Safety at Salina Regional Health Center

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Safety at Salina Regional Health Center

• 2004

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• Welcome to Salina Regional Health Center
• Salina Regional Health Center is a
  community-owned, not-for-profit, 385-bed hospital
  that was founded October 1, 1995, when Salina's
  two former hospitals (Asbury-Salina Regional
  Medical Center and St. John's Regional Health
  Center) consolidated

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Santa Fe Campus

• Clinical areas include
• Medical-Surgical Behavioral Health
• Critical Care Oncology
• Birth Center Emergency Department
• Pediatrics Cardiovascular Surgery
• Surgery Rehabilitation Services

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Penn Campus

• Clinical Areas
• Radiation Oncology
• Infant Child Development
• Hospice of Salina

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Parking

• Santa Fe Campus parking is available in the
  enclosed Parking Garage on Floors 2, 3, 4
• Penn Campus parking is available to the West of
  the building

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Safety

• In order to provide a safe learning experience
  students are asked to review the following
  content to become familiar with safety at Salina
  Regional Health Center and complete an
  assessment.

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Code White
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Code White

• Called by the administrator or patient
• services supervisor when notified by the
• Salina Police Department or Saline County
• Sheriffs Department that the health center
• is located in a geographic region covered by
• the tornado warning.

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Tornado Watch

• This is a forecast to alert the public when the
  weather situation appears favorable for tornado
  development
• Review in your mind what your responsibilities
  entail while you are working

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In the event of a tornado watch

• Students should keep in mind
• Location of their assigned patients (i.e. nursing
  unit, radiology, surgery, etc.)
• Visitors and family members of assigned patients
• Recognize that a Code White may be called
• Review with staff the evacuation plan

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Tornado Warning

• An announcement that a
• tornado has actually been
• sighted visually or
• detected by radar and
• that residents of the
• warning area should take
• cover

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In the event of a tornado warning

• 1. Director/clinical supervisor/charge nurse
  shall
• Assign patients to members of the nursing team
• Move ambulatory patients to inner corridors and
  rooms
• Non ambulatory movable patients moved to inner
  corridors and rooms
• Non- movable patients, give blankets to use for
  protection
• Direct movement of visitors to designated safety
  areas

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In the event of a tornado warning

• 2. Students will take directions from staff
  regarding their assistance in movement of
  patients to safe areas
• 3. Wait in designated safe area until further
  instructed. Do not attempt to leave the building
• 4. DO NOT USE ELEVATORS

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Code Gray
Code Gray
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Code Gray
(Mass Casualty)

• Any incident which places upon the health center
• a sudden excess of patients in urgent need of
• emergency treatment and at a greater rate that
  the
• center can normally absorb
• (Possible incidents include airplane, train or
  bus accident,
• mass food poisoning, contamination of water
  source, fire,
• hazardous materials incident, explosion)

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Notification
Code gray

• Department directors of personnel on call will be
  notified by registration personnel when code gray
  is paged.
• Other personnel within the department will be
  notified by calling tree.

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Responsibilities While Already on Duty

• Students will remain on their unit and continue
  their assignments
• Students will not be called in to help with the
  Code Gray

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Patient Flow Process

• All patients whether victims of the disaster or
  not will be evaluated by the triage team
• All patients, family members and/or visitors will
  be asked to remain with patient in the room until
  safe to leave health center
• Visitors or family will be escorted by staff or
  volunteers as they leave the facility

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Security

• Patients, families, physicians, employees,
  students, volunteers and visitors are entitled to
  a secure work and service environment.

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• Student measures to decrease risks and maintain a
  secure environment include
• Limit the number of valuables brought to
  clinicals
• Keep your personal belongings in the designated
  secure area provided in assigned clinical area

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• Student measures to decrease
• risks and maintain a secure
• clinical experience
• environment include (continued)
• Use night security for escorts as needed
• Lock your car
• When possible leave the building with other
  people
• Park in designated parking monitored by security
  during evening and night shifts

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• As a student, you can assist with security by
• Wearing your name tag for identification
• Notifying your clinical instructor of
  unauthorized people
• Do not prop open doors that are intended to be
  locked
• Reporting any security deficiencies by completing
  the Safety Security Form sending it to the Safety
  Officer (Dick Duree 7121)

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Security Risks Within the Hospital

• 1. Abduction (infant or child)
• 2. Violence
• 3. Theft and/or requests for Drugs
• 4. Bomb Threat
• 5. Compromise of confidential information
• Written (medical record, requisitions, etc.)
• Cellular phone
• Computer systems

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Code Adam Infant Abduction

• Mother-Baby, Labor and Delivery and Pediatrics
  have been identified as risk areas for infant and
  child abduction
• In the event of infant/child abduction a Code
  Adam should be called

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Code Adam

• Dial 7777
• State Code Adam, infant (or child) abduction,
  location (patient care station and campus any
  additional description as applies)
• Be alert for anyone with an infant/small child
• Ask people leaving with small children or infant
  to remain in the hospital until identity is
  confirmed and all clear is declared. Ask them to
  go to the Chapel at Santa Fe Campus or the Board
  Room at Penn Campus

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Infant/child abduction look for

• A hospital ID bracelet
• Someone looking around and walking rapidly, while
  restraining or carrying a child
• A person with a child who will walk or run away
  from employees when approached
• A person in the stairwell with an infant/child
• Any person carrying a box, package or backpack
  large enough to carry a child

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In the event of a Code Adam
DO NOT attempt to subdue person(s) Call for
help Make note of hair color, clothing, age and
facial characteristics and their destination
If getting into
a vehicle, get description of vehicle, license
number and direction of departure Give this
information to Patient Services Supervisor

Code Adam
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Code BlackBomb Threat
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Suspicious Objects

• If you locate a suspicious object do the
  following
• DO NOT move, touch or jar the object
• Notify house supervisor and your
• supervisor

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Bomb threat

• Most bomb threats are just thatthreats. But
• there is no way of knowing whether an
• actual bomb exists, and take precautions
• because the stakes are so high
• Usually made by phone
• Made to create an atmosphere of anxiety and panic

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General Instructions

• If you locate a suspicious object do the
  following
• DO NOT move, touch or jar the object
• Seal off the area to all persons
• Open all windows, if possible
• Communicate the description and location of
  objects to the Code Black command center
• Penn Administrative Conference Room ext 6161,
  Santa Fe Emergency Department 6655 6664

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Code Blue
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Code Blue Santa Fe

• If you find a person (patient, visitor or staff)
  without a pulse or not breathing
• Initiate Basic Life Support measures
• Call for help Dial 7777 and clearly state the
  campus and location (if phone is not available,
  call out for help or send someone for help)
• Code Blue will be announced overhead alerting
  Code Blue Team to respond to the situation

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Code Blue - Penn

• If you find a person (patient, visitor or staff)
  without a pulse or not breathing. Initiate Basic
  Life Support measures
• Call for help Dial 7777 and clearly state the
  location (if phone is not available, call out for
  help or send someone for help)
• Switchboard Operator
• speed dials 911 and gives information
• pages Penn maintenance staff to verify they
• heard the code
• notifies the emergency department of an
  impending patient

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Code Blue Team

• FIRST RESPONDER 1
• Determine that the person is in cardiac or
  respiratory arrest.
• Start CPR using single-rescuer standards, note
  the time, and call a CODE BLUE.
• FIRST RESPONDER 2
• Initiate two-person CPR.
• Students may be a first or second responder, if
  they are BLS certified

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• ALL OTHER FIRST RESPONDERS
• Get crash cart with monitor/defibrillator brought
  to the code blue site
• Make sure head board is off and room is clear of
  furniture. Place backboard beneath patient
• Start IV if not already done
• Remove other patient from room if feasible
• Bring chart to the bedside
• If trained to do so
• Apply monitor pads and connect monitor. Assure
  the correct mode for paddles or pads in on
• Begin ventilation with bag/valve/mask

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All Other Responders

• Students may assist with other duties during a
  Code Blue as directed by staff
• Students may observe a Code Blue after receiving
  permission from the preceptor and communicating
  who will provide care for their assigned patients
  during this observation experience

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Crash Cart
Look in your clinical area for the location of
the crash cart in the event you are asked to
bring one to a room.
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In the event of fire Dial 7777 Tell the operator
Code Red and give location
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• Fire First Response Team
• to assist in safeguarding patients, visitors and
  staff
• respond to fire to assist with containing and
  maintaining the fire
• Team members include
• Maintenance
• Food Service
• Patient Services Supervisor
• Environmental Services
• Rehabilitation Services

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• According to SRHC Fire Response Plan
• CODE RED indicates Fire
• When fire is discovered in your area
• R Rescue any people in danger
• A Dial 7777 and/or pull manual Alarm state the
  exact location of the fire including
  campus
• C Contain the fire by closing windows and
  doors. Attempt to extinguish, if contained and
  small
• E Evacuate first horizontally then vertically
  if necessary

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Rescue anyone in immediate danger. If another
employee is nearby, tell them to activate the
fire alarm and get help. Alarm know the
location of fire alarms in work areas and how to
use them. If the automatic smoke detection has
not activated alarm, then the employee should
activate a fire alarm pull station or Dial 7777
giving the exact location of fire. Contain the
fire. Close all doors, windows, chutes or
dumbwaiters. Turn off oxygen. Close and latch
doors to room and corridor. Know where to find
fire extinguisher and how to use it . Extinguish
fire only if small, contained and
controllable. Evacuate Know the evacuation
procedures for your department. First move
patients in immediate danger or nearest the fire
followed by ambulatory then non-ambulatory
patients. Keep visitors with patients.
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Hospital Evacuation

• Three stages of evacuation
• Horizontal evacuation moves all patients in the
  affected area through the fire doors into an
  adjacent safe area.
• Vertical evacuation moves patients to a safe
  area on a lower floor occurs in a major fire.
• Total evacuation moves patients out of building
  only the President/CEO or designee or fire
  department has the authority to order an
  evacuation.

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Know where to find an extinguisher on your
clinical area. Check label to see if it is the
correct extinguisher for the fire. Check gauge to
ensure the extinguisher is full. Know how to use
it .
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How to Use a Fire Extinguisher
P Pull the pin AAim the extinguisher nozzle
or hose at the base of the
fire SSqueeze or press the handle trigger S
Sweep from side to side at the base of the fire.
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Fire Hazards
Be alert for circumstances that may contribute to
fire situations such as inappropriate storage of
flammables, storage of combustibles near
electrical switch gear, fire doors wedged open,
unattended lit cigarettes, etc.
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• If the fire is not in your area
• Listen for location
• Close windows and doors
• Stay in your area. Keep patients and visitors
  calm and in rooms
• DO NOT Call switch board await instructions
• DO NOT USE ELEVATORS unless instructed to do so
  by the Patient Services Supervisor.

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Workplace Violence
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What is violence?

• Its using force or a threat of force to
• cause harm
• (e.g.. Threats (verbal or written), harassment or
  bullying, stalking, robbery, hitting, use of
  weapons, rape or sexual assault, murder or
  property damage)

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Verbal signs

• Talk about weapons
• Angry or threatening tone
• Shouting, screaming, cursing
• Threats or sexual comments
• Challenges rules
• Unreasonable demands
• Irrational thinking

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Physical Signs

• Pacing nervously
• Being restless
• Clenching fists or jaws
• Gripping objects tightly
• Throwing, pounding on or breaking objects

• Looking angry
• Staring
• Acts drunk or drugged
• Major changes in appearance or habits
• Having a weapon

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Violence

• The Emergency Department and Behavioral Health
  Unit have been identified as specific areas at
  risk for violence.
• In the event of violence in the hospital the
  person should summon help by Dialing 7777, state
  Dr. Armstrong identify the problem and the
  location.
• Wait for the Dr. Armstrong team to arrive.
• All other personnel are to proceed with work as
  usual.

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• Electrical
• Safety
• at
• Salina Regional Health Center

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SAFETY is everyones job! Report any unsafe
conditions or act that you observe to your
immediate supervisor, then complete a
safety/security report. Report defective or
damaged medical equipment immediately to clinical
engineering and take it out of service.
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Electrical Safety Precautions Check outlets
before using them. Do not bend blades of plug to
make it fit more securely.
REPORT cracked, chipped or broken outlets to
MAINTENANCE ext. 7117 Santa Fe
ext. 6154 Penn
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• ELECTRICAL POWER FAILURE
• Emergency Generators Work
• Only RED outlets work
• Make sure life support systems are on emergency
  power (red outlets)
• Notify Plant Operations 7117 Santa Fe 6154 Penn
  
• Ventilate patients by hand as necessary
• Use flashlights

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ELECTRICAL POWER FAILURE

• Total Power Failure no Emergency Backup
• No electricity anywhere in the hospital,
• Call
  Plant Operations
  7117 Santa Fe 6154 Penn Respiratory
  6795 Santa Fe
• Use flashlights lanterns
• Hand ventilate patients
  manually
  regulate IVs

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DO NOT Use Elevator In Power Failure Call
Plant Operations 7117 Santa Fe 6154 Penn After
hours call Patient Services Supervisor 7165
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COMPUTER SYSTEM FAILURE
NOTIFY Information Systems 7792
Use downtime paper systems

Nurse Call System
Failure Notify Plant Operations 7117 Santa Fe
6154 Penn
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PATIENT CARE EQUIPMENT FAILURE
Notify Clinical Engineering/Biomed
Santa Fe 7123
Penn 6181
after hours notify Patient Services Supervisor
Defective call Biomed
Replace and tag defective equipment
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Patient Owned Clinical Equipment Must have
written Dr. order prior to being used
at SRHC. Only following items may be used
Insulin Pump
Feeding Pump (Respite Only)
Apnea Monitor (Education Only)
TENS Units (Battery operated)
Breast Pumps (Battery operated)
Glucose Monitor (Education Only) Chemo
Pump (Pain control/battery operated)
Other devices permitted on a case by case

basis with Dr. order.
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Patient Owned / Non Clinical Equipment Only the
following are authorized for use at SRHC
Curling Irons (release signed prior to admit)
Lap-top computers (Battery only)
Radios AM/FM (Battery only)
CD Players (Battery only)
Video Games (Battery only)
Razors (Battery only)
Battery chargers (for items on list)
NO OTHER DEVICES APPROVED FOR USE IN THE
FACILITY! Devices must be checked at nursing unit
by designated staff.
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• What I need to know about
• Hazardous Wastes?
• Proper handling of hazardous materials and/or
  waste
• Hazardous items located in the clinical area
• Where to find the phone number for the MSDS sheet
  on demand. (On the phones 1-800-451-8346)
• Protective equipment needed for my job safety
• Under the Right-to-Know law SRHC provides you
  with information about all hazardous materials
  you have the potential to come in contact with in
  your assigned job

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Hazardous Materials

• Require special handling in use or whose presence
  requires that special precautions are taken
• Any materials that pose a threat to the health or
  well-being of personnel
• (materials giving off noxious vapors, damage skin
  or body parts, flammable or explosive)

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Hazardous Wastes

• Waste is considered hazardous if it causes or
  contributes to
• death
• serious illness
• hazardous to the environment

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Infectious/Biohazardous Wastes

• Defined as any waste, solid or liquid that is
  capable of producing an infection

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Infectious / Biohazardous Wastes

• Should be discarded directly into red containers
  or red plastic bags which are clearly
  identifiable and distinguishable from general
  hospital waste bags which are tan or buff.

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The following are classified as infectious
wastes

• Isolation wastes
• Cultures
• Needles and sharps
• Surgical specimens
• Blood or body fluids

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Radioactive Wastes

• Waste that contains characteristics of
  radioactive emissions that may be hazardous to
  humans, animals, and the environment
• Sign will be posted in the area
• containing radiation waste
• and accessible to patients,
• staff or the public.

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Hazardous Materials

• Two sources of information about hazardous
  materials are
• Labels
• Material Safety Data Sheets (MSDS)

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Read Labels

• Product Labels contain
• warnings and warning symbols
• risk statements
• first aid information
• reference to the MSDS
• (Transferring product to another container
  requires labeling with hazardous ingredients,
  warnings and protective equipment)

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Material Safety Data Sheets

• Information is provided on all hazardous
  materials
• on MSDS (Material Safety Data Sheets) to
• understand the nature of the hazard
• how to protect yourself and others
• what to do in an emergency

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• Where can I find Material Safety Data Sheets
• at SRHC?
• Each department has an inventory of the common
  hazardous materials used in that area.
• An MSDS can be obtained by calling the 3E
  company at 800- 451- 8346.

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Spills

• Ask yourself is it a hazard?

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If you are uncertain about hazard, chemical
product or need spill clean up assistance
call. Environmental Services Penn 6356 Santa
Fe 7122
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Infectious Waste Emergency

• Santa Fe
• Environmental Service Team Leader 6959
• Environmental Service Supervisor 7122
  Debbie Doerfler
• Director of Environmental Services 7121 Dick
  Duree

• Penn
• Environmental Service Team Leader 6356
• Environmental Service Supervisor 6356
• Max Mayfield
• Director of Environmental Services 7121
• Dick Duree

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Hazardous Materials Emergencies

• Santa Fe
• Environmental Service Team Leader 6959
• Environmental Service Supervisor 7122
  Debbie Doerfler
• Director of Environmental Services 7121 Dick
  Duree

• Penn
• Environmental Service Team Leader 6356
• Environmental Service Supervisor 6356
• Max Mayfield
• Director of Environmental Services 7121
• Dick Duree

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Care of the Patient with Latex Sensitivity/Allerg
y
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Providing Patient Care

• Use latex alternatives, if available
• Obtain latex free cart from Central Service
• Wash hands before touching the patient to remove
  latex proteins from hands
• If not use webril or cotton padding and latex
  free tape to cover latex sites (BP cuffs, EKG
  cables)
• Identify chart, patient, bed with allergy notices
• Remove latex products from the environment

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Providing Patient Care (continued)

• Wear a cover gown if possible (your uniform
  contains residues of powder from latex gloves)
• Use in-line stopcocks for IV medication
  administration. Tape over IV tubing ports and do
  not use
• Remove rubber stoppers used to draw up medication
• Glass syringe unless latex-free alternative is
  available
• Cover finger with clear plastic dressing (Op-site
  or Tegaderm) when doing pulse oximetry

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Allergic Health Care Workers

• Avoid all latex
• Use nitrile gloves
• Make co-workers aware of allergy
• Talk with supervisor for accommodations
• Talk with the employee health nurse
• Wear Medic Alert Bracelet and carrying
  anaphylactic kit or EpiPen

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Patient Rights
Knowledge is powerful medicine
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Patient rights revolve around

• Dignity and Respect
• Confidentiality/Privacy/Safety
• Right to participate in care decisions
• Billing/Business issues

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Dignity/Respect in Day to Day Job Performance

• Call patient by their name whether talking
  directly to them or discussing their care with
  staff
• Assist patient in understanding their diagnosis,
  testing and treatment plan

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Dignity / Respect

• Report observed abuse
• Respect belongings
• Ask them to join in their care if able
• Receive care without prejudice
• Appoint someone to make healthcare decisions if
  unable

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Dignity / Respect

• Confused, unconscious, sedated or mentally
  challenged patients have the right to be treated
  as if they were fully aware of what is going on
  around them or what is happening to them.

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Preserving Patient Confidentiality / privacy

• Keep computer screens written communication, and
  charts out of the sight of people not directly
  involved in patient care
• Do not repeat things about patients to friends,
  family or staff not involved in direct patient
  care

Did you hear
No what???

• Always discuss patients in private

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Patient Privacy

• Knock before entering a patient room
• Pull privacy curtains when needed
• Close doors to rooms while performing care and/or
  procedures
• Ask visitors to step out for procedures

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Patient Safety

• Come to clinicals prepared to care for assigned
  patient(s)
• Before leaving a patient
• ask Is there anything else you need, I have
  time?
• make sure call light, phone and water are within
  reach

Infection Control

• Complete mandatory safety education prior to
  starting clinicals

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Participate in Care Decisions

• Be informed of, and to participate in, decisions
  regarding your care.
• Be involved in care planning and treatment.
• Know about health status and receive information
  about any treatment or procedure in order to give
  informed consent or refuse treatment.

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Participate in Care Decisions

• Request or refuse treatment that the law allows.
• Have a representative and your doctor notified of
  your admission.
• Be informed of continuing health care needs
  following your discharge from the health center.

Discharge Instructions Diet Medications Dr.
Appt.
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Patient Responsibilities

• Provide correct and complete information about
  health
• Follow the treatment plan recommended by your
  Doctor
• Provide a copy of personal Advance Directives (if
  have one)

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Patient Responsibilities

• Tell caregivers about personal values and beliefs
• Respect the rights of other patients and health
  care staff
• Pay bill on time or make arrangements with
  Patient Financial Services 452-6299

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Responsibilities as a patient for safety

• Wear ID bracelet
• If a student does not look at your ID bracelet
  before drawing blood or giving you medication,
  please remind them

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Right to be free of pain

• Expectations as a patient
• Your pain will be assessed regularly
• Receive effective interventions
• Receive information about pain and relief measures

• Hospital staff expects you to
• Ask what to expect
• Discuss options with Dr. /or nurse
• Ask for pain relief when first occurs
• Tell pain level or if any pain will not go away

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Complaint or Grievance

• Patients with complaints or grievances should
• Speak to staff member or the supervisor of area
• Students need to refer the patients complaint or
  grievance to their preceptor or charge nurse

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Student expectations

• Treat all human blood, secretions, excretions and
  body fluids as though they are dangerous and can
  possibly spread infection
• Use Standard Precautions for the care of all
  patients, regardless of their infectious status,
  known or unknown

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• Remember that all personal protective equipment
  gown, mask, goggles must be removed before
  leaving patients room.
• Place disposables in the trash in the patients
  room.
• Laundry goes in yellow linen bags

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• Wash your hands before and after every patient
  contact

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• Ventilation devices or one way valve masks should
  be used to perform mouth to mouth resuscitation.
  (know where they are located)

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• NEVER RECAP NEEDLES USING TWO HANDS. There are
  sharps containers in every patient room and in
  other areas where contaminated sharps are
  generated.

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Blood/Body Fluid Exposure

• If your uniform becomes accidentally soiled with
  blood or body fluids contact the Patient Services
  Supervisor.
• Clean scrubs will be provided for you
• The health center will launder your clothing if
  you wish, or we will provide an impervious bag
  for you to place it in if you want to take it
  home

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Needle stick or other exposure

• If you have needle stick or other exposure to
  blood or body fluid follow the emergency first
  aid procedures you have been taught then report
  it immediately to the unit charge nurse, if it
  occurs in a patient area, and to your supervisor
• It is critical that any exposure be reported
  immediately

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Remember each of you are responsible for safety.
Know your role in maintaining a safe environment.