Student and Faculty Core Orientation © Approved 5 23 2011, Revised 4 22 2015 1.

Student and Faculty Core Orientation©

Approved 5 23 2011, Revised 4 22 2015

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Introduction

Welcome to the Student and Faculty Core Orientation! This presentation includes common orientation information that is required by healthcare agencies for faculty and health science students completing clinical rotations in North Carolina. The presentation is developed and maintained by the Clinical Consortium for Education and Practice. The NC AHEC Program website is the host for the Core Orientation presentation. If you have trouble accessing the presentation, please contact your school coordinator.

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Objectives

Upon completion of this orientation the participant will be able to describe the following as related to clinical practice:

• Standards of Behavior • Corporate Compliance- HIPAA, EMTALA, Reporting Code of

Conduct/Breaches• Infection Control• Policies and Procedures- Pain Management, Falls, Restraints• Emergency Codes• Patient Safety• Cultural Diversity• General Guidelines

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To provide the best healthcare possible, we believe that everyone must be committed to the healthcare agency’s values and standards of behavior.

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Expectations

While in Healthcare Agencies Faculty

and Students Demonstrate:

1. Professional Appearance• Wear PHOTO nametag at all times.

• Comply with dress code policy*.

* See dress code slides

2. Positive Attitude• Acknowledge the presence of patients and visitors.

• Don’t conduct personal and non-emergent conversations around patients and family members.

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Standards of Behavior

3. Professional Conduct• Respect the rights of others.

• Be careful not to tell inappropriate jokes.

4. Compassionate and Courteous Communication

• Address all patients/families by their names, not room numbers.

• Avoid terms such as “Honey” and “Sweetie.”

• Acknowledge patient/family complaints and concerns.

5. Clean/Safe/Attractive Environment• Keep workstations and patient rooms/environment neat and clean.

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6. Caring for Individuals: Anticipate Needs• Be aware of individuals who may need assistance.

• Ask “Is there anything else I can do?” before leaving the patient.

7. Maintaining Privacy and Confidentiality• When entering a patient room/residence, knock and wait for a

response.

• Identify yourself.

• State the purpose of your visit.

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8. Be Aware of Workplace Harassment• Harassment – Sexual harassment or any form of physical, mental or

emotional abuse will not be tolerated.

• Notify instructor or supervisor if you experience any issues which concern you.

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American Hospital Association - The Patient Care Partnership:

Understanding Expectations, Rights and Responsibilities

• High Quality Care• Clean & Safe Environment• Involvement in Care• Privacy Protection

Adapted from: http://www.aha.org/content/00-10/pcp_english_030730.pdf

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http://www.aha.org/content/00-10/pcp_english_030730.pdf

Dress Code• Picture identification badges must be worn above the waist

and must be fully visible.

• Clothing must be clean, neat, pressed and non-tattered.

• Shoes should be in good repair. No sandals or open toe shoes in patient care areas.

• Good personal hygiene. Use good grooming habits, regular bathing and shampooing, to avoid obvious and unpleasant odors.

• No perfumes, fragrances or after-shaves are to be worn inpatient-care areas.

• Hair should be styled as not to interfere with patient care. Beards and mustaches should be short, neat and trimmed. 10


Dress Code

• Tattoos and body art- see Healthcare agency policy.

• Nails must be neat, clean and short. NO artificial nails, nail applications or overlays are allowed for direct bedside caregivers.

• Underclothing must be worn and not visible.

• Use discretion for professional attire in the healthcareagency. Wear a lab coat over street clothes. NO tank tops, bare midriff, revealing clothing, sweat pants, leggings, active wear, denim, shorts or flip flops.

• Jewelry – Conservative and safe, based on the area assigned. Keep to a minimum in patient care areas.

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These are laws and regulations students and faculty should know.

HIPAA = Health Insurance Portability and Accountability Act

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Corporate Compliance:HIPAA Privacy and Security


What is Personal Health Information (PHI)?• Information that identifies a person who is living or deceased• Past, present, or future health information• Health information that is electronic, in paper form, or spoken in

conversation such as lab reports, conversations among clinicians,x-rays, and nursing notes.

PHI identifiers may include information such as:• Name• Name of relatives/family member/employer• Mailing and e-mail address• Phone number or fax number

– Social security number or medical record number– Date of birth, dates of service– Insurance and bank account numbers– Face photos, voice, finger or retinal prints– ZIP code– Unique identifiers

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The Privacy Rule:1. Allows patients to restrict their health information such as:

- Hospital Directory: Release of their condition, information given to clergy

- Providers involved in their care

- Right to review their PHI (Personal Health Information)

2. Disciplines workforce for inappropriate access to PHI

3. Potentially bars students from clinical rotation and future employment when PHI is intentionally

accessed inappropriately or PHI is disclosed and harm occurs

DO NOT

Write down, print, copy or remove confidential patient identifiers from the healthcare agency

The Security Rule: Protects an individual’s health care information maintained or transmitted electronically Requires administrative, physical, and technical safeguards for electronic PHI (ePHI) Disciplines workforce members who fail to comply with security policies and procedures

Corporate Compliance: HIPAA

Corporate Compliance: HIPAAPrivacy & Security

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Corporate Compliance: HIPAA Privacy & Security

• HIPAA is a federal law.

• Any information about a person’s healthcare

treatment or payment plan that allows you to identify the individual is Protected Health Information (PHI) by HIPAA.

• Any information that can be used to deduce an individual’s identity, such as an account number or health plan enrollment number is also Protected Health Information (PHI).

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Corporate Compliance: HIPAA Privacy & Security

Confidentiality is more than a legal and regulatory issue.

It is:

• A basic show of respect for all patients and employees.

• A trust issue. All patients must be able to trust the healthcare agency to protect their medical information from inappropriate access.

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Did you know?Within the Electronic Medical Records systems,

ACTIONS CAN BE TRACKED

• Each time a patient’s record is accessed.

• Which parts are accessed.

• Who accesses a record.

• How long a record is accessed.

Health Information Management (Medical Records) also tracks who accesses paper records.

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What Information Can YOU Access?

It must be:

• Information to perform your duties as a faculty/student.

• Patient must be in your care.

You CANNOT Access

• Medical records of friends, family, high-profile patients, other employees or your own record.

• Former patients, even to see how they are progressing.

Remember: This information is Protected Health Information (PHI) and not needed for your duties. 18


If a student or faculty member needs his/her medical information or that of a family member, he/she MUST contact the appropriate healthcare agency Medical Records section or Health/Medical Information Management.

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Always ask your instructor, preceptor, agency liaison, clinical coordinator or supervisor before sharing PHI without an authorization. They will

guide you as to the correct procedure.

• Note specific healthcare agency policy for patients who don’t want to be identified for any reason.

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When Can Information Be Given Without Prior Authorization?

• In medical emergencies (life or death) when there is no one available to give consent.

• If there is a possibility of abuse and neglect, healthcare workers follow legal guidelines for reporting (follow health-care agency policy).

• If there is a communicable disease, it must be reported to public health agencies.

Therefore, you need to notify your instructor, who will notify the appropriate person/Infection Prevention/Control Department.

• In verifying medical treatment for insurance claims/Medicare payments.

• For subpoenas or court orders.

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Ask yourself this question:

Can I identify the patient from the information shown?

If the answer is “yes,” then this patient care information must be hidden from public view.

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Caution

• Confidentiality extends to social networking (Facebook, Twitter, YouTube, etc.) sites. As these become more commonplace, it is imperative no one discusses or posts patient information on these sites. Taking/posting photographs is not allowed.

• Always adhere to academic and healthcare agency policies.

• For more information specific to nursing please visit:

https://www.ncsbn.org/NCSBN_SocialMedia.pdf

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Some Reasonable Safeguards to Protect PHI

Remember that PHI can be spoken, written and electronic

• Place charts and reports facedown.

• Log off before leaving the computer.

• Avoid discussing patients in public areas (elevators, cafeteria, hallways).

• Place census lists in an area not visible to the public.

• All hard copy reports – worksheets or report sheets- developed during clinical, and all electronic reports are to be protected from public view and must not leave the healthcare agency.

• Copies of medical information with PHI are not permitted to leave the healthcare agency.

• See healthcare agency’s policy regarding process for copying and/or destroying paperwork.

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Factors that determine incidental use and disclosures are:

• PHI is communicated without intent while performing normal and permitted activities.

• These cannot be prevented using reasonable measures and are limited in nature.

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NOTE: The HIPAA Privacy Rule is not intended to impede these customary and essential communications and practices and, thus, does not require that all risk of incidental use or disclosure be eliminated to satisfy its standards. Rather, the Privacy Rule permits certain incidental uses and disclosures of protected health information to occur when the covered entity has in place reasonable safeguards and minimum necessary policies and procedures to protect an individual’s privacy.http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/incidentalusesanddisclosures.html

Incidental Uses and Disclosures


http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/incidentalusesanddisclosures.html

How to Prevent Violations?

• Keep telephone calls and oral reports confidential.• Protect computer passwords.• Verify fax numbers.• Remove patient names or other information that identifies a patient before recycling papers.

− Use the identified Shred containers or

− Use a heavy black marker

• “De-identify” other patient materials, e.g., such as armbands, before throwing away.

De-identify means removing all PHI identifiers, i.e., any item that can identify a patient.

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How to Prevent Violations?• “De-identify” Includes this type of information:

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Information cannot include parts or derivatives of identifiers, such as the last four digits of a Social Security number or a patient’s initials.

For dates directly related to an individual all elements (except year) should be removed

Only the three initial digits of a zip code may be included where the population of that zip code exceeds 20,000.

For populations of less then 20,000 - no portion of the zip code may be used.

The name of health care providers may be included in de-identified information

http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/De-identification/guidance.html#rationale • Place all information in a secure container for disposal or cut them into

small pieces before leaving the clinical area.• Check with your instructor to assure your compliance.


http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/De-identification/guidance.html

http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/De-identification/guidance.html

Written Authorization

• The patient’s written authorization is required before information from the medical record is given out.

• Contact your Instructor, Health/Medical Information Management or Medical Records for guidance.

• Refer to the healthcare agency policies on uses anddisclosures of Protected Health Information.

• Refer to academic and healthcare agency Social Media Policy for information on written authorization.

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How to Say “No” with a Smile

• “I can’t talk about it. It’s private.”

• “We are required to protect the patient’s privacy.”

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HIPAA Violations

• Patient charts left open in the healthcare agency or information is observable in vehicles.

• Discussions about patients in hallways, elevators, cafeteria, telephones or other public places.

• Computer screen open and visible.

• Reports left on fax machines and printers.

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Report Privacy Violations

• Reports of a privacy violation should be reported per healthcare agency policy.

A healthcare agency must notify patients, the Department of Health and Human Services (DHHS) and/or the NC Attorney General (NCAG) of any inappropriate disclosure of PHI that compromises the confidentiality or security of PHI including inappropriate access.

• It is crucial that a known or suspected privacy breach is reported as soon as possible:

Discuss first with your instructor,

Other appropriate personnel to approach would be the charge nurse, or the healthcare agency Privacy Officer or Corporate Compliance Officer.

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Corporate Compliance: Code of Conduct

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The Health Information Technology for Economic and Clinical Health Act(HITECH)

HITECH Act of 2009 Final Rule includes additional regulatory requirements related to:

• Breach Notifications

• Business Associate Agreements (BAA)

• De-Identification of Information

http://www.hhs.gov/ocr/privacy/hipaa/administrative/enforcementrule/hitechenforcementifr.html




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HITECH Act

Breach Notifications

• Breaches are now presumed reportable unless, after completing a risk analysis applying four factors, it is determined, that there is a “low probability of PHI compromise.”

• This risk assessment is completed by the organization’s Compliance Office.• Breaches must be reported to patient and/or federal agency (HHS) within 60

days. This means you MUST report a breach or a potential breach to your

instructor and facility Compliance Office AS SOON AS YOU ARE AWARE OF THE SITUATION.

This enables them to conduct the investigation and determine the notifications that need to be made by the 60 day deadline.


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HITECH Act• Breach Notifications

Penalties for violations of privacy and security laws have been substantially increased.

Breach enforcement civil penalties were increased - up to $1.5 million per year for each violation

Criminal charges may result for breaches – even if information was not used for personal gain.

• Business Associates

Entities that do work on behalf of providers and health insurers are subject to the same privacy and security rules as providers.

Includes subcontractors of Business Associates PHI storage providers


Federal False Claims Act (FFCA)

It is a crime for any person or organization to knowingly make a false record or file a false claim with the government for payment.

No proof of specific intent to commit fraudis required.

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What Is a Violation of the Federal False Claims Act?

• Providing services such as drugs, oxygen or X-rays without a documented physician order and allowing billing to occur for those services.

• Caregivers without current licensure and required certifications.

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Important Compliance Issues and Definitions

• Fraud is intentionally filing an incorrect claim to state or

federal government for payment.

• Abuse is filing a claim that you did not know was incorrect.

• Anti-kickback laws govern issues such as paying for

referral of patients or accepting inappropriate gifts.

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Important Compliance Issues and Definitions

• Stark Law - report any known or suspected violations to the healthcare agency’s compliance officer

The Stark Law applies to physicians who refer Medicare patients for designated health services (DHS) such as:

Clinical laboratory services Radiology services Home health services Outpatient prescription drugs or Inpatient/outpatient hospital services

Referrals for DHS can not be made to a healthcare agency with which a physician or any immediate family members have a financial relationship.

If a referral is made, the healthcare agency may not bill for the DHS unless an exception applies.

This is to prevent self-interests from out-weighing sound medical judgment.

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Gifts from Patients

• Students/Faculty cannot personally accept gifts, tips, money or other gratuities from patients and/or their families.

• To allow the patient to show appreciation for care, small tokens such as cards, flowers, plants or candy may be accepted on behalf of the unit/healthcare agency, but they are discouraged.

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Consequences if Studentsand/or Faculty Don’t Comply

• Students/Faculty and/or the Academic Institution could lose clinical privileges and/or working in the healthcare agency.

• Fines and/or imprisonment for healthcare agency and school, (everyone involved).

• Healthcare agency could lose its Medicare and Medicaid funding and ability to treat patients. 40


Questions or Concerns?• Talk to your instructor, department director/manager.

• See Compliance and Privacy (HIPAA) information in thespecific healthcare agency’s policies/guidelines.

• Call the healthcare agency’s Compliance/Privacy Officer or hotline.

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Corporate Compliance: EMTALA

EMTALA: What Is It?

• It is a federal law.

• EMTALA: Emergency Medical Treatment Labor Act.

• Every patient who comes to the Emergency Department requesting emergency medical care gets evaluated: - By a qualified healthcare provider within the healthcare

agency. - Regardless of the individual’s ability to pay.• If there is an emergency condition, the patient is treated or

transferred to another hospital with specialized care.Also known as COBRA and “Antidumping” Act 42

Required to Report Concerns • Abuse - intentional inflection of pain, injury or mental anguish. Signs: multiple injuries,

bruises, inappropriate burns or fractures, repeated ED visits, no opposition to painful procedures.

• Neglect – failure to provide adequate materials, shelter or food necessary for the health. Signs: poor hygiene, hunger, emaciation, delay in reporting injuries, abandonment.

• Exploitation – the illegal or improper use of a child or a disabled adult or the person’s resources for another’s profit or advantage. Signs: sudden change in banking practices, unpaid bills when resources are available, previously uninvolved relatives claiming rights to possessions.

• If you suspect any of the above, seek guidance from Instructor/Care Provider.

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Corporate Compliance:Reporting Abuse

Children, Disabled and Aged are the most susceptible

Corporate Compliance: Safety Management and Reporting

Be certain you have training before using equipment or performing procedures

You have a responsibility to report workplace hazards to your instructor/supervisor.

You must IMMEDIATELY report the following incidents to your instructor or supervisor:Broken equipment or utility interruptionsInjuriesSpillsAny other health and safety incident

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http://unifiedconstructs.com/wp-content/uploads/2011/05/bigstock_Safety_First_Vector_7506065.jpg

Corporate Compliance:Reporting Malfunctioning Equipment

Safe Medical Devices Act (SMDA)

Medical devices include anything, other than drugs, used in a patient care or diagnostic setting such as:

• Beds • Defibrillators• Rehab Equipment • IV Sets

• Implants • Wheelchairs

• Bandages • Lift Equipment• Infusion Pumps • Monitors

• Lab Devices • Catheters

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Corporate Compliance: Reporting

Safe Medical Devices Act (SMDA)

Federal law requires a report of all incidents where there is a reasonable suspicion that a medical device caused or contributed to a patient’s:

• Serious injury • Serious illness • Death

Incidents are reportable if they:• Require surgery or medical intervention.

• Result in permanent impairment of a body function.

OR

• Permanently damage a body structure.46

Safe Medical Devices Act (SMDA)If a patient is injured by a medical device, you should:

1. Take care of the patient’s immediate needs.

2. Remove the device (save all settings and disposables).

3. Label device “Do not use” and include date and time.

4. Alert your instructor, so he/she can alert the supervisor.

5. Report unsafe device according to the healthcare agency policy.

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Corporate Compliance: Reporting

Hand Hygiene

The expectation is that each healthcareworker (including students) will performproper hand hygiene whether wearing gloves or not:

• Before touching a patient or his/her environment.

• After touching a patient or his/her environment.

Infection Prevention/Control

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Hand Hygiene Compliance

As a healthcare agency, we take proper hand hygiene very seriously.


What if I fail to perform proper hand hygiene?

• If a student is observed failing to perform proper hand hygiene, the clinical instructor, as well as the school may be notified.

• Repeated failings could jeopardize a student’s clinical rotation.

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Bloodborne Pathogens

The healthcare agency’s Bloodborne Pathogen (BBP) Exposure Control Plan provides information on:

• Hepatitis B Vaccinations.

• Jobs and tasks that are risky.

• How to choose Personal Protective Equipment (PPE).

If you have questions about BBP:

• Contact appropriate agency department or refer to the agency’s policy manual/resource.

• After hours, contact the house supervisor or equivalent.

• To review the BBP Exposure Control Plan, access the healthcare agency’s resource/policy manual.


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Blood Spills and PPE

When handling blood or “Other Potentially Infectious Materials” (OPIM) and anytime there is a risk of a splash, you MUST use the following Personal Protective Equipment (PPE):• Gloves – When handling blood, OPIM or non-intact skin.

• Gowns – When there is a risk of splash of blood or OPIM to clothing.

• Masks and Goggles (both) or Face Shields – When blood or OPIM could splash your face.

Make sure you know where to find these items and how to use PPE.

If it is wet, dripping, and does not belong to you, wear PPE!


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Blood Spills and Exposures

In the event of a blood spill or exposure:1. Follow healthcare agency policy.

2. Report the spill or exposure to the instructor, preceptor or agency liaison.

If you are exposed to blood or

other body fluids:3. IMMEDIATELY wash the exposed skin with soap and water or flush mucous

membranes with water or saline.

4. Report to infection prevention/control department or specialist/department per the agency policy.

5. Complete an appropriate report per agency policy.


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Sharps Safety

Sharps Safety Devices are for your protection and, by law,you MUST use them. Examples of Sharps Safety devices:

• IM/SQ needles and syringes.

• Needle-less IV tubing sets.

• Safety lancets.

• Phlebotomy devices.

• IV safety catheters

Sharps should be thrown away in a Sharps disposal box or use an approved alternative method for home use

http://www.epa.gov/osw/education/pdfs/han-care.pdf


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Standard Precautions

In addition to hand hygiene, PPE and safe injection practices, other elements of standard precautions include:

• Care and cleanliness of the work area.

• Cough etiquette and respiratory hygiene.

• Safe handling of laundry.

• Use of bag technique• http://journals.lww.com/homehealthcarenurseonline/Fulltext/2014/01000/Bag_Technique__Preventing_and_Controlling.6.aspx

• Patient isolation and transportation.

• Handling of dirty patient-care equipment, instruments and devices.

Guidelines for Isolation PrecautionsRefer to healthcare agency policies and procedures


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TB Precautions

To prevent the spread of TB, patients suspected of having TB must:

• Wear a surgical mask until they are placed in a negative pressure, private room.

• Be placed on “Airborne Precautions.”• Wear a surgical mask anytime they are outside the negative pressure room.

Any one entering the room of a patient on Airborne Precautions must wear an N-95 mask or Powered Air Purifying Respirator (PAPR). Fit-testing is required for N-95 mask wear.

Students/faculty NOT fit-tested for N-95 masks should NOT be caring for patients with Airborne Precautions.


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Frequent Safety Round Issues

Frequent infection prevention issues cited during safety rounds:

• No food or drink in clinical areas.

• Linen – Clean linen must be covered. NEVER place bags of linen on the floor.

• Portable patient care equipment – Must be cleaned between patients and identified as “CLEAN” per agency policy.


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• Contact specific healthcare agency to find out where to access Policies and Procedures.

• It is important you are familiar with individual agency’s Policies and Procedures in providing patient care.

Policies and Procedures

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Patients have a Right to Pain Management

• Pain is the fifth Vital Sign assessment

• Tools:

• Medications

• Emotional Support

• Comfort measures

• Alternative therapies

• Refer to the healthcare agency’s Pain Assessment & Reassessment Policy & Procedure

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FALL REDUCTION

Is Everyone’s Business

In a hospital, an accidental fall can change a short stay for a minor problem into a prolonged stay.

• Prevent Falls o identify “At Risk” Patientso bed in low positiono call device in reacho non-clutter and removal of throw rugso pain assessment & med administration/ med evaluationo routine checkso adequate lightingo non-skid footwearo routine toileting/ bedside commode if indicatedo bed or chair alarm

• Refer to the healthcare agency’s policies

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RRT: Rapid Response Team

For Deterioration in a Patient’s Condition

Purpose is to provide early and rapid interventions to promote positive outcomes

• Identify Early Warning Signs & Report

• Refer to healthcare agency’s process for managing unstable patient situations

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Safety Reporting Systems (SRS)

Reportable Events

Events that are inconsistent with Standards of Care

Types of Events:

• Near Misses

• Serious & Non-Serious

• Sentinel Events

• Goal: Improve quality & safety

• Refer to the healthcare agency’s Reporting of Adverse Events Policy & Procedure61

RESTRAINTS

Limited use for Medical or Behavioral Reasons

• Alternative Measures First

• Preserve Safety & Dignity

• Requires training

• Required periodic release and offer of food, water & toileting

• Requires physician time-limited order, not PRN

Refer to the healthcare agency’s Restraint Policy & Procedure


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Hazardous Material or “Haz Mat” IncidentWhen a significant chemical spill/exposure has occurred within the health agency.

• Avoid the area until “all clear” is announced.• Trained health agency personnel will respond to the scene and notify the

Fire Department if necessary.• Nearby departments should prepare to receive re-routed traffic and be

ready for possible evacuation.• Other departments throughout the building are on stand-by to assist if

needed.

No announcement is made for spills that are manageable within the department.

Department staff should be trained to clean spills of chemicals they use regularly.

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Controlling Chemical Hazards

• Respect and understand chemical characteristics.• Use only if you are qualified.• Use only properly labeled containers.• Never use unidentified chemicals.• Store chemicals in approved areas.• Immediately report spills, leaks, or accidents.• Use Personal Protective Equipment (PPE).• Properly dispose of used chemicals/ containers.• Ask instructor/supervisor if you don't understand label

information.• Know what to do in an emergency.

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Internal Haz Mat Incident

• On product labels.

• Via the Globally Harmonized System of Classification and Labeling of Chemicals (GHS).

• In departmental training.

• In safety policies.

Every chemical container must include:

Chemical Name Manufacturer Warnings

If a product is transferred into a new container, ALL the above information must be on the new container.

For the protection of employees, students, etc., safety information about chemicals used within the healthcare agency is available:

You have the right to know about the risks associated with the

hazardous chemicals that you use.

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“Haz Mat” IncidentA GHS tells how to:

• Use• Store• Clean up a spill• Offer first aid • Dispose of a chemical

GHS information is available online. Know how to access the GHS information in the area you are assigned.

For emergencies:Follow healthcare agency’s

policy.66


Hazardous Waste

Regulated Medical Waste:

Blood or body fluids in containers > 20 ml Pathological waste (lab, tissues, organs) Microbiological waste Bloody (saturated) dressings, gauze Blood transfusion bags and tubing Materials used for cleaning blood spills if > 20 ml

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http://www.bing.com/images/search?q=red+bag+waste

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Hazardous WasteRed Sharps Boxes• Used syringes/needles

Unregulated Waste

Plain IVs – Can still go down the drain. Examples include: Saline, Potassium, D5, Electrolytes, and Lactated Ringers. (No Medications Instilled)

Empty IVs, vials, wrappers, and syringes will continue to be disposed of according to current procedures. An item is empty if it contains 3% or less of it’s original volume.

Follow healthcare agency policy and procedure.

“Plain down the drain”

NARCOTICS and other

Controlled

Substances

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Pharmaceutical Waste

Pharmaceutical Waste is defined as medication: partially administered in vials/ampules, leftover or unused, not given or refused such as:

IV bags and tubing w/ >10% medication remaining

Oral medications

Ointments and creams

Physician samples

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Hazardous Waste

Each healthcare agency will have a policy for the disposal for hazardous pharmaceutical waste. The appropriate container may be:

Indicated on the pharmacy medication label

Indicated in the medication dispensing system

Check the healthcare agency’s policies for appropriate disposal

External Haz Mat Incident

If a chemical spill/exposure occurs in the community, and the agency is expecting to decontaminate and treat victims in the Emergency Departments, external haz mat precautions will be initiated.

In response:• Members of the HazMat response team should

respond to the Emergency Department.

• Contaminated patients should not be allowed into hospitals without decontamination.

• Other directions will be given per healthcare agency policy

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Please Note:

Each healthcare agency has identified specific emergency codes and terminology. Please refer to each specific healthcare agency’s orientation

material for codes, alerts, and emergency telephone numbers.

Emergency Codes

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Fire

Emergency Codes

ctivate the alarm and call the emergency number.

4 steps to respond to a fire:escue anyone in immediate danger.

lose doors and windows.

xtinguish if possible. Evacuate if necessary.

R

CE

4 steps for using an extinguisher--“PASS”:

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1 2 3 473

Fire

Emergency Codes

Oxygen tanks and other compressed gas cylinders can explode. They must be handled with extreme care – it’s federal law!

Secure with a chain or in a rack when stored

Use only an approved carrier during transport – an approved carrier is designed for this purpose.

Store in limited quantities

Full and empty tanks must be stored separately and clearly labeled for easy identification.

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• Only properly trained individuals may handle or administer radioactive materials.

• Signs must be posted in rooms where radioactive materials are stored or used.

• Do not enter without proper supervision.• You may not eat or store food in these areas.• When unattended, materials must be secured.

Radiation Safety

Emergency Codes

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Bomb Threat

Emergency Codes

In response to a bomb threat announcement, each person should:

• Immediately check your department or area for any items (boxes, backpacks, computer cases, etc.) that don’t belong.

• Call Security to report anything found that could be related to the threat.

• Refer to specific healthcare agency policy for further information or talk with your area supervisor for specific directions.

• Prepare to evacuate if directed.

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Disaster Codes

Emergency Codes

Disaster means something has happened that changes the way we will deliver services, and may mean a large number of casualties.

For example:

• An outbreak of infectious disease.

• A large plane crash.• A weather-related disaster.• Sudden increase in patient census.

Be ready to respond! Review your healthcare agency’s disaster plan. Remain in your location – you will be contacted if needed.

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Security Alert Codes

Emergency Codes

What is security alert?• Response to an incident of civil or emotional unrest within

healthcare agency that threatens the safety of patients, visitors and staff.

• Potential reasons to activate security alert include, but are not limited to:– Heightened emotional or behavioral

response, even after de-escalation attempts.– Visible weapons.– Physical altercations.– Hostage situations.– Communication of threats.

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When an active shooter is in your vicinity follow your healthcare agency’s specific policy/procedure

– HIDE• Hide in an area out of the shooter’s view• Block the entry to your hiding place, lock doors, turn out

lights• Call security or 911 for help• Silence mobile devices• Wait for the “all clear”

Emergency Codes

Active Shooter Guidelines

– Follow Directions given by law enforcement officers

•Remain calm, and follow officers’ instructions •Put down any items in your hands (i.e., bags, jackets)•Immediately raise hands and spread fingers•Keep hands visible at all times •Avoid making quick movements toward officers such as holding on to them for safety •Avoid pointing, screaming and/or yelling

Adapted from homeland security publication How to Respond to An Active Shooter at http://www.dhs.gov/active-shooter-preparedness, March 24, 15.

Emergency Codes

Active Shooter Guidelines

http://www.dhs.gov/active-shooter-preparedness

http://www.dhs.gov/active-shooter-preparedness

Infant or Child Abduction

Emergency Codes

When an infant or child is missing everyone’s help is needed to locate an infant or child.

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http://nnlm.gov/sea/seacurrents/2001/bioterrorism_logo.jpg

Missing Infant or Child

Emergency Codes

Be familiar with agency policy if you are working with infants and children.

The first few minutes are critical. Quick, decisive action may result in finding the infant.

• Stop : Unless you are involved in a life-saving procedure, immediately stop where you are and what you are doing to search the immediate area.

• Secure : All entrances and exits. • Search: Look for suspicious persons with bundles, bags, and/or carrying infants. Report suspicious persons or items to the organization’s security or law enforcement.

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Some healthcare agencies are participating in a North Carolina statewide program to implement standardized armband colors for improved safety. Check each agency’s orientation material for participation and use of the colored bands or other method of identification.

Banding Together for Patient Safety

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Patient Safety

• Annually, patient safety goals are determined for healthcare agencies. Various accrediting bodies establish the goals for various practice areas like the Joint Commission (TJC), & the Accreditation Commission for Health Care (ACHC), etc.

• Healthcare providers are responsible for knowing and implementing these in patient care.

• Click on the link below and read the required patient safety focus and goals for assigned clinical area(s):

http://www.jointcommission.org/standards_information/npsgs.aspx

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Patient Safety

REFLECTION:According to the National Patient Safety Goals, how many patient identifiers are required prior to administering medication:A. 1

B. 2

C. 3

D. 4

To go back to the NPSG link click here

85

Patient Safety

• Good attempt! This is incorrect.• Please try again Slide 84

86

Patient Safety

• Correct response.

• Good job! Slide 87

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Cultural Diversity

To demonstrate the values of outstanding customer service, integrity and a caring spirit, honor individual differences by treating everyone with respect, courtesy and sensitivity to their unique needs, concerns or beliefs.

About 32% of the U.S. population belongs to ethnic or racial minority groups: 12% African-American; 9% Hispanic; 4% Asian; and 2% belong to other groups. (CiNet Healthcare Learning: EDA 450-0069)

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Cultural Diversity

Assumed Similarity:Thinking that everyone else seesthe world the same way you do.

Example: Healthcare provider assumes that the patient can read a brochure because (s)he can read it.

Not all people learn the same way. A patient may understand spoken English but not be able to read it. Use multiple approaches when teaching patients and families.

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Cultural Diversity

Comfort with the Familiar:We are often drawn to otherswho look, act, or think theway we do. Example: People froma specific unit will tend to eat with other members from their same department because they are familiar.

A new person may feel more comfortable eating with someone they met during orientation.

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Cultural Diversity

Anxiety and Tension:

These emotions can happen when you feel uncomfortablearound people who are differentthan you. The key is how youhandle those emotions.

Example: A new person eatswith people from another department; co-workers or fellow students can invite him or her to eat with them.

How the co-workers treat the new person will affect everyone – it will either add to or cut down on the anxiety and tension.

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Cultural Diversity

Ethnocentrism:

The belief that one’s own cultureor ethnic group is better than others. Differences are often viewed as inferior.

Example: If a new personthinks of boldness as a good thing, he or she may feel free to ask questions and debate issues with instructor/boss.

If the instructor/boss is from a different culture that values harmony over boldness, he or she may think the new person is bossy or rude.

Before taking offense, put yourself in the other person’s place. Think about their cultural norms.

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Cultural Diversity

Stereotyping:

A stereotype is an exaggeratedbelief about a person based on his or her background.

Example: Thinking that all Healthcare workers from other countries are poorly trained.

Judge a person based on what he or she actually does. Do not judge based on what you think that person will do.

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Cultural Diversity

Prejudice:

Prejudice is a hostile attitude toward people who do not fit in with your group.

Example: Treating a co-worker/student from another country as if he or she is not smart.

Language often can be a big problem for staff/students from another country. The medical terms are different, and medications have different names.

A co-worker/student with limited English communication skills often mentally translates words before responding.

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Cultural Diversity

Patients from DifferentCultures:

It is possible to tailor your speaking style to the needs of the patient.

The more you know about your patient’s culture and values, the more likely you are to get your point across.

Interpreters are available at most agencies. Contact your department supervisor for more information.

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Cultural Diversity

Patients from Different Cultures: (continued)

Ask about the patient’s culture as it relates to treatment: • Some patients may have special dietary needs. • Explain to the patient what to expect in the way of treatment. • Explain how the treatment may differ from what the patient expects.

Asking questions about a patient’s culture will add to your ability to see issues from his or her point of view.

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Cultural Diversity

Communication:

• Pay attention to how the patient answers questions• A person who values boldness may think it is polite to make eye contact.• Watch how close the person stands to you and gestures. Also note the tone of his or her voice.• In some cultures, standing close when speaking is a sign of respect.• If you accidentally offend someone, apologize.• Smile, speak in a friendly tone of voice, treat others fairly and respectfully.• Don’t forget that about 90% of communication is non-verbal.

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Chain of Command

For any Concerns, Questions or Issues

• Speak with your Instructor or Healthcare Provider, first and as appropriate.

• The Instructor /Healthcare Provider will guide you further as needed.

General/Miscellaneous Information

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Palliative Care

The comprehensive care and management of the physical, psychological, emotional, and spiritual needs of patients (all ages) with chronic, debilitating, life threatening illness and their families.

Palliative Care Focus• Pain management• Symptom management• Hydration / Nutrition• Holistic approach & support


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Transplant Safety

• Only Trained Personnel from an Organ Procurement Organization (OPO) is permitted to offer families the option to donate, recover donated organs, and distribute in an equitable manner

• Refer questions to your clinical instructor, preceptor or agency liaison.

See the Healthcare agency’s Policy and Procedure regarding Organ Donation


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Meals

Libraries

Student Parking

Many agencies encouragecarpooling and parking areasare agency specific for students.

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See specific healthcare agency guidelines for details.


Personal Electronic Devices/Valuables

• Personal electronic devices – see Healthcare

agency policy.

• Storage is limited for personal belongings.

• Valuables cannot be secured.

• No photography is allowed in the clinical

setting.

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Theft PreventionReduce your risk of becoming the victim of a theft. Your best defense is to limit the opportunity.

Here are some basic security reminders:

Parking Lots

• Keep valuables out of sight.

• Place money, purses/wallets, GPS devices, packages and shopping bags in your car’s trunk.

• Always lock your vehicle.

• Park in well-lighted areas.

• When it’s dark outside, walk to your car with friends and fellow students. At some facilities you also may request an escort by calling Security.

• Secure bikes, motorcycles and mopeds.


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E-Cigarettes are also

prohibited

Now that you have completed the core orientation, please return to your

school’s website to take the orientation test if it is required.

If you have questions, contact your school coordinator.

Core Orientation Test

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Student and Faculty Core Orientation © Approved 5 23 2011, Revised 4 22 2015 1.

Documents

Transcript of Student and Faculty Core Orientation © Approved 5 23 2011, Revised 4 22 2015 1.