Directions

Welcome to Bay Regional Medical Center You are responsible for the information

contained in this orientation Review all of the following information When you are finished follow directions

on last slide. You may print a certificate indicating

completion of required on-line orientation. (for individuals not participating in “on-line digital documentation this certificate must be presented to individual you report to at BRMC

Bay Regional Medical Center

Student Orientation

Mission

McLaren Health Care Corporation, through its

affiliates, will be Michigan’s best value in healthcare as defined by quality, outcome

and cost

Vision

To be the healthcare system of choice for :

EmployeesPhysicians

Patients

Core Values Patients are the reason we exist People are the source of our success Each person is unique, is to be valued,

and will be treated with dignity and respect

Our community is whom we serve Strategic Initiatives: Customer service,

Quality, Financial, Human Resources, Market Growth and Physicians

Bay Regional Medical Center

System-wide Emergency Codes

2009

BRMC Emergency Codes Code Red – Fire Code Weather Alert –

Tornado/Severe Weather Watch Code Weather –

Tornado/Severe Weather Warning

Code Blue – Cardiac Arrest Adult Code Blue Pediatric – Cardiac

Arrest Pediatric Code Triage External Alert –

Potential External Disaster Code Triage External –

External Disaster Code Triage Internal – Internal

Disaster Code Yellow Alert – Bomb

threat has been received Code Yellow – Suspicious item

has been found

Code Pink – Infant Abduction Code Purple – Pediatric

Abduction Code Orange – Hazardous

Material Response Code Green –

Biological/Chemical Response Code Silver – Hostage Situation’ Dr. Strong – Additional

personnel needed Rapid Response Team – Multi-

disciplinary emergency team Stroke Response Team –

Stroke patient Dr. Heart – Acute Myocardial

Infarction Condition H – Family/Patient

initiated Rapid Response Code Clear – All Clear

Important Steps in an Emergency

Stay in your department/unit. If away, return immediately. Assess situation, be alert to surroundings, protect your patients.

Refer to your department/unit/hospital emergency plan. Maintain communication with RN responsible for your patient and rest of staff.

Code Red (Fire)

Return to department/unit immediately

RACE Rescue those in danger Activate fire alarm Confine the fire by closing doors Extinguish fire (if small)/Evacuate

PASS Pull pin on extinguisher Aim Squeeze Sweep

Code Blue (Adult Medical Emergency)

Assess patient’s airway, breathing and circulation

Call emergency number

Initiate CPR Do not leave patient

Code Blue Pediatric (Pediatric Medical Emergency)

Assess patient’s airway, breathing and circulation

Call emergency number

Initiate CPR Do not leave patient

Code Pink (Infant Abduction < 1 yr old)

Monitor hallways, stairwells and elevators

Observe for person: carrying a bag large enough to

hold an infant carrying a coat/baby blanket or person, in a nurse’s

uniform/scrubs, carrying an infant, without appropriate identification

Note identifying characteristics of person, take down license number of vehicle

Call emergency number immediately

Code Purple (Child Abduction > 1 yr old)

Monitor hallways, stairwells and elevators

An abductor can be a stranger, or family member, such as a non-custodial parent

Children, may or may not be able to verbally communicate a threatening situation

Note identifying characteristics of person, take down license number of vehicle

Call emergency number immediately

Code Weather (Warning) Return to department/unit Close all doors, blinds,

drapes, if possible Move ambulatory patients

and visitors to inner hallways, away from windows and doorways

Pull cubicle curtain around non-ambulatory patients to minimize potential for glass injuries from broken windows

Reassure patients and visitors

Dr. Strong (Combative Person)

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

Code Silver (Weapon / Hostage)

A weapon is defined as any firearm, knife, or instrument that can cause bodily harm or injury

If a person is found (or suspected) of having a weapon, call emergency number immediately

If someone is being held hostage call emergency number immediately.

Seek cover and warn others of the situation

Code Orange (Hazardous Material Spill)

Isolate area

If spill is small and containable, use appropriate spill kit for cleaning.

If spill/release is large, evacuate the area and contact HazMat Team or outside contractor

Code Yellow (Bomb Threat)

If you receive a bomb threat: Call the emergency number

immediately Give your name, phone number and

location Gather as much information as

possible: Description of bomb, location, when it will

explode Listen to voice, speech patterns, accents,

noises

Don't go looking for it on your own If you find a suspicious package or

device: Do not touch it Call emergency number immediate.

Code Green (Biological/Chemical Response)

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

Code Triage – Internal (Disaster)

An event that causes disruption in our ability to care for patients.

Return to department/unit immediately.

Department/unit/hospital emergency plan is initiated.

All breaks/meals are suspended until released by department management.

Staff may be re-deployed, by management, to other areas.

Staff (completing their shift), are not to leave until released by management, or the disaster alert is cancelled.

Code Triage – External (Disaster)

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

See Code Triage Internal

Rapid ResponseA rapid response is initiated by the RN

when a patient’s condition is deteriorating, the nurse has a “bad

feeling”, or can’t get a hold of a Dr. for orders etc.

It’s intention is that staff can intervene before the patient’s condition

deteriorates to the point of a cardiac or respiratory arrest

When paged, the “Rapid Response” Team responds and functions according to

protocols.

Condition H

This is a situation that is paged when a patient or family member feels that the patients’ condition is deteriorating and their concerns are not being addressed

by the staff or Dr.’sWhen paged, the RN, supervisor and manager respond to the patients’ room

Corporate Compliance

Reporting Compliance Violations

Open Communication helps to respond to compliance problems

If you see something that seems to violate the law or BRMC’s policies & procedures you should:

1. Report the problem to your instructor and RN responsible for your patient

2. Report the problem to Mike Jamrog, the compliance officer@894-3849

3. Report the problem on the compliance Hot Line - 894-3945

Noncompliance & It’s RamificationsWhat is fraud? Crimes of guile & Deceit Material false statements or representations

made to obtain some benefit to which one is not entitled

Act performed knowingly, willing and intentionally

What is Abuse?

Abuse Includes: Negligent or careless practices resulting in inappropriate

billing or increased costs Overuse of medical services, products or both Medically unnecessary services or products Provision of services inconsistent with professional

standards Unfair or unreasonable pricing Restrictions of Patient choice Restrictions in competition Accepting cash or equivalents from patients or their family Taking hospital property for personal use

Standards of Conduct Purpose – All MHCC Board members,

employees, physicians, volunteers, contractors following the same guidelines

Governing board supports Leadership must support and lead by example Standards are the outward/public sign of BRMC

compliance to legal and ethical behavior State a commitment to do the right thing in all

our operations

Standards of Conduct A Commitment to Providing Patient Care

A Commitment to Our Community – Your are BRMC to the public

A Commitment to Environmental Health and Safety – Protect our patients and employees

A Commitment to Proper Employment Practices – Establish a public trust, do not accept gifts of any kind from patients or their families

A Commitment to Ethical Business Conduct – Honest, accurate and ethical business practices

Standards of Conduct A Commitment to Accurate Coding and Billing

Transactions

A Commitment to Physician Relations – Apply privileging requirement equally to all physicians

A Commitment to Confidentiality and Electronic Security – Privacy of and security of every patients information

• A Commitment to Laws and Regulations – operate in accordance with current and future rules and regulations

• A Commitment to Ongoing Monitoring – Report any situation that does not seem right to you

What Does This All Mean to Me? Our patients and our community

have a right to expect we will always operate in keeping with all Federal, State and Local laws & regulations

It is the responsibility of every employee, volunteer, physician & student to perform their job in a fair and honest manner

What Does This Mean to Me?

Trust your instincts. If a situation doesn’t seem right, it probably isn’t. Stop and ask

for clarification from your instructor, RN, Nurse Manager,

Supervisor, compliance representative or Compliance

Officer

What Does This Mean to Me? Report any activity you know or

suspect to be in violation of compliance policies

Do not accept gifts from patients or their family or vendors

Declare any conflict of interest that may arise

What Does This Mean to Me? Violations of compliance policies

can result in disciplinary actions up to including discharge or your removal from BRMC as a student

Compliance is everyone’s responsibility!!

Health Insurance Portability and Accountability Act HIPAA

Regulates the use and disclosure of what is known as protected health information or “PHI”

PHI is any information that can be used to identify the past, present or future healthcare of an individual or the payment for that care

PHI Virtually all information about a patient,

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

HIPAA Confidentiality HIPAA privacy also protects the

following: The reason the patient is sick or in the

hospital The treatments & medications he or

she receives Caregiver’s notes Information about past health condition

Use of protected health information

Before looking at a patient’s health information ask yourself:

“Do I need to know this to do my job?”

If the answer is “Yes” proceed. If the answer is “No” you need to STOP immediately.

Use of electronic protected health information (ePHI) HIPAA security rules apply only to ePHI

stored, maintained or transmitted in an electronic format

ePHI is the same information as PHI Monitor the use of cellular phones

Information and images (ePHI) can be sent over the internet

It is not allowed to send ePHI over the e-mail system

Use of ePHI Use E-mail and Internet access

appropriately Workforce member (including

students) should remember that e-mails sent to or from BRMC’s computers are not considered private

BRMC can and does audit e-mail and Internet usage

Use of ePHI Never share your password Sign off computer appropriately If you believe your password has

been compromised, call the HELP desk immediately (49572) Tell them your concern and ask for a new password

What does HIPAA mean to me? Our patients have a right to expect

we will keep their information confidential. Their information includes anything that could identify or be used to find out the identity of the patient or their medical condition

What does HIPAA mean to me? As students you come into contact

with many forms of patient information, i.e. surgical lists, lab draw lists, patient census lists, etc.

You need to understand what are acceptable use of this information

What does HIPAA mean to me? Follow the “need to know” rule: Ask yourself: “do I need to see

patient information to perform my job” If the answer is “Yes”, you have nothing to worry about. If the answer is “no”. STOP

What does HIPAA mean to me? The cafeteria or elevator is not the

place to discuss the medical condition or other aspects of a patient’s care

Information you have access to must not be the subject of conversations with family, friends or neighbors

What does HIPAA mean to me? Violations can also result in personal

civil penalties of up to $25,000 per person and criminal penalties of up to $250,000 and/or 10 years in prison

Report privacy violation to Mike Jamrog, Privacy Officer 894-3849, call the Compliance Hot Line - 894-3945 or the Privacy line - 894-3970

Patient Confidentiality NO names or identifying information

may leave the patient care unit on ANY form

Information may not be given to any person, friend or family member unless they know the PIN number This number is given to the patient upon

admission. Patients are instructed to share this number with anyone who they want information released to.

ANY BREACH OF PATIENT CONFIDENTIALITY MAY

RESULT IN YOUR REMOVAL FROM DOING CLINICALS

AT BAY REGIONAL MEDICAL CENTER

Infection Control

Transmission Based Precautions; Respiratory

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

Keep patient’s door closed at all times

Transmission Based Precautions; Droplet

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

Transmission Based Precautions; ContactA bright green sign will be on the door of a

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

If You Are Injured While Providing Patient Care

at BRMC

Report injury immediately to Instructor

Instructor will direct you for appropriate medical follow-up (cost is responsibility of the student

Complete a “Process Improvement” form and forward to Kathy Warszawski (Risk Management)

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

Source patient will be tested

Policies & Procedures Policies & Procedures are available on-

line Go to the “Intra-net” Home Page Go to BRMC section Click on Policies & Procedures In the “search” bar indicate what you are

looking for All policies that reference what you are

looking for will appear. Click on appropriate policy title Print policy.

Diligent ProgramBRMC cares for the safety of our patients

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

Bay STARS

A Commitment to Service Excellence S - Service Encounters T - Tracking A - Accountability R - Reward & Recognition S - Service Recovery

Who are our Customers?

Patients: They are the reason we are here Families: They watch and listen to everything

we do for their loved one Physicians: They direct patient care and work

closely with us to provide that care Fellow Employees and Volunteers: We are

customers to one another Regulatory Agencies: They inspect our every

activity Vendors: They bring us the latest products to

provide care The Public: We are 24-hour-a-day

ambassadors/advertisers of our service

Bay Pride: C.A.R.E.

At Bay Regional Medical Center and Bay Special Care Hospital, we live our commitment to customer service by taking PRIDE in everything we do.

The philosophy of Bay Pride is embodied in the word CARE

C.A.R.E. Communication

Attitude Responsibility Expectations

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

CommunicationCommunicate relevant information

understandably and effectively Use Plain Language Answer the telephone professionally within 3 rings

Subsidiary name Your name How may I help you?

Introduce yourself and your role Engage your patient in discussions/conversations Escort your customers to their destination (No Pointing)

Attitude Treat everyone as if he or she is the

most important person in our facility Always demonstrate a positive attitude Smile; make eye contact Maintain patient dignity Do whatever it takes Leave your personal problems at home Be approachable

Responsibility

We are all responsible for our own behavior, appearance and professionalism

Be dependable Take pride in your job and work

environment Make it your responsibility

Expectations

Exceed Customer Expectations It’s all about the customer; not us Use key words at key times

(Scripting) We must earn customer

compliments, not complaints Respond quickly

Expectations of you in your role as a student

Consistent Communication Use Scripting Effectively

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

Scripts

When leaving a patient’s room, ask “Is there anything else I can do for you before I leave?”

  When performing duties that may

compromise a patient’s privacy or dignity, offer to help by saying, “I am going to close this curtain (door), to help maintain your privacy.”

 

Scripts

When entering an elevator, allow patients to enter with their caregivers first, and ask if you may ride along. If a patient is on a gurney, wait for the next car.

When riding on an elevator, make sure to include the patient and/or visitors in conversation.

If a customer appears confused or needs assistance, offer to help by asking, “May I help you?”

Scripting Scripting isn’t intended to turn us into

robots. Scripts are encouraged because they make our jobs easier, and customers are more likely to remember their experience positively.

  Use the scripts. Make them part of your

normal workday.

You’ll find that consistent communication from person to person, department to department, will help to create an atmosphere of trust and safety.

When Things Go Wrong:Service RecoveryDespite our best efforts, lapses in service

can occur. When customers are unhappy we need to fix it … fast.

We’ve developed a process to make Service Recovery a bit easier, but especially to make it consistent across the organization:

HEART Hear, Empathize, Apologize, Respond &

Thank

H.E.A.R.T.H: Hear

E: Empathize A: Apologize R: Respond

T: ThankService Recovery is the process of regaining

customer confidence after a service failure. It isn’t difficult to remember the process, but it can be difficult to approach angry or upset patients, families, physicians, or fellow employees.

“Grey Chart” If a patient has a grey chart, it means

that something has occurred where we did not meet a customers’ expectations and they are unhappy.

Look on the inside of the cover of the chart and it will describe the situation (i.e. the patient had to wait in the ED for several hours for a monitored bed,test or procedure cancelled.)

Acknowledge the event using H.E.A.R.T.

Dress Code Administration Policy # 212.00

Key Points Jewelry: maximum of 3 earrings per ear NO VISIBLE body piercing Rings: 2 out of 10 fingers may have rings Tattoos MUST be covered No artificial nails. Real nails; moderate

length and light polish No more than light odor from perfume, after

shave. Cigarette smoke odor is not acceptable.

Bracelets: no large, porous or charm bracelets

Parking Although parking spaces for employees and

students can be occasionally difficult to locate, it is not permitted to park in areas designated for our patients and visitors.  

If you have questions about where to park, please check with your instructor, any BRMC employee, or refer to the signs at the parking lot entrances.

  Students who park in spaces reserved for

others may be removed from BRMC and not able to complete their clinical assignment

Security AlertWhen you feel you are personally in

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

 

Suspected Practitioner Impairment or Disruptive Behavior

It is a requirement that each patient and every employee of BRMC have a hospital environment that is non-threatening. (Medical Staff By-Laws 3.1-9 Professional Conduct)

If you have reasonable suspicion that a practitioner may be impaired or is acting in a threatening manner you should report immediately to your instructor or Gay Showalter, 894-9518 making every effort to assure confidentiality

Search Warrant If you are presented with a search warrant ask to

see the agents ID and look at the search warrant Stay calm and call your instructor Call the emergency number 2-2-2-2-2 and ask for

the Corporate Compliance Office or Risk Manager. If they will not wait for until the supervisor arrives,

take them to the area designated on the search warrant. Do not destroy or conceal anything.

Do not discuss the raid with media, friends, family or co-workers ad you may become a witness.

Sexual Harassment Bay Regional Medical Center’s policy

(Human Resources Policy #12.00; Sexual Harassment in the Workplace) is that sexual harassment resulting in an intimidating, hostile, or offensive working environment is not permitted.

Any student with an allegation of sexual harassment should confidentially report the allegation to their instructor and Gay Showalter; 894-9518

Medical Error Reporting If you make, or discover a medical

error or potential error, including a medication error, Assure patient safety Report immediately to your instructor

and the RN responsible for your patient. Complete “Process Improvement” form;

include only facts, no “finger pointing”

Hazard Communication A master MSDS book is located in Risk

Management. MSDSs specific to each unit are kept in the department and are available 24hr/day/7days a week. Included in the MSDS sheet is Name of chemicals used in the area Type of personal protective equipment

required when working with each chemical What to do in the event of a chemical spill The meaning of any labels placed on chemical

containers

Defective Equipment If any equipment you are using is

defective you need to Assure patient safety and notify instructor

and RN responsible for patient if necessary Take defective equipment out of service

Place defective sticker on equipment indicating type of malfunction

Do not place defective equipment “back where you got it”

Documentation At BRMC we use 3 components to

our documentation: Flow sheet Integrated Plan of Care (IPC) Narrative “Nursing Notes”

Documentation: Flowsheet The flow sheet is located at the

patient’s bedside If you are caring for that patient you

need to document on the flow sheet. Findings need to be validated with your instructor and RN responsible for your patient

Documentation All nursing students will be responsible for

documenting on the flowsheet RN students should complete IPC and

narrative nursing notes (DAR format) after approval of instructor

LPN students will only document on the IPC and Narrative Notes in the event of an “out of the ordinary” event that requires immediate documentation of situation

Documentation : IPC Every patient will have an IPC that

is diagnosis specific: (i.e. CHF) The IPC guides nursing care:

Nursing Actions Patient Outcomes The student will make sure that RN

that is responsible for that patient is aware of information that is documented on flowsheet, IPC and narrative notes

SBAR Communication Any time care is handed off from

one provider to the next, change of shift, transfers, breaks & lunch, etc. you must use the SBAR format. S: situation B: background A: assessment R: recommendation or request

Report can be written or verbal

IMPORTANT You must also attend one of the “on-

site” orientations at Bay Regional Medical Center Thursday, September 3, 2009; 1500 -

1900 or

Friday, September 4, 2009; 0800 - 1200 Orientation will be held at the Lincoln

Center, 820 S. Lincoln Ave.

You have one last step to complete the additional training material for Bay Regional Medical Center.

Follow the hyperlink below to register completion of the additional training material. You must complete this step in the passport process.

By continuing, I agree to have read the training material provided by Bay Regional Medical Center.

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Document Completion of Additional Training Material