tell patients if someone has snooped into their information protected by HIPAA. We must also notify patients any time their protected health information was inappropriately disclosed outside of the facility, or if it was stolen or breached. We are required to notify the patient in writing and report all breaches of PHI to the Federal Government. 13

Who do we need to notify if a breach of PHI is detected?
All of the affected patients. The Federal Government. Local media if 500 or more patients in the same area are affected. 14

Examples of Breaches Lost laptop or PDA
PHI left behind in the cafeteria, lounge, or public area “Snooping” in patient records without a need to know the information “Cell phone pictures” taken by associates that identify a patient or characteristics of a patient (x-ray or body part) PHI faxed to the wrong fax number, or ed to the wrong address Information intended for one patient handed to another patient (not verifying your work). 15

Increased HIPAA enforcement actions could directly affect you!
If you are found to be responsible for any type of a HIPAA violation that the State Attorney General believes has threatened or in some way harmed a patient who is a resident of your State, you can be held responsible for your actions. The State Attorney General can bring a civil action in federal court against you! 16

Conclusion We must all remember to protect the privacy and security of patient information at all times. We are all patients from time to time. How would you feel if your own health information was used or disclosed in a way that was harmful to you or your family? If you have a question about HIPAA, ask your supervisor or your Privacy Officer. 17

Corporate Compliance The purpose of the Compliance program is to ensure that the Hospital Conducts all business in compliance with all applicable federal and state statutes, regulations and healthcare program requirements Adheres to the highest ethical standards in all actions

If you become aware of a violation, questionable conduct, or questionable practice violating the Compliance and Ethics Program, you should immediately report the concern to one of the following: Your instructor The nurse manager or CNO The Hospital Compliance Officer (HCO) The Divisional Compliance Officer (DCO) The Director of Compliance or VP of Compliance The General Counsel The Compliance Helpline or Compliance Post Office boxtraining

Compliance Helpline notices are prominently displayed throughout the hospital. Calls to the Helpline go directly to an outside company who generates a report to forward to the Home Office Compliance Department. The Compliance Program strictly prohibits retaliation against any person who has reported a suspected violation.

Compliance Risk Areas Outpatient procedure coding
Submission of inaccurate claims Outpatient procedure coding Billing errors in admissions and discharges, Improper relationships between the hospital and physicians Violations of the EMTALA legislation

PROVIDING EXEMPLARY CARE AND SERVICE TO OUR PATIENTS
CUSTOMER SERVICE PROVIDING EXEMPLARY CARE AND SERVICE TO OUR PATIENTS

Who are our Customers? Physicians Patients Family Members Visitors
Employees Other Departments Vendors Community

LEGENDARY SERVICE TREAT EVERYONE AS IF HE OR SHE IS THE MOST IMPORTANT PERSON IN OUR FACILITY!

Communication with Patients 5 Steps
A Acknowledge the patient by name I Introduce yourself (credentials, experience) D Duration (length of time to expect for test or procedure) E Explanation (of test or procedure details) T Thank the patient for choosing River Oaks

HOURLY ROUNDING FACTS Every employee is responsible for patient rounding Each patient room has a white board to list: Date Names of caregivers Plan of care for the day Patient Safety assessment includes patient access to: Water (if allowed) Tissue Call System Telephone TV Remote Trash Can Before leaving the room, every caregiver should ask the patient: “Is there anything else I can do for you?”

responsible for rounding! 5 components of hourly rounding:
Why do hourly rounding? Research demonstrates that hourly rounding: Decreases call light usage Increases patient satisfaction Decreases patient falls Develops trust Anticipates a patient’s needs Every employee Is responsible for rounding! 5 components of hourly rounding: Personal Needs Pain Position Patient Safety/Environmental Plan Plan of care

Bedside Reporting Bedside reporting means that conversations are moved from outside the room or at the nurses station to the bedside with the patient actively involved in the report of care. Bedside report should happen at any transfer from unit to unit and at the change of shift. Advantages for the Patient: Perception that they are a priority, not the staff schedule or staff comfort zones They see and hear from the team of professionals providing care They are reassured that each shift of caregivers are getting the necessary information about what is going on with their care Improved communication Reduced alone time during shift change Advantages for the Staff: Improved communication Allows staff to be better prepared about the patient’s condition Keeps report to items related to patient condition/care Accountability increases for the care provided The off-going nurse can use “hands-on” to show the oncoming nurse how to operate special equipment or how special orders are being handled

EXCELLENCE! We believe that a patient entering River Oaks Hospital has the right to expect the highest quality of care necessary to aid him/her in regaining or maintaining a maximum level of health.

Code of Conduct The Code of Conduct policy states that disruptive and inappropriate behavior will not be tolerated. Examples include: Verbal outbursts, yelling, profane/angry language Refusing to perform assigned tasks Name-calling, ethnic jokes, unnecessary sarcasm Eye-rolling, making faces, inappropriate gestures Intimidating physical behavior, physical threats Failure to keep confidences Starting, repeating or spreading rumors about others Criticism of healthcare professionals in front of patient or other professionals Sexual harassment

Includes Physicians And Other Independent Practitioners
Risk Management General Staff Orientation Disruptive Behavior Includes Physicians And Other Independent Practitioners Policy It is the policy of CHS that all individuals within its facilities be treated courteously, respectfully, and with dignity. To that end, CHS empowers the Board of Trustees of each facility to require that all individuals, employees, physicians, and other independent practitioners conduct themselves in a professional and cooperative manner while in the Hospital or while involved in Hospital business. 31 31

Definition Of Disruptive Behavior
Risk Management General Staff Orientation Definition Of Disruptive Behavior Disruptive behavior is any inappropriate and/or abusive behavior that may disrupt hospital operations, create a hostile or dangerous work environment or which may negatively impact patient care. 32 32

DO YOU KNOW? Patient Bill of Rights
Patient has the right to refuse students if they so desire.

PROFESSIONALISM Remember that you represent your profession and your school Be quiet and respectful Silence cell phones

DRESS CODE Wear your name badge or student ID at all times
Wear your uniform or lab coat over street clothes Avoid perfumes, heavy make-up, or jewelry Keep fingernails trimmed and neat

STOP ROH DID YOU REMEMBER TO LEAVE ALL PATIENT INFORMATION IN THE HOSPITAL? Check your pockets for any patient data! All patient information must remain in the hospital! This is a privacy and confidentiality issue! Remember to use the paper shredder box! DO NOT put any identifying patient information in the trash cans, including IV bags

EVERY BODY WANTS THE CHART!
Avoid shift change times for getting patient info Take chart out to counter instead of sitting at nurse’s desk Put the chart back where you got it when you are finished

DISASTER CODES DIAL 444 GIVE TYPE OF CODE TO BE CALLED AND LOCATION
REPEAT INFORMATION THREE TIMES

CODE YELLOW External/Internal Disaster
A telephone call notifying the hospital of an anticipated influx of casualties will be relayed to Senior Administration or nursing supervisor/Security Dispatch… (mostly ROH unless transferring from other hospitals) It could also be an internal disaster with staff casualties. CEO or Administrator on call will be notified… decision to implement CODE YELLOW will be made based upon the incident….

CODE YELLOW Nursing units—will have staff members collect wheelchairs and stretchers which will be placed on standby on the unit. Unit staff will report back to their department for assignment

CODE YELLOW All available associates report to their departments for assignments. Department directors will issue assignments to their associates and coordinate and distribute resources. Directors will receive overhead pages or runners informing them of meeting times and locations for updates from the hospital command center.

HOSPITAL EVACUATION PLAN
HORIZONTAL TO THE NEAREST SMOKE COMPARTMENT VERTICAL TO NEXT FLOOR DOWN TOTAL EVACUATION OF THE HOSPITAL

EVACUATION STAGING AREAS
Suites Building Evacuation – Southwest corner of property Vision Building – Southwest corner of property Main Hospital – East side of property beside the ED parking area

WHAT TO DO IN THE EVENT OF A BOMB THREAT “Code Brown”
Be prepared! Keep a bomb threat report form by your telephone in order to obtain important information. Remember to remain calm and try to get as much info as possible from the caller.

Directors will then go back to their departments and form the initial search teams while police and fire are contacted by administration/security If the location of a suspicious package is known, do not touch or move the object! Inform the hospital command center! Evacuation will be considered. If the location of the bomb is unknown…administration may initiate a Code Yellow and/or an evacuation ALL 2-WAY AND CELL PHONE TRAFFIC CEASES! Regular telephones are all right to use however!

CODE RED Fire somewhere inside one of the buildings or outside in a parking lot

CODE RED KNOW FIRE DOORS/WALLS LOCATION KNOW EVACUATION ROUTES
KNOW YOUR SPECIFIC DEPARTMENT DUTIES

In a Code Red DRILL: Respond exactly like you would in a real fire
Pull the fire alarm pull station and follow R.A.C.E.

CODE PINK CHILD/INFANT ABDUCTION (Could also be used for an adult patient if appropriate, e.g. Down’s Syndrome patient) Know your department’s responsibility for exit doors - associates go to assigned exits and do not let anyone in, or anyone out. Also ask to see inside all bags. Security will report to area Pediatric Security: Be vigilant on the Pediatric Unit…. Ensure all staff wear their badge and secondary badge at all times!! Remember to watch for anyone acting suspicious!!

CODE WHITE A combative, disruptive person in the area
Dial 444 to report location Code white team will respond

CODE SILVER Person with possible deadly force (serious threat or weapon) Dial 444 if safe to do so Get out of area/building if possible and if safe Stay away from area Lock & barricade the doors to your area Hide behind furniture, and turn out lights and cell phones Security will respond and assess the situation Flowood police will be contacted

CODE BLACK Code Black Watch will be called when conditions are right for severe weather Code Black Warning will be called for severe inclement weather or tornado ANNOUNCED BY OPERATOR OR SECURITY

CODE BLACK WARNING Move patients, visitors, employees into hallway away from outside of building Close all doors Know location of EOC manual or how to access it on the intranet Know when normal duties resume

What is a Rapid Response Team?
A team of clinicians who are available to assist in the rapid evaluation, assessment, and stabilization of any patient who appears unstable or acutely ill. Rapid Response Teams (RRTs) are a part of the Institute for Healthcare Improvement’s 100,000 Lives Campaign

How do I call the Rapid Response Team?
When the assistance of the Rapid Response Team is needed: Dial 444 Give operator location of patient Operator will page the RRT to patient location

When do I call the Rapid Response Team?
Criteria includes but is not limited to: Bad feeling about patient Chest pain Acute change in heart rate <40 or >130 bpm Acute change in BP <90 or >200 mmHg Respiratory distress or acute change in rate Acute change in oxygenation <90% despite O2 Acute changes in mental status Acute change in blood glucose <60 or >500 Acute change in urine output Seizures Acute significant bleeding

How will calling the Rapid Response Team help me? Help my patient?
Opinion Second STAT Think of the rapid response team as a way to get a “Second Opinion STAT”! If you are worried about your patient or just feel something is not right…call the RRT

CODE BLUE CARDIOPULMONARY ARREST CODE 99 – PEDIATRIC CODE BLUE
Code team will respond to the room or area CPR, ACLS, PALS, NRP as needed All others stay out of area

WHO RESPONDS TO A CODE BLUE/CODE 99???
Nurse Manager Staff Nurse Nursing Supervisor ER Physician ER & ICUnurse Respiratory Therapy Radiology Tech Laboratory Tech Security

CODE ASSIST This is used for lifting help
All available employees will go to the area to assist with lifting

CODE PURPLE A CODE PURPLE should be called for any spill of a hazardous material. DO NOT CALL A CODE PURPLE FOR A MINOR BLOOD SPILL. Do not attempt to clean up an unknown substance. Leave the area, close the doors and wash hands with soap and water. Post staff at doors to warn people who may be trying to enter the area. CALL 444 AND REPORT A CODE PURPLE!!! APPROPRIATE PERSONS SHOULD BE NOTIFIED!

OBTAINED on the Intranet under Services– MSDS Online
SDS SHEETS MAY BE OBTAINED on the Intranet under Services– MSDS Online

EGRESS ROUTES and PANELS
Ensure all doors with an exit sign are NOT BLOCKED Also make sure that all medical gas panels and electrical panels are NOT BLOCKED with equipment Ensure all hallways are clear of equipment and items not currently in use. “In use” means you are near the equipment actively using it.

Lock All Known Exits Code lake
This code will be called on authority of Administration or Incident Commander

CODE ORANGE Code Orange will be called in the event of a radiologic disaster

ELECTRICAL SAFETY It’s everybody’s responsibility!
Avoid using extension cords Never bend or break off the ground plug Don’t use the “cheater plugs” that change 3-prong plugs into 2-prong plugs Don’t roll equipment over cords

More electrical safety tips:
Keep areas around electrical equipment and cords free from water or wetness Keep cords away from grease, oil, sharp objects and heat Make sure the switch is OFF before plugging a piece of equipment in Do not use water on an electrical fire Grasp a plug firmly and pull to remove from a socket—never pull by the cord

EQUIPMENT SAFETY….. If a piece of equipment gives you a tingle or shock, blows a fuse, stalls, sparks or trips a circuit breaker… Take it out of service Tag it with the orange label Place a work order for repair via bio-med

LOCK OUT/TAG OUT Maintenance will secure electrical disconnect or piping valves while conducting work on equipment. Do not remove or tamper with device that has been locked or tagged.

HAND HYGIENE…… …..THE SINGLE MOST EFFECTIVE WAY TO PREVENT INFECTIONS!
Alcohol foam – more effective than handwashing except for C difficile infections USE IT! Handwashing: Wet hands using warm water Work up a lather with soap Scrub for at least 15 seconds Clean under nails Rinse well – fingertips down Dry hands well & use dry paper towel to turn off faucets

STANDARD PRECAUTIONS Exceeds universal precautions
Avoid contact with any body fluid except sweat Personal protective equipment – available in all patient care areas

ISOLATION….. STOP before you enter…
3 types of isolation at ROH: Droplet precautions Contact precautions Airborne precautions Check the sign on the door for necessary PPE before entering!

Isolation Works This Way
Isolation is based on the 3 basic ways germs spread in hospitals Contact – must be picked up by contact with hands or clothes to be spread. Droplet – uses large droplets from sneezing and coughing to spread Airborne – uses very small particles floating in the air to spread. Isolation Works This Way Contact Isolation uses Gloves and Gowns as a barrier between the germs and your skin or clothes to prevent you from carrying the germs you could pick up from patients to another patient or yourself. We always use Contact Isolation for MRSA, VRE, C.Diff and other MDROs With Contact Isolation you are required to put gloves on before entering the room, and wear a gown if you are going to touch the patient, the bed or other equipment in the room. You must remove both the gloves and gown before leaving the room. Don’t forget to Wash Your Hands. Contact: Green Sign on door Each person in Contact Isolation should have their own stethoscope, BP cuff and thermometer as well as a bottle of Hibiclens in the room.

Droplet Isolation uses Masks, Eye Protection and Face Shields as a barrier between the germs and your eyes, nose and mouth. These germs are spread by spraying out of droplets when the patient coughs and sneezes. We always use Droplet Isolation for Influenza, both seasonal and H1N1, and Bacterial Meningitis. Droplet: Gold Sign on door With Droplet Isolation you are required to put on a mask before entering the room. You may need to wear eye protection or a face shield if the the patient is not using Respiratory Hygiene. In addition a gown and gloves may be needed because the droplet spray may spread the germs on the bed linen. You must remove all the barriers used before leaving the room. Don’t forget to Wash Your Hands. RESPIRATORY HYGIENE Patients should cover their nose and mouth with tissues to contain respiratory secretions when coughing and sneezing, discard when used and perform hand hygiene. If Patients are in an open area waiting for care they should wear a mask. Each person in Droplet Isolation should have their own stethoscope, BP cuff and thermometer as well as a bottle of Hibiclens in the room.

Airborne Isolation uses HEPA (N95) Masks as a barrier between the germs that are floating in the air and your lungs. These germs are so small that they spread by floating in the air after patients cough, sneeze or talk. Other patients and health care workers come along and breath in the germs. We always use Airborne Isolation for TB, Chickenpox, Disseminated Shingles and Measles. If you are not immune to Chickenpox or Measles – you should not care for these patients. If you do not know if you are immune, check with Employee Health. With Airborne Isolation you are required to put on a HEPA mask before entering the room. It provides a high filtration barrier between the floating germs and your lungs. You need to be fit tested and evaluated by Employee Health before you can wear a HEPA mask and care for patients in Airborne Isolation. You are allowed to re-use your HEPA mask for your entire shift unless it is damaged. You should remove the HEPA mask after leaving the room. Don’t forget to Wash Your Hands. Airborne Pink Sign on door

HAZARDOUS WASTE Infectious waste other than sharps must be placed in red bio-hazard bags. All needles, scalpels and other sharp instruments or devices must be disposed of in “sharps containers” Bio-hazard bags and sharps containers are placed in “BIOHAZARD” bins.

BACK INJURY PREVENTION PROGRAM
The Safe Patient Handling Program, an important ERGONOMIC solution for clinical staff, includes the following: Safe Patient Handling Policy Mechanical Lifting devices Friction Reducing devices Gait Belts

FRICTION REDUCING DEVICES (NOW AVAILABLE)
ErgoSlides To be used when patient needs assistance to move up in bed or repositioning Lateral Transfer Slides To be used when patient needs assistance moving from bed to another bed or stretcher

What Is Risk Management?
An on-going systematic process for loss prevention & control A means to minimize risks for patients, visitors, and personnel by providing a safe environment A process that supports, maintains, and enhances the quality of patient care by preventing/decreasing the frequency and severity of adverse events The process of reducing loss to the hospital

PURPOSE EVERYONE WHO is responsible for Risk Management?
To maintain a safe and effective health care environment for patients, visitors, and employees, thereby preventing or reducing loss to the organization. WHO is responsible for Risk Management? EVERYONE

Steps to Take When an Event Occurs
First and foremost: make sure the patient receives any medical care necessary. Notify the physician if the patient is injured there is a need for a physician examination or new treatment orders there is any patient fall, with or without injury Complete an Event Report and review it with your supervisor Notify the Risk Manager of the event

What Should Be Reported?
Any event or condition which: May result or has resulted in an injury to a patient or impairment of patient care Reflects a deviation from hospital policy, procedure, or practice Is an unusual occurrence that is outside the norm of daily activities

Examples Of What Should Be Reported
Medication variance Unanticipated outcome Patient or Visitor fall Hazardous Material spill Security Issue Equipment or medical device failure Procedure variance Refusal of treatment AMA Property loss or breakage Safety Issue

Event Report Completion DOs & DON’Ts
DO document the details of the incident in the medical record DO document the facts DO document follow-up treatment and/or action taken DO fill in all the blanks, sign and date the report DON’T record in the medical record that an event report was completed DON’T place the event report in the medical record DON’T document your opinion DON’T tell patient/family a report has been written DON’T make a copy of the event report DON’T discuss an event except when authorized by the Risk Manager

Recognizing and Reporting Abuse
The responsibility of the health care worker when any abuse is suspected is to notify the physician and Social Services

Child Abuse We are required by law to report suspected child abuse
Report is confidential We are immune from liability for reporting

Signs of Child Abuse Unexplained bruises, welts, lacerations, burns, fractures Internal injuries with symptoms of nausea, vomiting, blood in urine Physical indicators of sexual abuse such as lacerations and bruises Behavioral indicators, such as hostile behavior toward adults, running away, bedwetting Sleep/Speech disorders Habit disorder such as rocking Consistent hunger, poor hygiene Listlessness

Vulnerable Adult Abuse
We are required by law to report suspected abuse of a vulnerable adult—any adult unable to care for themselves. Any patient in the hospital can be considered vulnerable Could be physical, emotional, financial, or sexual abuse or neglect Report suspected abuse to the physician and the Social Service Department

Domestic Abuse Domestic violence is the leading cause of injury in women ages Occurs in approximately 33% of pregnant women 25-30% of women treated in the ER are there for on-going abuse Men as well as women can be victims Domestic violence cannot be reported to the police without the victim’s permission Notify the physician and Social Services of concerns about domestic violence

Our Performance Improvement (PI) Methodology is based on the PDCA model for improvement.
Plan Do Act Check

What is PDCA? Plan – Decide what to improve and analyze existing information to plan and design a change which should result in improvement. Do Test out the design change and measure the results. Check Use measures to determine if the design implemented was effective. Act If the change was effective, make the change permanent On-Going Measure of Effectiveness Sustained improvement is important to maintaining the highest quality care / service and in achieving our Mission.

What are the Focus Areas for our PI Priorities?
Satisfaction Patient Physician Employees Patient Safety Ensuring a safe environment for our patients, visitors, volunteers, our staff and physicians. The Joint Commission’s National Patient Safety Goals drive our safety goal initiatives. Core Measures River Oaks – SCIP -Surgical Care Improvement Project (inpatient and outpatient) CHF AMI Pneumonia VTE Prevention

Core Measures The monitoring of core measures provides a way for hospitals to standardize performance measures across the nation and identify opportunities for improvement. Core measures are monitored because they are considered high volume and/or high risk for patients.

Hospital Ethics Committee
Purpose: To direct staff in appropriate actions for the discussion and resolution of ethical issues Members: Medical staff, clergy, community representatives, hospital employees

Ethics Committee (cont’d)
A meeting of the Ethics Committee may be requested by a physician, patient/family, or health care provider Meeting is confidential Ethical Behavior can be described as doing the right thing.

Culture: “The values, beliefs, and practices shared by a group”
Cultural Considerations Culture: “The values, beliefs, and practices shared by a group” Healthcare workers need cultural competencies – these are skills you use to work well with patients of all cultures. The first step toward cultural competence is simply being aware of your own cultural beliefs

Cultural Tidbits Avoid stereotyping
Take cues. Avoid eye contact, sitting close, etc., if patient avoids these Ask about proper practices if you are unsure Discuss one topic at a time Avoid using medical jargon or slang Ask about ways of showing respect such as how the patient wants to be addressed Use words the patient understands Approach a new patient slowly Don’t be too casual or familiar Focus on showing respect

Learn about cultural differences!
Direct eye contact is considered impolite or aggressive in many American Indian, IndoChinese and Arab cultures Hispanic patients may keep their eyes downcast as a sign of respect to others Some Asian-Americans consider touching a person’s head to be impolite because they believe the spirit resides there A hurried attitude on your part could offend Hispanic or Asian patients who value politeness or American Indian patients who value an unhurried approach to communication

Language River Oaks has access to language interpreters through the Language Line. The phone to access this service is kept in the nursing supervisor’s office. River Oaks is contracted with interpreters for the deaf to help communicate with the hearing impaired

What do you feel when you see these patients?
Bariatric Patients Sensitivity Training What do you feel when you see these patients? Empathy: Identification with and understanding of another’s situation, feelings, and motives. Synonyms: compassion, understanding, insight, appreciation.

What about this patient?
ap·a·thy (ă p’Ə -th ē) Lack of interest or concern, especially regarding matters of general importance or appeal; indifference. Lack of emotion or feeling; impassiveness. How do we feel about these patients? If you are like many nurses, doctors and other health professionals, you might feel sorry for them, but its’ a different kind of sorry….we wouldn’t want to be in their shoes. Or if we were, we would certainly do something about it. How many of us actually view these patients as diseased? Would we go out of our way to help them? 101

Don’t they know that they’re fat?
Do you think you’re the first person to stare at or make fun of them? Remember, this person gets up everyday and the first person they see each day is themselves. No one knows better than the patient that they have a weight issue. They live with the discomfort and social isolation everyday Sometimes, their worse critics are themselves When you encounter an obese patient, you have no idea what their social support network is like. Many obese people are in bad marriages or come from less than ideal home situations in which they get little support. 102

Do…. Monitor facial expressions Plan ahead
Communicate size requirements with other departments so equipment can be on hand upon patients’ arrival. Anticipate the needs of the patient…they may be too intimidated to ask for it Ask the patient how they do ______ at home. Toileting Ambulating Dressing/undressing Personal hygiene Items to consider: large/xlarge BP cuffs Tongue blades Longer needles Gowns, slippers, etc. 103

Do… Assess psychological well-being and motivation
What support do they have at the hospital? Who will be there when they get home? Touch the patient! Obese patients reported less physical touching by the caregiver than the non-obese patients Nurses’ attitudes about obesity can hinder good nursing care Treat the patient the way you would want your loved one treated

Do Not…. Call bariatric equipment ‘Big Boy’, ‘Heavy Duty’….
Make loud, public requests for extra lifting help Publicly announce the patient’s weight Roll your eyes when you first visualize your patient…they can see that. Act exasperated when they ask for assistance Make verbal/non-verbal expressions of disgust when you have to get special or extra equipment

Student Injury If injured during clinical experience, notify immediately: - your instructor - the nurse manager - the supervisor - the employee health nurse Hospital protocols will be followed

MEDICATION ADMINISTRATION
Standard times – see “Fast Facts” MAR Worksheet – take to bedside Two patient identifiers: Name, DOB Look alike/sound alike drugs – posted in unit medication room Now doses – as soon as possible after the order is written Stat doses – with highest priority after the order is written New orders – must be verified by staff Accudose access via instructor Narcotics: nurse, instructor & student

Basics of Documentation
Clinical Risk Orientation Basics of Documentation Write legibly Use only black ink Never erase or use correction fluid, tape, magic markers Do not skip lines or leave blanks Chart in chronological order Corrections - single line through incorrect entry (do not obliterate) - make correct entry - initial, date and time correction Late entries - Date and time of entry - Statement: “late entry for _____ (date entry should have been made) 108 108

Review of basics….cont’d
Clinical Risk Orientation Review of basics….cont’d Use only hospital approved abbreviations and symbols Do not use “Unapproved Abbreviations” listed in any patient chart Be sure patient identifying information is on each page Date each page, especially of a bi-fold or tri-fold form Record the date and time of each entry and event Document when events occur Do not document anything in advance of its being done Sign per hospital policy – each entry should be signed Do not document for someone else without proper notation: ex: foley catheter inserted per J. Doe, RN 109 109

Basics of Documentation (Cont’d)
Clinical Risk Orientation Basics of Documentation (Cont’d) Document outcomes of nursing interventions to show effectiveness of patient care Document the patient’s refusal of treatment and/or your teaching about the need for treatment and possible consequences of refusal Don’t insert information in the margins NEVER, NEVER, NEVER alter a record 110 110

FOOD DRUG INTERACTIONS
Patient brochures on nursing units Document education on patient education sheet

FOCUS DOCUMENTATION Used on MedSurg nursing units

FOCUS D—DATA Assessment A—ACTION Intervention R—RESPONSE Outcome

D----DATA ASSESS THE PROBLEM
Your assessment What the patient tells you Significant lab values, vital signs, etc.

A=ACTION YOUR NURSING INTERVENTIONS
What you do Who you call What you report PRN medications Comfort measures

R=RESPONSE Patient’s response to your interventions What you see
What the patient states Changes in measurements

TIME FOCUS D-DATA A-ACTION R-RESPONSE
10:00 PAIN D- Pt c/o pain in R hip. States pain is “8” on intensity scale Describes pain as throbbing. States pain gets worse when he turns to R side N.NURSE RN A- Tylox 1 given p.o. Assisted patient to reposition to L side 10: IV D. IV in R hand swollen, infiltrated. Pt c/o discomfort at site N.NURSE RN A. Discontinued intact 18 gauge angiocath from R hand, no redness or drainage at site. Restarted IV in L forearm with 16 gauge angiocath using sterile technique, sterile transparent dressing applied N.NURSE RN R. D5W infusing at 75cc/hr L forearm without s/s infiltration 10:30 PAIN States pain is now a 3 on intensity scale N.NURSE RN

My patient is in pain…. Pain is a FOCUS Use the appropriate pain scale
Check for response Do pain assessment every shift and as needed

Pain Documentation MINIMUM OF EVERY SHIFT on the flow sheet
USE appropriate pain scale Document response to interventions for pain How do we measure pain?

Falls Prevention - Assessment
Risk Management General Staff Orientation Falls Prevention - Assessment Assess your patients for falls on admission using the Morse Fall Risk Assessment tool. Reassess your patient every 12 hours and additionally if the patient falls or his condition changes. Document your assessment according to policy. 120 120

Falls Prevention – Interventions
Educate patient and family on fall safety and document. Hourly Rounds should be made but patients should not be awakened for rounding assessment Components of Hourly Rounds Potty (toileting assistance) Personal Needs – items in easy reach Positioning Pain Plan of Care

Falls Prevention - Interventions
Environmental interventions Side rails up – but remember, having 4 side rails up is considered a restraint. Bed in lowest position with wheels locked Remove any clutter / obstructions in room Call light and personal items within reach Night light working Secure, non-skid footwear Bed alarm, as applicable

When a fall occurs Ensure patient safety
Ask patient about injury, pain Do not move patient until potential injuries are identified and safety assured Assist patient to bed in safest manner Ask patient how the fall occurred Assess vital signs Assess environment for safety issues

Notification of the fall:
Notify the shift supervisor Notify the physician Notify the family as soon as possible Notify the risk manager by phone immediately in the event of a serious injury Documentation of the fall: Complete Event report for any fall or assisted to floor event. Document specific facts in nursing notes Document preventive measures initiated Update fall prevention assessment and fall prevention plan of care.

THE NURSING CARE PLAN The “Plan of Care” is part of the patient care record Document nursing interventions Resolve problems

DVT Prevention Flowtron Pumps
Thigh, Calf, or Foot Wraps Inspect every SHIFT Report any s/s skin irritation to physician and Wound Care nurse Keep heels off bed Remove and inspect with any c/o pain

RESTRAINT SHOULD BE USED AS THE LAST ALTERNATIVE!
Alternatives first! Review Restraint policy

Be alert for s/s of physical distress in the restrained patient….
Dyspnea Flushed face Tachycardia Diaphoresis Cyanosis Hypertension

IV THERAPY 1 attempt per student, then seek assistance
No lower extremity sites Site/tubing changes q 72 hr Hyperal tubing q 24 hr Central lines – review policy

National Patient Safety Goals
Risk Management General Staff Orientation National Patient Safety Goals Goal 1: Identify patients correctly Use 2 patient identifiers ( Name and DOB for adults, Last Name and account # for infants) Eliminating Transfusion Errors – requires a (2) person check at the patient’s bedside Label blood and specimen containers in the presence of the patient 130 130

Risk Management General Staff Orientation National Patient Safety Goals Goal 2: Improve the effectiveness of communication among caregivers. Report critical results of tests and diagnostic procedures on a timely basis 131 131

Risk Management General Staff Orientation National Patient Safety Goals Goal 3: Improve the safety of using medications Label all medications, medication containers (syringes, medicine cups, and basins), and other solutions on and off the sterile field in perioperative and other procedural settings. Take extra care with patients who take medicines to thin their blood. Record and pass along correct information about a patient’s medications. Find out what meds they take at home and compare those to new meds given in the hospital. Make sure the patient knows which meds to take when they go home. Tell the patient to take an up-to-date list of meds every time they go to a doctor. 132 132

Goal 6: Use Alarms Safely Make improvements to ensure that alarms on medical equipment are heard and responded to on time.

Risk Management General Staff Orientation National Patient Safety Goals Goal 7: Prevent infection A. Meeting hand hygiene guidelines B. Using proven guidelines to prevent: Multi-drug resistant organism infections Central-line associated blood stream infections Post-op infections UTI from Foley catheters 134 134

Risk Management General Staff Orientation National Patient Safety Goals Goal 15: Identify patient safety risks. A. Risk Assessment to be performed on any patient expressing suicidal ideation. B. Provide patient and family members with information on the crisis prevention hotline if identified at risk for suicide. 135 135

Risk Management General Staff Orientation National Patient Safety Goals Prevent Mistakes in Surgery Follow the Safe Procedure Review: A. Assure the correct surgery is done on the correct patient and at the correct place on the patient’s body B. Mark the procedure site C. Perform a Safe Procedure Review just prior to procedure to make sure a mistake is not being made 136 136

THE END

River Oaks Hospital STUDENT ORIENTATION.

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River Oaks Hospital STUDENT ORIENTATION.

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