1

PARK RIDGE HEALTH (PRH) STUDENT ORIENTATION

Welcome to Park Ridge Health!

Customer Service is our main priority at Park Ridge Health

Mission of Park Ridge HealthOur mission is to provide professional health care in an atmosphere of Christian healing and compassion.

We value the safety of our patients and their family protecting them emotionally, physically and confidentially as if they were our own family.

We are committed to providing excellent care and hope to exceed the expectations, physically, emotionally and spiritually of our patients and families.

Accessing PRH Policies

Students may access any of the PRH policies at any computer on the nursing units.

1. Click on Internet Explorer

2. Click on Forms & Policies on PRH ARC

Note: Location to find Material Safety Data Sheets if you accidently spill a chemical or come in contact with a chemical. It gives information for first aid treatment as well as follow up treatment required.

2

NATIONAL PATIENT SAFETY GOALS

*GOAL: Improve the accuracy of patient identification When giving medications, administering blood, taking blood samples and other specimens,

providing treatments or procedures – use patient’s name and birth date to identify the correct patient.

Specimen containers are to be labeled while in the presence of the patient.

*GOAL: Improve the effectiveness of communication among caregivers All verbal orders, telephone orders or reporting critical test results, must be “read-back” or “RB”

documented by the physician’s order. -Associates/Students must comply with PRH “Do Not Use List of Abbreviations” when

documenting or taking orders. See list below for abbreviations not allowed at PRH.QD QOD QID U IUMS MS04 MgS04 Per os QNTAC TIW BT Trailing zero

(e.g. 2.0 mg)Leading decimal

point (e.g. 0.1 mg) Critical test results and values will be reported in a timely manner (within one hour). Refer to

PRH Interdisciplinary policy: Critical Values and Test Results” for further information. Use a “Hand off” communication method when giving report to allow opportunity to ask and

respond to questions-Nursing is using the SBAR (e.g. Situation, Background, Assessment, Recommendation) format and patient’s ClinPic in Cerner.

*GOAL: Improve the safety of using medications Pharmacy has standardized and limited the number of drug concentrations available on clinical

units. Pharmacy has identified and reviews annually list of look-alike/sound-alike drugs & takes action

to prevent errors. This list is posted in medication dispensing rooms. All medications, medication containers (syringes, medicine cups, and basins), or other solutions

on and off the sterile field must be labeled if not immediately administered. Labeled medication to include: medication name, strength, quantity, diluents/volume (if not apparent), expiration date/time

PRH has a program to reduce the likelihood of patient harm associated with the use of anticoagulation therapy. This involves using standardized order sets, pharmacy reviewing lab work of patients on anticoagulant therapy, nursing and dieticians educating patients on medications and nutrition.

*GOAL: Reduce the risk of health care-associated infections Associates and students are to comply with current CDC hand hygiene guidelines taking 15 to

20 seconds to perform hand hygiene when using alcohol based products and soap and water. Comply with posted isolation signs posted on door frames to patient rooms. All unanticipated death or major permanent loss of function associated with health care-

associated infections are to be reported as sentinel events. PRH has implemented evidence-based practices to prevent health care associated infections

due to multidrug resistant organisms. PRH has implement evidence-based practices to prevent central line-associated bloodstream

infections (e.g. catheter insertion checklist, using maximum sterile barrier precautions, disinfecting catheter hubs, removing central lines as soon as possible)

Sample of Patient ID at PRH

Patient’s name

Patient’s birth date

3

PRH has implemented best practices for preventing surgical site infections by using antibiotics prophylactically, use clippers for hair removal, and educate patients/families on surgical site infection prevention.

*GOAL: Accurately and completely reconcile medications across the continuum of care A complete list of patient’s current medications is made upon admission. A complete list of the patient’s medication is communicated to the next provider of service on

referral or transferred to another setting, service, practitioner, or level of care within or outside the organization and also on discharge.

*GOAL: Reduce the risk of patient harm resulting from falls PRH has a fall reduction program and need associates and students to assist in this program

(refer to PRH Nursing policy: Fall Prevention for further information) Patients are assessed on admission and every shift using the Morse Fall Risk Assessment tool.

If patient has a moderate to high risk of fall, the yellow Fall Risk arm band is applied to alert all staff and students. See below. Measures such as double sided nonskid socks to be applied, making sure bed is in the low position and wheels are locked, personal care items are in close reach of patient, and items that may cause falls in patient’s rooms or hallways are removed.

Remind patients/families to call for assistance to get out of bed for those patients at risk for falls.

*GOAL: Encourage patients’ active involvement in their own care as a patient safety strategy. PRH is educating patients and their families on ways to preventing infections, preventing

surgical infections and safety. PRH encourages them to report any concerns about safety to any associate.

Methods used at PRH to address this include: instructed on admission, SHARE cards, surveys, discharge procedures, through PRH web site

*GOAL: The organization identifies safety risks inherent in its patient population. The organization identifies patients at risk for suicide. This is part of the behavioral health areas

process. In all others, once patient is identified as having behavioral health issues it is done as part of the nursing assessment and referrals are made as indicated. (Refer to PRH Nursing Policy: Suicide Prevention)

*GOAL: Improve recognition and response to changes in a patient’s condition Rapid Response Team can be called by any associate/student when a patient’s condition

appears to be worsening. To activate this team, dial 5555 on any telephone in PRH and request Rapid Response Team to ______ (room/area). The Rapid Response Team consists of an ICU RN and RT who have protocols they can follow and they communicate assessment of patient to the patient’s physician.

UNIVERSAL PROTOCOL

This refers to the preoperative verification process in place at PRH as below: Preprocedure verification-documents/equipment for procedure in place, correct patient

using 2 patient identifiers, review procedure and sites involving patient Licensed independent practitioner who is accountable for the procedure is responsible for

marking the operative site prior to surgery with his/her initials.

The falling star magnet means this patient has already fallen.

4

“Time out” is called immediately before a procedure/surgery is started to make sure the right patient and right procedure is being done for the patient and documented.

OTHER HEALTHCARE IMPROVEMENT PROGRAMS INSTITUTED AT PRH INCLUDE: Prevent Ventilator-Associated Pneumonia and Prevent Adverse Drug Events.

PRH SAFETY “ALERT” WRISTBANDS

Red colored band

Yellow colored band

Purple colored band

PARK RIDGE HEALTH EMERGENCY CODES

To activate all Codes at PRH, dial 5555 and tell the operator what Code needs to be announced over public paging system and location if indicated.

Code Amber This is any missing child/abduction. Search entire building for the child. If child cannot be found, 911 will be called to obtain help from authorities. Do not allow anyone to leave if possible. If person insists on leaving during this code, allow the person

to leave but note what they look like, wearing and what they are carrying. You may follow at a safe distance to see where the person goes or what vehicle they leave in that might help the authorities.

Protect the crime scene where the abduction may have occurred. Do not touch anything!

Code Apgar Key medical emergency personnel will respond for additional help needed for a delivery occurring

outside the labor and delivery area

Code Black – Refers to Severe Weather Alert Remove items from window edges. Close blinds. With warning announced, patients will be moved into hallways.

Code Blue To be called when a patient has stopped breathing and/or heart has stopped. Place patient head flat/raise bed/side rails down. Assist with CPR if BLS certified and requested. (Remember no mouth to mouth resuscitation.) Remember if a patient is showing signs of deterioration (e.g. ↓ blood pressure, ↓ respiratory rate or

trouble breathing, chest pain) a Rapid Response Team can be called by dialing 5555 and requesting “Rapid Response Team to _____ (room/area)”

If a patient has an allergy to anything-food, medicine, dust, grass, pet hair, anything, this band is to be applied to the patient’s arm.

When assessment indicates through the Morse Fall RiskAssessment that patient is at risk of falling or has fallen this band is to be applied to the patient’s arm. This indicates the patient needs assistance when walking or he/she may fall.

When a patient has a Do Not Resuscitate (DNR) order, this band is to be applied to the patient’s arm. This means the patient does not want CPR or to be intubated. Refer to PRH Administrative Policy/Do Not Resuscitate and Medical Order for Scope of Treatment (MOST) for proper procedure to apply DNR wristband.

5

Code Decon This is called when patient(s) contaminated by hazardous substances, including chemical, or biological

agents, come to the hospital. These patients need to be told to go back out the entrance they came in and go to the ER.

Only designated, trained Decon Team members respond to this Code.

Code i This is when Cerner (PRH computer documentation system) is down.

o Do not chart in the system until you hear “Code i all Clear”. Downtime policy located on PRH arc is to be followed for when this happens.

Code Orange-Bomb Threat If a person calls in a bomb threat to the hospital and you answer, listen to what everything person says

paying attention to voice and background noise if possible. Do not place caller on hold. Write note to associate that you have a bomb threat called in. The associate is to call 5555 to

announce Code Orange. Search area. Report anything suspicious to charge nurse or supervisor but do not touch or move

anything.

Code Pink – Infant Abduction occurred in Obstetrics area Do not allow anyone to leave if possible. If person insists on leaving during this code, allow the person

to leave but note what they look like, wearing and what they are carrying. You may follow at a safe distance to see where the person goes or what vehicle they leave in that might help the authorities

Search entire building for the infant.

Code Red - FireR=Remove patient from immediate dangerA=Activate the nearest fire AlarmC=Confine or contain fire by closing the doorE=Evacuate when instructed by charge nurse or supervisor

FIRE EXTINGUISHERS AT PRH Can put out all types of fires but only very small fires such as fire in trash cans To operate

P-Pull the pin A-Aim the hose at the base of the fire S-Squeeze the handle S-Sweep the hose from side to side

Code Search means missing vulnerable adult (e.g. elderly, disabled, confused) Search everywhere in the building. If patient cannot be located, the nurse in charge of the area shall notify administration. Notify Security. Refer to Emergency Preparedness (EOC) plans located on PRH ARC

Code Silver means there is a hostage situation Try to stay calm. Only talk when asked. Try to remove ID badge etc.

Code Strong Use in event that an associate/student feels threatened by patient and/or visitor. Associates who have completed a Crisis Prevention Institute course will respond.

6

Code Yellow is called when a Disaster has occurred requiring additional help Stay in the area you are in until otherwise asked by the charge nurse or your instructor to report to

some other area/unit. You may be asked to help in the event of a disaster.

EMERGENCY PREPAREDNESS PLAN

PRH Emergency Preparedness (EOC) Plan is located on PRH ARC. Plan delineates specific responses to emergency situations.There are specific Incident Plans (e.g. responses to specific disasters such as bomb threat, power loss).Job Action Sheets are provided for different incident plans to give personnel guidance on what to do.Plan also contains helpful information such as telephone numbers of goods and services.Staff called in to hospital for a disaster or emergency or extra staff to report to the PRH cafeteria.

BLOOD/BLOOD PRODUCTS ADMINISTRATION

Nursing Students may not assist in this procedure. They may only observe the process.

MEDICATION ADMINISTRATION

Nursing Students may only administer medications under the supervision of their school instructor or PRH RN precepting the student. Refer to the Nursing Policy/Medication Administration on PRH intranet for details. Nursing Students may not administer any chemotherapy medications.

DISPOSAL OF MEDICATIONS

Park Ridge Hospital (PRH) is dedicated to protecting the environment for staff, community and future generation. One way is ensuring the proper disposal of pharmaceutical and hazardous waste. Areas throughout the hospital have signs posted to help assist staff and students to be compliant in this program. These signs address specific waste containers and items that are to be disposed of in these containers.

Emergency Plan can be accessed by clicking here on Emergency

Preparedness (EOC).

7

Remember any sharps, glass ampoules, and syringes (with medication or empty) are disposed of in the sharps containers.

SAFETY

Diagnostic Imaging staff will ensure students wear the proper leaded protective gear when indicated.

Electrical safety Report any electrical hazard noted to nurse in charge (e.g. broken fray, cords). A work order is sent via the intranet to the engineering dept and a copy attached to the

equipment that is malfunctioning or not working. Red outlets are for emergency power.

ERGONOMICS

Remember to do the following to protect your back:Use good posture at work.Don’t lean over work.Wear comfortable/well supported shoes.Lift with legs, bend at knees and not at back.Hold load close to body.Use two or more people and/or equipment to assist in transferring or moving patients.

I

8

NFECTION CONTROL

Clothing contaminated with blood or body fluid must be placed in a red bag, labeled with student’s name, school, and sent to Environmental Services. The clothing will be laundered. The student should check with Environmental Services for retrieval of clean clothing.

Do not recap needles. All safety engineered devices are to be activated prior to discarding. Dispose all sharps and syringes in the needle boxes provided on units/patient’s rooms. If injured by a sharp, report to instructor/charge nurse. There is a Hospital Exposure packet with information located on Associate Health Section of HR website for instructor/charge nurse and student to complete.

Isolation & Infection Prevention Control Information Red labeled Isolation binders are located on each unit with Centers for Disease Control (CDC)

information on illnesses and types of isolation precautions patients are to be placed in. Isolation signs are in the isolation binders and boxes on the nursing units. Obey signs posted on door frames for patients in isolation. Notify receiving area of patient’s isolation precaution needs (e.g. PPE) prior to transport of the

patient to that area

Use standard precautions for the care of all patients which includes wearing all the required personal protective equipment (PPE) such as gowns, gloves, and masks necessary to care for that specific patient.

HAND HYGIENE

Alcohol hand rub products provided can be used between patients.Must use soap/water for:

Caring for a patient with Clostridium difficle (C. diff) When hands are visibly dirty Before eating, drinking, and after using the bathroom Suggested after every 10 uses of our alcohol hand rub products

AIRBORNE INFECTION PRECAUTIONS

This is used for organisms transmitted on normal air currents (e.g. measles, chicken pox, TB, SARS, Avian Flu). These patients are:

Placed in negative airflow room. All staff entering must wear N95 mask. Staff enter the room via Anteroom, if available

Students will not be taking care of these patients.When a TB patient is taken out of the negative airflow room for procedures, they need to wear surgical mask.

CONTACT PRECAUTIONS

Patient with methicillin resistant staph aureus (MRSA), vancomycin resistance enterococus (VRE), Clostridiumdifficile (C. diff) infections are placed on contact precautions.

Gloves and gowns are to be worn when entering the room.

CLOSTRIDIUM DIFFICILE (C. diff)

There will be a separate contact precautions isolation sign for this (brown bar is on the sign).

Hand hygiene must be only performed with soap and water. A universal red symbol for NO is placed on the alcohol dispenser to remind staff not to use this

for hand hygiene.

9

DROPLET PRECAUTIONS

This precaution is put in place to protect from the spread of illness where germs are propelled through the air for short (3-6 feet) distances (e.g. influenza, mumps, meningitis).

Required PPE is a mask with a face shield or a mask and goggles.The required PPE for some diseases in this category (e.g. influenza) may change depending on current situations (e.g. pandemic flu, unusual strain or transmission capabilities).

CONFIDENTIALITY OF PATIENT INFORMATION

The Health Insurance Portability & Accountability Act (HIPPA) is a federal regulation that guarantees patients a right to privacy and a right to access their protected health information

You are only allowed to access, discuss, and/or release patient information if you are: directly involved in the patient’s care or need the information to perform your job. You may discuss patient information with your instructor.

Personal cameras and camera cell phones may not be utilized to take photographs of the workplace, patients, staff, or visitors without the express written authorization of the person(s) being photographed.

Personal cell phones may not be used during working time or in working areas of this facility except in response to a facility or personal emergency. You may use personal cell phones before coming onto the unit or after leaving the unit, during authorized breaks and during meal periods.

HIPPA HINTS:Do not discuss patient information in public place.Shred all documentation that includes Protected Health Information (patient name, date of birth, SS#, address).Do not share information with family over phone unless you know who you are speaking with.You may share information with family members who are involved in the patient’s care unless the patient has requested otherwise.If patient does not want information to be shared with certain people, must complete restrictions form (located on PRH intranet). Completed form sent to Privacy Officer-Mike Payne (650-6965).

PRIVACY OFFICERReport all violations regarding HIPPA to the Privacy Officer – Mike Payne (650-6965) or to the Compliance Hotline 888-924-8433.

EMERGENCY MEDICAL TREATMENT & ACTIVE LABOR ACT (EMTALA)

We must provide a medical screening to anyone who comes to us requesting an emergency medical evaluation. We must complete a transfer form for any patient going to another facility.

INTERPRETER SERVICES

The Language Line using a speaker phone is available to interpreter services.

PATIENT SAFETY/CARE ISSUES

If an unexpected event happens to patient, visitor, or employee (e.g. fall, lost property, injuries, medication error), complete Medication Error/Occurrence Reporting Form on PRH ARC.

10

Remember to provide appropriate treatment or removing safety hazards as indicated. Notify nurse in charge of patient, instructor, and manager of the occurrence.

If occurrence involves a patient, document in patient’s chart what happened, notification of physician if applicable, treatment, and patient’s response.

Do not chart in patient’s chart, Occurrence Report completed.

PATENT ABUSE OR NEGLECT

Categories of abuse and neglect include: Abuse or neglect of children Abuse or neglect of disabled adults, including disabled elderly adults Physical assault Rape or other sexual molestation Domestic abuse

Injuries or behaviors that may indicate possible violence or abuse include: Burns Bruises Human bites marks Repeated injuries Injuries in shape of weapon Fear

NC LAW MANDATES REPORTING OF THE FOLLOWING:

Known or suspected abuse or neglect of childrenKnown or suspected abuse or neglect of disabled adultsCertain categories of wounds, injuries, or illnesses.If you suspect abuse, please inform Charge Nurse on the Unit or Nurse in charge of patient. Refer to PRH Administrative Policy “Abuse, Caring for Possible Victims” for more information.

RESTRAINTS

Restraints shall be used only after alternative methods have not been effective.Restraints are items that prevent or hinder movement of any part of the body.They can be physical-such as hand mitts, wrist or ankle straps, waist straps, or vest restraints.They can be chemical-drugs that control mood, mental condition or behavior such as tranquilizers, sedatives and antidepressants.

FIRST CONSIDER ALTERNATIVES Ask them what they need Offer comfort measures, repositioning

Location of Medication Error/Occurrence Reporting

Form on PRH ARC.

11

Provide client with an activity, TV, music Exercise-walk with patient Assess need for toileting Decrease noise level or lighting if it bothers them Make room changes to reduce risk of falls Place items within easy reach Use alarms, bed monitors, bed in low position Have family members stay with patient

TYPES OF RESTRAINTSMedical/Surgical restraint is used to limit mobility temporarily.Behavioral restraint is used for behavioral management in an emergency or crisis situation for violent and aggressive behavior.Chemical restraint is a drug used for the emergency control of behavior.

WHEN ALL ELSE FAILS – APPROPRIATE APPLICATION OF RESTRAINTS IS REQUIRED Lap belts should be applied snugly, but not interfere with breathing. You should be able to pass your

hand between the device and the patient’s waist. Wrist restraints should be applied snugly, allowing enough room to slide your fingers between the

restraint and wrist. Straps should be tied with a slip knot tie (for quick release) to a moveable part of the bed, but not to the

side rails. Remember all 4 side rails up on a patient’s bed are considered a restraint.

RECOGNIZE SIGNS OF PATIENT DISTRESS WHEN IN A RESTRAINT Physical Signs

Difficulty breathing-heavy, too fast or too slowSkin color-blue color to face and/or extremitiesSweating-pale color to face and/or extremitiesRestlessnessSkin tears, redness or abrasions at areas where restraints are applied

Psychological SignsIncreased confusion Increased anxiousness or agitation Increased restlessness

RESPONDING TO SIGNS OF DISTRESSIf client is having difficulty breathing-stay with patient, remain calm, and call the nurse.If client is restless or agitated-stay with patient, remain calm, and call the nurse.If extremities (hands) are blue or pale-loosen restraints and call the nurse.If patient is trying to get out of bed and has a restraint on, stay with the patient, call the nurse.If patient is caught up in restraints or side rails, assist to a safer position, stay with patient and call the nurse.

PATIENT SAFETY/CARE ISSUES

Informed Consents Must be completed and signed before an invasive procedure and before blood administration. See Administrative Policy “Informed Consent” located on the PRH intranet in policies under

Forms & Policies tab Students are not allowed to sign any consents as a witness.

Patients are given a copy of the “Patients Rights and Responsibilities” on admission and it is posted in different areas throughout the hospital.Only Case Managers, the Administrator on Call, the Marketing Director, and the President or his designee are authorized to talk to the media.

12

MISCELLANEOUS

Students are to wear the required school uniforms and the name badge provided by the school.

If coming to hospital the evening before clinical to obtain patient assignment and to review chart per school directions, the student must wear the required school uniform or lab coat with the school name badge. Always report to the charge nurse first prior to accessing patient information, etc.

No Smoking allowed in hospital or on property for our staff and students.

Students are to park in the parking lot located at the front of the hospital nearest to Naples Road.

We hope this information is helpful to your experience here at PRH.

Please complete the following quiz (page 13) and return it to your instructor.2011-2012 PRH Student Orientation Quiz

13

2011-2012 PRH Student Orientation QuizAnswer the following questions. Sign and date on the bottom of this form. Once completed, return this quiz to your instructor.

1. What are the two patient identifiers used at PRH when administering medications or obtaining aspecimen._________________________________________________________

2. You may document QD and QOD in a patient’s chart at PRH. True or False

3. You can perform hand hygiene with alcohol based hand rub or gel wipes when you’ve been in contact with blood or body fluids. True or False

4. Hand hygiene should be performed for ___________ seconds.

5. You find a patient not breathing lying in bed. What telephone number do you dial from the patient’s room to announce the code needed to get the appropriate people to respond to this emergency?________________.

6. What Code would you request for the patient situation addressed in #5? __________________

7. What is the name of the Code that is announced over the public address system that means Cerner is down and no further documentation in Cerner system is allowed?__________________

8. What is the Code announced over the public address system for a child missing from the medical surgical unit? ____________

9. What is the Code announced over the public address system for a vulnerable adult that is missing from a unit? ____________

10. What is the Code you can request to receive additional help when you feel threatened by a person or patient in the hospital? ______________________

11. All the following will decrease the risk for a back injury EXCEPT:a. Keeping the load as close to your body as possible.b. Bending over at waist to lift.c. Getting assistance when the load is too heavy.

d. Pushing rather than pulling whenever possible

12. What do the following letters mean when responding to fire in a patient’s hospital? R_____________________________________ A___________________________________ C_____________________________________ E___________________________________

13. You are required wear your ID badge at all times when at PRH as a student. True or False

14. North Carolina state law mandates reporting of all the following categories of abuse and/or neglect EXCEPT?a. Childrenb. Disabled adults

c. Certain categories of wounds, infections d. Domestic violence

15. When patients are placed in wrist restraints, the straps should be tied using a quick release knot/tie tothe moveable part of the bed but not to the side rails. True or False

I have read the PRH Student Orientation educational material and completed this quiz. ____________________________________ _________________________________________

Print Signature Sign Signature Date

I have reviewed this quiz and shared any corrections with the student.

____________________________________ ____________________________ _______________HR/Instructor School (if applicable) Date