Appendices

A-Scan Biometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Canthotomy and Cantholysis: A Sight-Saving Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Checklist for Pre-op of Cataract Surgery Patients at SA V AHCS . . . . . . . . . . . . . . . . . . . . . . . 9

Confirming Curriculum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

CPT Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Poster Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Sign-Out Tools and Evaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Survival Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

VERGE Software for Event Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Work-Related Injuries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Banner Dress Code Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

1st Year Residents Only

Optics Manual

Pediatric Rotation Disk (CD in back of binder)

1

2

3

Errors Inherent with

Contact Technique

Most common error is

corneal compression

Cornea indented by probe

touch

• Erroneously shortmeasurement

Immersion Technique

Probe immersed in

shell of saline

Most accurate/no corneal compression

(0.0126 - 0.05 mm

depending on

manufacturer)

Hansen Shell

• Place shell on

anesthetizedlimbus

• Fill with contact

lens saline

Immerse probeinto fluid and align

Errors Inherent with

Contact Technique

AEL 25.18 LT 4.41 ACD 2.87 AEL 25.80 LT 4.41 ACD 3.49

Immersion Technique

No tech-dependency

• Less risk for corneal abrasion

Faster technique

• More consistency

Less repeating

"Gold Standard of Care"

Prager Shell PragmSluill

l]Fi :le:>'

-I

4

4

5

6

LATERAL CANTHOTOMY VIDEOS https://www.youtube.com/watch?v=tgQaKVGynFA https://www.youtube.com/watch?v=r2BZVb687T0 https://www.youtube.com/watch?v=MhGQ1ikN93M Wills Eye Manual  

7

11

Department of Ophthalmology 5

Canthotomy and Cantholysis: A Sight-Saving Intervention (ContinuedfromPage4)

Discussion

Retrobulbar hemorrhage causing acute loss of vision is a rare

but serious and potentially blinding condition. Hemorrhage can

occur with minor trauma or in a delayed fashion. As ophthalmic

consultation may not be always readily available, physicians

triaging ocular trauma must familiarize themselves with the

needed examination and interventional skills.

Any trauma to the orbit can cause a retrobulbar hemorrhage.

Severe hemorrhage can cause orbital compartment syndrome,

like any space-occupying lesion. The orbit is enclosed by bony

anatomy, and any forward displacement is limited by the eyelid

apparatus and tethering of optic nerve to the globe. As intraorbital

pressure rises, ocular perfusion pressure decreases, leading

to ischemia. Multiple cranial nerves within the orbit may be

compromised, including the optic nerve and nerves controlling

eye movement. Animal studies have shown signs of ischemia after

100 minutes of central retinal artery occlusion; therefore, prompt

reversal of high intraorbital pressure is recommended.

The eyelids are fixated to the lateral rim by the lateral canthal

tendon. A lateral canthotomy is performed to expose the inferior

limb of the lateral canthal tendon (Figure 3). The inferior portion

of the lateral canthal tendon is palpable as a distinct corded entity

along the orbital rim, and the tendon is cut to ensure laxity of the

lower eyelid (Figure 4). The endpoint of the procedure is to allow

for additional forward movement of the intraorbital contents, and

less so for actual drainage of the hematoma.

While there are no large published case series guiding when

treatment should be initiated, the finding of an APD is diagnostic

of optic nerve compromise and should prompt urgent intervention

when accompanied by the aforementioned signs and symptoms.

In a darkened room, the pupils are examined with a bright light

source with the patient fixating at a distant target. The light is

repeatedly swung from the unaffected eye to the affected eye.

An APD is present if dilation, instead of constriction, is seen

in the affected eye in response to light.

While a multitude of adjunctive medical therapy has been

described, such as systemic and topical IOP lowering agents

and high-dose corticosteroids, these measures should not delay

surgical intervention. Some causes of retrobulbar hemorrhage can

be medically managed, but this should be reserved for cases with

close collaboration with ophthalmology. Further decompression

of the orbit in the operating room may be needed if surgical and

medical therapies fail to decrease the patient's IOP.

Our patient underwent a bedside lateral canthotomy and inferior

cantholysis within one hour of presentation and ultimately eight

hours after injury. Thirty minutes after the procedure, her IOP

was 23. Three months after injury, the patient's vision ultimately

recovered from hand motions vision to 20/50.

Roxana Fu is a third-year resident in ophthalmology at the

University of Pittsburgh School of Medicine. Evan (Jake)

Waxman is associate professor of ophthalmology and director

of both the Comprehensive Eye Service and the ophthalmology

residency program at UPMC. Contact Dr. Fu at fur@upmc.edu

and Dr. Waxman at waxmane@upmc.edu.

References

Bhatnagar A, Mayberry JC, Nirula R. Rib Fracture Fixation for Flail 1. Scott M,

Thomson A. Prompt Recognition and Treatment in Traumatic Retro-Orbital

Hematoma in Anticoagulated Elderly People Can Save Sight. Journal of the

American Geriatrics Society. 2009:57(3):568-9.

Hayreh SS, Jonas JB. Optic Disk and Retinal Nerve Fiber Layer Damage After

Transient Central Retinal Artery Occlusion: An Experimental Study in Rhesus

Monkeys. Am J Ophthalmol. 2000:129(6):786-95.

Chen YA,Singhal D,Chen YR et al. Management of Acute Traumatic

Retrobulbar Haematomas: A 10-year Retrospective Review. J Pfost Reconstr

Aesthet Surg. 2012:65(10):1325-30.

Goodall KL, Brahma A, Bates A et al. Lateral Canthotomy and Inferior

Cantholysis: An Effective Method of Urgent Orbital Decompression for Sight

Threatening Acute Retrobulbar Haemorrhage. /njury.1999:30(7):485-90.

Mcinnes G, Howes DW. Lateral Canthotomy and Cantholysis: A Simple,

Vision-saving Procedure. Can J Emerg Med. 2002:(4):49-52.

Brucoli M, Arcuri F, Giarda M. Surgical Management of Posttraumatic

lntraorbital Hematoma. Journal of Craniofacial Surgery. 2012:23(1):58-61.

UPMCPhysicianResources.com/Ophthalmology 8

Checklist for Pre-op of Cataract Surgery Patients at SAVAHCS

Pre-op visit:

• Perform comprehensive eye exam including;

o MRx

o BAT if VA 20/40 or better

o SLE

o DFE w Indirect exam

• Assess if patient is a good candidate for cataract surgery by resident or attending only

o Attending only if monocular, dense cataract, advanced glaucoma, previous PPV Sx

• Ask about general medical condition, especially regarding heart problems with recent events or

procedures

• Refer to Cardiology/Pulmonology/Neurology if medical problem for clearance for CE Sx.• Refer to retina if high myopia, retinal pathology or uveitis• Assess if MRx corresponds with IOL master results. **Note: pts in RGPs need to be out of them for

1 month prior to measurements, then re-measured 2 wks later. If Ks change, need re-meas. again.• Most the majority of applications, the Holliday 2 formula is used. Other formulas might be

considered in the following cases:

o If AL<22mmHg, rerun measurements using HofferQ or Haigis formula

o If Al >26 mm Hg, rerun measurements using SRK/T or Haigis formula

**In cases where other than piano is the target refraction, the patient will need to be re­

scanned.

• Corneal Topography if high or irregular astigmatism or other relevant corneal pathology.• Inform about visual outcome as well as risks and complications of cataract surgery• Obtain informed consent in IMEDConsent - Include all cataract surgery attendings, so pt can

change dates and attendings if needed. Make addendum to consent -" In addition, patient is

informed and agrees to the procedures pars plana vitrectomy, pars plana lensectomy, retinal

detachment repair and any other procedures deemed necessary if needed."• Sign the white Pre-op/Post-op order form.

• Write an H&P Note using the H&P template. Do not copy and paste ...

o In the H&P, write how patient will be transported to and from

surgery .

o Write if pt has current depression, how it is treated and if there

are any suicidal ideas.

o Insert IOL Master K-readings and axial length for each eye.

o Fill out the pink sheet with Preop Exam info including

o Pre-op date o BCVA

o BAT result if needed

o MRx

o Previous Cataract Sx, IOL used, date, MRx and BCVA if known

o Pupil size

o Allergies

o Anticoagulants - Can pt stop blood thinners 7-10 days prior for retrobulbar block for

beginning Cataract surgeon? If pupils are very small and iris hooks or Malyugin ring will

be used, can pt stop anticoagulants? If not, make it attending case

o BPH status and BPH meds, Tamsulosin etc.

o Corneal pathology, s/p refractive sx

9

Pre-op Visit (continued)

o DM status/CSM E/Retina I pathology

o C/D ratio - Glaucoma status, s/p glaucoma Sx?

o Ability to cooperate w Sx? Claustrophobia? PTSD

Requirements for standard pre-op tests:

• EKG within 6 months

• Labs: CBC and Lytes-Cr-BUN within 3 months

• Informed consent within 2 months

• H&P within 1 month

• Inform pt where to get Labs/EKG

• Inform about when to start pre-op meds

• Inform about NPO/small amount of water with meds for the heart, BP, pain, seizures and

anxiety in AM of Sx.

• Give pt Blue and Green instruction sheets and yellow parking permit.

• Give all sheets back to Monica. She will place OR Consult.

• Have an attending examine the patient and approve cataract surgery

At least 2d prior to surgery: - If not done, surgery may be cancelled!

• Discuss planned case and IOL selection with attending

• Go to consult tab - OR Consult - Action - Consult tracking - Add comment

"I have reviewed the chart with attending Dr. X. The patient is cleared for surgery."

o Or verify that the attending has placed a similar comment

• If H&P update is needed, call pt at home and make sure there have been no changes in the

medical condition. Make new note with current date. Write "I have discussed the planned

surgery with the patient and there are no reported changes in the medical condition."

Tips for decreasing risk of cancellation of surgeries: • Call pt yourself a few days prior to Sx and check for recent changes in medical condition, remind them of

surgery date and f/u date and time. Inform that Sx time will be notified PM prior, otherwise call in and

talk to ambulatory surgery per phone number on the green sheet. Remind of NPO after midnight and

small amount of water with meds (usually good idea to hold oral hypoglycemics, and, if they take it, only

½ dose of insulin the night before).• Check for current Labs, EKG, H&P, Consent, PAT note (pre-anesthesia), H&P, recent Cardiac events or ED

visits.

10

CONFIRMING CURRICULUM (New Innovations)

View Curriculum

• Go to Schedules> Curriculum

• Click on the name of a Curriculum to view it.

Curriculum

CQNSUUS C11uk11lum

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Confirm Curriculum

• Go to Home Page• In the Notifications section, under Curriculum, click Unconfirmed curriculum for your

review

EVALUATIONS

39 __ evaluations_ to __ complete

Choose .. a_ person .. or __ rotation. to __ evaluate

• Click the link in the Curriculum column. For example, click O of 1 confirmed.

11

Block Views

MY�<i�lt111,

Pct,oml?her!"��,i:)a!i�· Acbd�mic Year. lzoi�:201?,il

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[•�nrt !� f•�sl

• Scroll down to the bottom and click on the name of the rotation to review.• After reviewing, click Confirm

Rota.tlon Information

R�tati(ln Definition: St.tit Obit; tnd Date: Program: 50tu1, Post Graduate Y<ir: Workload: Compensation $t,tu1:

ruining Lo,;ation{s):

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12

Curriculum - View/Confirm Mobile

The steps below will help you use your mobile device to view and confirm your curriculum.

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*t1tlAlt"T ": lli!i�·,'\M • :a

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My Account

13

View and Confirm Curriculum

1. Tap Notifications

2. Tap Unconfirmed curriculum for your review

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CURRICULUM

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your review

EVALUATIONS

CHECKLISTS

Complete 5 Onboarding tasks

PORTFOLIO

3. Confirm that you have read the curriculum using one of these two methods:

• Tap the name of the rotation to view the curriculum, then click Confirm

JGB tnt�:tnbl Mcdicirtc:­JG8 lnter.nal Meditine )GS Internal Medicine JG& !ot•mal M<t<fiooe JGS Intemal Medicine

• Tap O of 1 confirmed (for example), then tap Confirm

5.tattDate-- frui Date Rotatir..n Pfimary

7/l/2013 7/3ill0l3 � •

W2(1U ll/ll/2013 .l!M"',Mll Ii>

9/1/2013 9/30/2013 � 1111

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14

OCULOPLASTICS CPT CODES

Entropion Levator Advancement

Ectropion Levator Recession Lateral Tarsal Strip Wedge Suture

Blepharoplasty Upper lid Upper lid dermatochalasis Lower Lid Lower lid with herniated fat

Electrolysis - lid 67825 Canthotomy 67715 Canthoplasty 67950 Lateral canthopexy 21282 Medial canthopexy 21280 Canalicularplasty 68700

Ptosis supraciliary approach 67900 Frontalis Sling 67901 Gold Weight 67912 Thyroid Ophthalmolopathy (transconj

approach with decompression) 67414

TUMORS Excision eyelid lesion

Shave lesion 67840

<0.Scm 11310 <1cm 11311 <2cm 11312 >2cm 11313

W/,w/o direct closure (not chalazion) 67840

Eyelid Biopsy-malignant 67810 Malignant lesion 1.1-2cm 11642

RECONSTRUCTION

67904

67903 67917 67016 67914

15822 15823 15820 15821

Pedicle flap 15576 Island pedicle flap 15740 Fullthickness Free graft 15260 Neovascular pedicle flap 15750 Adjust tissue transfer/rearrangement <10cm2 14060 Layered closure 2.6-Scm 12052 Suture recent wound full thickness 67935 Complex Repair 1.1x2.5cm 13151 Auricular Cartilage Graft 15760

TRAUMA EUA 92019 (limited)

92018 (complete) Globe perforation repair 92019, 66020, 65280, 65272 Cornea perf w/ uveal tissue 65285 Cornea perf w/o uveal 65820 Medpore implant 65310, 15730, 68320

CPTCODES

TRAUMA (continued)

Apply glue to cornea 65286

Evisceration with implant 65093

Nasolacrimal duct Probing with irrigation 68810

Crawford tubes 68815

lnfracture 30930

Iris laceration 65285

lridectomy 66625

Anterior Vitrectomy 67010

Inject air into AC 66020

lntravitreal injections 67028

ANTERIOR SEGMENT

STRABISMUS Adjust.suture 2 Horizontal

67335 67312 67311 67316 67314

CORNEA

1 horizontal vertical muse RIO myectomy

PKP aphakic Pseudophakic Except aphakia

Pterygium with graft Prokera DSAEK

65750 65755 65730 65426 65780 65710

LRI 65772 Post.synechiolysis 65875 Reprosition IOL w/incision 66825 Insertion of IOL without CE 66985 IOL exchange 66986 Suture of IRIS 66682

PREOP H&P PRIOR TO CE 0014F (DFE 2020F; H&P 3325F)

PCIOL PHACO 66984 Complicated 66982 Secondary IOL 66982 YAG capsulotomy 66821

Chalazion in clinic 67800 General anesthesia 67801

GLAUCOMA Trab Ab externo 66170 lridectomy, glaucoma 66625 Trab w/ MMC 66172 Molteno valve 66180 YAG Pl 66761

Transcleral CPC 66710 LASER

SLT 65855 YAG LPI 66761 Severe AC adehesions 65860 Yag Capsultomy 66821

15

RETINA

DILATED RETINAL EYE EXAM WITH INTERPRETATION 2022F

FLUORESCEUN AGNIOGRAPHY WITH INTERPRETATION AND REPORT 92235

FUN DUS PHOTOGRAPHY WITH INTERPRETATION AND REPORT 92250

HUMPHREY VISUAL FIELD EXAMINATION UNI OR BILATERAL 92083

16

POSTER GUIDELINES Link to Ophthalmology Template: www.eyes.arizona.edu/deptforms.html

General Aim and Format • A poster is a graphically based approach to presenting research. In presenting your research with a poster, you should aim to

use the poster as a means for generating active discussion of the research.• Limit the text to about one-fourth of the poster space, and use "visuals" (graphs, photographs, schematics, maps, etc.) to tell

your "story."

Design and Layout Specifications • The entire poster must be size as required by guidelines (36x56" is size used for ARVO). The poster does not necessarily

have to fill the entire working area. The maximum width for the Department's poster printer is 36".• The board must be oriented in the "landscape" position (long dimension is horizontal).• A banner displaying your poster title, name, and department (or class, if appropriate) should be positioned at top-center of the

board (see Figure 1).• Make it obvious to the viewer how to progressively view the poster. The poster generally should read from left to right, and

top to bottom.• Leave some open space in the design. An open layout is less tiring to the eye and mind.

Lettering

DD □

Figure 1: Conventional layouts for a poster. Long panel at top-center is title/author banner. Individual panels can be connected by numbers and arrows. Also, note the use of space between panels to achieve visual appeal. (From CW Connor, 1992, The Poster Session: A Guide for Preparation: US Geological Survey Open-File Report 88-667.)

• Word-process all text (including captions). Print on plain white paper with a laser printer or inkjet printer.• Text should be readable from 5' away. Use a minimum font size of 20 points.• Lettering for the title should be large (at least 60-point font). Use all capital letters for the title.

Visuals • Present numerical data in the form of graphs, rather than tables (graphs make trends in the data much more evident). If data

must be presented in table-form, KEEP IT SIMPLE.• Visuals should be simple and bold. Leave out or remove any unnecessary details.• Make sure that any visual can "stand alone" (i.e., graph axes are properly labeled, maps have north arrows and distance

scales, symbols are explained, etc.).• Use color to enhance comprehension, not to decorate the poster. Neatly coloring black-line illustrations with color pencils is

entirely acceptable.• Make sure that the text and the visuals are integrated. Figures should be numbered consecutively according to the order in

which they are first mentioned in the text. Each visual should have a brief title (for example: Figure 1-Location of study area).

Text • Keep the text brief. Blocks of text should not exceed three paragraphs (viewers won't bother to read more than that). Use text

to (a) introduce the study (what hypothesis was tested or what problem was investigated? why was the study worth doing?),(b) explain visuals and direct viewers attention to significant data trends and relationships portrayed in the visuals, and (c)state and explain the interpretations that follow from the data. In many cases, conclusions can be summarized in a bullet­point list.

• Depending upon the stage or nature of your project, the text could also include sections on future research plans orquestions for discussion with viewers.

• Cite and reference any sources of information other than your own, just as you would do with a research paper. Ask yourprofessor about the particular citation system that you should use (every discipline uses slightly different styles). The"References Cited" is placed at the end of the poster.

Miscellaneous Suggestions • SIMPLICITY IS THE KEY. Keep to the point, and don't try to cover too many things. Present only enough data to support

your conclusions. On the other hand, make sure that you present sufficient data to support your conclusions.• When you begin to make your poster, first create a list of the visuals that you would use if you were describing your project

with only the visuals. Write the text after you have created the list of visuals.• Before the poster session, rehearse a brief summary of your project. Many viewers will be in a hurry and will want a quick

"guided tour" of your poster. Don't be afraid to point out uncertainties in your work; this is where you may get useful feedback.

17

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26

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28

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30

31

32

VERGE for Event Reporting

1. Click on the "Online Event Reporting" link on the Banner Homepage

2. Choose the appropriate category for your event and click either the icon or the event category

name.

3. Page one of the event report will load automatically

a. Answer all of the basic information questions

b. The description of what happened should be clear and concise

c. Click "next" to go to page two

4. Answer the event specific questions on page 2.

5. Click Next

6. Click Save and Submit

33

Where to find work-related injury forms

Creation Date: 3/10/2015 Last Modified Date: 3/10/2015

Staff Work Related Injury Forms can be located under the BUMCTS employee website. Search for Departments and either the Risk Management or Human Resources/Employee Health Department link for the Work Related Injuries, Illnesses and Exposure forms:

Staff Work Related Injury Accident Report form

Supervisor Accident Investigation form

Report of a Significant Work Exposure to Bodily Fluid form.

Treatment for Injured Staff Members/Volunteers Injured staff members should be referred to Banner UMC Tucson or South Employee Health Department by the supervisor as soon as possible after the accident. The Employee Health nurse will assess the injury and refer the staff member to the designated occupational physician, if necessary. The occupational physician will determine the staff member's work status.

If the staff member's accident occurs after Banner - University Medical Center Employee Health hours (Monday to Friday, 7:30 a.m. - 4:00 p.m.), or South Employee Health hours (Monday to Friday, 8:00 a.m. 4:30 p.m.), staff members must report to Employee Health the next day that Employee Health is open for normal hours of operation.

Because Banner Health Workers' Compensation program is self-insured, the Arizona Workers' Compensation Employers' statute restricts the injured employee the right to choose his or her own physician if medical services are provided by the employer. If the staff member fails to follow through with the medical services made available by Banner UMCTS, the staff member may be personally responsible for any cost of unauthorized medical care outside of the services made available by Banner Health.

Main Contact Information Name: Anna Llamas E-Mail: Anna.Llamas@bannerhealth.comPhone: 520-694-4386Department: Worker's Comp

34

��

Banner Health· POLICY and PROCEDURE

TITLE: System Dress Code Policy

Number: 9512 Version: 9512.3

Type: Administrative Author: HR Employee Handbook/Policy Team; Brenda Dietrich, Zsaber Gere

Effective Date: Original Date: 9/18/2008 Approval Date: Deactivation Date:

2/1/2016 9/15/2015

Facility: System

Population (Define): All Employees

Replaces:

Approved by: Administrative Policy Committee, Senior Operations Team

Overview

Purpose

Definitions

1. To provide dress and grooming standards appropriate to the work environment.

2. To enhance the customers' image of the organization by establishing consistentguidelines for the personal/professional appearance of Staff Members.

3. To communicate to Staff Members that personal appearance and appropriatedress are regarded as important aspects of a Staff Member's overalleffectiveness.

Medical Clogs: are clogs with skid-proof bottoms, easily cleaned, and have a strap or safety lip in the back.

Personal Hygiene: Refers to cleanliness, including but not limited to,

• bathing/showering,

• shaving,• combing of hair, and• trimming/cleaning of fingernails

Staff Members: Refers to employees, volunteers, students, and contracted staff members.

• Direct Care Givers: Fifty percent (50%) or greater direct patient careresponsibilities, regardless of job title. Responsibilities include patientcentered activities in the presence of the patient and activities that occur awayfrom the patient that are patient related. Examples:

o Medication administrationo Treatments

Continued on next page

May not be current policy once printed Print Date: 6/26/2017

Page 1 of 7

35

�Banner Health· Policy Title: System Dress Code Policy

Overview, Continued

Definitions, ( continued)

Policy

o Roundso Admission, transfer, discharge activitieso Patient teachingo Patient communicationo Coordination of patient careo Documentation timeo Treatment planning

• Indirect Care Givers: Refers to staff members not delivering direct care topatients (see above).

General Policy 1. All Banner Health Staff Members represent the organization through theirStatements appearance and actions. It is the responsibility of each Staff Member to be neat,

clean, and appropriately attired in the workplace.

2. It is the responsibility of management to ensure that their Staff Members presenta professional appearance that reflects Banner Health's Core Behaviors.

3. Department and certain job classifications may have more specific dress coderequirements for legitimate safety, regulatory and public contact reasons.

4. Those working in areas with no designated uniform must dress in a professionalmanner appropriate for their work area.

• Articles of clothing

o with Banner's logo may be permittedo that advertise or denote logos from healthcare facilities other than

Banner are not permitted

5. Staff Members who wear business attire should comply with the same highstandards as those who wear uniforms.

• Clothing should be neat and clean, and appropriate to the work assignment.• Business attire may be worn by Staff Members in designated work units,

subject to approval by the unit manager.• Business attire for men and women includes, but is not limited to:

Continued on next page

Page 2 of 7

36

�Banner Health· Policy Title: System Dress Code Policy

Policy, Continued

General Policy Statements, ( continued)

o suits,o dresses or skirts for women,o dress or casual slacks for men and women,o blouses for women,o shirts with or without ties for men,o polo shirts, ando shirts with collars for men

6. Staff Members who wear scrubs must comply with Banner's appearancestandards listed below.

• Scrubs must be kept neat, clean, free of holes, and are required to bechanged when wet or soiled by blood and/or bodily fluid.

• If a Staff Member's personal scrubs become soiled and need to bechanged before the Staff Member's shift is complete, hospital issuedscrubs may be obtained from and returned to the linen department.

• Staff Members who work in an area requiring them to change into hospitalissued scrubs are expected to dress appropriately and be aware of theirappearance when entering and leaving the facility campus.

7. The facility issued ID badge must be worn on the upper part of the body at alltimes while on the campus.

• For safety concerns, the use of lanyards is discouraged.• The face of the ID badge must remain visible for identification and safety

reasons and must not be defaced with stickers, ribbons, or pins so thatthe face or identifying words are covered.

8. If a Staff Member reports to work improperly dressed or groomed, his/hersupervisor may instruct the Staff Member to return home to make appropriatechanges.

• Time away to correct their dress/grooming is not considered worked timeand may result in counseling or further corrective action in accordancewith the Corrective Action policy.

9. Proposed changes by management to the Uniform and Dress Standards must bereviewed in advance by the Operations Integration Council (OIC) by submitting arequest through the portal on the Banner Health employee website.

Continued on next page

Page 3 of 7

37

�Banner Health· Policy Title: System Dress Code Policy

Policy, Continued

General Policy Statements, ( continued)

10. Exceptions to this policy may be made based on a Staff Member's religiousbeliefs, disability, medical condition, or other compelling reason requiring anexception.

• For example, a Staff Member undergoing chemotherapy may be permittedto wear a bandana, or a Staff Member with a broken foot may be excusedfrom wearing a shoe.

• If an exception is requested, the facility HR representative will evaluate.

• Unless required by law, the facility HR representative shall have noobligation to grant an exception to this policy.

11. This policy may be suspended on a facility or departmental basis for specialevents with the approval of the facility CEO.

Dress Code/Professional Appearance Standards

Uniforms 1. Staff Members are required to wear the designated uniforms for their areas.

Business Attire 1. Business Attire must fit so that inappropriate exposure does not occur during

Shoes

normal work activities. The following are prohibited:

• miniskirts,• shorts,• tank tops/spaghetti straps

o Tank tops and spaghetti straps are allowed if a coat or jacket is wornover them as the outer garment.

• spandex,• midriff shirts,

• low slacks

1. Shoes are to be worn at all times by all Staff Members.

2. Shoes must be clean, in good repair, and professional in appearance andappropriate for the work area.

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Dress Code/Professional Appearance Standards, Continued

Shoes, ( continued)

3. All Direct Care Givers must wear close-toed shoes with a closed heel or heelstrap.

• Slippers, toe shoes, flip-flops are prohibited.• Departments may designate specific safety shoes.• Direct Care Givers may wear Medical Clogs.

o Direct Care Givers may wear athletic shoes, as long as they are clean,and in good repair.

• Indirect Care Givers are permitted to wear open-toed or sling back shoesprovided they are business professional in appearance.

Body and Hair 1. Body and hair cleanliness is mandatory.

2. Body odor and bad breath which are offensive to others, or which may interferewith the health of a patient are not permitted. This includes heavily scented

• colognes,• perfumes,• body lotions, and• cigarette smoke odor

3. Tattoos must not convey a message that is contrary to Banner's ethical standardsand must not pose a potential customer relations issue.

• Visible tattoos that are obscene, lewd, crude, or portray or representnudity, vice or crime or contain profanity are strictly forbidden.

• Staff Members are required to cover such tattoos.

4. Hair must be clean, combed, and neatly trimmed or arranged to conform to thesafety requirements of the specific work area.

• Shaggy, disheveled hair is not permitted regardless of length.• Sideburns, moustaches, and beards must be neatly trimmed; a beard

hood may be required in certain areas.• In keeping with the professionally appropriate attire, eccentric styles of

hair and/or unnatural hair colors (yellow, green, pink, purple, etc.) are notpermitted.

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Banner Health· Policy Title: System Dress Code Policy

Dress Code/Professional Appearance Standards, Continued

Jewelry 1. Jewelry should not interfere with work performance, the use of appropriatepersonal protective equipment, or present a safety hazard.

• Direct Care Givers may not wear earrings which dangle more than oneinch from the ear lobe. Barbells or chains that stretch between holes andgauges larger than 6 (4.1 mm) are not permitted.

• Piercings determined to be an infection prevention issue or pose apotential customer relations issue, must be removed or covered.

Fingernails 1. Long or artificial fingernails are prohibited for those Direct Care Givers providingdirect patient care or those preparing products for patients. (See Hand Hygiene,Antisepsis, and Artificial Fingernails Policy)

Portable Music 1. Portable music devices or headsets, unless required to perform the job, areDevices prohibited in Banner hospitals, outpatient clinics, and other clinical settings for

Staff Members in the work area during the work shift.

Headgear

Meetings

2. This includes any area where the Staff Member is performing the work tasks.

3. Staff Members may use these devices during their breaks and meal period.

1. Bandanas, hats, and caps are prohibited, except where required and/ornecessary for completion of job activities.

1. Staff Members must wear clothing appropriate for the work setting whenattending mandatory meetings, classes, and/or in-services for which they arebeing compensated to attend as described in General Policy Statement #4.

Other Information

Documentation 1. Department Uniform Responsibility Agreement may be required for certain areas.

2. Who Wears What Document (located on the AZ Region Uniform Program andDress Code web page)

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�Banner Health· Policy Title: System Dress Code Policy

Other Information, Continued

Other Related Policies/ Procedures

Keywords

1. Banner Health Core Behaviors2. Hand Hygiene, Antisepsis, and Artificial Fingernails (#12584)3. Corrective Action Policy (#7647)

Professional Appearance Dress Clothing Safety Professional Conduct Staff Expectation HRPolicies

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