HOSPITAL ORIENTATION 2010 June 22, 2010 Center for Health and Healing.
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Transcript of HOSPITAL ORIENTATION 2010 June 22, 2010 Center for Health and Healing.
HOSPITAL ORIENTATION 2010
June 22, 2010Center for Health and Healing
Dr. Donald Girard, Associate Dean of GME & CME
Dr. Andrea Cedfeldt, Assistant Dean for GME
Dr.Tana Grady-Weliky, Associate Dean of Undergraduate Medical Education
ACGME Core Competencies
Patient AdvocateSusan Yoder, RN, BSN
Director, Department of Patient RelationsAdministrator on Duty & Decedent Affairs
Manager
Patient Advocacy• Complaint Management• Mediation & Conflict Resolution• Accessing & Navigating Systems
Palliative Care Consult ServiceSpiritual Support – Chaplaincy ServicesMedical Ethics ConsultationCrisis Intervention & Debriefing for Staff
Department of Patient Relations
Administrator on Duty & Decedent Affairs
Administrator on Duty• Front Line Hospital Administration • “House Supervisor” (on steroids)• Patient Placement/Access Management• Bereavement & Requesting Organ/Tissue Donation• Conflict Resolution/Crisis Intervention • Resource to the Healthcare Team (policies, etc.)Decedent Affairs• Track documentation & location of deceased patient• Work with providers, staff, ME, Funeral Directors & Loved
Ones for a smooth, compassionate process
Contacts:
Patient Relations for an Advocate X4-7959Administrator on Duty (AOD) pager 12241 24X7Decedent Affairs Coordinator pager 12813
(covered by AOD after hours)Hospital Chaplain – Campus Operator
Susan Yoder pager 11405
Welcome to OHSU!
E*Value SystemChristine Flores
Evaluations and Time Keeping
Sleep Deprivation in Residency
Dr. Holger LinkSleep deprivation in residency
Epworth Scale
The Scope of the Problem
“… I always had a prior theory that when you look up all the old sixties research how do you brainwash someone? You sleep deprive them. That’s number, two, and three. Sleep deprive them. You feed them bad food and you repeat things over and over again. It’s like that kind of covers residency.”
© American Academy of Sleep Medicine
© American Academy of Sleep Medicine
American Academy of Sleep Medicine
Epworth Sleepiness Scale
Sleepiness in residents is equivalent to that found in patients with serious sleep disorders. Mustafa and Strohl, unpublished data. Papp, 2002
0
5
10
15
20
Mean 5.90 2.20 11.70 14.70 17.50
Normal InsomniaSleep Apnea
Residents Narcolepsy
Consequences of Insufficient Sleep
• Increased medical errors• Impaired judgment• Impaired learning• Impaired physical health• Impaired mood and energy• Drowsy driving
Adapting to Sleep Loss
• Sleep need is genetically determined
• You can’t “adapt” to getting less sleep than you need
• Performance may improve somewhat with effort
• You can not achieve optimal performance!
Recovering from Sleep Loss
• Recovery from on-call sleep loss generally takes at least 2 nights of extended sleep
• Most sleep debts can be paid off in 3-4 days!
Source: www.drowsydriving.org
Driving Home Post Call
Signs of Drowsy Driving
Trouble focusing on the road
Difficulty keeping your eyes open
Nodding
Yawning repeatedly
Drifting from your lane, missing signs or exits
Not remembering driving the last few miles
Closing your eyes at stoplights
Drowsy Driving:
What Doesn’t Work
Turning up the radio
Opening the car window
Chewing gum
Blowing cold air (water) on your face
Slapping (pinching) yourself hard
Promising yourself a reward for staying awake
4 second lapse = drowsy crash
Drive Smart and Safe
Do not drive drowsy!
Take a 10-20 minute nap and/or drink a cup of coffee before going home post-call
Stop driving if you notice the warning signs of sleepiness
Pull off the road at a safe place, take a short nap
Get ride home, take taxi, or use public transportation
Napping
Benefit: Temporarily improves alertness
Types: Preventative (pre-call)
Operational (on the job)
Length:
Short naps: no longer than 20 minutes to avoid grogginess Long naps: 2 hours (range 30 to 180 minutes). Be aware of sleep-inertia.
Caffeine
Strategic consumption is key
Effects within 15 – 30 minutes; half-life 3 to 7 hours
Use for temporary relief of sleepiness
Cons:
Disrupts subsequent sleep (more arousals)
Tolerance may develop
Diuretic effects
Library ServicesAndrew Hamilton
Overview of the Library
Library is here
OHSU Library
• You need one• Where you can get
one– Library circulation
desk– Online at
www.ohsu.edu/xd/education/library/services/forms/barcode.cfm
Barcode
The Library Home Pagewww.ohsu.edu/xd/education/library/
Online Catalog
Get access from off-campus
Get help
Databases
Electronic articles and journals are linked from within databases.
Databases may include their own links to full text, as well as the “Find It@OHSU Library” link.
3 different ways to get to the article
Manage your citations
What if we don’t have it?
Summit Catalog
• Includes 36 college and university libraries in Oregon and Washington
• You can request books, videos, CDs through Summit and they will be sent to the OHSU Library for you to pick up or will be sent directly to distance students
• Generally it takes less that 72 hours to get the book• 95,000 titles at OHSU; 9.2 million titles in Summit• IT’S FREE• More information at
www.ohsu.edu/library/orbiscascade.shtml
Ways to get help:•Ask a Librarian links•Chat•Email•Phone
Infection Prevention & Control Summer, 2010
Department of Infection Prevention & Control: Objectives
• How to contact our program• Review resources that will be helpful when
caring for patients• Review the OHSU isolation categories• Organism – specific guidelines• Employee Health topics
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Department of Infection Prevention & Control
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VA Medical Center Rita Tjoelker- 5-7143 Sherri Atherton-5-7144
Tom Ward, MD– Infectious Diseases
Phone: 494-6694 M-F 7:30AM - 5:00PM– Contact AOD after hours
• Physician Epidemiologists– John Townes, MD Adult Infectious Diseases– Judy Guzman-Cottrill, DO Pediatric Infectious Diseases– Lynne Strasfeld, MD Transplant Infectious Diseases
• Infection Control Program Manager– Marjorie Underwood RN, CIC
• Infection Control Specialists– Linda Young RN, MSN, CIC– Molly Hale MPH, CIC– Emily Ackiss MPH, CIC– Gail Carberry RN, MSN
The IC Isolation Grid as a Resource
35
Isolatable Infections & Conditions
36
De-isolation Grid
37
EPIC VRE Alert Screen
38
Back to Basics:Hand Hygiene
39
Cleaning your hands isthe most important thing you can do to prevent transmission of infection
Hand Hygiene
Interrupts the chain of disease transmission
• Antibacterial Soap & Water – Hand friction for 15 seconds
• Hand Sanitizer needs to dry
• Ensure all surfaces of hands, in between fingers & nail beds are cleaned
WHO: “5 Moments of Hand Hygiene”
Hands Visibly Dirty? Wash Your Hands with Soap and Water
Turn on faucet Wet your hands with warm
water Apply soap Scrub your hands for at
least 15 seconds Pay attention to fingernails
and areas around jewelry (rings and watches)
Dry hands completely with a paper towel
Use a paper towel to turn off faucet
Hands Not Visibly Dirty? Use alcohol-based waterless product
Apply enough to cover all surfaces of the hands, rub until dry, about 15 seconds.
Resident Hand Hygiene Compliance
45
How do Residents Compare With Others?
46
Standard Precautions: Protect Yourself!
• 100% compliance with hand hygiene• Gloves if touching non-intact skin or rash,
any body fluid or mucous membrane• Gown if you may get it on you• Mask/face protection if you may get
sprayed or splashed in the face
…Think about it before it happens!
Remember - if it is wet and it is not yours- use a barrier!
Standard PrecautionsDetails you might not know…
• During aerosol generating procedures (bronchs, suctioning, intubation, nasal wash, NP cx, etc.) use face shield or mask & goggles
• If pulmonary TB or other diseases requiring airborne isolation is suspected, wear a fit-tested N95 masks or PAPR
• Wear masks for spinal procedures (myelograms, LPs, spinal or epidural anesthesia)
Respiratory Hygiene & Cough Etiquette
• YOU and your patients should follow these rules!
• Wash hands after coughing and using tissue
• Wear mask/eye protection if close to coughing patient (if contagious disease is suspected, patient should be in private room)
• Provide patients with tissues, instruct them to cover their coughs, have hand sanitizer available
Isolation Precautions (In addition to Standard Precautions)
1. Contact Precautions2. Modified Contact Precautions3. Droplet Precautions4. Airborne Precautions
Isolation categories may be used in combination, if needed – Example: Chickenpox (airborne + contact)
51
Contact PrecautionsExamples
– Diarrhea - if incontinent, diapered, or contaminating the room
– Norovirus until 72 hours after lastdiarrhea episode
– Multi-drug resistant organisms (MDRO)– Draining wounds or body substances not contained– Nasty rashes that may be contagious
• Scabies, secondary syphilis
MRSA and VRE & Other Multi-drug Resistant Organisms (MDRO)
• For colonized and actively infected pts• Contact Precautions
– You must wear gloves and gowns every time you go into the patient room
– Even if you are not touching patient or environment!
• Patient’s room & equipment contaminated• Hand Hygiene after gloves come off
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“De-isolation” for MDRO
• Usually occurs in the ambulatory setting, because patient must be clinically well
• Rule of 3’s:– 3 months since last positive result (cx or PCR)– Must be off abx for 3 weeks– Obtain 3 screening tests 1 week apart
• Contact Infection Control Dept for additional guidance or for EPIC alert screen removal
54
Modified Contact Precautions
• Same as Contact Precautions with the exception that traditional handwashing with antimicrobial soap and water must be used
• NO hand sanitizer• Use for patients with positive, symptomatic C.
difficile diarrhea or high clinical index of suspicion • Isolate until Rx complete and 72 hr symptom free• Rooms cleaned with bleach to kill C. diff spore
Droplet Precautions
• Used for pts known or suspected to be colonized or infected with microorganisms transmitted by large-particle respiratory droplets
• Conditions that may require Droplet Precautions– Any symptomatic respiratory viral illness, even if
pathogen unknown– Haemophilus influenza type b (Hib)– Meningococcal disease– Mumps– Pertussis (Whooping Cough)
Contact + Droplet Precautions
• When one set of precautions is not enough!• Conditions that may require Contact and
Droplet Precautions– Respiratory Syncytial Virus (RSV)– Adenovirus pneumonia– Parainfluenza– Influenza A &B– All pediatric bronchiolitis (even if culture negative)– All immunocompromised hosts with respiratory
viral infection
How do YOU take off YOUR gloves, mask and gown?
Airborne Precautions
• Small droplet nuclei stay suspended in the air for prolonged periods of time
• Room Requirements: – Private room– Negative pressure airflow with ante-room– Doors always closed except for entry/exit
• Personal Protective Equipment:– Fit-tested N-95 Mask or PAPR
• Diseases requiring airborne precautions: – Pulmonary or laryngeal tuberculosis– Measles– Chicken Pox (Varicella) or disseminated zoster
N95 Respirator or PAPR
• A Fit Test is now required if you wear an N95 TB mask (orange duckbill)– Fit-check each time mask is put
on
• If you cannot or have not been fit tested for N95 mask:– Use a Powered Air Purifying Respirator
(PAPR) to enter a room with a patient who has active pulmonary TB
– Disinfect the PAPR on the inside of the hood and then on the outside in between use.
Tuberculosis
• Airborne Precautions in negative airflow room– Rule out pulmonary TB (work up in progress)– Confirmed pulmonary TB– Laryngeal TB
• Patients need to be restricted to their rooms other than medically necessary procedures (no smoking!)
• OR cases- Should be the last case of day, unless emergent
• Discontinue Isolation– 3 negative AFB-smear sputum samples– ADEQUATE SPUTUM SAMPLES
Reportable Infections (Case Reporting to the Health Department)
• If disease confirmed by a lab test, OHSU lab automatically reports cases to the health department
• Clinicians required to report to county of patient’s residence for clinically suspected cases or culture-negative cases– Toxic shock syndrome, hemolytic uremic syndrome
• Call Infection Control Program for assistance
Spotlight on Infection Prevention:Central Line-Associated Bloodstream Infections(CLABSI)
• Evidence-based guidelines must be followed (CLABSI Bundle) every time
Hand hygiene Maximum sterile barrier precautions Chlorhexidine skin antisepsis Choosing best anatomical site for insertion Use of an Insertion Checklist Remove line ASAP
• Mandatory CLABSI Educational Module (Big Brain) for all house staff
• Rates are publicly reported in Oregon
Sani Cloth® Plus
• Use on computers: keyboard, mouse and screen
• Patient care equipment: wheelchair, gurney, BP cuff, stethoscope, etc.
• Use 2 wipes(1) Clean off debris, gross contaminants
(2) Disinfection• Allow 5 minutes to dry (“contact time”)
69
Avoiding Exposure to Bloodborne Pathogens
• Minimize or eliminate splash, spray, splatter, and droplet/aerosol generation
• Do not bend or recap sharps or needles• Contain specimens during transport• Proper use/laundering of scrubs, etc• No food/drink near blood or other
potentially infectious material– No food/drink in patient care areas!!!
Protect Yourself!
Use Standard Precautions every time you care for a patient
or handle blood & other specimens
Safety goggles are available through
Logistics
What to do if you have a blood or body fluid exposure
1. Wash the area well with soap and water
2. Flush eyes well with water if splashed
3. Immediately report accident to your supervisor
4. Call Employee Health for low risk exposure advice Monday-Friday
5. Report to the Emergency Department for high risk exposures or those occurring after hours, or on weekends
6. Bring patient name, medical record number, and any known HIV risk factors
• Complete confidential and free baseline & follow up lab testing and counseling
2009 OHSU Bloodborne Pathogen Exposures
• 368 exposures in 2009– 150 hollow needles– 133 solid sharps– 78 splashes– 7 Bites & Scratches
• Source Patient– 2% HIV +– 16% HCV+– 0.3% HBV+
• No Conversions
Employee Health Program
• Main phone number is 4-5271• TST is required on hire and ANNUALLY• Exposure follow up
– Bloodborne pathogens– Communicable diseases
• Immunization history and vaccines– Annual Influenza vaccine– Tdap
INFECTION PREVENTION & CONTROLWe are here to assist you!
• Call us when you have questions or need clarification
• Call if a patient needs an MDRO alert screen placed
• We like to be involved earlier rather than later…
Phone: 4-6694Email: [email protected]
76
Interpreter ServicesSamia Saad
Resources and Legal Requirements
If you talk to a man in a language he understands, that
goes to his head. If you talk to him in his
language, that goes to his heart.
-Nelson Mandela
OHSUMedical Interpreter Services
Mission Statement
“Our goal as Medical Interpreters is to provide communication support for the healthcare professional and the patient. Our
support gives strength the interpersonal relationship between the hospital staff and the patient, and therefore enhances the
quality of patient care. We are committed to service excellence by our dedication to all parties who need our
services.”
OHSU Medical Interpreter Services
• MIS Department was established 30 years ago. It is located on OHSU campus.
• Interpreter Services Department serves all OHSU patients in all OHSU departments.
• MIS department serves all languages in person, via telephone, and video.
• Interpreter operation at OHSU is 24 hours a day, 7 days a week.
Why does OHSU Provide Medical Interpreters?
• Communication is the very heart of health care. It is a process that leads to the development of trust between a patient and a provider.
• Growing diversification of the U.S. population brings a necessity to provide equal access to health care for people who have limited English Proficiency (LEP) or the deaf and hearing impaired.
• It is the policy of OHSU to provide equal access and equal participation in health care activities for persons who are deaf or hearing impaired, and for persons with Limited English proficiency as governed by Title VI of the Civil Rights Act of 1964.
• All recipients of federal funds must comply with these requirements at no cost to the patient or to the healthcare professional. The function of a medical interpreter in this process is to facilitate the implementation of this policy.
Top 20 Languages used July 2009- Feb 2010
76%
10%
4%
3%
1%1%
1%
1%
1%
1%
1%
0%0%
0%
0%0%
0%0%
0%0%
Spanish Russian Vietnamese Cantonese Sign Language Mandarin Somalia
Arabic Korean Farsi Burmese Cambodian Bosnian Nepalese
Japanese Romanian Ukrainian Mien Laotian Kirundi
Who are the OHSU professional health care interpreters?
• OHSU Medical Interpreters are native speakers and linguist professionals. They have been certified by the OHSU Translation & Interpreter Dept as Medical interpreters after successfully passing a written and oral examination for medical interpreters developed and administered by the OHSU Translation & Interpreter Services Department.
• They are fluent and proficient in English and the target language• They possess vast knowledge of medical terminology • Medical Interpreters are professionally trained to interpret in consecutive
mode of interpretation and are able to do sight translations • They comply with The National Standards of Practices and The Code of
Ethics for Interpreters in Health Care, established in this industry
Scope of Service:
• Medical Interpreter Services is able to provide the following specific services:
• Telephone interpretation (about 80% of the total volume)
• Face-to-Face interpretation
• Videoconferencing (VIP) At CHH
• Limited translation services are available for discharge instructions, letters to patients, directions to the medical facilities and instructions on taking medications. Any complex or lengthy materials will be referred to the contract translation agency
• A selection of translated documents is available on the OHSU Translation Web Site at http://ozone.ohsu.edu/healthsystem/PED
OHSU MEDICAL INTERPRETER SERVICES
OHSU MEDICAL INTERPRETER SERVICES
Business hours are:
Monday through Friday
7:30am to 5:30pm
INTERPRETING SERVICES ARE AVAILABLE AT ALL TIMES, EVERY DAY 24 HOURS A DAY.
Our main telephone number is
503-494-2800 option 1
For scheduling
For interpreting and translation questions
For language competency exams
For any question pertaining to interpreting services
Direct telephone numbers to specific languages for phone interpreting:
Spanish is 503-494-8900
Russian is 503-494-8922
Vietnamese 503-494-8989
Chinese 503-494-4914
DURING BUSINESS HOURS WE COUNT ON:
1 Chinese interpreter
3 Russian interpreters
1 Vietnamese interpreter
11 Spanish interpreters
4 language agencies
AFTERHOURS:
Call OHSU Operators at 503-494-8311
They can connect you to any language interpreter for phone interpreting and assist you in getting a face to face interpreter if the need arises.
There is a Spanish interpreter at OHSU Monday to Friday until 11:30pm. On Saturdays, Sundays and Holidays, there is Spanish interpreter on campus from 8am to 6pm.
FOR FACE TO FACE INTERPRETING
Call the dispatcher at 503-494-2800 option 1
For clinic appointments:
Language indicator in Epic has to be present in RED. This automatically schedules a phone interpreter for all appointments.
We have to rely on phone interpreting because DEMAND FOR OUR SERVICES IS MUCH GREATER THAN INTERPRETER THE AVAILABILITY
While phone interpreting may seem less than ideal, our experience has shown that many encounters can successfully and effectively done with a phone interpreter.
Given our limitation of resources, we have to be very judicious about scheduling face to face interpreters, hence you will probably be asked why you need an interpreter in person versus by telephone
There are encounters are much more effectively done with a face to face interpreter
If in doubt, please call us
How to schedule interpreters?
Bilingual Assessment Tests for all OHSU employees
• MIS Department provides free bilingual assessment tests for all OHSU employees for all languages.
• The exam consists of a written part, and an oral part. Passing score should be at 80% or more for
both exams in order for employee to be certified by MIS.
• The exams were developed by MIS Department to enable employees to use their language skills with
patients or customers at OHSU.
• Bilingual exams available:
1. Professional Interpreters Exam (Employees who would work as Medical interpreters)
2. Language Proficiency for Medical Staff- Doctors, Nurses or any staff members who use medical terminology in their scope of work
3. Language Proficiency Exam for Non- Medical Staff- Registration people, case workers, schedulers etc.
Call Samia Saad, or Monica Serrano at 4-2800 to schedule time for the exam.
Testing are done between 8:30am and 3pm Monday-Friday.
Questions?
سؤال أيВопросы?
¿PREGUNTAS?
Safety/Environment of CareNina Wolf
Ben RichardsEnvironment of Care
The Joint Commission
Environment of Care
Standards in OHSU Hospitals and Clinics
Environment of CareCommittee
503/494-7795
Why?
Goal: “Provide a safe, functional, supportive, and effective environment for patients, staff, and visitors.”
Test:
What do you expect if YOU are a patient?
Patients are being taught to look for, and empowered to ask about safety issues.
General Safety
• Ergonomics – Adjustable furniture (including CIMs) and
assessment help• Incident Reports• Patient Lifting
– Page the Lift Team… ask your nurses• Tobacco Free Campus• Waste Handling
– Trash, Medical (Red Bags), Pathological, etc.
Hazardous Materials Safety
• Know what you are working with• Labels–Manufacturer containers–Secondary containers
• Material Safety Data Sheet (MSDS)• Spill Response Team
Personal Protective Equipment (PPE)
N95 – requires medical certification and fit test (annual event)
Use: whenever there is a potential or actual exposure risk
Limitations: soak through, single use, etc.
Types: mask, gloves, face mask, gown, lab coats (sometimes), eye protection, etc.
Fire Response
• RACE:– Rescue anyone in danger– Activate the Alarm– Confine the fire (close doors and windows)– Evacuate – if ordered
• Moving around– Avoid the elevators - Some are safe, but reserve them
for people who can’t use the stairs– You CAN go through fire doors…
just make sure they close after you– Move to another compartment
if instructed (marked by flame decal)• Listen for instructions from area leadership
Medical Equipment
• Train before use and document your training• Clinical Technology Services checks all equipment
prior to use around patients– Inspection and
Periodic Maintenance• Lasers, X-ray, Fluoroscopy, others
– Training? Tests? Badges? • Department specific requirements
• Cell phones and other devices– Settings can be changed when used close to
medical equipment• Malfunction? Clinical intervention & report!
Preventative Maintenance
Done _________ By ____________
Due __________ CE# ___________
Utility Problems
• What do you do?• Clinical intervention • Refer to Emergency Resource Book! to
call the right people
Emergency power: red plugs Critical equipment only
4-8054
Public Safety
• Photo Identification – always!• Security Sensitive Areas - ED, Pharmacy, Pediatric
areas, L&D, Mother Baby, inpatient psych, etc.
• Emergency? – 4-4444• “Dr. Strong”• Forensic Patients – orientation handout to
officers, safety considerations• Code Pink – your role• Clinical Violence Alert Symbol
Emergency Preparednessand Response
• Emergency Resource Books and Manuals• Prioritize your personal safety• Assess your area for safety hazards,
injuries, damage, utilities • Report to area supervisor• Defer to staff expertise• Incident Command System
– NOT normal operations
• Incident Information Hotline 503 494-9021
• Printed: ERBs, badge backers, yellow phone stickers, etc.
• OHSU Faculty, Staff & Students• Great O-Zone sites• Environmental Health & Radiation
Safety (4-7795)• Public Safety (4-7744)• : (4-4444)
Injury, Fire, Chemical Spill
Resources
15 Minute Break