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Restraint Policies There are two categories of restraints. In both cases, alternatives to restraint are to be tried or considered before restraints are applied. Goals/outcome of treatment: using the least restrictive method necessary to maintain patient/staff safety. Behavioral Restraint Management When a patient is a serious danger to himself or others: Physician must evaluate patient before or within 1 hr of restraint application. One hour “face to face” evaluations for behavioral restraints will be done by a “Qualified Psychiatric RN”. Behavioral Restraint Orders must be renewed every 4 orders for patients 18 and older, every 2 hours for patients 9-17 years and every hour for patients 8 and younger. Orders can be renewed verbally except once every 24 hours a MD/ARNP/PAC must write an in-person order. Monitoring required every 15 mins. for patients in behavioral restraints. (This is required for patients in restraint, seclusion or both restraint and seclusion. The need for a sitter is determined by the RN based on level of observation needed). Assessment and documentation frequency every 24 hrs as per the “Order Form”. Restraint Policies There are two categories of restraints. In both cases, alternatives to restraint are to be tried or considered before restraints are applied. Goals/outcome of treatment: using the least restrictive method necessary to maintain patient/staff safety. Behavioral Restraint Management When a patient is a serious danger to himself or others: Physician must evaluate patient before or within 1 hr of restraint application. One hour “face to face” evaluations for behavioral restraints will be done by a “Qualified Psychiatric RN”. Behavioral Restraint Orders must be renewed every 4 orders for patients 18 and older, every 2 hours for patients 9-17 years and every hour for patients 8 and younger. Orders can be renewed verbally except once every 24 hours a MD/ARNP/PAC must write an in-person order. Monitoring required every 15 mins. for patients in behavioral restraints. (This is required for patients in restraint, seclusion or both restraint and seclusion. The need for a sitter is determined by the RN based on level of observation needed). Assessment and documentation frequency every 24 hrs as per the “Order Form”. Release Criteria for Behavioral Restraint: Patient no longer a danger to self. Patient no longer a danger to others. Trial Release Intermittent releases will be used to evaluate if less restrictive measures are appropriate and/or restraints can be discontinued. Earthquake Emergency Procedures Drop - Take shelter under a table or desk. Seek cover against an interior wall. Cover - Protect your head and neck with your arms. Hold - Stay under cover until the shaking stops and it is safe to move. Medical Restraint Plan When a patient is cognitively impaired and has been attempting to remove lines/support equipment, or is a demonstrated fall risk. Medical Restraints do NOT require daily orders. Initial order only. Order restraints prior to application; if emergently placed, the restraint order must be obtained within 12 hrs. Assessment and documentation frequency every 24 hrs as per the “Order Form”. Fraud vs. Abuse Fraud is intentional violations. Abuse is a pattern of violations resulting from deliberate ignorance or reckless disregard for the rules. Criteria for Release: Pt. no longer drowsy or sedated. Tubes/devices no longer in place. Alert, oriented, following commands. Able to ambulate safely independently. Release Criteria for Behavioral Restraint: Patient no longer a danger to self. Patient no longer a danger to others. Trial Release Intermittent releases will be used to evaluate if less restrictive measures are appropriate and/or restraints can be discontinued. Medical Restraint Plan When a patient is cognitively impaired and has been attempting to remove lines/support equipment, or is a demonstrated fall risk. Medical Restraints do NOT require daily orders. Initial order only. Order restraints prior to application; if emergently placed, the restraint order must be obtained within 12 hrs. Assessment and documentation frequency every 24 hrs as per the “Order Form”. Criteria for Release: Pt. no longer drowsy or sedated. Tubes/devices no longer in place. Alert, oriented, following commands. Able to ambulate safely independently. Patient Confidentiality HMC follows HIPPA regulations. Patient charts/any patient information must be disposed of properly in confidential paper bins only, NOT waste/recycle. Chemical Spills Rescue patients, staff and visitors (if safe). Call Public Safety at 4-5555 and state “Code Orange”. Workplace Violence Stay calm Alert Public Safety at 4-5555 Go to a safe area Wait for Public Safety Earthquake Emergency Procedures Drop - Take shelter under a table or desk. Seek cover against an interior wall. Cover - Protect your head and neck with your arms. Hold - Stay under cover until the shaking stops and it is safe to move. Fraud vs. Abuse Fraud is intentional violations. Abuse is a pattern of violations resulting from deliberate ignorance or reckless disregard for the rules. Patient Confidentiality HMC follows HIPPA regulations. Patient charts/any patient information must be disposed of properly in confidential paper bins only, NOT waste/recycle. Chemical Spills Rescue patients, staff and visitors (if safe). Call Public Safety at 4-5555 and state “Code Orange”. Workplace Violence Stay calm Alert Public Safety at 4-5555 Go to a safe area Wait for Public Safety EMERGENCY PROCEDURES Fire Exercise R-A-C-E Procedures RESCUE ALARM CONTAIN EVACUATE Evacuation Plan Methods Lateral – Inpatient Patient Care Vertical in West Clinics, Harborview Hall, and most off campus buildings. Emergency Codes Bomb Threat (4-5555) Code BRAVO Cardiac/Respiratory Arrest (222) Code BLUE Cyber Disaster (3-7012) Code CYBER Evacuation (4-5555) Code ECHO Fire (4-5555) Code RED Hazardous Material Spill (4-5555) Code ORANGE Heightened State of Alert (check Email and/or 4-4636) Code ZEBRA High Census Management PURPLE LEVEL 1 or 2 Infant/Child Abduction (4-5555) Code AMBER External Disaster Code ‘External Triage + #of Injured ‘ Internal Disaster Code ‘Internal Triage + Location’ Lockdown/Police Activity (check Email) Code SILVER Medical Assistance (222) MEDICAL ASSISTANCE Out of control behavior (4-5555) Code GRAY EMERGENCY PROCEDURES Fire Exercise R-A-C-E Procedures RESCUE ALARM CONTAIN EVACUATE Evacuation Plan Methods Lateral – Inpatient Patient Care Vertical in West Clinics, Harborview Hall, and most off campus buildings. Emergency Codes Bomb Threat (4-5555) Code BRAVO Cardiac/Respiratory Arrest (222) Code BLUE Cyber Disaster (3-7012) Code CYBER Evacuation (4-5555) Code ECHO Fire (4-5555) Code RED Hazardous Material Spill (4-5555) Code ORANGE Heightened State of Alert (check Email and/or 4-4636) Code ZEBRA High Census Management PURPLE LEVEL 1 or 2 Infant/Child Abduction (4-5555) Code AMBER External Disaster Code ‘External Triage + #of Injured ‘ Internal Disaster Code ‘Internal Triage + Location’ Lockdown/Police Activity (check Email) Code SILVER Medical Assistance (222) MEDICAL ASSISTANCE Out of control behavior (4-5555) Code GRAY Reporting Exposures Report to your attending or nurse manager. Seek evaluation and prophylaxis through Employee Health Service (x3081) or Emergency Trauma Center. Compliance Compliance is HMC’s efforts to maximize our compliance with laws and regulations that apply to us in order to minimize risk of violations and penalties. Compliance is important because of a greater focus by the Federal government with new laws, enforcement and investigations. TB Exposure Early identification and isolation to prevent spread. PAPR’s are available at x3305. Training is required. Bloodborne Pathogens Prevention Strategies: Vaccination for Hepatitis B. Proper disposal of used needles and syringes in a sharps container, NOT in a waste can. Infection Control OSHA/WISHA Infection Control Training available on-line. The HMC Infection Control Manual is online: https://hmc.uwmedicine.org/BU/InfectionControl/Pages/InfectionControlManual. aspx HMC Pocket Reference Card Key Information for Medical Staff and Housestaff HMC Mission Statement Harborview Medical Center is a comprehensive health care facility dedicated to the control of illness and the promotion and restoration of health. Its primary mission is to provide and teach exemplary patient care and to provide health care for those patients King County is obligated to serve. Quick Help: Turn to Emergency Reference Guide Charge Nurse/Nurse Manager Medical Staff and Housestaff Orientation Manual https://hmc.uwmedicine.org/PolicyProcedure/Pages/PolicyH ome.aspx Key Phone Numbers Medical Director’s Office: 744-3134 Public Safety/Security: 744-5555-emergency/ 744-3193-routine Compliance: 543-3098/ 616-5248 Risk Management: 744-9570 Revised 02/2012 Reporting Exposures Report to your attending or nurse manager. Seek evaluation and prophylaxis through Employee Health Service (x3081) or Emergency Trauma Center. Compliance Compliance is HMC’s efforts to maximize our compliance with laws and regulations that apply to us in order to minimize risk of violations and penalties. Compliance is important because of a greater focus by the Federal government with new laws, enforcement and investigations. TB Exposure Early identification and isolation to prevent spread. PAPR’s are available at x3305. Training is required. Bloodborne Pathogens Prevention Strategies: Vaccination for Hepatitis B. Proper disposal of used needles and syringes in a sharps container, NOT in a waste can. Infection Control OSHA/WISHA Infection Control Training available on-line. The HMC Infection Control Manual is online: https://hmc.uwmedicine.org/BU/InfectionControl/Pages/InfectionControlManual. aspx HMC Pocket Reference Card Key Information for Medical Staff and Housestaff HMC Mission Statement Harborview Medical Center is a comprehensive health care facility dedicated to the control of illness and the promotion and restoration of health. Its primary mission is to provide and teach exemplary patient care and to provide health care for those patients King County is obligated to serve. Quick Help: Turn to Emergency Reference Guide Charge Nurse/Nurse Manager Medical Staff and Housestaff Orientation Manual https://hmc.uwmedicine.org/PolicyProcedure/Pages/PolicyH ome.aspx Key Phone Numbers Medical Director’s Office: 744-3134 Public Safety/Security: 744-5555-emergency/ 744-3193-routine Compliance: 543-3098/ 616-5248 Risk Management: 744-9570 Revised 02/2012