DCH Health System Orientation for Clinical Students

Welcome to DCH ! We are glad to have you here as a clinical student in one of our facilities: • Regional Medical Center • Northport Medial Center • Fayette Medical Center Your orientation today is provided at the beginning of your clinicals to present required information to you as you join the DCH team in delivering quality care to our patients.

DCH Mission • DCH Health System provides high quality compassionate community-based health services to the community we serve through our employees, physicians, and volunteers in a financially responsible manner.

DCH Vision • DCH Health System will be the best health system in the nation for the patients to receive care, employees and volunteers to work, and physicians to practice medicine.

DCH Values • The customer’s needs are critical. • We will seek to improve processes without focusing on blame. • Quality is everyone’s job. • The person doing the job knows it best. • People deserve respect. • Teamwork works. • There is value in differences. • Involvement builds commitment. • Support, recognition, and open communication build success. • You make the difference.

DCH Behavioral Standards • Be considerate and courteous to everyone. • Treat others like you want to be treated. • Be supportive and cooperative with each other. • Display pride in your job. • Demonstrate positive leadership qualities.

Dress Code • • • •

Approved school uniforms No jeans Close toe shoes Name badge should be worn at all times and visible • Nails should be short, and clean • No perfume/cologne in patient care areas • No gum chewing

Confidentiality • You cannot disseminate, discuss or relate the contents of any patient record except as necessary in the course of care for the patient. • You are not to allow anyone else access to patient information using your name or password. • You cannot disseminate, discuss or relate the communications concerning a patient. • Penalties for breach of patient confidentiality can result in disciplinary, punitive and/or legal action against you.

National Patient Safety Goals • Since 2003, The Joint Commission has developed NPSGs annually as ongoing opportunities for improvement related to patient safety. These are included for your review as they relate to your role in providing patient care. It is not meant for you to memorize or know the goals by number, only focus on the intent and take action consistently to meet the Goals and therefore improve patient safety.

Wristband Standardization All DCH Facilities will use standard wristband colors to promote safety and decrease healthcare worker confusion. These changes will take effect January 20, 2009.

Yellow wristband for Fall Risk

Orange wristband for Surgical Site Identification

White band with blue stripes is the new Blood Bank Band. Each hospital will have their name on the band.

Green wristband, green sticker on chart and green sign on door for Latex Allergies

Blue wristband for Bloodless Medicine

Resuscitation physician order label and DNR stickers for the chart will be

purple

DCH - Student and Instructor Parking •Students and instructors are to park in lower end (back rows closest to UOC & the U of A campus) of the DCH Laundry parking lot at the corner of Dr. Edward Hillard Drive and Paul Bryant Drive East (across the street from the Fire Station). Walk to the top of the hill of this lot and cross the street at the traffic light across from DCH Trustee Hall (near the Easter Seals building) or cross the street at the light at Bryant Dr. & Dr. Edward Hillard Dr. •After crossing, continue to walk straight from the Bryant Dr. East light along the sidewalk. •Enter the Outpatient Center entrance and cross the lobby going toward the hospital / physicians’ parking area. •Walk through the physicians’ parking area. Upon re-entering the main hospital, turn left and go straight to the center elevators. •Shuttle Service is available M>F / 5:45am-10am and 2pm-6:30pm. •DCH Security Office may be contacted for escort or vehicle assistance, such as flat tires or dead batteries, by dialing 759-7320.

•Parking at Northport Medical Center is located at the back of the facility at the emergency room entrance

DCH Health System

Environment of Care 4JCAHO term for physical environment of hospital – Building – Equipment – People

Environment of Care 4 Objectives: – To provide a safe environment for patients, staff, and others – To minimize environmental hazards, risks, and injuries – To comply with standards and regulations

Safety is Everyone’s Job 4Authority: Board of Directors Administrators Safety Officer Environment of Care Committee Individual Department YOU

The Seven Environments of Care Safety and Worker Safety Security Fire Safety Emergency Management Hazardous Materials and Waste Medical Equipment Utilities

Safety Activities 4Risk Assessment 4Employee education 4Inspection, preventive maintenance, and testing of equipment 4Recalls 4Hazard Surveillance Rounds 4Policies and Procedures 4Incident Reporting

DCH is a smoke free environment, except Approved Employee Smoking Areas: South and West Parking decks *designated areas only North Smoking Hut (adjacent to North Entrance)

NMC – Smoking Court only

NO SMOKING INSIDE, PERIOD!

Security Activities 4Monitoring and surveillance - assigned posts 4Risk Assessment 4Controlled access 4Camera surveillance 4Employee education 4ID badges 4Policies and procedures

Security Is Provided By: The Wackenhut Corporation Tuscaloosa Police Officers Law Enforcement Agencies DCH Employees - YOU

Reporting Security Concerns

RMC - 7320 Security Control

Code Strong-22 Code Blue-22 Code Red-22 NMC - 22 or 0

Identification Badges Employees must wear ID Badges Wear it high Keep name visible Badges are color coded Volunteers, vendors, and contractors are required to wear identification

Fire Prevention 4No Smoking 4Preventive Maintenance and Testing of Equipment

Fire Response

Rescue Reassure patients and visitors Rescue horizontally, then vertically Charge personnel will make decision about O2

Alarm Pull nearest alarm box Call out for help Dial 22 Code Red

Confine Close patient doors Assure that fire and smoke doors are closed “Compartmentalization” - Smoke and fire compartments for protection

Extinguish Pull the pin Aim the nozzle Squeeze the handle Sweep nozzle side to side

Fire Tips - What Should I Know? 4Know location of Fire Extinguishers 4Know Location of Pull Boxes 4Know Fire Response for your work area 4Drills conducted quarterly 4Fire Extinguishers checked monthly by Security and annually by external company

Emergency Management 4 Mitigation - prevention 4 Preparedness - training, policies, and community interactivity 1. Internal Disasters 2. External Disasters

Emergency Management 4Response – hospital-wide and department-specific response plans; “scalable” to event. 4Recovery – return to “normal” activities; recovery of lost expenses through FEMA

Emergency Codes Code Red - Fire Code Gray - Severe Weather Code Strong - Show of Force Code Blue -Medical Emergency Code Purple - Medical Emergency/Child Code Yellow Alert- An Emergency to be implemented Code Yellow Active - An Emergency is implemented Code White - Lock Down Code Pink – Infant/Child Abduction Alert All Clear - All clear repeated three times

Hazardous Materials and Waste “Right to Know” Proper Medical Waste Disposal

Sharps Container

Red Bags for Medical Waste

MSDS Material Safety Data Sheets Required for each Hazardous Material/Agent Each Department/Unit Maintains Their Collection Each Sheet Contains Information About: - Properties - Hazards - Spill/Cleanup Procedures - Disposal Instructions MSDS

Hazardous Chemicals Labeling and Chemical Information Product Name Manufacturer/supplier/im porter name and address List hazardous chemicals contained within Appropriate hazard warning

Hazardous Materials Hazardous Substances Fire Hazards ~ Health Hazards ~ Other Hazards

Learn which materials are used in your job (medications, cleaning agents, gasses, hazards, etc.) Know the rules – MSDS Proper Labeling Know disposal requirements for medical waste Safe Handling and storage Know if PPE is required

Medical Equipment Maintained by Clinical Engineering Contact CE (7185) with Medical Equipment Problems Safe Medical Device Act (SMDA) - Applies to healthcare professionals - Legally imposed duty to report: - unexpected outcomes - reasonably linked to medical device

Emergency Power EMERGENCY

Receptacles labeled “Emergency” or “Critical” are powered by a back up generator Receptacles should be routinely used for critical medical equipment Receptacles are RED

Utilities

Report Utility Problems to Clinical Engineering DCH is on Auxiliary Electrical Power - activated in less than 5 seconds - critical medical equipment to be plugged into RED plugs

Parking RMC ONLY DAY SHIFT EMPLOYEES: South Parking Lot, Trustee Hall Lot, Laundry Parking Lot, and West Parking Lots (by the West Deck). Parking is FREE in all of these locations. ABSOLUTELY NO PARKING IN PARKING DECKS

EVENING/NIGHT SHIFT EMPLOYEES: Same as above. Also permitted to park on designated employee levels in the South Parking Deck; $1 to exit the deck. NO PARKING IN WEST DECK

PREPAID PARKING PARTICIPANTS: Required to park on designated levels in the South Parking Deck. Contact HR to apply for waiting list.

Parking continued Absolutely NO employee parking in the West Parking Deck adjacent to the Outpatient Center and Medical Tower. Violators of DCH’s parking policy are subject to disciplinary action. NORTHPORT MEDICAL CENTER Employee parking in designated areas outside ED/Outpatient Entrance.

SAFETY QUIZ Match the following codes to the appropriate meaning: 1. 2. 3. 4. 5.

__ Medical Emergency A. Code Gray B __Lockdown B. Code Blue E __Infant/Child Abduction C. Code Red D __Fire D. Code Pink C __Severe Weather E. Code White

A

Continued • The RACE acronym stands for:

–R___________________ Rescue –A___________________ Alarm –C___________________ Confine –E___________________ Extinguish

Infection Control and Prevention

Infection Control Chain Infectious Agent Bacterium, Virus, Fungus, Parasite

Infection Control Chain Infectious Agent Bacterium, Virus, Fungus, Parasite

Susceptible Host Very young & elderly Poor nutrition Impaired immune system Non-intact skin Underlying disease

Infection Control Chain Infectious Agent Bacterium, Virus, Fungus, Parasite

Susceptible Host

Mode of Transmission

Very young & elderly Poor nutrition Impaired immune system Non-intact skin Underlying disease

Bloodborne Airborne Droplet Contact

Precautions to Prevent Transmission: Standard Precautions:  Bloodborne Isolation Precautions:  Airborne  Droplet  Contact

Bloodborne Pathogens Disease causing microorganisms that are present in human blood or other body substances, which include but are not limited to: HIV Hepatitis B Hepatitis C

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Work practice and environmental controls are used to prevent exposure to bloodborne pathogens.

Barriers as appropriate for the patient care situation: Gloves, Gowns, Goggles, Masks

Environmental Cleaning

CDC Hand Hygiene Guidelines  When hands are visibly dirty, contaminated, or soiled, wash with nonantimicrobial or antimicrobial soap and water.  If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands. Guideline for Hand Hygiene in Health-care Settings. MMWR 2002; vol. 51, no. RR-16.

Hand Hygiene

The most important way to prevent the spread of infection!

Hand Hygiene Reminder Stickers

. k . o s ’ It sk! a o t

Body Fluids that may Pose Risk of BBP Transmission • Blood

• Peritoneal fluid

• Semen

• Pericardial fluid

• Vaginal secretions

• Amniotic fluid

• Cerebrospinal fluid

• Pleural fluid

• Synovial fluid

Body Substances that do Not Pose Risk of BBP Transmission Unless Visibly Bloody • Urine

• Nasal discharge

• Sputum

• Tears

• Saliva

• Sweat

• Emesis

Safety Sharps Devices

Sharps Disposal Container

Hepatitis B Vaccination > Pre-exposure Protection Protects you from Hepatitis B infection if you have an exposure incident You must take 3 shots over a period of 6 months to get best protection

Hepatitis B Post-exposure prophylaxis (If exposed person has not been vaccinated and source of exposure is known positive)

HBIG x 1, as soon as possible and within 24 hours HBV vaccine series

What to do if you get exposed . . . 1. First Aide 2. Fill out Work Injury Report & Notify Supervisor *(Include patient name and D# on report) 3. Follow school policy for follow-up

Exposure Control Plan (Located in the “*P/P Infection Control” in Meditech)

 Employer responsibilities (testing to include System healthcare employees, physicians, medical staff, and medical students)

 Employee responsibilities  Who is at risk  Procedures and practice to protect you  What to do if you get exposed . . .

Occupational Safety and Health Administration OSHA Purpose: To provide a safe workplace for employees Wrote the Bloodborne Pathogen Standard which was designed to limit exposure to bloodborne pathogens in the work setting

Airborne Precautions: For organisms which 'float' in the air, either alone or attached to small droplets. May be breathed in by visitors or health care workers. Masks are worn to prevent inhalation of these organisms.

Electronically Monitored Negative Pressure Room

Ruling out TB? Use Airborne Precautions

Droplet Precautions: For organisms that only travel a short distance and don't stay in the air. Droplets are generated during coughing, sneezing, talking, and procedures such as suctioning and bronchoscopy.

Note: Includes the diseases: •Influenza •Bacterial Meningitis •Pertussis (whooping cough) •German Measles •Mumps

Contact Precautions:

Diseases spread by contact: Herpes Clostridium difficile Scabies Head lice MRSA VRE

May be picked up by others when touching infective material or contaminated surfaces. Gloves, & gowns are worn when contact with the patient or the patient’s environment is anticipated.

The Environment Can Facilitate Transmission X represents germ culture positive sites

~ Contaminated surfaces increase cross-transmission ~ Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL.

OR VISITATION INFORMATION

I. Arrival a. Report to the OR Control Desk for identification and assignment.

II. Confidential Information a. Personal information concerning a patient’s condition may never be discussed either inside or outside DCH RMC. b. Admitting that a specific individual is a patient is a violation of this policy.

III. Aseptic Technique a. All operating room staff and visitors will adhere to established aseptic technique guidelines b. If in doubt about the sterility of any item, consider it unsterile. c. Unsterile persons will not touch the sterile field, reach over it, or allow unsterile articles to come in contact with it. d. Unsterile persons never walk between two sterile fields.

continued:

e. When passing a sterile field, unsterile persons maintain at least twelve (12) inches of distance. f.

Unsterile persons always face the sterile field.

g. If an unsterile person brushed against an area designated as “sterile”, it is considered contaminated.

IV. Dress Code a. All operating room staff and visitors will adhere to the established dress code. b. Approved, clean and freshly laundered scrub suits should be worn by anyone entering the procedural area. These will be provided by the OR.

continued:

c. Warm up jackets or a long sleeved T-Shirt worn under scrub top should be worn in restricted areas. Warm up jackets are snapped and any ties are tied to prevent flapping. d. Personal Protection equipment (PPE) should be worn when exposure to blood or infectious material is reasonably anticipated.

continued:

e. Protective eye/ face shield/ mask/ shoe covers should be worn whenever activities could place personnel at risk for spills, splashing or spraying. f. If shoe covers are worn, they should be changed whenever they become torn, wet or soiled and should be removed before leaving the procedural area.

continued:

g. All persons entering restricted areas should wear a mask when open sterile items and equipment are present. h. The mask must fit properly to completely cover the entire mouth and nose.

continued:

i. Masks are carefully removed and discarded by handling only the ties. Masks are not to be saved by hanging around the neck or tucking into a pocket for future use. j. Hair coverings-head and facial hair, including sideburns and neckline, should be covered when in procedural areas. Bouffant and hood style are provided.

continued:

k. Disposable hair coverings should be discarded immediately after use.

V. Illness in the Operating Room a. If you become ill during a procedure: i. Inform the circulating nurse. ii. Leave the room if possible. iii. To avoid injury, if unable to leave the room, sit down next to the nearest wall.

VI. Fire Safety in the Operating Room a. All operating room staff and visitors will adhere to the established policy for fire safety in the procedural area.

continued:

b.

The DCH fire procedure is outlined as follows:

R-rescue or remove any person in immediate danger. A-alarm or pull the alarm box then dial 22. C-confine the fire E-extinguish the fire if you can do so safely. CODE RED indicates that a fire alarm has been activated

VII. Exposure Prevention a. The OR is a high risk area for blood and body fluid exposure so it is very important to take all appropriate precautions for prevention. b. Wear appropriate PPE c. Always keep hands out of surgical site unless asked to perform a function. d. Let the Scrub Tech maintain the instrumentation.

continued:

e. Always be aware of the location and use of sharps. f. Always handle and pass instrumentation as you would use it, tip away from you or the person you are giving it to.

VIII. Exposure Protocol a. “First aid” first. Immediately wash or flush the area. b. Fill out a Work Injury Report and notify the Department Supervisor. (include patient name and D# on the report) c. Report to Employee Health or ED if after office hours.

Thank you for your attention during this orientation! • If you have questions about the information covered in this orientation, please talk with your instructor / direct supervisor and they can refer your concerns to the appropriate hospital representative.

• We look forward to having you at DCH!