Directions

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Directions

• Welcome to Bay Regional Medical Center
• You are responsible for the information contained
  in this orientation
• Review all of the following information
• When you are finished print out the certificate
  verifying that you completed and understand the
  information
• The certificate of completion must be presented
  to Gay Showalter along with the Clinical
  Passport before you can begin your clinicals
  (Keep a copy for yourself)

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• Bay Regional Medical Center
• Student Orientation

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Mission

• McLaren Health Care Corporation, through its
  affiliates, will be Michigans best value in
  healthcare as defined by quality, outcome and cost

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Vision

• To be the healthcare system of choice for
• Employees
• Physicians
• Patients

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Core Values

• Patients are the reason we exist
• People are the source of our success
• Each person is unique, is to be valued, and will
  be treated with dignity and respect
• Our community is whom we serve
• Strategic Initiatives Customer service,
  Quality, Financial, Human Resources, Market
  Growth and Physicians

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Bay Regional Medical Center

• System-wide Emergency Codes
• 2007

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Important Steps in an Emergency

• Stay in your department/unit. If away, return
  immediately. Assess situation, be alert to
  surroundings, protect your patients.
• Refer to your department/unit/hospital emergency
  plan. Maintain communication with RN responsible
  for your patient and rest of staff.

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Code Red (Fire)

• Return to department/unit immediately
• RACE
• Rescue those in danger
• Activate fire alarm
• Confine the fire by closing doors
• Extinguish fire (if small)/Evacuate
• PASS
• Pull pin on extinguisher
• Aim
• Squeeze
• Sweep

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Code Blue (Adult Medical Emergency)

• Assess patients airway, breathing and
  circulation
• Call emergency number
• Initiate CPR
• Do not leave patient

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Code White (Pediatric Medical Emergency)

• Assess patients airway, breathing and
  circulation
• Call emergency number
• Initiate CPR
• Do not leave patient

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Code Pink (Infant Abduction lt 1 yr old)

• Monitor hallways, stairwells and elevators
• Observe for person
• carrying a bag large enough to hold an infant
• carrying a coat/baby blanket
• or person, in a nurses uniform/scrubs, carrying
  an infant, without appropriate identification
• Note identifying characteristics of person, take
  down license number of vehicle
• Call emergency number immediately

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Code Purple (Child Abduction gt 1 yr old)

• Monitor hallways, stairwells and elevators
• An abductor can be a stranger, or family member,
  such as a non-custodial parent
• Children, may or may not be able to verbally
  communicate a threatening situation
• Note identifying characteristics of person, take
  down license number of vehicle
• Call emergency number immediately

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Code Weather (Warning)

• Return to department/unit
• Close all doors, blinds, drapes, if possible
• Move ambulatory patients and visitors to inner
  hallways, away from windows and doorways
• Pull cubicle curtain around non-ambulatory
  patients to minimize potential for glass injuries
  from broken windows
• Reassure patients and visitors

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Dr. Strong (Combative Person)

• Established to provide a backup to Security
  during a disaster or disturbance at the East
  Campus after it is determined that additional
  personnel are needed.

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Code Silver (Weapon / Hostage)

• A weapon is defined as any firearm, knife, or
  instrument that can cause bodily harm or injury
• If a person is found (or suspected) of having a
  weapon, call emergency number immediately
• If someone is being held hostage call emergency
  number immediately.
• Seek cover and warn others of the situation

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Code Orange (Hazardous Material Spill)

• Isolate area
• If spill is small and containable, use
  appropriate spill kit for cleaning.
• If spill/release is large, evacuate the area and
  contact HazMat Team or outside contractor

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Code Yellow (Bomb Threat)

• If you receive a bomb threat
• Call the emergency number immediately
• Give your name, phone number and location
• Gather as much information as possible
• Description of bomb, location, when it will
  explode
• Listen to voice, speech patterns, accents, noises
• Don't go looking for it on your own
• If you find a suspicious package or device
• Do not touch it
• Call emergency number immediate.

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Code Green (Biological/Chemical Response)

• A Code Green has been established to provide a
  hospital-wide mobilization plan designed to
  manage a hazardous material response in the
  community.

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Code Triage Internal (Disaster)

• An event that causes disruption in our ability to
  care for patients.
• Return to department/unit immediately.
• Department/unit/hospital emergency plan is
  initiated.
• All breaks/meals are suspended until released by
  department management.
• Staff may be re-deployed, by management, to other
  areas.
• Staff (completing their shift), are not to leave
  until released by management, or the disaster
  alert is cancelled.

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Code Triage External (Disaster)

• An event that throws upon the healthcare system,
  a sudden excess of patients in urgent need of
  emergency treatment, at a rate greater than the
  system is equipped to normally accommodate.
• See Code Triage Internal

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Rapid Response

• A rapid response is initiated by the RN when a
  patients condition is deteriorating, the nurse
  has a bad feeling, or cant get a hold of a Dr.
  for orders etc.
• Its intention is that staff can intervene before
  the patients condition deteriorates to the point
  of a cardiac or respiratory arrest
• When paged, the Rapid Response Team responds
  and functions according to protocols.

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Condition H

• This is a situation that is paged when a patient
  or family member feels that the patients
  condition is deteriorating and their concerns are
  not being addressed by the staff or Dr.s
• When paged, the RN, supervisor and manager
  respond to the patients room

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Corporate Compliance
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Reporting Compliance Violations

• Open Communication helps to respond to compliance
  problems
• If you see something that seems to violate the
  law or BRMCs policies procedures you should
• 1. Report the problem to your instructor and
  RN responsible for your patient
• 2. Report the problem to Mike Jamrog,
  the compliance officer

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Noncompliance Its Ramifications

• What is fraud?
• Crimes of guile Deceit
• Material false statements or representations made
  to obtain some benefit to which one is not
  entitled
• Act performed knowingly, willing and
  intentionally

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What is Abuse?

• Abuse Includes
• Negligent or careless practices resulting in
  inappropriate billing or increased costs
• Overuse of medical services, products or both
• Medically unnecessary services or products
• Provision of services inconsistent with
  professional standards
• Unfair or unreasonable pricing
• Restrictions of Patient choice
• Restrictions in competition
• Accepting cash or equivalents from patients or
  their family
• Taking hospital property for personal use

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What Does This All Mean to Me?

• Our patients and our community have a right to
  expect we will always operate in keeping with all
  Federal, State and Local laws regulations
• It is the responsibility of every employee,
  volunteer, physician student to perform their
  job in a fair and honest manner

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What Does This Mean to Me?

• Trust your instincts. If a situation doesnt
  seem right, it probably isnt. Stop and ask for
  clarification from your instructor, RN, Nurse
  Manager, Supervisor, compliance representative or
  Compliance Officer

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What Does This Mean to Me?

• Report any activity you know or suspect to be in
  violation of compliance policies
• Do not accept gifts from patients or their family
  or vendors
• Declare any conflict of interest that may arise

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What Does This Mean to Me?

• Violations of compliance policies can result in
  disciplinary actions up to including discharge or
  your removal from BRMC as a student
• Compliance is everyones responsibility!!

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Health Insurance Portability and Accountability
Act

• HIPAA
• Regulates the use and disclosure of what is known
  as protected health information or PHI
• PHI is any information that can be used to
  identify the past, present or future healthcare
  of an individual or the payment for that care

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PHI

• Virtually all information about a patient,
  whether written on paper, saved on a computer or
  spoken aloud. This includes their
• Name
• Address
• Age
• Social Security Number
• Other personal information
• License plate numbers
• Fax machine numbers

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HIPAA Confidentiality

• HIPAA privacy also protects the following
• The reason the patient is sick or in the hospital
• The treatments medications he or she receives
• Caregivers notes
• Information about past health condition

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Use of protected health information

• Before looking a a patients health information
  ask yourself
• Do I need to know this to do my job?

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Use of electronic protected health information
(ePHI)

• HIPAA security rules apply only to ePHI stored,
  maintained or transmitted in an electronic format
• ePHI is the same information as PHI
• Monitor the use of cellular phones
• Information and images (ePHI) can be sent over
  the internet
• It is not allowed to send ePHI over the e-mail
  system

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Use of ePHI

• Use E-mail and Internet access appropriately
• Workforce member (including students) should
  remember that e-mails sent to or from BRMCs
  computers are not considered private
• BRMC can and does audit e-mail and Internet usage

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Use of ePHI

• Never share your password
• Sign off computer appropriately
• If you believe your password has been
  compromised, call the HELP desk immediately
  (49572) Tell them your concern and ask for a new
  password

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What does HIPAA mean to me?

• Our patients have a right to expect we will keep
  their information confidential. Their
  information includes anything that could identify
  or be used to find out the identity of the
  patient or their medical condition

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What does HIPAA mean to me?

• As students you come into contact with many forms
  of patient information, i.e. surgical lists, lab
  draw lists, patient census lists, etc.
• You need to understand what are acceptable use of
  this information

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What does HIPAA mean to me?

• Follow the need to know rule
• Ask yourself do I need to see patient
  information to perform my job If the answer is
  Yes, you have nothing to worry about. If the
  answer is no. STOP

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What does HIPAA mean to me?

• The cafeteria or elevator is not the place to
  discuss the medical condition or other aspects of
  a patients care
• Information you have access to must not be the
  subject of conversations with family, friends or
  neighbors

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What does HIPAA mean to me?

• Violations can also result in personal civil
  penalties of up to 25,000 per person and
  criminal penalties of up to 250,000 and/or 10
  years in prison

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Patient Confidentiality

• NO names or identifying information may leave the
  patient care unit on ANY form
• Information may not be given to any person,
  friend or family member unless they know the PIN
  number
• This number is given to the patient upon
  admission. Patients are instructed to share this
  number with anyone who they want information
  released to.

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ANY BREACH OF PATIENT CONFIDENTIALITY MAY RESULT
IN YOUR REMOVAL FROM DOING CLINICALS AT BAY
REGIONAL MEDICAL CENTER
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Infection Control
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Transmission Based Precautions Respiratory

• Respiratory precaution rooms will have a bright
  pink sign on the patients door. Patients in
  respiratory precaution require a private room
  that have negative pressure, where the air is
  exhausted outside. Rooms with negative pressure
  at BRMC are 215, 293,295,329,331,429 and 431
• Keep patients door closed at all times

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Transmission Based Precautions Droplet

• Patients in droplet precautions will have a
  bright orange sign on their door. Patients
  require a private room but door can remain
  opened. Masks must be worn if you come within 3
  feet of the patient.

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Transmission Based Precautions Contact

• A bright green sign will be on the door of a
  patient in contact precautions. Patients require
  a private room UNLESS 2 patients with the same
  microorganism are cohorted together (i.e. MRSA,
  VRE). Gowns and gloves are to be put on before
  entering the patients room and removing just
  prior to leaving the room. When caring for
  patients with C.difficle or who are being ruled
  out for C.difficle, you must use soap and water
  for hand hygiene (not the alcohol hand gel).

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If You Are Injured While Providing Patient Care
at BRMC
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• Report injury immediately to Instructor
• Instructor will direct you for appropriate
  medical follow-up (cost is responsibility of the
  student
• Complete a Process Improvement form and forward
  to Kathy Warszawski (Risk Management)

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• If you are contaminated with body fluids of a
  patient (i.e. needle stick) report name of
  patient to Manager/Supervisor/Employee Health.
• Source patient will be tested

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Policies Procedures

• Policies Procedures are available on-line
• Go to the Intra-net Home Page
• Go to BRMC section
• Click on BRMC Intranet
• Sign-on using access code
• Go to left side of screen and click policies
  procedures

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Diligent Program

• BRMC cares for the safety of our patients as well
  as our staff. The diligent program is a huge
  investment intended to provide equipment to keep
  caregivers safe and free from injuries. Each
  patient is assessed for mobility and the
  appropriate equipment to use in transferring and
  lifting. Be sure that you know what equipment is
  needed and find out how to use it from the RN
  and/or Diligent Coaches on your unit.

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Bay STARS
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A Commitment to Service Excellence

• S - Service Encounters
• T - Tracking
• A - Accountability
• R - Reward Recognition
• S - Service Recovery

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Who are our Customers?

• Patients They are the reason we are here
• Families They watch and listen to everything we
  do for their loved one
• Physicians They direct patient care and work
  closely with us to provide that care
• Fellow Employees and Volunteers We are
  customers to one another
• Regulatory Agencies They inspect our every
  activity
• Vendors They bring us the latest products to
  provide care
• The Public We are 24-hour-a-day
  ambassadors/advertisers of our service

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Bay Pride C.A.R.E.

• At Bay Regional Medical Center and Bay Special
  Care Hospital, we live our commitment to customer
  service by taking PRIDE in everything we do.
• The philosophy of Bay Pride is embodied in the
  word CARE

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C.A.R.E.

• Communication
• Attitude
• Responsibility
• Expectations
• Taking pride in serving others has earned our
  employees and hospitals state and national
  honors, but the real reason for sticking to the
  values and practices introduced here is that they
  work, theyre efficient, and customers respond to
  them positively.

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Communication

• Communicate relevant information understandably
  and effectively
• Use Plain Language
• Answer the telephone professionally within 3
  rings
• Subsidiary name
• Your name
• How may I help you?
• Introduce yourself and your role
• Engage your patient in discussions/conversations
• Escort your customers to their destination (No
  Pointing)

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Attitude

• Treat everyone as if he or she is the most
  important person in our facility
• Always demonstrate a positive attitude
• Smile make eye contact
• Maintain patient dignity
• Do whatever it takes
• Leave your personal problems at home
• Be approachable

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Responsibility

• We are all responsible for our own behavior,
  appearance and professionalism
• Be dependable
• Take pride in your job and work environment
• Make it your responsibility

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Expectations

• Exceed Customer Expectations
• Its all about the customer not us
• Use key words at key times (Scripting)
• We must earn customer compliments, not complaints
• Respond quickly

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Expectations of you in your role as a student

• Consistent Communication
• Use Scripting Effectively
• Patients and visitors feel welcome, comfortable
  and safe in our facilities when we use
  appropriate, consistent messages. For instance,
  when a visitor or family member approaches the
  nursing station use the following greeting
• Hello, or Good (morning, afternoon,
  evening.) welcome to (Department name). How may
  I help you?

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Scripts

• When leaving a patients room, ask Is there
  anything else I can do for you before I leave?
•  
• When performing duties that may compromise a
  patients privacy or dignity, offer to help by
  saying, I am going to close this curtain (door),
  to help maintain your privacy.
•  

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Scripts

• When entering an elevator, allow patients to
  enter with their caregivers first, and ask if you
  may ride along. If a patient is on a gurney,
  wait for the next car.
• When riding on an elevator, make sure to include
  the patient and/or visitors in conversation.
• If a customer appears confused or needs
  assistance, offer to help by asking, May I help
  you?

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Scripting

• Scripting isnt intended to turn us into robots.
  Scripts are encouraged because they make our jobs
  easier, and customers are more likely to remember
  their experience positively.
•  
• Use the scripts. Make them part of your normal
  workday.
• Youll find that consistent communication from
  person to person, department to department, will
  help to create an atmosphere of trust and safety.

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When Things Go WrongService Recovery

• Despite our best efforts, lapses in service can
  occur. When customers are unhappy we need to fix
  it fast.
• Weve developed a process to make Service
  Recovery a bit easier, but especially to make it
  consistent across the organization
• HEART
• Hear, Empathize, Apologize, Respond Thank

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H.E.A.R.T.

• H Hear
• E Empathize
• A Apologize
• R Respond
• T Thank
• Service Recovery is the process of regaining
  customer confidence after a service failure. It
  isnt difficult to remember the process, but it
  can be difficult to approach angry or upset
  patients, families, physicians, or fellow
  employees.

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Grey Chart

• If a patient has a grey chart, it means that
  something has occurred where we did not meet a
  customers expectations and they are unhappy.
• Look on the inside of the cover of the chart and
  it will describe the situation (i.e. the patient
  had to wait in the ED for several hours for a
  monitored bed,test or procedure cancelled.)
• Acknowledge the event using H.E.A.R.T.

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Dress Code

• Administration Policy 212.00
• Key Points
• Jewelry maximum of 3 earrings per ear
• NO VISIBLE body piercing
• Rings 2 out of 10 fingers may have rings
• Tattoos MUST be covered
• No artificial nails. Real nails moderate length
  and light polish
• No more than light odor from perfume, after
  shave. Cigarette smoke odor is not acceptable.
• Bracelets no large, porous or charm bracelets

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Parking

• Although parking spaces for employees and
  students can be occasionally difficult to locate,
  it is not permitted to park in areas designated
  for our patients and visitors.  
• If you have questions about where to park,
  please check with your instructor, any BRMC
  employee, or refer to the signs at the parking
  lot entrances.
•  
• Students who park in spaces reserved for others
  may be removed from BRMC and not able to complete
  their clinical assignment

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Security Alert

• When you feel you are personally in danger, but
  cannot alarm the person who is making you
  uncomfortable because he or she is close to you,
  touch 2-2-2-2-2 on your phone. When the operator
  answers, ask for extension 600 and then stay on
  the line. The Switchboard Operator will
  automatically send a Security Officer to your
  area.
•  

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Suspected Practitioner Impairment or Disruptive
Behavior

• It is a requirement that each patient and every
  employee of BRMC have a hospital environment that
  is non-threatening. (Medical Staff By-Laws 3.1-9
  Professional Conduct)
• If you have reasonable suspicion that a
  practitioner may be impaired or is acting in a
  threatening manner you should report immediately
  to your instructor or Gay Showalter, 894-9518
  making every effort to assure confidentiality

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Search Warrant

• If you are presented with a search warrant ask to
  see the agents ID and look at the search warrant
• Stay calm and call your instructor
• Call the emergency number 2-2-2-2-2 and ask for
  the Corporate Compliance Office or Risk Manager.
• If they will not wait for until the supervisor
  arrives, take them to the area designated on the
  search warrant. Do not destroy or conceal
  anything.
• Do not discuss the raid with media, friends,
  family or co-workers ad you may become a witness.

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Sexual Harassment

• Bay Regional Medical Centers policy (Human
  Resources Policy 12.00 Sexual Harassment in the
  Workplace) is that sexual harassment resulting
  in an intimidating, hostile, or offensive working
  environment is not permitted.
• Any student with an allegation of sexual
  harassment should confidentially report the
  allegation to their instructor and Gay Showalter
  894-9518

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Medical Error Reporting

• If you make, or discover a medical error or
  potential error, including a medication error,
• Assure patient safety
• Report immediately to your instructor and the RN
  responsible for your patient.
• Complete Process Improvement form include
  only facts, no finger pointing

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Hazard Communication

• A master MSDS book is located in Risk Management.
  MSDSs specific to each unit are kept in the
  department and are available 24hr/day/7days a
  week. Included in the MSDS sheet is
• Name of chemicals used in the area
• Type of personal protective equipment required
  when working with each chemical
• What to do in the event of a chemical spill
• The meaning of any labels placed on chemical
  containers

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Defective Equipment

• If any equipment you are using is defective you
  need to
• Assure patient safety and notify instructor and
  RN responsible for patient if necessary
• Take defective equipment out of service
• Place defective sticker on equipment indicating
  type of malfunction
• Do not place defective equipment back where you
  got it

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Documentation

• At BRMC we use 3 components to our documentation
• Flow sheet
• Integrated Plan of Care (IPC)
• Narrative Nursing Notes

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Documentation Flowsheet

• The flow sheet is located at the patients
  bedside
• If you are caring for that patient you need to
  document on the flow sheet. Findings need to be
  validated with your instructor and RN responsible
  for your patient

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Documentation

• All nursing students will be responsible for
  documenting on the flowsheet
• RN students should complete IPC and narrative
  nursing notes (DAR format) after approval of
  instructor
• LPN students will only document on the IPC and
  Narrative Notes in the event of an out of the
  ordinary event that requires immediate
  documentation of situation

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Documentation IPC

• Every patient will have an IPC that is diagnosis
  specific (i.e. CHF)
• The IPC guides nursing care
• Nursing Actions Patient Outcomes
• The student will make sure that RN that is
  responsible for that patient is aware of
  information that is documented on flowsheet, IPC
  and narrative notes

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SBAR Communication

• Any time care is handed off from one provider to
  the next, change of shift, transfers, breaks
  lunch, etc. you must use the SBAR format.
• S situation
• B background
• A assessment
• R recommendation or request
• Report can be written or verbal

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IMPORTANT

• You must also attend one of the on-site
  orientation at Bay Regional Medical Cente
• September 4, 2008
• 0800 1200 OR 1600 2000
• Orientation will be held at the Lincoln Center,
  820 S. Lincoln Ave.
• Make copies for your own records of both the
  Clinical Passport and the Certificate of
  Completion of BRMCs orientation.
• You may need them for Winter Semester

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Orientation Completion

• You have completed the Bay Regional Medical
  Centers hospital specific orientation for the
  Academic Year 2008/2009.
• Click Here to print certificate_____