Volunteer Orientation SelfStudy Manual

1
Volunteer Orientation Self-Study Manual
2
Welcome to Volunteers in Medicine of
Jacksonville. As a new volunteer, there are some
things that you probably would like to
familiarize yourself with. This manual is broken
down into sections so that you may read those
that will be applicable to your role within VIM.
Please take the time to review each of those
sections. Click on the first section to view it,
to return to this menu, click on the home
button on the menu at the end of that section.
1. VIM Overview/Finding and Contacting VIM

• 2. Charting for Nurses and MAs

3. Charting for Providers
4. The Role of Students
5. Biohazardous Waste / Lab Procedures
6. Infection Control, HIV/AIDS, and HIPPA
3
Location

• Volunteers in Medicine Jacksonville is located in
  downtown Jacksonville
• 41 E. Duval Street
• Jacksonville, FL 32202
• Phone [phone]
• Fax [phone]

4
Hours

• VIMs hours for seeing patients are 9am to 5pm on
  Tuesday through Friday, and 9am to 1pm on
  Saturdays. However, some educational classes may
  be scheduled outside of these times.
• Patient appointments are generally scheduled in
  15 minute blocks.

5
VIM History and Purpose

• An estimated 120,000 working Jacksonville
  citizens have no health insurance.
• VIM-Jax proposes to serve the working uninsured
  and their families by operating a volunteer-run
  clinic where patients will receive free primary
  medical care, counseling services and medications
  they need to live healthy productive lives.
• The VIM model was created in 1994 by Dr. Jack B.
  McConnell in Hilton Head Island, South Carolina.
• VIMs model is demonstrated through its many
  independently operated, volunteer run clinics
  from Florida to Oregon.
• See www.vim-jax.org if you would like further
  information on the history of VIM.

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VIM Objectives

• Provide free primary care medical and counseling
  services.
• Improve community health through education and
  preventative medicine.
• Encourage care providers and receivers to
  contribute to the communitys well being.
• Promote volunteerism and community spirit.

7
Patient Criteria for Services

• Residency-patients live or work in Duval County
• Income-patients have an income level between
  13,000-23,925 per year for a single individual.
• Uninsured-patients are without private or
  government funded medical insurance.
• Employment-one or more family members are
  gainfully employed, working at least 20 hours per
  week.

8
Vision

• May we have eyes to see those rendered invisible
  and excluded open arms and hearts to reach out
  and include them healing hands to touch their
  lives with love, and, in the process, heal
  ourselves.
• See Volunteers in Medicine Institute for more
  information www.vimi.org
• Keys to Success
• Quality Management
• Efficient, Low-cost Operation
• Enthusiastic and Committed Volunteers
• Broad Base of Community Involvement and Support

9
People to Know at VIM

• Although there are many dedicated Volunteers at
  VIM you will soon get to know (hopefully you will
  be one of them), here is a list of the full-time
  employees that comprise the backbone of VIM.
• Donna Van Loock Clinical Director
• Jeff Matthews Business Director
• Catie Wallace Volunteer Coordinator
• Kim Fields Office Coordinator

10
Board of Trustees

• James N. Burt, MD
• Hope E. Brank
• Dorothy S. Dorion, RN, MS
• Guy Cuiddihee
• Li Loriz RN, PhD
• C.B. McIntosh, MD
• William Mercer

• Rev. Richard A. Petry
• George E. Ridge, Esq.
• Andrea Giggetts
• Sister DeSales Wisniewski, RN, MS
• Rev. Eugene M. Zimmerman

11
Staff

• Care is provided by volunteer physicians, nurses,
  nurse practitioners and non-medical community
  volunteers.
• Community partners providing specific services on
  an outsource basis
• Operations are funded through private and
  corporate donations, grants, and on-going
  fundraising

12
Patient Education

• Patient education is everyones responsibility.
  Whether you are a student, nurse, or provider,
  just taking the time to find out if your patients
  have all the information that they need can make
  a huge difference in the quality of care we
  provide at Volunteers in Medicine. If you
  determine that a patient needs more information,
  or if you are asked for more information on a
  topic, you are encouraged to utilize the patient
  education files located on the main floor across
  the hallway from the medical professionals desk
  area in. These files contain written materials
  approved by Volunteers in Medicine to be used in
  conjunction with verbal discussion or
  demonstration education given by medical
  professionals on a variety of topics. New
  materials are being continuously added to this
  collection. If there is only one copy of a
  handout on the topic you are about to use
  remaining, please make use of the copy machine to
  be sure there is always at least one left in the
  filing cabinet. A list of topics currently
  available for your use in clinical practice
  includes

13
Scheduling

• Scheduling of Volunteer hours at VIM is normally
  done in four hour blocks 9am to 1pm, or 1pm to
  5pm. If you are scheduled and can not make it to
  clinic due to an emergency, please call the
  office as soon as possible. Here at VIM, we take
  pride in our quality services, if we are not
  properly staffed we may have to cancel
  appointments. Please do your very best to be on
  time.

14
Parking

• Parking behind VIM is limited. The Methodist
  church on Church street has been kind enough to
  allow us at VIM use of their parking facilities.
• A pass may be obtained from the front desk at
  VIM, or from your volunteer coordinator during
  the orientation process. Please place this pass
  on your dashboard if instructed to use the
  churchs parking facilities. Your volunteer
  coordinator will instruct you on where you should
  park.
• If the VIM parking lot is full, please utilize
  First United Methodists parking lot on the
  corner of Church and Market Streets.

15
Charting Responsibilities for Nursing Staff

• RNs/MAs/Nursing staff are responsible for the
  completion of the sections of the forms described
  in the following slides

16
Health History

• The patient will be asked to fill this form out.
  The nurse will collect this form from the patient
  and review it for completeness. If necessary, the
  nurse will assist the patient by clarifying any
  areas of confusion or filling it out for the
  patient.

17
Health History Continued

• The nurse will then sign off and date the labeled
  area on the back of the form indicating the form
  has been reviewed and is complete.

18
Medical Summary Page

• The nurse will fill out the patients name, date
  of birth, allergies, and chart number at the top
  of this form.

19
Medications List Progress Notes

• The nurse will fill out the patients name, date
  of birth, allergies, and chart number at the top
  of each of each of these forms.

20
Initial Assessment Form

• The nurse will fill out the patients name,
  status (new or established patient), sex, date of
  birth, chart number, chief complaint, date, and
  allergies at the top of this form. The nurse will
  then obtain and document vital signs, height,
  weight, waist measurement, and calculated BMI in
  the appropriately labeled area in the top right
  portion of the form. If applicable, the nurse
  will obtain and record the date of the last
  menstrual period.

21
Pharmacy Log

• When drugs are dispensed to a patient, the
  pharmacy log is to be completed by the nurse
  including date, patient name, drug name, drug
  strength, quantity, lot number, expiration date,
  and prescribing provider. The medication label is
  to be filled out completely and applied to the
  medication container before being dispensed to
  the patient. An example of the log and also the
  label are to the right ??????

22
Patient Disposition

• The nurse will fill out the date, patient name,
  DOB, chart number, and provider name at the top
  of this form.

23
Breast Cancer Screening Referral

• If a patient is referred for breast cancer
  screening, this form is to be filled out. The
  form consists of a demographic questionnaire,
  history, referral area, and consent. The patient
  is asked to fill out the demographic information,
  the nurse will then review for completeness and
  then complete the history section of the form.
  The nurse will then have the patient sign and the
  consent, the nurse will witness. The only area to
  be left blank is the referral area.

24
Laboratory Sheet

• If lab work is to be ordered on a patient, the
  nurse is responsible for filling out the
  following patient name, chart number/social
  security number, date of birth, and will check
  the box labeled office account at the top of
  the form titled Consolidated Laboratory
  Services.

25
Providers Documentation Responsibilities

• Healthcare providers at VIM are responsible for
  the completeness of all documentation of
  assessment, treatment, and care provided.

26
Medical Summary Page

• Chronic Problem List
• Surgical History
• Family History
• Social History
• Immunizations
• Significant Radiological Reports/Consultations
• Health Maintenance

27
Chronic Medications List

• Name, Dose and Frequency of medication
• Start and stop date of medication

28
Initial Assessment Form

• History prior to incident
• Reviewed Past Medical History, and Social History
  (Y/N)
• Reviewed Medications, Labs, and ER visits (Y/N)
• Physical Exam Findings and Symptoms
• Assessment
• Plan
• Providers name and date

29
The Role of Students at VIM

• A partnership exists between Volunteers in
  Medicine and the University of North Floridas
  Brooks College of Health.
• Nurse practicioner students rotate through VIM
  with Donna Van Loock, who is also faculty at UNF.
  
• Pre-Licensure nursing students may rotate through
  VIM for their community courses, or other
  courses.
• Nutrition majors may rotate through VIM and may,
  among other things, teach classes to patients on
  proper nutrition. One of the major roles of
  nutrition majors has been diabetes education.
• Health administration majors have helped the
  clinic with various other projects.
• Physical therapy students from UNF also come to
  VIM.
• Other schools have also sent their students,
  pharmacy students from University of Florida have
  completed clinical hours on site.

30
Student Responsibilities and Expectations

• Students all have varying roles in VIM, and must
  look to their instructor, course requirements,
  and Donna Van Loock to understand any
  expectations, responsibilities, or restrictions
  placed on their work here at VIM.
• Students are expected to sign in and out at the
  front desk in order to have their clinical hours
  validated.

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Student Parking

• Due to limited parking in the VIM lot, students
  are expected to park behind First United
  Methodist church.
• Directions from UNF
• Total Est. Time 15 minutes
• Total Est. Distance 10.15 miles
• 1 Start out going northwest on St. Johns Bluff
  Road toward Alumni Way. 1.3 miles
• 2 Turn LEFT onto Beach Blvd/ US-90 W / FL-212 W.
  3.2 miles
• 3 Merge onto FL-228 W / Hart Bridge expy toward
  Atlantic Blvd / Downtown. 4.9 miles
• 4 Take the Duval St. exit. 0.2 miles
• 5 Turn SLIGHT LEFT onto E Duval St. 0.3 miles
• 6 End at 41 E Duval St Jacksonville, FL
  32202-3201 [phone]

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Lab Safety

• Never manually bend, break, or recap needles.
• Dispose of all sharps in proper containers.
• Wear personal protective equipment when
  necessary.
• Wear gloves for each phlebotomy and when handling
  lab specimens.
• Wash hands after removing gloves.
• No food or drinks in laboratory refrigerators.
• Never pipette by mouth.
• Do not smoke, eat, drink, or apply cosmetics in
  lab areas.

33
Biomedical Waste

• Definition Biomedical Waste is any solid or
  liquid waste which may present a threat of
  infection to humans.
• Identification and Segregation Items of sharps
  and non-sharps biomedical wastes generated at VIM
  include
• Sharps to dispose of in specific sharps
  containers Needles, scalpels
• Non-sharps to dispose of in red bag biohazardous
  waste containers Bloody gloves, dressings soaked
  with blood or bodily fluids, vaginal speculums,
  cervical spatulas, endocervical brushes.
• If biomedical waste is in a liquid and semi-solid
  form, and aerosol formation is minimal, the waste
  may be disposed into a sanitary sewer system or
  into another system approved to receive such
  waste by the Department of Environmental
  Protection or the DOH.
• Red bags are available and accessible by staff in
  the supply cart.

34
Biomedical Waste Continued

• Containment Biohazardous waste must be disposed
  of at the point of origin, meaning the sharps
  container or red bag inside the exam room.
• Full bags or sharps containers must be sealed
  inside the exam room from which it originates.
• Labeling Facilitys name and address must be
  present on sealed red bag or sharps container
  before being transported offsite.

35
Biomedical Waste Continued

• Storage Using appropriate personal protective
  equipment, biomedical waste removed from exam
  rooms will be sealed in a small, biohazard bag
  and then placed in the labeled larger bag-lined
  approved biohazard waste receptacle located in
  the indoor loading dock. The loading dock floor
  is level, impervious to liquids, and easily
  cleanable. This area is only accessible by VIM
  employees and the licensed waste transporter. The
  pick-up schedule is posted on the garage door.
• Transport The company that picks up biomedical
  waste is Stericycle of Jacksonville, FL. Pick-up
  receipts must be retained by VIM for three years.

36
Biomedical Waste Continued

• Procedure for decontaminating biomedical waste
  spills
• Don appropriate personal protective equipment
• Soak up fluids with disposable cloths
• Use forceps to sweep or pick up objects, place in
  sharps container
• Cleanse area thoroughly with soap and water
• Disinfect area with a diluted bleach mixture (1
  oz. bleach to 9 oz. water) for 10 minutes
• Dispose of cloths and gloves in a red bag
• A copy of VIMs biomedical waste operating plan
  is kept in the business administrators office
  along with permits, transport logs, and
  inspection reports.

37
Quiz Yourself on Biomedical Waste!

• Which of the following terms are found in either
  the Florida Statutes or the Florida
  Administrative Code?
• Biomedical waste
• Regulated waste
• Biomedical waste
• Exposure control plan
• Transportation

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Answer

• Which of the following terms are found in either
  the Florida Statutes or the Florida
  Administrative Code?
• Biomedical waste
• Regulated waste
• Biomedical waste
• Exposure control plan
• Transportation
• Note others are terms from OSHAs Bloodborne
  Pathogens standard

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Quiz Yourself on Biomedical Waste!

• 2. Which of the following is considered
  biomedical waste?
• Heavily soaked bloody dressing
• A bloody urine cup
• Needles
• Saliva contaminated gloves
• Blood contaminated flexible tubing

40
Answer

• 2. Which of the following is considered
  biomedical waste?
• Heavily soaked bloody dressing
• A bloody urine cup
• Needles
• Saliva contaminated gloves
• Blood contaminated flexible tubing

41
Quiz Yourself on Biomedical Waste!

• 3. Which of the following are examples of sharps
  biomedical waste?
• Used needles
• Unused needles
• Intact contaminated glass
• Carpules
• Self-sheathed safety needles

42
Answer

• 3. Which of the following are examples of sharps
  biomedical waste?
• Used needles
• Unused needles
• Intact contaminated glass
• Carpules
• Self-sheathed safety needles

43
Quiz Yourself on Biomedical Waste!

• 4. Which of the following are examples of
  non-sharps biomedical waste?
• Drop of blood on a cotton ball
• Disposable gloves contaminated with saliva only
• Heavily blood and body fluid soaked 4x4 dressing
• Bloody vinyl gloves
• Sterile tubing

44
Answer

• 4. Which of the following are examples of
  non-sharps biomedical waste?
• Drop of blood on a cotton ball
• Disposable gloves contaminated with saliva only
• Heavily blood and body fluid soaked 4x4 dressing
• Bloody vinyl gloves
• Sterile tubing

45
Quiz Yourself on Biomedical Waste!

• 5. Which of the following best describes the
  states the state of Floridas definition of
  point of origin?
• Pont at which waste is taken to on a transfer
  basis
• Pont on a patients body where the injection is
  given
• Point of contamination where germs begin to
  divide and multiply
• Room or area where biomedical waste is generated
• Room or area where biomedical waste is stored
  before transport

46
Answer

• 5. Which of the following best describes the
  states the state of Floridas definition of
  point of origin?
• Pont at which waste is taken to on a transfer
  basis
• Pont on a patients body where the injection is
  given
• Point of contamination where germs begin to
  divide and multiply
• Room or area where biomedical waste is generated
• Room or area where biomedical waste is stored
  before transport

47
Quiz Yourself on Biomedical Waste!

• 6. Sharps containers should be sealed closed
  when?
• After the 30 day time period
• When full
• When gloves are sticking out of the top
• After someone is stuck
• After it is knocked off a countertop

48
Answer

• 6. Sharps containers should be sealed closed
  when?
• After the 30 day time period
• When full
• When gloves are sticking out of the top
• After someone is stuck
• After it is knocked off a countertop

49
Quiz Yourself on Biomedical Waste!

• 7. Red bags may be purchased from what type of
  facility?
• a. Department Store during the holidays
• b. From any distributor who provides
  documentation their red bags meet Floridas
  strength specifications
• c. From the home shopping network
• d. State of Californias regulated waste
  transporter
• e. From a hustlers vehicle trunk

50
Answer

• 7. Red bags may be purchased from what type of
  facility?
• a. Department Store during the holidays
• b. From any distributor who provides
  documentation their red bags meet Floridas
  strength specifications
• c. From the home shopping network
• d. State of Californias regulated waste
  transporter
• e. From a hustlers vehicle trunk
• Note Red bags are plentiful during the holidays,
  but are not approved biomedical waste bags

51
Quiz Yourself on Biomedical Waste!

• 8. Storage of biomedical waste shall be in
• Red bags
• Clear specimen bags with a red biohazard symbol
• Sharps containers
• Black solid waste garbage bags
• Both a and c above

52
Answer

• 8. Storage of biomedical waste shall be in
• Red bags
• Clear specimen bags with a red biohazard symbol
• Sharps containers
• Black solid waste garbage bags
• Both a and c above

53
Quiz Yourself on Biomedical Waste!

• 9. The minimum size of any international
  biological hazard symbol is
• 2 inches
• 4 inches
• 6 inches
• 8 inches

54
Answer

• 9. The minimum size of any international
  biological hazard symbol is
• 2 inches
• 4 inches
• 6 inches
• 8 inches

55
Quiz Yourself on Biomedical Waste!

• 10. In addition to the symbol, the generating
  facilitys name and address shall be added to
• The offsite transport container
• A red bag lining of an offsite transport
  container
• Individual red bags and sharps containers in a
  box without a red bag liner
• Box of red bags in storage area

56
Answer

• 10. In addition to the symbol, the generating
  facilitys name and address shall be added to
• The offsite transport container
• A red bag lining of an offsite transport
  container
• Individual red bags and sharps containers in a
  box without a red bag liner
• Box of red bags in storage area

57
Quiz Yourself on Biomedical Waste!

• 11. The proper strength of bleach mixed with
  water for disinfection purposes is
• 1 oz. bleach per gallon of water
• One gallon bleach per mop bucket
• Half bleach, half water
• 1 oz. bleach for every 10 oz. water
• 1 oz. bleach for every 9 oz. water

58
Answer

• 11. The proper strength of bleach mixed with
  water for disinfection purposes is
• 1 oz. bleach per gallon of water
• One gallon bleach per mop bucket
• Half bleach, half water
• 1 oz. bleach for every 10 oz. water
• 1 oz. bleach for every 9 oz. water

59
Quiz Yourself on Biomedical Waste!

• 12. An approved method of transporting biomedical
  waste is
• Carefully placed under a car or trucks seatbelt
• In the uncovered bed of a pickup truck
• In a red beg in the vehicles trunk next to the
  spare tire
• In a trunk, in an otherwise empty toolbox with
  the top secured and labeled properly
• On the vehicles dashboard

60
Answer

• 12. An approved method of transporting biomedical
  waste is
• Carefully placed under a car or trucks seatbelt
• In the uncovered bed of a pickup truck
• In a red beg in the vehicles trunk next to the
  spare tire
• In a trunk, in an otherwise empty toolbox with
  the top secured and labeled properly
• On the vehicles dashboard
• Note A plastic container is best as it can be
  disinfected without rusting

61
Fecal occult Blood (FOB) testing using single
Hemoccult slides

• Rationale
• Fecal occult blood test is a rapid, convenient
  and qualitative method for detecting fecal occult
  blood which may be indicative of gastrointestinal
  disease.The Hemoccult test reaction is based on
  the oxidation of guai by hydrogenperoxide, to a
  blue-colored compound. Because hemolysis is
  promoted by substances in the feces (primarily
  water and salts), hemoglobin is released if blood
  is present in a fecal specimen. Having peroxidase
  activity, the heme portion of hemoglobin reacts
  with the Hemoccult test by catalyzing the
  oxidation of alpha guaiaconic acid (the active
  component of the developer) to form a highly
  conjugated blue quinine compound.

• Collection A fecal specimen shall be collected
  from a gloved finger during a digital rectal
  exam, from a bowel movement or toilet tissue
  using an applicator stick.
• Labeling and Processing The hemoccult card will
  be labeled with the patient's name and date of
  birth if they are not processed immediately in
  the patient's room during the exam. The cover
  flap of the slide will be kept sealed until ready
  to use. The slides will be protected from heat,
  light, and volatile chemicals. The developer will
  be protected from heat and the bottle kept
  tightly capped when not in use.

62
Fecal occult Blood (FOB) testing using single
Hemoccult slides Continued

• 8. Wait 3 to 5 minutes before developing test.
• 9. Open back slide cover and apply two drops of
  Hemoccult developer to guaiac
• paper directly over each smear.
• 10. Read results within 60 seconds any tract of
  blue on or at the edge of the
• smear is positive for occult blood.
• 11. The Performance Monitor area must be
  developed on every slide by applying one drop of
  Hem occult developer between the positive and
  negative Performance Monitor areas.
• 12. Read results within 10 seconds a blue color
  will appear in the positive Performance Monitor
  area and no blue will appear in the negative
  Performance Monitor area.
• 13. Test results will be verbally reported to the
  MD/ARNP who is responsible for
• documentation in the medical record.

• Gather suppliessingle hemoccult card, hemoccult
  developer within expiration, exam gloves and
  water-based lubricant (for a digital rectal
  exam), stool cup and applicator stick (for
  specimen retrieved from a bowel movement)
• Explain the procedure to the patient and obtain
  verbal consent
• Proceed with specimen collection as previously
  outlined.
• Open front of slide cover and apply a thin fecal
  smear covering Box A.
• Apply a second thin smear from a different part
  of the specimen covering Box B.
• Close front cover flap.
• Dispose of applicator in waste can.

63
Fecal occult Blood (FOB) testing using single
Hemoccult slides Continued

• Instrument calibration. maintenance. and
  freQuency intervals
• Completing the Performance Monitor test on east
  slide as described in step-bystep procedure
  assures accuracy of test results.
• Equipment range of reportable patient tests
• Test results are qualitative and may be read as
  negative or positive only. The intensity or shade
  of the blue positive test results is significant.
• Volunteers in Medicine-Jacksonville Clinical
  Services Policy and Procedures Manual
• Qualitv control (QC) policies and procedures
• The function and stability of the slides and
  developer are tested using the on-slide
  Performance Monitor feature previously described
  in the step-by-step section. The positive
  Performance Monitor feature provides assurance
  that the guaiac paper and developer are
  functional.
• Remedial action when controls not acceptable
• In the event that the Performance Monitor areas
  do not react as expected any applying developer,
  the test results should be regarded as invalid,
  the MD/ ARNP shall be informed and determine any
  further course of action. The Beckman Coulter
  Technical Marketing Department should be
  contacted at 800-877-6242 or 650-845-3526 for
  assistance. The Clinic Director will be notified
  of the problem.
• Limitations in testing methodologies
• Bowel lesions, including some polyps and
  colorectal cancers, may not bleed at all or may
  bleed intermittently. Also, blood if present may
  not be distributed uniformly in the fecal
  specimen. Consequently, a test result may be
  negative even when disease is present.
  Conversely, a Hemoccult test may be positive on
  specimens from healthy patients. This may be due
  to interfering substances in the diet or to
  medications, e.g., read meats, raw fruits and
  vegetables, fruit juices, steroids,
  anticoagulants, vitamin C, NSAIDs to name a few.
  Menstruation, active hemorrhoids or urinary tract
  infections may also contaminate a fecal sample
  with resultant false positive results. Fecal
  occult blood test results cannot be considered
  conclusive evidence of the presence or absence of
  gastrointestinal bleeding or pathology.
• Normal values Negative.
• Panic values and established procedure for
  reporting critical values There are no
• Established panic values for fecal occult blood
  testing however,
• a positive result will be verbally reported to
  the MD/ ARNP
• for interpretation and determination of any
  further course of action.

64
Glucose Monitoring Using Accu-check Advantage
Meter

• Rationale
• Blood glucose levels may be measured accurately
  within seconds in the clinic setting to help
  guide treatment decisions in patients with
  diabetes or suspected diabetes.
• Specimen collection
• The Accu-chek Advantage requires a single drop of
  blood obtained from a fingertip pierced by a
  lancet device.
• Specimen labeling and processing procedure
• The specimen of blood shall be immediately
  applied to the test strip in the Accuchek
  Advantage meter and results will be ready in a
  second. The lids ofthe test strip vials and
  control solution bottles will be kept tightly
  closed and stored in the Accu-chek Advantage case
  away from extreme heat and moisture.

65
Using Accu-check Advantage Meter Step-by-step

• 1. Gather supplies a) Accu-chek Advantage meter
  b) Accu-chek Advantage test strips c) Lancet d)
  Lancet device (optional) e) Cotton balls or
  tissue paper f) Alcohol wipes (optional)
• 2. Explain the procedure to the patient and
  obtain verbal consent.
• 3. The patient and health care provider
  performing the test shall wash their
• hands with warm soapy water, rinse well and dry
  completely.
• 4. Wipe the selected fingertip with an alcohol
  wipe and allow to dry completely
• (optional).
• 5. Turn the meter on and insert a test strip.
• 6. Prepare the lancet device
• a) Pull off the cap.
• b) Insert a lancet until it clicks.
• c) Twist off the lancet's protective cover.
• d) Snap the cap back on after lining up the
  notches
• e) Twist the cap to set the lancet depth,
  starting at 2 or 3. Increase the number or depth
  upward if skin is tough or unable to obtain a
  large enough specimen on first attempt.
• f) Press the plunger (like a pen) until it
  clicks. The release button turns
• yellow when the device is ready.
• 7. Apply the lancet end of the device firmly to
  the fingertip and press the
• release button.
• 8. Gently squeeze the fingertip to obtain a drop
  of blood.
• 9. Touch and hold the blood drop to the edge -
  not the top - of the yellow

66
Glucose Monitoring Using Accu-check Advantage
Meter Continued

• Instrument calibration. maintenance. and
  frequency intervals
• The Accu-check Advantage meter shall be kept free
  of dust. If it needs to be cleaned, with the
  meter off, gently wipe the meter's surface with a
  soft cloth slightly dampened with 70 alcohol or
  mild diluted dishwashing liquid or 10 household
  bleach (1 part bleach to 10 parts H20). The meter
  needs no maintenance with normal use. It
  automatically tests its own systems every time
  you turn it on and lets you know if something is
  wrong. If the monitor detects a malfunction it
  displays the "error" message and an appropriate
  symbol. Refer to pages 52-55 in the user's manual
  for an explanation of each code and subsequent
  corrective action required. If any of these error
  messages continues after troubleshooting call the
  Service Center at 1-800-858-8072.
• Equipment range of reportable patient tests
• The Accu-chek Advantage can read blood glucose
  between 10-160 mgldL.
• Qualitv control (QC) policies and procedures
• Control tests ensure that both the meter and the
  test strips are working properly and giving
  reliable results. A control test shall be run
• a. If meter is new
• b. Upon opening a new box of test strips
• c. If cap left off test strip vial
• d. If meter was dropped
• e. Each day a patient test is performed
• f. You want to check performance of the meter and
  test strips g. Your test results don't coincide
  with the patient's clinical
• presentation
• Control solution
• 1. The control solution must match the type of
  test strips. The Accu-chek Comfort Curve Control
  Solution (blue liquid) is used with Accu-chek
  Comfort Curve Test Strips.
• 2. Date the control solution bottle upon opening
  it. The control solution is good for three (3)
  months from that date or the expiration date on
  the bottle, whichever comes first.
• 3. Control solution can stain clothes therefore,
  handle it with care.
• 4. Keep cover on control solution closed tightly.
• 5. Store solution at room temperature.

67
Glucose Monitoring Using Accu-check Advantage
Meter Continued

• Remedial action when controls not acceptable
• If the result of the initial Level 1 control test
  is outside the range noted on the test strip
  vial, use Level 2 control solution repeating the
  steps above. The Level 2 result should then be
  compared to the Level 2 range on the test strip
  vial. If the result still isn't within the
  acceptable range, contact Accu-chek Customer Care
  at 1-800-858-8072. Report. The MD/ARNP shall be
  informed at the malfunction and they will
  determine if the patient needs to be sent out to
  the lab for testing.
• Limitations in testing methodologies
• The following can cause unusually high or low
  results, despite a control result within the
  acceptable range
• 1. Blood sample was too small.
• 2. Strip was out of vial longer than three (3)
  minutes before blood sample applied.
• 3. Strip was used after ''use by" date.
• 4. Strip was not stored in vial with cap tightly
  sealed.
• 5. Code number of meter and strips do not match.
• 6. Proper maintenance and handling procedures for
  the Accu-chek meter have not been followed.

• Normal values The fasting blood glucose range
  for a non-diabetic is between 70-110 mg/dL. Two
  hours after meals the blood glucose level for a
  non-diabetic is less than 140 mg/dL.
• Panic values and established procedure for
  reporting critical valuesThere are no
  established panic values for blood glucose
  testing however, a blood glucose below 50 or
  greater than 400 mg/dL along with the clinical
  picture will require careful interpretation by
  the MD/ ARNP. All blood glucose test results will
  be verbally reported to the MD/ ARNP who is
  responsible for documentation on the medical
  record.
• Course of action to be taken if a test system
  becomes inoperable The MD/ ARNP will be informed
  of any malfunction of the Accu-chek Advantage
  meter and will determine if the patient needs to
  be sent out to the lab for testing. The Clinic
  Director will be informed of the problem.

68
Urinalysis using Reagent Strips

• Rationale Reagent strips provide tests for
  glucose, bilirubin, ketone (acetoacetic acid),
  blood, protein, urobilinogen, nitrite,
  leukocytes, specific gravity, and pH. Test
  results may provide information regarding the
  status of carbohydrate metabolism, kidney and
  liver function, acid base balance, and urinary
  tract infection.
• Specimen Collection Urine specimens should be
  collected using the "clean catch" method Patient
  should be instructed to carefully wash the
  urogenital area with an antiseptic towelette,
  then collect midstream sample of urine in a
  sterile container after urine flow is
  established.
• Specimen labeling and processing Supply the
  patient with a sterile cup labeled with the
  patient's name and date of birth. Patient is
  instructed to leave labeled specimen in
  designated restroom and inform the nurse/MA. The
  urine should be tested as soon as possible after
  collection. If testing cannot be performed within
  one hour after collection, the specimen should be
  placed in lab specimen refrigerator and returned
  to room temperature before testing.

69
Urinalysis using Reagent Strips Continued

• Step bv step procedures
• 1. Explain the procedure to the patient and
  obtain verbal consent.
• 2. Proceed with specimen collection as previously
  described.
• 3. Follow specimen labeling and handling as
  previously described.
• 4. Mix urine well immediately before testing.
• 5. Remove one strip from bottle and replace cap.
• 6. Completely immerse reagent areas of the strip
  in fresh urine and remove
• immediately to avoid dissolving out reagents
• 7. While removing the strip, run the edge of the
  entire length of the strip against
• the rim of the urine container to remove excess
  urine.
• 8. Turn the test strip on its side and tap once
  on a piece of absorbent paper to
• remove any remaining urine, and to prevent the
  possible mixing of chemicals.
• 9. After the appropriate time, hold strip close
  to color blocks on the strip bottle
• and match carefully
• 30 seconds glucose and bilirubin
• 40 seconds ketone
• 45 seconds specific gravity
• 60 seconds pH, protein, urobilinogen, blood, and
  nitrite
• 2 minutes leukocytes

70
Urinalysis using Reagent Strips Continued

• Equipment range of reportable patient tests
• URINALYSIS (Reagent Strip) Range
• Specific gravity 1.000, 1.005, 1.010, 1.015,
  1.020, 1.025, 1.030
• PH 5,6, 7, 8, 9
• Leukocytes negative, trace, ,
• Nitrite negative and positive
• Protein negative, trace, 30 mg/dL (), 100
  mgldL ( ),500 mgldL ( ) Glucose normal,
  50 mgldL, 100 mgldL, 250 mg/dL, 500 mgldL, 1000
  mg/DL
• Ketones negative, small (), moderate ( )m
  large ( )
• Urobilinogen normal, 1 mgldL, 4 mgldL, 8mgldL,
  12 mgldL
• Bilirubin negative, , ,
• Blood negative, trace, 50 Ery/uL, 250 Ery/uL
• Quality control (QC)
• Calibration of the test strips by the user is not
  required. Ensure that reagents have been properly
  stored and within the known expiration period. If
  the expected results are not obtained and
  repetition of the assay excludes errors in
  technique, the MDI ARNP should be notified and
  shall determine if the urine should be sent out
  to a lab for a microscopic U/A. Negative and
  positive specimens or controls may also be
  randomly hidden in each batch of specimens
  tested, and shall be used if found.
• Limitations in testine methodoloeies
• Substances that cause abnormal urine color, such
  as drugs containing azo dyes (e.g., Pyridium, Azo
  Gantrisin, Azo Gantanol), nitrofurantoin (Macro
  dantin, Furadantin), and riboflavin may affect
  the readability of reagent areas on the strip.
  The color development on the reagent pad may be
  masked, or a color reaction may be produced on
  the pad that could be interpreted as a false
  positive. For limitations specific for each
  analyte, refer to dipstick package insert.

71
Urinalysis using Reagent Strips Continued

• Normal values
• URINALYSIS (Reagent strip) Normal Range
• Specific gravity 1.005, 1.010,1.015, 1.020,
  1.025 PH 5,6, 7, 8
• Leukocytes negative
• Nitrite negative
• Protein negative, trace
• Glucose normal
• Ketones negative
• Urobilinogen normal, 1 mg/dL
• Bilirubin negative
• Blood negative, trace
• Panic values and established procedure for
  reportine critical values
• There are no established panic values for a
  urinalysis using reagent strips however, all
  test results will be verbally reported to the MD/
  ARNP for interpretation.
• Course of action to be taken if a test system
  becomes inoperable
• All urine specimens will be sent out to a lab if
  reagent strips not available.
• Reference Bayer Multistix package insert.

72
Wet Prep Microscopy

• Rationale Microscopic examination of vaginal
  discharge allows the clinician an inexpensive
  timely means of identifying causative organisms
  of vaginitis Trichomonos vaginalis, clue cells
  of Bacterial vaginosis, and hyphae and budding
  yeast of vaginal condidiasis. Immediate
  identification of these causative organisms
  allows for prompt treatment decisions.
• Specimen collection procedures A specimen of
  vaginal discharge will be obtained by the MD/
  ARNP using a swab and smeared on a glass slide.
• Specimen labeling and processing procedures The
  slide will be labeled with the patient's name and
  date of birth before the specimen is collected.
  After the specimen is collected, 1-2 drops of
  normal saline will be added, and then the slide
  covered with a glass cover slip. This slide will
  be kept in the room with the patient until the
  entire examination is completed, then
  hand-carried by the MD/ ARNP for microscopic
  examination.

73
Wet Prep Microscopy Continued

• Step by step procedure
• 1. Proceed with specimen collection and
  preparation as previously described.
• 2. Turn the microscope on and place the prepared
  slide under the microscope lens and examine using
  the 40x and 80x power fields, observing for the
  appearance of (unreadable) clue cells, hyphae and
  budding yeast.
• 3. Turn microscope off.
• 4. Dispose of the slide in a Sharps container.
• 5. Document findings on medical record.
• Instrument calibration. maintenance and frequency
  internals Calibration of a microscope is not
  necessary. The microscope lens and eyepiece
  should be gently wiped with a soft lint-free
  cloth or lens paper prior to each use. As needed
  a lens cleaner solution may be utilized, followed
  by wiping dry with the soft lint-free cloth or
  lens paper. The finish of the microscope may be
  wiped with a mild detergent or alcohol as needed.
  The microscope will be covered when not in use. A
  volunteer Biomedical Technician will be called as
  needed for any further maintenance and
  documentation will be kept.
• Equipment range of reportable patient tests The
  presence of the causative organisms of vaginitis
  are reported as being present, rate, few,
  moderate or many.
• Qualitv control (QC) policies and procedures Wet
  prep microscopy is the only provide, performed
  microscopy to be performed, and no quality
  controls are readily available for this
  procedure. Results of the Papanicolaou smear (if
  done during same exam) may confirm or refute
  microscopic findings.
• Limitations in testing methodologies A specimen
  of vaginal discharge does not capture the entire
  vaginal flora therefore, there is a possibility
  of false negative readings.
• Normal values Negative

74
Pregnancy Test Procedure
75
Infection Control

• Hand hygiene is the single most important method
  of preventing the spread of infection!
• You can help prevent the spread of infection by
  implementing the following basic guidelines.

76
Practice Optimal Hand Hygiene

• Hand Hygiene is the single most important method
  of preventing the spread of infection.
• Hand Hygiene is a general term that includes
• Hand washing with plain soap or antiseptic soap
  and water.
• Use of waterless hand rub for routine hygiene.

77
Remember to Always Perform Hand Hygiene When

• When arriving at the clinical work area
• Before and after having direct patient care
  contact with the patients intact skin.
• Before performing invasive procedures or other
  sterile procedures, whether or not sterile gloves
  are worn.
• Before meals
• After coughing, sneezing, or blowing your nose
• After using the restroom
• When hands are visibly soiled

78
Most Effective Hand Washing Technique

• Wet hands with warm water
• Apply 3-5 ml (2-3 teaspoons) of soap to hands
• Rub hands together for at least 15 seconds,
  covering all surfaces of the hands and fingers
• Rinse hands with water and dry thoroughly
• Use towel to turn off the faucet

79
HIV/AIDS

• Human Immunodeficiency Virus is a retrovirus that
  causes AIDS.
• It destroys the essential conduction of the
  immune system
• The only way to determine whether HIV is present
  is through blood test.

80
HIV is Transmitted By

• Exposure to blood or other potentially infectious
  material
• IV drug users from needle sharing
• Homosexual contact
• Heterosexual contact

• Transfusion of blood or blood products
  contaminated with HIV
• Occupational needle stick injury and other blood
  exposures
• During pregnancy, during delivery and after birth

81
HIV is NOT Transmitted By

• Touching
• Social kissing
• Coughing
• Sneezing
• Contact with eating utensils, water fountains and
  toilet seats

• Using public facilities such as swimming pools
• Being close to other people or in crowded spaces

82
Prevent the Spread of HIV By

• Do not share or reuse needles or personal items
  which may be contaminated with blood.
• Protect open wounds from contact with blood and
  body fluids by properly covering any broken skin
  surfaces.

• Practice good hand hygiene
• Hand hygiene before and after patient contact,
  even if gloves are worn
• Use appropriate protective equipment, gloves,
  gown, masks, etc.

83
OSHA/Blood Borne Pathogens

• OSHA is a regulatory agency that oversees
  occupational health and safety.
• Blood borne pathogens may potentially reside in
• Blood
• Semen
• Vaginal secretions
• Body fluid with visible blood
• Other body fluids

84
Fire Safety

• There are three exits, the main entrance, a rear
  exit on the first floor and a rear exit on the
  second floor.
• A fire extinguisher is located on the first floor
  near the reception area. Extinguisher
  instructions
• 1. Pull ring pin
• 2. Stand 8 from fire
• 3. Aim at the base of the fire, use
  extinguisher upright.
• 4. Squeeze the lever, sweep from side to side

85
HIPPA

• What is it? National Legislation passed by
  congress in 1996 that resulted in total reform.
• It was passed to guarantee that persons changing
  jobs would not lose coverage.
• It standardizes how medical information is shared
  and guarantees patient security and
  confidentiality.

86
HIPPA Why is it important to VIM-Jax?

• All volunteers are going to be exposed to
  sensitive information.
• To protect the dignity and privacy of our guests,
  we need to respect their protected health
  information.

87
What constitutes protected health information?

• Name and Address
• Phone and fax numbers
• Medical record numbers
• Insurance information
• Social Security numbers
• Certificate/license numbers
• Internet addresses

• Hospital records
• Identifying characteristics
• Vehicle ID Numbers
• Photographs
• Device identifiers
• Any medium with patient information.

88
HIPPA Summary

• Treat all guest information with confidentiality.
• Only disclose the minimum amount of information
  necessary.
• Give personal information only to those directly
  relevant to care and treatment.
• Patients ultimately make the decision regarding
  the use and release of their information.