Download 05-Orientation Packet-Student Revised Nov_2011

ORIENTATION
Dear Instructor/Student:
As part of Sunrise Health Hospitals ongoing efforts to give you the best clinical
experience possible, the following information is provided for your review and
education:
Mission, Vision, Values
Cardiac/Respiratory Arrest
Patient/Family Education
Cultural Sensitivity/Diversity
Safety & Environment of Care
National Patient Safety Goals
Advance Directives
Ethics and Compliance Program/Code of Conduct
HCAHPS
Patient/Family Rights & Responsibilities
Patient Treatment/Classification/Limitation
Dress Code
No Smoking Policy
Patient Confidentiality/HIPAA
Hospital Policies
Infection Control
Age Specific Guidelines
Incident Reporting
Please remember that you are responsible to adhere to all safety regulations
established by the hospital. Thank you in advance for your cooperation.
Sincerely,
Barb Fraser, Director of Education – Sunrise Hospital / Sunrise Children’s Hospital
Karen Greenberg, Education Coordinator – Southern Hills Hospital
Louise Colwill, Education Coordinator – MountainView Hospital
(last updated 11/2011)
1
ORIENTATION
FOR
Students/Instructors
MountainView Hospital 3100 North Tenaya Way, Las Vegas, Nevada 89128
Phone: (702) 255-5000, www.MountainView-Hospital.com
Southern Hills Hospital 9300 West Sunset Rd., Las Vegas, Nevada 89148
Phone: (702) 880-2100, www.SouthernHillshospital.com
Sunrise Hospital / Sunrise Children’s Hospital:
3186 South Maryland Parkway, Las Vegas, Nevada 89109
Phone: (702) 731-8000, www.Sunrisehospital.com
2
Table of Contents
Welcome
Mission, Vision, Values
No Smoking Policy
Patient Confidentiality
Hospital Policies
Ethics and Compliance Program/Code of Conduct
HCAHPS
Dress Code Policy
Patient Safety Goals
Cardiac/Respiratory Arrest
Patient/Family Education
Incident Reporting
Safety / Environment of Care Procedures
Infection Control Standards
Transmission Based Precautions
Patient / Family Rights and Responsibilities
Advanced Directives
Patient Treatment/Classification/Limitation
Age Specific Guidelines
Cultural Sensitivity/Diversity
HIPAA Training
HIPAA Post Test
3
“WELCOME”
W
Wee aarree vveerryy hhaappppyy ttoo hhaavvee yyoouu jjooiinn oouurr tteeaam
m.. P
Plleeaassee rreeaadd
aallll tthhee m
maatteerriiaallss iinn tthhiiss ppaacckkeett..
MountainView
“MISSION”
Sunrise
“MISSION”
MountainView Hospital is
committed to the care and
improvement of human
life. In recognition of this
commitment, we strive to
deliver high quality, cost
effective healthcare in the
community we serve.
The mission of Sunrise
Hospital is to achieve an
unequaled level of
measurable quality in the
delivery of a continuum
of cost-effective,
integrated health care
services that are
responsive to the needs
of the patients,
physicians, employees
and community.
“VISION”
“VISION”
“Caring, Compassion,
Commitment.”
Sunrise Hospital sets the
standard of excellence
every day.
Southern Hills
“MISSION
&
VISION”
Our staff is committed to
the care and
improvement of human
life. In recognition of this
commitment, we strive to
deliver high quality, and
cost effective healthcare
in the community we
serve.
Sunrise Health Hospitals Values
 We recognize and affirm the unique and intrinsic
worth of each individual.
 We treat all those we serve with compassion and
kindness.
 We act with absolute honesty, integrity, and
fairness in the way we conduct our business and
the way we live our lives.
 We trust our colleagues as valuable members of
our health-care team and pledge to treat one
another with loyalty, respect, and dignity.
4
SMOKING POLICY
A.
Sunrise Health Hospitals have declared themselves a smoke-free organization in
order to protect the health of non-smokers and patients already at risk for medical
complications related to inhaling tobacco smoke and the use of tobacco products.
Therefore, it is the policy of our hospitals that smoking is prohibited in the facility.
B.
Please find the designated smoking areas for each facility.
PATIENT CONFIDENTIALITY
Confidential information about our patients is a valuable asset. Although you may use
confidential information to perform your job, it must not be shared with others outside of
the Sunrise Health System or other departments unless the individuals need to know this
information for the performance of his or her job duties. Confidential information includes
personnel data, patient lists and clinical information, pricing costs data, certain processes
and procedures, financial data, research data, employee lists and data, supplier and
subcontractor information, and proprietary computer software.
HOSPITAL POLICIES
Policies & Procedures are located on the hospital’s intranet site or linked to that site in
Meditech. At Southern Hills the Policies & Procedures are on the “S” drive on the
computer. It is your responsibility to become familiar with and follow hospital policies.
Should you have any questions, please ask the person in charge of the department/unit
you are working on.
5
ETHICS AND COMPLIANCE PROGRAM/CODE OF CONDUCT
Our Commitment to Ethical and Compliant Conduct
“We are committed to ethical and legal conduct that is compliant with all relevant
laws and regulations and to correcting wrongdoing wherever it may occur in the
organization.”
“Each colleague has an individual responsibility for reporting any activity by any
colleague, physician, subcontractor, or vendor that appears to violate applicable
laws, rules, regulations, accreditation standards, standards of medical practice,
Federal healthcare conditions of participation, or [the HCA] Code of Conduct.”
A Tradition of Caring, p. 32
Personal Obligation to Report
We rely on you to report potential misconduct so that we may take corrective action and
implement changes to prevent a similar violation from occurring.
If you report an issue that poses serious compliance risk and it appears nothing has been
done to address that risk, you must raise it to a higher level within your facility or to the
Corporate office.
Reporting Channels
Your Supervisor
Generally your supervisor is the best person to start with.
Human Resources (HR) Department
The HR Department is the best place to go for HR-related issues (e.g., payroll,
benefits or disciplinary issues).
Facility Ethics and Compliance Officer (ECO)
The ECO, who is a member of the management team, is familiar with a wide
variety of issues, particularly those involving ethics and compliance (e.g., gifts,
conflicts of interest, use of company resources).
The Ethics Line: 1-800-455-1996
If you are uncomfortable raising the issue at your facility or you otherwise prefer,
the Ethics Line is available toll-free, 24 hours a day, 7 days a week.
6
HCAHPS
Hospital Consumer Assessment of Healthcare Providers and
Systems (HCAHPS)
In the United States, in excess of 540,000 patients are cared for in hospitals each day.
Did each patient receive a high quality of care? Unfortunately, the patient and provider
often define "quality" differently: healthcare professionals are concerned with the
patient's clinical recovery and prognosis, while patients often relate their overall
"perceptions" and "experience." Although the goal of healthcare is "patient centered,"
many organizations have lost touch with the importance of patient perception and
satisfaction.
In 2008, the Centers for Medicare and Medicaid Services (CMS) required hospitals to
participate in Hospital Consumer Assessment of Healthcare Providers & Systems
(HCAHPS), a patient experience of care survey. Unlike internal surveys to improve care,
the results of HCAHPS will be published to allow consumers to compare hospitals.
Therefore, a patient's perceptions have the potential to influence the future survival and
growth of a hospital. Hospitals that are the most successful will be those that make the
patient the focus of care. Returning to patient-centered care is important, but may require
a change in the way providers think about their delivery of care. Specific issues that
patients find important are communication, cleanliness, medication management and
staff responsiveness.
What is HCAHPS?
A survey instrument developed by the Agency for Healthcare Research and Quality
(AHRQ) and CMS to provide a standardized methodology for measuring patients'
perspectives on hospital care. The goals of this survey are:
1) To produce comparable data on the patient's perspective on care that allows
objective and meaningful comparisons between hospitals on domains that are
important to consumers;
2) Public reporting of the survey results is designed to create incentives for hospitals
to improve their quality of care;
3) Public reporting will serve to enhance public accountability in health care by
increasing the transparency of the quality of hospital care provided in return for the
public investment.
7
The HCAHPS Hospital Survey is composed of 18 patient rating and patient perspectives
on care items that encompass seven key topics:
1) Communication with doctors
2) Communication with nurses
3) Responsiveness of hospital staff
4) Cleanliness and quietness of hospital environment
5) Pain management
6) Communication about medicines
7) Discharge information.
Additionally there are four screener questions and five demographic items, some of which
may be used for adjusting the mix of patients across hospitals and for analytical
purposes. The survey is 27 questions in length. The full survey is available in English,
Spanish and Chinese.
Why should we care if the patient is satisfied?
1. Because it is the right thing to do.
2. Because the healthcare consumer may choose their hospital based on the scores.
3. Because hospital reimbursement for services may soon be based on these scores.
4. Because managed care insurance companies may soon stop using hospitals with
poor scores.
Patient satisfaction data is an incentive for hospitals to improve their quality of care.
8
9
10
11
DRESS CODE POLICY
POLICY:
It is the policy of Sunrise Health Hospitals that students adhere to the dress
code policy of their learning institution at the time they are in the hospital as a student.
Attire should be clean, professional in appearance and properly fitting. Student Hospital
identification badges must be worn above the waistline, and be visible at all times.
12
2012 National Patient Safety Goals
Goal 1:
Improve the accuracy of patient identification
Use at least two patient identifiers when providing care, treatment or
services.
Intent is twofold:
o Identify the patient as the person for whom the service or
treatment is intended.
o Match the service or treatment to that individual.
At least two patient identifiers are used when doing the following:
o Administering medications or blood products.
o Collecting blood samples or other specimens for clinical testing.
o Providing other treatments or procedures.
Containers used for blood and other specimens are labeled in the
presence of the patient.
At Sunrise Hospital we use three patient identifiers, they are:
1. Patient name – you must ask the patient his/her name and compare their
response to their arm band.
2. Date of birth.
3. Medical Record # or Account #.
NOTE: Computerized electronic records including those utilized by interfaced/Bar coded medication
systems reference the patient’s Account Number as a unique patient identifier. These electronic systems
include: eMAR, AcuDose, Pharmacy Robot, MedDirect, Med Carousel and NarcStation. Pharmacy utilizes
the patient name and account number as the two patient identifiers in the medication preparation process.
Eliminate transfusion errors related to patient misidentification.
Example: Blood or Blood Component Transfusion
Before initiating blood or blood component transfusion:
o Match blood or component to the order.
o Match patient to blood or blood component.
o Use two-person verification process or a one-person verification
process accompanied by automated identification technology,
such as bar coding.
Two person verification process:
o One is the qualified transfusionist who will administer the blood or
blood component.
o Second individual is qualified to participate in process, as
determined by hospital.
Goal 2:
Improve the effectiveness of communication among
caregivers
Report Critical Results of tests and diagnostic procedures on a timely
basis.
 All verbal communication of a Critical Result/Test requires verification
read-back by the person receiving the result (now TJC standard).
 The read-back procedure utilized shall follow the hospital’s policy.
13
2012 National Patient Safety Goals
Goal 2:
Report Critical Results (continued)
– Verbal orders should only be taken in case of an emergency.
They are documented using VVO (verified verbal order) after
verification read-back.
– Telephone orders are documented using VTO (verified
telephone order) after verification read-back
If the Licensed Care Provider (LCP) receiving the Critical
Result/Test result is unable to act on the report, the ordering Physician is
to be notified by the LCP or designee within the hospital defined time of
the LCP receiving the Critical Result/Test report.
 If there has been no response to the initial call within the hospital defined
time, a second call will be placed to the Physician.
 If the LCP has not had a return call from the Physician, the LCP should
initiate chain of command for direction from administrative and medical
staff leadership (within the hospital defined time of the initial call to the
physician) or sooner, based on the clinical condition of the patient.
 If at any time the patient condition deteriorates, the LCP should initiate
chain of command or call a Rapid Response or call a Code Blue.
 The LCP notifying the Physician must document the Critical report given
(the date, time and the name of the person the report has been given to)
into Meditech, or as applicable on a hard copy form.
Goal 3:
Improve the safety of using medications
Label all medications, medication containers, and other solutions on
and off the sterile field in perioperative and other procedureal settings.
Note: Medication containers include syringes, medicine cups and basins.
The requirements are:
 In perioperative and other procedural settings both on and off the sterile
field, label medications and solutions that are not immediately
administered. This applies even if there is only one medication being
used.
- Note: An immediately administered medication is one that an
authorized staff member prepares or obtains, takes directly to a
patient, and administers to that patient without any break in the
process.
 In perioperative and other procedural settings both on and off the sterile
field, labeling occurs when any medication or solution is transferred from
the original packaging to another container.
 In perioperative and other procedural settings both on and off the sterile
field, medication or solution labels must include the following:
- Medication name
- Strength
- Quantity
- Diluent and volume (if not apparent from the container)
- Expiration date when not used or drug expires within 24 hours
14
2012 National Patient Safety Goals
Goal 3:
Label all Medications (continued)
 Verify all medication or solution labels both verbally and visually.
Verification is done by two individuals qualified to participate in the
procedure whenever the person preparing the medication or solution is
not the person who will be administering it.
 Immediately discard any medication or solution found unlabeled.
 Remove all labeled containers on the sterile field and discard their
contents at the conclusion of the procedure.
- Note: This does not apply to multiuse vials that are handled
according to infection control practices.
 All medications and solutions both on and off the sterile field and their
labels are reviewed by entering and exiting staff responsible for the
management of medications.
Reduce the likelihood of patient harm associated with the use of
anticoagulant therapy.
It is important to note that anticoagulation medications are more likely than
others to cause harm due to complex dosing, insufficient monitoring, and
inconsistent patient compliance.
 Use protocols for initiation and maintenance of long term anticoagulation
therapy.
 Before starting a patient on warfarin, assess the patient’s baseline
coagulation status; for all patients receiving warfarin therapy, use a
current International Normalized Ratio (INR) to adjust this therapy. The
baseline status and current INR are documented in the medical record.
 Use programmable infusion pumps for IV heparin to provide consistent
and accurate dosing.
 Use only oral unit dose products, pre-filled syringes or pre-mixed
infusion bags when available.
 For pediatric patients: prefilled syringes should be used only if
specifically designed for children.
 Provide education on anticoagulant therapy to patients and families.
 Use authoritative resources to manage potential food and drug
interactions for patients receiving warfarin.
 The hospital evaluates its anticoagulation safety practices, takes
appropriate actions to improve practices and measures the effectiveness
of those actions on a regular basis.
 Patient/family education includes:
– Importance of follow-up monitoring
– Compliance with instructions
– Drug-food interactions
– Potential for adverse drug reactions/interactions
15
2012 National Patient Safety Goals
Goal 3:
Maintain and communicate accurate patient medication
Information
There is a process for comparing the patient’s current medications with
those ordered for the patient while under the care of the organization.
Rationale: Patients are at high risk for harm from adverse drug events when
communication about medications is not clear. The chance for
communication errors increases whenever individuals involved in a patient’s
care change. Communicating about the medication list, making sure it is
accurate, and reconciling any discrepancies whenever new medications are
ordered or current medications are adjusted are essential to reducing the
risk of transition-related adverse drug events.
 Obtain and document a complete list of the patient's current
medications, including name of medication, dose, rate and frequency
when the patient enters the hospital or is admitted, with the involvement
of the patient and family as needed.
 These home medications must be compared to the medication orders
for the patient on admission, transfer and discharge from the hospital.
 The process must include prescription meds, herbal remedies, vaccines,
respiratory therapy treatments, IVs, nutriceuticals, over the counter
drugs, diagnostic & contrast agents, parenteral nutrition, sample meds,
vitamins, radioactive meds, blood derivatives.
 In an emergency situation, the reconciliation should take place as soon
as the patient is stabilized.
Note: Updating the status of patient’s medications is also an important
component of all patient care handoff communications.
Communicating Medications to the Next Provider
 The patient’s most current reconciled medication list is communicated to
the next provider of service, either within or outside the hospital. The
communication between providers is documented in the medical record.
 At the time of transfer, the transferring hospital informs the next provider
of service how to obtain clarification on the list of reconciled medications.
 Alternatively, when a patient leaves the hospital’s care to go directly to
his or her home, the complete and reconciled list of medications is
provided to the patient’s known primary care provider, the original
referring provider, or a known next provider of service.
Note: When the next provider of service is unknown or when no
known formal relationship is planned with the next provider, giving
the patient and, as needed, the family the list of reconciled
medications is sufficient.
– On transfer from one organization to another:
 Communicate complete list of patient’s medications to the next
provider and document communication.
16
2012 National Patient Safety Goals
Goal 3:
Communicating Medications to the Next Provider (continued)
– On discharge to home provide a complete & reconciled list to:
 Primary Care Provider (PCP), original referring or known
provider of service
 Patient with list explained
 Family as needed with list explained.
Providing a Reconciled Medication List to the Patient
 A current complete list of reconciled medications is provided and
explained to the patient and their family as needed.
 This education is documented in the medical record.
Settings in which Medications Are Minimally Used
 Obtain and document an accurate list of the patient's current
medications and known allergies in order to safely prescribe any settingspecific medications (for example, IV contrast media, local anesthesia,
antibiotics) and to assess for potential allergic or adverse drug reactions.
 When only short-term medications (for example, a pre-procedure
medication or a short-term course of an antibiotic) will be prescribed and
no changes are made to the patient’s current medication list, the patient
and, as needed, the family are provided with a list containing the shortterm medication additions that the patient will continue after leaving the
hospital.
 This list of new short-term medications is not considered to be part of the
original, known, and current medication list. When patients leave these
settings, a list of the original, known, and current medications does not
need to be provided, unless the patient is assessed to be confused or
unable to comprehend adequately. In this case, the patient’s family is
provided both medication lists and the circumstances are documented.
 In these settings, a complete, documented medication reconciliation
process is used when:
– Any new long-term (chronic) medications are prescribed.
– There is a prescription change for any of the patient’s current, known
long-term medications.
– The patient is required to be subsequently admitted to an
organization from these settings for ongoing care.
Goal 7:
Reduce the risk of health care associated infections
Comply with either the current Center for Disease Control and
Prevention (CDC) hand hygiene guidelines or the current World Health
Organization (WHO) hand hygiene guidelines.
 Handwashing is the single most important means of preventing the
spread of infection.
 Handwashing is required before and after each patient encounter.
17
2012 National Patient Safety Goals
Goal 7:
Hand Hygiene (continued)
 Hand Hygiene is also required after touching the environment, prior to
doing a procedure.
 When your hands are not visibly soiled Cal-Stat (alcohol-based cleaner)
may be used.
 Rub dry ~ average time = 30 seconds:
– Before having direct contact with patients.
– Before donning sterile gloves when inserting a central intravascular
catheters.
– Before inserting indwelling urinary catheters, peripheral vascular
catheters, or other invasive devices that do not require a surgical
procedure.
– After contact with a patient’s intact skin (e.g. when taking a pulse or
blood pressure, and lifting a patient).
– After removing gloves
– On leaving an isolation area or after handling articles from an
isolation area.
– On completion of duty.
Implement evidence-based practices to prevent healthcare associated
infections (HAIs) due to multiple drug-resistant organisms (MDROs) in
acute care hospitals
 Requirement applies but is not limited to organisms such as:
– Methicillin-resistant Staph Aureus (MRSA).
– Clostridium Difficile (CDI).
– Vancomycin-resistant Enterococci (VRE)
− Multiple drug resistant gram-negative bacteria
 Provide education to patients, and families as needed, who are infected
or colonized with a MDRO about Healthcare Associated Infection (HAIs),
MDROs and prevention strategies.
 Utilize targeted surveillance program to include a laboratory-based alert
system to identify new, readmitted or transferred patients with MDROs.
 Monitor MDRO infection rates, compliance with evidence-based
guidelines or best practices and evaluate education programs. Provide
MDRO surveillance data to hospital leaders, LIPs, nursing staff and
other clinicians.
 Educate staff and LIPs at hire and annually about HAIs, MDROs and
prevention strategies.
Implement evidence-based practices to prevent surgical site infections
Implement evidence-based practices to prevent Central lineassociated bloodstream infections (BSI)
Note: This requirement covers short- and long-term central venous catheters and
peripherally inserted central catheter lines
18
2012 National Patient Safety Goals
Goal 7:
Prevent BSI (continued)
responsibilities about health care-associated infections, central lineassociated bloodstream infections and the importance of prevention.
 Prior to insertion of a central venous catheter (CVC), educate patients
and/or families about central line-associated bloodstream infection
prevention.
 Use a catheter checklist and a standardized protocol for CVC insertion to
assure:
– Hand hygiene is done prior to insertion or manipulation
– For adults, femoral vein is not used unless other sites are unavailable
– Use standardized supply cart or kit for line insertion
– Use of maximum sterile barrier precautions during line insertion
– Use of chlorhexidine-based antiseptic for skin preparation in patients
over 2 months of age unless contraindicated
– Use of a standardized protocol to disinfect catheter hubs and
injection ports before accessing
– Evaluation of all CVCs routinely and removal of nonessential
catheters
• Monitor BSI infection rates, compliance with evidence-based guidelines
or best practices and evaluate education programs.
Implement evidence-based practices to prevent indwelling catheterassociated urinary tract infections (CAUTI)
Note: This requirement is not appliacable to pediatric populations. Research
resulting in evidence-based practices was conducted with adults and there is not
consensus that these practices apply to children.
Goal 15:
The hospital identifies safety risks inherent in its patient
population
Identify Patients at Risk for Suicide
Note: this requirement applies only to patients being treated for emotional or behavioral
disorders in the hospital
Rationale: Suicide ranks as the eleventh most frequent cause of death
(third most frequent in young people in the United States). One person
dies from suicide every 16.6 minutes.
 Suicide of a care recipient while in a staffed, round-the-clock care setting
has been the #1 most frequently reported type of sentinel event since
the inception of the Joint Commission's Sentinel Event Policy in 1996.
 Identification of individuals at risk for suicide while under the care of a
health care organization is an important first step and protecting and
planning the care for these at-risk individuals.
19
Universal Protocol for Preventing Wrong Site, Wrong Procedure, and
Wrong Person Surgery:
Conduct a Pre-Procedure Verification Process
Implement a pre-procedure process to verify:
 The correct procedure
 For the correct patient
 At the correct site
Note: The patient is involved in the verification process when possible
Identify the items that must be available for the procedure and use a standardized list
to verify their availability. At a minimum, these items include the following:
 Relevant documentation (for example, history and physical, signed procedure
consent form, nursing assessment, and pre-anesthesia assessment)
 Labeled diagnostic and radiology test results (for example, radiology images and
scans, or pathology and biopsy reports) that are properly displayed
 Any required blood products, implants, devices, and/or special equipment for the
procedure
 Match the items that are to be available in the procedure area to the patient.
Mark the Procedure Site
 Incision or insertion sites are marked when there is more than one possible location
for a procedure and when performing the procedure in a different location would
negatively affect quality or safety.
Note: For spinal procedures, in addition to pre-operative skin marking of the general
spinal region, special intra-operative imaging techniques may be used for locating and
marking the exact vertebral level.
 Mark the procedure site before the procedure is performed and, if possible, with the
patient involved.
 The procedure site is marked by a licensed independent practitioner who is ultimately
accountable for the procedure and will be present when the procedure is performed.
 The method of marking the site and the type of mark is unambiguous and is used
consistently throughout the hospital.
Note: The mark is made at or near the procedure site and is sufficiently permanent to
be visible after skin preparation and draping. Adhesive markers are not the sole
means of marking the site.
 An alternative process is in place for patients who refuse site marking or when it is
technically or anatomically impossible or impractical to mark the site.
Note: Examples of other situations that involve alternative processes include:
– Minimal access procedures treating a lateralized internal organ, whether
percutaneous or through a natural orifice
– Teeth
– Premature infants, for whom the mark may cause a permanent tattoo
A Time-Out is performed before the procedure
 Conduct a time-out immediately before starting the invasive procedure or making the
incision.
20
2012 National Patient Safety Goals
Time Out (continued)
 The time-out has the following characteristics:
– It is standardized
– It is initiated by a designated member of the team
– It involves the immediate members of the procedure team, including the
individual performing the procedure, the anesthesia providers, the circulating
nurse, the operating room technician, and other active participants who will be
participating in the procedure from the beginning.
 When two or more procedures are being performed on the same patient, and the
person performing the procedure changes, perform a time-out before each
procedure is initiated.
 During the time-out, the team members agree, at a minimum, on the following:
– Correct patient identity
– The correct site
– The procedure to be done
 Document the completion of the time-out.
 Mark operative site for procedures involving:
- Right/left distinction
- Multiple structures (fingers or toes)
- Multiple levels (as in spinal surgery)
 Conduct a “Time Out”:
- Immediately before the start of the procedure
- With “active” communication among all members of the team
- Initiated by a designated team member.
 The procedure is not started until any questions or concerns are resolved.
PATIENT/FAMILY EDUCATION
Patient/family education is an important aspect of patient care. Every patient, regardless
of age or culture, has the right to information about his or her health. Patients and their
families have a right to understandable explanations and learning materials related to
diagnoses, treatments, and expected outcomes.
As you perform patient care duties, take time to explain to the patient/family what you
plan to do to improve the patient’s health or comfort level. Start by assessing the
patient/family’s readiness to learn.

Are they interested in long detailed explanations or is there too much pain/fear/other
concerns to process more than a brief explanation?

What does the patient/family already know about the diagnosis/procedure – did they
understand previous information correctly?
21

Is the patient/family able to read written materials or is there an issue of literacy/visual
impairment/language barrier that would prevent them from receiving the benefit of
written materials?

What is the patient/family’s preferred method of learning – reading, watching, and/or
doing?
Ask your resource person about documentation of teaching and location of educational
materials for the department. Sunrise Health Hospitals have a variety of educational
brochures and videos to enhance patient/family teaching. If you need additional materials
contact the Education Department within the hospital.
INCIDENT REPORTING
An Incident Report needs to be completed by a staff member or charge/supervisory
personnel when something occurs that is not consistent with the patient’s routine care, or
when there is an unexpected event with a visitor or employee, which results in a possible
injury or illness.
Examples of Incidents:
 Slips or falls
 Incorrect instrument or sponge count
 Equipment malfunction
 Cuts, burns, or bruises
 Medication errors (i.e. wrong dose, wrong drug, wrong time)
 Errors in orders
What is your responsibility at the time of the Incident?
 Tell your Charge Nurse/Supervisor
 Respond appropriately to any emergency situation
 Provide a careful and detailed description of the incident to your instructor and
the charge/supervisory person, information to include:
1. What happened?
2. When did it happen?
3. Where did it happen?
4. Who did it happen to?
22
SAFETY PROCEDURES – “UNIVERSAL CODE” DEFINITIONS
(For all situations requiring emergency response, dial “4” at Sunrise Hospital and Southern Hills
Hospital and dial “44” at MountainView Hospital.)
“UNIVERSAL CODE” CALLED:
SITUATION:
 Code Blue (“Code Blue Adult”
& “Code Blue Pediatric”)
Cardiac Arrest
 Code White
Stroke
 Condition Red
Actual Fire
 Condition Yellow
Fire Drill
 Condition Green
 Code Triage – Internal
(Level I & Level II)
 Code Triage – External
(Level I & Level II)
All Clear
(Return to normal
operating conditions)
INTERNAL DISASTER
EXTERNAL DISASTER
 Code Gray
Workplace Violence
 Code Black
Bomb Threat
 Code Pink
Missing/Abducted Minor
Child
 Code Orange
HAZMAT Incident/Spill
 Code Silver
Person with a weapon
Additional Codes (not Universal)Hospital-Specific:
 Cardiac Alert (ED Patients)
(Sunrise, MTV, So. Hills)
 Code Stork
(Sunrise only)
 Code Walker
(Sunrise only)
 Code 246
(Sunrise only)
 Code Chill
(MountainView only)
 Mr. Lift
(Southern Hills only)
Chest pain with ST
elevation on EKG-Patient
to Cath Lab
Imminent delivery out of
L&D
Missing Adult with
Limited Mental Capacity
Remain Clear of Area
Announced
Hypothermia
Fall Assistance Required
*ALL CODES ARE ANNOUNCED ON THE OVERHEAD SYSTEM. WHEN YOU HEAR ONE OF THE
ABOVE CODES TAKE DIRECTIONS FROM YOUR INSTRUCTOR AND/OR CHARGE PERSON.
23
CARDIAC/RESPIRATORY ARREST
CODE BLUE
“Code Blue Adult”
“Code Blue Pediatric”
A.
B.
Activate the Code Emergency Response System:
1.
Dial “44” at MountainView, and dial “4” at Sunrise & Southern
Hills
2.
Notify PBX of “Code Blue Adult” or “Code Blue Pediatric” - the Patient room
number and/or the Department where the patient is located.
Patient Intervention:
1.
First Responder:




2.
Second Responder:



3.
Check airway/pulse
Initiate CPR as necessary, if qualified
Use ambu mask or pocket mask
DO NOT PERFORM MOUTH –TO– MOUTH RESUSCITATION
Bring crash cart to Code Blue site
Attach cardiac monitor to the patient
Place patient on cardiac backboard
Code Team Arrival:
(ICU R.N., ER M.D., Respiratory Therapists, Nursing
Supervisor, EKG Tech)



Assist Code Team as needed
Notify patient’s primary physician
Make patient chart available
FACILITY-WIDE FIRE DRILLS
Sunrise Health Hospitals conduct “Facility-Wide” Fire Drills, when the fire alarm sounds
the following steps are to be followed:
A.
Ensure all doors close automatically, if not automatic, close them.
B.
Go through the R.A.C.E. procedures.
24
Fire In Your Area:
A.
B.
C.
D.
E.
F.
G.
Attend to the needs of your patients and visitors.
Check for SMOKE.
Check the LOCATIONS of the Fire Extinguisher.
If you discover a fire in your area, call PBX by dialing “4” (Sunrise and Southern
Hills) OR “44” (MountainView)C, state the location of the fire, remain calm and wait
for assistance or further instructions or pull the fire alarm.
Reassure patients and visitors.
DO NOT USE ELEVATORS - Use Fire Stairs in the event evacuation is necessary.
Exercise what you have been taught. . . . . .R.A.C.E.
*
*
*
*
R
A
C
E
=
=
=
=
Rescue/Remove
Alarm
Contain
Extinguish or Evacuate as necessary
Environment of Care Infection Control Standards
The Occupational Safety and Health Administration (OSHA) mandates under the CODE
OF THE FEDERAL REGISTER (CFR) number 29CFR1910.1200 that all employees be
informed of the hazards present within his/her working environment. The Law requires
that we as employees and employers inform those coming into our work environment of
the hazards they could come in contact with.
This information is most commonly disseminated through the use of MSDS (Material
Safety Data Sheets). These documents detail the hazards associated with particular
substances.
Ensure that you have all of the MSDS information for the substances located in your work
environment. Read and understand this information. If you have difficulty ask your
instructor or Charge personnel for assistance.
OSHA BLOODBORNE PATHOGEN STANDARDS
IF IT IS WET - WEAR GLOVES
1.
2.
3.
25
Wear gowns or aprons when splash with blood or body fluids is anticipated (e.g.,
Labor & Delivery).
Wear masks and protective eyewear if aerosolization or splattering is likely to occur.
Bag all trash and linen securely to confine and contain any body substances. Treat
all trash and linen as potentially infectious.
4.
Students need to report to their instructor immediately all needle stick accidents,
mucosal splashes, or contamination of open wounds with blood or body fluid
substances to receive follow up instructions.
Hand Hygiene
In compliance with the Centers for Disease Control recommendations hand hygiene is
considered the single most important procedure in preventing nosocomial infections.
Decontamination of hands may be accomplished by the use of an antimicrobial soap and
water or the utilization of an alcohol-based hand rub.
1.
26
Indications for hand washing and hand antisepsis:
a.
When hands are visibly soiled, wash hands with soap and warm water.
b.
If hands are not visibly soiled, use an alcohol based hand rub for routinely
decontaminating hands.
c.
Decontaminate hands before and after direct patient contact.
d.
Decontaminate hands before donning sterile gloves when inserting
catheters or other invasive devices.
e.
Decontaminate hands after contact with a patient's intact skin (e.g. taking
pulse, blood pressure, and lifting a patient.)
f.
Decontaminate hands after contact with body fluids or excretions, mucous
membranes, non-intact skin, and wound dressings if hands are not visibly
soiled.
g.
Decontaminate hands if moving from a contaminated body site to a clean
body site during patient care.
h.
Decontaminate hands after contact with inanimate objects (including
medical equipment) in the immediate vicinity of the patient.
i.
Decontaminate hands before donning sterile gloves when inserting
catheters or other invasive devices.
j.
Decontaminate hands after removing gloves and/or other protective
clothing.
k.
Before and after using a restroom, wash hands with soap and water.
l.
Decontaminate hands after blowing or wiping the nose.
2.
m.
Decontaminate hands upon leaving an isolation area or after handling
articles from an isolation area.
n.
Decontaminate hands upon leaving the work area.
Artificial Nails
a.
For employees who are patient care providers, artificial nails are prohibited
b.
Natural nail tips will be less than 1/4 inch long.
c.
Polish is not to be chipped
Preventing and Controlling the Spread of Infections
and Communicable Diseases
Standard Precautions are a set of infection control practices used to prevent
transmission of diseases that can be acquired by contact with blood, body fluids, nonintact skin (including rashes), and mucous membranes. These measures are to be used
when providing care to all individuals, whether or not they appear infectious or
symptomatic. Measures include:
• Hand Hygiene
•
Personal Protective Equipment (PPE)
•
Needle stick and sharps injury prevention
•
Cleaning & Disinfection
•
Respiratory Hygiene (Cough Etiquette)
•
Waste Disposal
Personal Protective Equipment (PPE)
• PPE includes items such as gloves, gowns, masks, respirators, face shields and
eyewear used to create barriers that protect skin, clothing, mucous membranes,
and the respiratory tract from infectious agents.
27
•
Use PPEs to protect the mucous membranes of the eyes, nose and mouth during
procedures and patient-care activities that are likely to generate splashes or sprays
of blood, body fluids, secretions, and excretions.
•
The PPE items selected for use depend on the type of interaction a healthcare
worker will have with a patient and the likely modes of disease transmission.
•
Wear gloves when touching blood, body fluids, non-intact skin, mucous
membranes, potentially contaminated intact skin (patients incontinent of stool &
urine) and contaminated items.
•
Gloves must always be worn during activities involving vascular access, such as
performing phlebotomies.
•
Wear a surgical mask and goggles or face shield if there is a reasonable chance
that a splash or spray of blood or body fluids, secretions or excretions may occur to
the eyes, mouth, or nose.
•
Per OSHA’s TB Control Plan for Cough/aerosol generating procedures, wear a
respirator (N-95) mask that you have been fit tested to wear.
•
Examples of cough generating procedures include bronchoscopy,
intubation, and respiratory treatments.
•
Wear a gown if skin or clothing is likely to be exposed to blood or body fluids,
secretions or excretions.
•
If PPE or other disposable items are saturated with blood or body fluids such that
fluid may be poured, squeezed, or dripped from the item, discard into a biohazard
bag. PPE that is not saturated may be placed directly in the trash.
Needle Stick and Sharps Injury Prevention
• Safe handling of needles and other sharp devices prevent health care worker
exposure to blood borne pathogens. The Needle Stick Safety and Prevention Act
mandates the use of sharps with engineered safety devices when suitable devices
exist.
28
•
The safety devices on needles and other sharps should be activated immediately
after use.
•
Used needles should be discarded immediately after use and not recapped, bent,
cut, removed from the syringe or tube holder, stuck into the mattress, or otherwise
manipulated.
•
Any used needles, lancets, or other contaminated sharps should be placed in a
leak-proof, puncture-resistant sharps container that is either red in color or labeled
with a biohazard label.
•
Do not overfill sharps containers. Discard after 2/3 full or when contents are at the
“full” line indicated on the containers
Cleaning & Disinfection
• Patient care areas, common waiting areas, and other areas with potentially
contaminated surfaces or objects that are frequently touched by staff and patients
(side rails, doorknobs, sinks, toilets, other surfaces and items in close proximity to
patients) should be cleaned routinely with EPA registered disinfectants; following
the manufacturers’ instructions for amount, dilution, and contact time.
•
Some pathogens such as Noroviruses and Clostridium Difficile may not be
inactivated by routinely used commercial disinfectants. In situations where an
outbreak with these pathogens is suspected, a bleach solution (1:10) is
recommended for disinfecting contaminated surfaces and items post standard
terminal cleaning of the areas.
•
Some patient care items may be damaged or destroyed by certain disinfectants.
Consult with the manufacturer of the items before applying disinfectants
Respiratory Hygiene (Cough Etiquette)
• Individuals in waiting rooms or other common areas can spread infections to others
in the same area. Measures to avoid spread of respiratory secretions should be
promoted to help prevent respiratory disease transmission.
•
Elements of respiratory hygiene and cough etiquette include:
–
Covering the nose/mouth with a tissue when coughing or sneezing or using
the crook of the elbow to contain respiratory droplets.
–
Using tissues to contain respiratory secretions and discarding in the nearest
waste receptacle after use.
–
Performing hand hygiene immediately after contact with respiratory
secretions and contaminated objects/materials.
–
Asking patients with signs and symptoms of respiratory illness to wear a
surgical mask while waiting in common areas or placing them in areas away
from others.
–
Supplies such as tissues, waste baskets, alcohol based hand sanitizers,
and surgical masks should be provided in waiting and other common areas
in local public health agencies. Place cough etiquette signs where the
general public can see them.
Waste Disposal
• Sharp items should be disposed of in containers that are puncture resistant, leakproof, closable, and labeled with the biohazard symbol or are red in color.
29
•
Sharps containers should be replaced when filled up to the indicated “full” line.
Items that should be discarded into sharps containers include contaminated items
that may easily cause cuts or punctures in the skin (used needles, lancets, broken
glass or rigid plastic vials) and unused needles and lancets that are being
discarded. Syringes or blood collection tube holders attached to needles must also
be discarded still attached to the needles.
•
Non-sharp disposable items saturated with blood or body fluids (i.e. fluid can be
poured or squeezed from the item or fluid is flaking or dripping from the item)
should be discarded into biohazard bags that are puncture resistant, leak-proof,
and labeled with a biohazard symbol or red in color. Such items may include used
PPE and disposable rags or cloths.
Types of Isolation Precautions
• Airborne
• Droplet
• Contact
•
Patients and visitors must comply with hospital policies. They do not have the right
to disregard isolation precautions. They have the responsibility to comply.
•
Hospital staff must educate patients and visitors on isolation requirements. If they
are non-compliant, staff must use the “Chain of Command” procedure immediately
for problem resolution.
Contact Isolation
• Organisms are spread by direct contact.
•
Our hands pick up organisms and carry it to our nose/eyes.
•
Examples of organisms that require contact isolation are C difficile, noroviruses ,
and intestinal tract pathogens.
•
Healthcare personnel caring for patients on Contact Precautions must wear a
gown and gloves for all interactions that may involve contact with the patient, bed
furniture or equipment in the room.
•
Putting on PPE upon room entry and discarding before exiting the patient room is
done to contain pathogens, especially those that have been identified in
transmission through organisms spread by direct contact.
Droplet Precautions
• Private Room required.
•
30
Wear a surgical mask when close to patient.
•
Examples of organisms that require droplet precautions are Influenza, Bacterial
meningitis, and Mumps.
MRSA spread and effective control strategies
• MRSA is spread between patients by healthcare workers and others on hands,
clothes, and shared equipment.
•
Control of MRSA includes the following:
o Active surveillance cultures.
o Screening to identify MRSA and patients.
o Barrier precautions.
o Gowns and gloves for all MRSA and patients, and masks per CDC
recommendations.
o Barriers/cleaning of shared equipment i.e. stethoscope.
o Compulsive hand hygiene.
o Disinfecting the environment.
o Ownership and support of infection control practices.
What can be done to control MRSA
• Careful, compulsive hand hygiene for all patient interactions.
•
Standard and transmission based precautions include the use of barriers such as
gowns, gloves, and masks.
•
Effectively clean the patient care environment.
•
Clean shared dedicated equipment such as stethoscopes, BP cuffs or
thermometers.
•
Appropriate use of antibiotics
•
MRSA screening is essential because we cannot apply appropriate barriers if we
do not know who needs them.
Multi-Drug Resistant Organisms (MDRO)
• MDROs are found on the hands of healthcare workers caring for infected/colonized
patients.
•
31
MDROs are found on the gloves of healthcare workers caring for
infected/colonized patients.
•
MDROs are also found on the following objects(70% of MRSA rooms had MRSA
recovered from the environment):
o Computer keyboards
o Patient gowns
o Bed linens
o BP cuffs
o Over bed tables
o Stethoscopes
Airborne Precautions
• Preventing the spread of pathogens that are transmitted by the airborne route
requires the use of special air handling and ventilation systems to contain and
safely remove the infectious agent.
•
Everyone entering the room must be fit tested and wear a n-95 mask.
•
Patients wear a regular surgical mask when outside the room.
•
Examples: chicken pox and TB
Tuberculosis
• Symptoms of TB include:
•
Cough for over 3 weeks
•
Fatigue
•
Unplanned weight loss
•
Fever and night seats
•
Chest pain
Who is at risk for TB infection?
• Indiviuals with low income and/or poor access to health care.
•
Those with diabetes and other chronic medical conditions.
•
Residents of long term care facilities and prisons.
•
Healthcare workers.
•
Immigrants for high risk countries.
Who is infectious?
• Individuals with pulmonary or Laryngeal TB
32
Who is not infectious?
• Person with positive TB test but no symptoms.
•
TB patient under treatment with negative sputum.
•
TB in non pulmonary site i.e. kidney
Caring for C. difficile Patients
C. difficile can be spread by direct or indirect contact with the patient or their environment.
When patients are identified with this organism:
1. Place patient in Contact Precautions (i.e., assigned to a private room with a
bathroom that is solely for use by that patient or ensuring proper space between
beds).
2. Use compulsive hand hygiene between patient contact or when in contact with
the patient’s environment – every patient, every time.
3. Use gloves, gowns and other personal protective equipment (PPE) when in
direct contact with the patient, environmental surfaces or patient care items to
avoid transfer of microorganisms to other individuals or environments.
4. Use patient dedicated equipment or clean all equipment with Hospital
approved disinfectant cleaner before using on another patient.
Environmental controls
C. difficile patients contaminate their environment and the C. difficile spores can persist
for months in the healthcare environment and be transmitted during this time. Adherence
to CDC guidelines for environmental infection control in healthcare facilities are critical to
reduce the spread of infection.
o Surfaces should be kept clean, damp dusting and mopping should be done,
and body substance spills should be managed promptly, as outlined by the
CDC. High-touch surfaces and equipment must be thoroughly cleaned and
disinfected to remove and/or kill spores.
o Use bleach and bleach products to kill C. difficile spores according to CDC
recommendations. Cleaning and disinfection activities using the physical
motions of cleaning and use of the routine germicide removes and dilutes
spore concentration and is acceptable in the absence of an outbreak.
Hand hygiene
Prevention of CDI requires strict adherence to established CDC hand hygiene practices.
Gloves should be worn to provide patient care. After gloves are removed, healthcare
providers’ hands should be washed with soap and water.
Hand washing
Soap and water is the preferred method of hand hygiene for care of patients with CDI to
physically remove spores from the hands.
33
Every patient every time
Sanitize hands when going IN and OUT of patient rooms – every patient, every time.
Wash hands with soap & water when visibly soiled.
DO NOT ENTER AN ISOLATION ROOM WITH OUT APPROPRIATE PPE
• BEFORE entering an isolation room:
o All staff & visitors must comply with posted contact/droplet/airborne isolation
signs before entering patient room
o “Mask required” if patient has MDRO such as MRSA/VRE
o Remove all personal items, i.e.. stethoscope, fanny packs
o Remove secondary clothing such as lab coats, sweaters
o Follow posted isolation sign and apply required PPE (mask, gown, gloves)
o Sanitize hands before putting gloves on – no exceptions
•
When EXITING an isolation room:
o Remove all your PPE in the room and discard used PPE in the trash bag
located in the isolation room.
o Sanitize hands after removing gloves and when exiting patient room – NO
EXCEPTIONS !
Remember….
To sanitize hands apply a quarter size amount Cal-Stat.
Rub hands together briskly for 30 seconds until dry.
When an isolation caddy does not contain enough supplies for the next person to don a
full required isolation set, YOU are responsible to notify the nursing staff or refill the
caddy.
Everyone in the hospital is responsible for good hand hygiene, maintaining isolation
precautions, and not coming to work when ill to prevent the spread of infection.
Patient/Family Rights and Responsibilities
The Sunrise Health Hospitals do not discriminate with regard to race, religion, sex, color,
national origin, creed, and sexual orientation, on the basis of disability or age in the
practice of admissions, access to care or provision of treatment in the facilities.
Patients receive a written statement of their rights prior to the provision of patient care,
whenever possible. They include the right to: personal privacy and confidentiality of
information; considerate and respectful care; express spiritual beliefs and cultural
practices, if not harmful to others; informed participation in the development and
implementation of their plan of care; family member notification of admission; information
from the physician for giving informed consent for procedures or treatments, including
risks and benefits and alternatives; understandable information about their diagnosis, plan
of treatment and prognosis; information of research or educational projects related to their
medical treatment; accept or refuse medical treatment to the extent permitted by law,
34
informed of associated risks; participate in the consideration of ethical issues in provision
of care; formulate advance directives; designate a representative decision maker in the
event incapable of understanding; have reasonable requests for services fulfilled within
the hospital’s ability to provide; receive information in ones’ predominant language; be
transferred to another facility if needs are not able to be met; receive medical treatment
with recognition of comfort, dignity and effective pain management; reasonable visual and
auditory privacy; have access to their medical record; request room transfer if disturbed;
receive name and professional qualification information of persons providing care and
coordinating medical treatment; receive resource information; examine hospital bill and
receive explanation; voice grievances, without recrimination and have prompt
investigation and response; receive care in a safe setting; be free from abuse or
harassment; be free from restraints not medically necessary; and be informed about
outcomes of care.
Patients/patient family members have the responsibility to: provide complete and accurate
information about their health; report perceived risks and unexpected changes in
condition; report understanding of treatment plan and what is expected; express concerns
regarding the ability to comply with a treatment plan; participate in controlling pain; follow
the hospital’s rules and regulations; be considerate of others rights; assist in controlling
noise; follow the “No Smoking” policy; be respectful of other persons and hospital
property; and understand potential results of actions if treatment refused or instructions
not followed.
Advance Directives
Patients have a right to make decisions in their care and have those decisions carried out
by hospital personnel and physicians. The inclusion of Advance Directives is important in
a patient’s plan of care. Patients are provided education, assistance in executing an
Advance Directive if desired, and the facilitation of continuity of care in accordance with
Federal Law (PSDA) and Nevada Statutes (NRS 449.535-449.860).
On admission, all adult patients will be given the State of Nevada’s “Patient Information
on Nevada State Law Concerning Advance Directives” and the “Advance Directive
Questionnaire” for completion. Patients wanting to change an existing directive or sign a
new one may obtain a Declaration/Living Will and/or Durable Power of Attorney for
Healthcare Decisions from the hospital. Two witnesses are required on these legal
documents.
Patient Treatment/Classification/Limitation
Pursuant to OBRA 1990 Patient Self-Determination Act and NRS449.535 to 449.690, the
hospital has a process for making decisions about life-sustaining treatment. The hospital
philosophy recognizes the value of human life and as a part of its mission, works diligently
to preserve and enhance it. Patients are not obligated to endure medical treatment that
prolongs their dying without offering reasonable benefit. Each situation is unique and
35
decisions are personal. It is the patient’s right of self-determination, through the process
of informed consent, to refuse any or all treatment options.
The hospital has general guidelines for patients: to make healthcare decisions and in
continuing, limiting, declining or discontinuing any treatment option; the right to refuse
treatment by a competent adult and incompetent patients; rendering futile treatment;
providing comfort and relief from pain; withholding and withdrawing treatment;
presumption against judicial review; limits of responsibility; decision making; and
classification status.
All patients admitted to the hospital will receive full therapeutic efforts (Classification I)
unless otherwise specified by the use of the Patient Classification Orders. Physicians are
responsible for classification of patients, based on discussions with the patient and their
expressed wishes (or the appropriate surrogate if the patient is unable). Classification II
and III have treatment limitations and are ordered by the physician following the same
process.
Refer to the hospital specific policies for more detail and specific policy and
procedure.
AGE SPECIFIC GUIDELINES
Regulatory Requirements
Regulatory agency guidelines require hospitals ensure that “Patient needs are met by ongoing assessment of patients.” Caregivers at Sunrise Health Hospitals are required to
possess age appropriate care competencies and modify care based on patient age and
developmental status. These age appropriate guidelines are included in each patient’s
care plan in Meditech (if the area utilizes Meditech Care Plans).
Note: The patient who does not function as expected for age, is treated according to
developmental / cognitive level.
Standard of Care
Caregivers must be able to demonstrate knowledge, critical thinking, psychomotor, and
interpersonal skills necessary to provide care to all developmental stages / ages of
patients served in his / her area of service, within his / her scope of practice.
Age Specific Criteria
Adult:
Adolescent 13-18 years
Young adult 19 – 40 years
Middle adult 41 – 65 years
Older adult 66+ years
36
Pediatric:
Neonate 0–1 month
Infant 1–18 months
Toddler 19–36 months
Preschool 4-6 years
School age 7-12 years
Adolescent 13-18 years
Developmental/Cognitive Disability
or Delay
NEONATE
Extreme Prematurity:
 28 – 33 weeks Average Gestational
Age (A.G.A.)
 Easily overstimulated
 Poor Temperature Control
 Sucking is weak, and not
synchronized with swallowing
Borderline Prematurity:
 24 – 37 weeks A.G.A
 Tolerant to environmental stress
 Persistent weight gain
 Sustained social interaction
Neonate:
 40 – 44 weeks A.G.A.
 Rapid growth and development
 Sucking is strong and coordinated with swallowing and breathing
 Parents should spend as much time as possible with child.
INFANT





37
Rapid growth and development
Crying is one of the infant’s major modes of communication
Sucking is used as a means of communicating stress and ability to interact
Important to provide social interaction and play to decrease environmental
stressors.
Allowing infant to feed when ready is more conducive to promotion of growth and
weight gain
TODDLER


Emotionally vulnerable to hospitalization
Physical growth slows, but psycho – social growth continues at a rapid pace.
 Play is an effective method of decreasing stress
PRESCHOOLER



May see hospitalization as a punishment
Ability to construct sentences
Keep explanations short and simple




Strong sense of right and wrong
Differences in growth and maturity between boys and girls are evident at this age.
Permanent teeth complete by age 12
Allow as much privacy as possible
SCHOOL AGE
ADOLESCENT




Understand physiological basis for their current condition
Good problem solving skills
Most important people are peers
May not want parents involved in decision making
YOUNG ADULT




38
Accepts self and stabilizes self concepts and body image
Reaches physical and sexual maturity
Four major causes of death are related to violent death
May experience anxiety and depression
MIDDLE ADULT




Discovers and develops new satisfaction
Learns to balance work with other roles
Achieves mature social and civic responsibility
Accepts and adjusts to physical change
OLDER ADULT


Immune system less resilient
Hearing loss is evident
 Loss of bone density
Never use age as a barrier to learning in the adult population. It is visual loss, cognitive
loss, or hearing loss that sometimes occur as we age that can make teaching more
difficult, not the fact that the patient is over 65. (Think of all the active older adults in our
community.)
DEVELOPMENTAL/COGNITIVE DISABILITY OR DELAY




39
Assists in own care as age and capabilities permit
Provide and help devise methods to facilitate maximum functioning
Instruct when to seek assistance from family or healthcare providers
Interpret patient’s behavior toward caregiver(s) to prevent unwarranted negative
reaction.
CULTURAL SENSITIVITY
DIVERSITY IN THE HEALTHCARE FIELD
Culture and language have considerable impact on how patients
access and respond to health care services.
Culture determines the following for each of us:
 Physical attributes
o Hair color
o Skin pigmentation
 Food preferences
 How we think and view the world around us
 What language we speak
 Our religious and spiritual beliefs.
Culture often determines people’s health practices, as well as the way they respond to
illness, injury and pain. We often use our own culture and background to determine what
is “normal”. It is human nature to view our own familiar culture and religion as natural and
right.
Cultural Competency begins with understanding one’s self. It includes knowledge and
understanding of various cultural characteristics. It requires applying this cultural
knowledge and understanding in the healthcare setting.
The healthcare system has its own beliefs, values and practices that may not be shared
by all patients, for example:
 Appointments: run by clock time and promptness is valued.
o Appointments may feel rushed and shorter than patients expect.
 Checkups, immunizations and screenings are valued as preventive health
measures.
o Patients may not value or chose to have these preventive measures.
 Illness is generally seen as having a physical cause. Treatment emphasizes
technology and physical procedures.
o Patients may have a religious or cultural foundation that attributes illness to
other causes. The patients may be suspicious or fearful of modern
technology.
 Patients are expected to take medications exactly as prescribed.
o Patients may not like to take medication or have a belief that medication is
not needed.
40
Avoid Stereotyping
We must not presume that all people of a certain culture adhere to all aspects of cultural
beliefs. The healthcare provider must identify which aspects are appropriate for each
patient during the admission process.
Some common stereotypes of American citizens include:
 Boastful and arrogant
 Disrespectful of authority
 Extravagant and wasteful
 Generous
 Ignorant of other countries and cultures
 Informal
 Insensitive
 Lazy
 Loud and obnoxious
 Rude
 Know it all
 Thinks every country should operate like the U.S.A.
Ethnocentrism
Despite the fact that we really know that everyone is different, we still tend to
subconsciously believe that our culture and religion is the right one. We may view other
cultures and religions as bizarre, strange, inferior or unenlightened.
Ethnocentrism prevents healthcare providers from delivering therapeutic and culturallysensitive care to patients and their families. This practice can cause harm in health care
by:
 Failure to provide adequate pain relief
 Incorrect diagnosis

Accusation of child abuse due to misunderstood cultural childrearing beliefs and
practices
Some peoples belong to more than one ethnic and/or cultural group. The importance of
religion and other cultural practices varies among individuals. By being open-minded and
respectful toward others beliefs, values and practices, you can help patients feel more
comfortable.
41
Language and Communication
There are federal regulations for patient rights to access interpretation services - Title VI
of Civil Rights Act of 1964/ Office for Civil Rights Policy Guidance (OCRPG) and The
Office of Minority Health: National Standards on Culturally and Linguistically Appropriate
Services (CLAS). They require that Health organizations receiving federal funding must:
 Provide language assistance to any patient with limited English proficiency (LEP).
 Providers must not use a patient’s friends or family members as interpreters.
 Language assistance be provided at no cost & notices of service posted.
 Competency is assured of those providing interpretation.
o May not use staff unless deemed competent by organization
 Signage and patient materials are posted in the most common languages
Foreign Language Interpretation: Contact language line used at hospital and request
interpreter. Utilize language identification card/brochure if unable to determine language
spoken. Document use of service in patient’s medical record.
Services for Hearing Impaired: Utilize TDD/TTY phones that allow hearing impaired
persons to communicate by phone or Sign Language Service provided by the language
line service computers or through the hospital. Document use of service in patient’s
medical record.
42
HIPAA Privacy & HITECH Orientation
The objectives of the HIPAA training are:
 To heighten your awareness of and commitment to HIPAA regulations.
 To reinforce the role you play in creating and maintaining organizational
integrity, ethics, and compliance.
 To renew your working understanding of HIPAA requirements.
What is HIPAA?

The Health Insurance Portability and Accountability Act of 1996

Privacy section of Federal regulatins – 45C.F.R., parts 160 and 164

A mandatory federal law with both civil and criminal penalties of up to $250,000 and/or up
to 10 years in prison for failure to comply

Privacy regulations that cover oral, written and electronic communications
Purpose of HIPAA:

Protect health insurance coverage, improve access to healthcare

Reduce fraud and abuse

Improve quality of healthcare in general

Reduce healthcare administrative costs (electronic transactions)
What is HITECH?

Added to HIPAA in 2009 - Subtitle D of the American Recovery and Reinvestment Act of
2009 (ARRA)

Health Information Technology for Economic and Clinical Health Act

A mandatory federal law
Purpose of HITECH:
• Makes massive changes to privacy and security laws
• Applies to covered entities and business associates
• Creates a nationwide electronic health record
• Increases penalties for privacy and security violations
Key HITECH Changes:

43
Breach Notification requirements

Applies to treatment, payment, and healthcare operations in Electronic Health Record
(EHR) environment

Business Associate Agreements

Restrictions

Criminal provisions

Penalties

Copy charges for providing copies from EHR

Private cause of action

Sharing of civil monetary penalties with harmed individuals
Civil Penalties for Non-Compliance
Violation Category
Each Violation
All violations of an identical
provision in a calendar year
Did Not Know
$100 - $50,000
$1,500,000
Reasonable Cause
$1,000 – $50,000
$1,500,000
Willful Neglect – Corrected
$10,000 - $50,000
$1,500,000
Willful Neglect – Not
Corrected
$50,000
$1,500,000
•
For health plans, providers, clearinghouses and business associates that knowingly
and improperly disclose information or obtain information under false pretenses.
These penalties can apply to any “person”.
Penalties are higher for actions designed to generate monetary gain
•
up to $50,000 and one year in prison for obtaining or disclosing protected health
information
•
up to $100,000 and up to five years in prison for obtaining protected health information
under "false pretenses"
•
up to $250,000 and up to 10 years in prison for obtaining or disclosing protected health
information with the intent to sell, transfer or use it for commercial advantage, personal
gain or malicious harm
44
How does HIPAA affect you?
•
A Notice of Privacy Practices brochure is given to every admitted patient at Registration
concerning our patient privacy protection policy.
•
Patients are given the option to “opt out” of our directory.
•
Patients have a right to a copy of their medical record
•
Authorizations need to be obtained from patient to release information for reasons other
than for treatment, payment or healthcare operations (TPO)
What is Protected by HIPAA (PHI)?

Name

Address

Why patient is being treated

Names of relatives

Name of employers

All elements of dates except year (i.e. DOB, Admission, Discharge, Expiration, etc.)

Telephone numbers

Fax Numbers

Electronic e-mail addresses

Social Security Number

Medical record number

Health plan beneficiary number

Account number

Finger or voice prints

Photographic images

Any other unique identifying number, characteristic, code
Each patient receives a Notice of Privacy Practices explaining how their PHI will be used.
What does that mean to me?

You can share information without patient authorization as it relates to needed treatment

Other covered entities will request only minimum necessary to perform their job

You may need to verify the requestor according to policy

Patient charts need to be kept in a secure area

PHI must be placed in Shred-It containers for disposal – No PHI can be taken from the
hospital!
45

Discussions of patient information should not occur in public places such as elevators,
hallways and cafeteria
Disclosing PHI to Family Members and Friends Who Call the Unit/Department

Patient will be assigned a four-digit passcode

Distribution of passcode will be the responsibility of the patient

Passcode may be changed during treatment

Revocation and password change form must be routed to the Facility Privacy Officer (FPO)

Passcode will be last 4-digits of patient account number
Requestors via phone will need:

Patient SS#, DOB and one of the following:
- Account number, street address, MR#, birth certificate, insurance card or policy #
A patient can opt out of directory at anytime but this will probably happen during
admission process. If they opt out then the following applies:

You may not acknowledge the patient is in the facility or give information about the patient to
friends, family or others who may inquire

Can still release information to family and friends with 4-digit passcode

Forward any request for opt out to Registration for processing

Patients have the right to request a privacy restriction of their PHI

NEVER agree to a restriction that a patient may request

All requests must be made in writing and given to the FPO to make a decision

NO request is so small that it should not be routed to the FPO
Patient Privacy complaints
a) Anyone with a concern about a breach of privacy has the right to file a complaint with the FPO or
the Secretary of Health and Human Services. The complaints and the resolution process must be
made available to the Department of HHS or OCR if requested.
Any concerns should be reported to the Charge Nurse.
46
Information Security
If you have access to information systems, please keep in mind that your password acts as an individual
key to our network and to critical patient care and business applications, and it must be kept confidential.
It is part of your job to learn about and practice the many ways that you can help protect the confidentiality,
integrity and availability of electronic information assets.
Confidential Information.
A patient’s diagnosis, the Company’s marketing strategy, and computer network configurations are all
considered confidential information. The Confidentiality and Security Agreement states that individuals with
access to confidential information will not disclose or discuss any confidential information even after
termination of their relationship with HCA.
No HCA colleague, affiliated physician, or other healthcare partner has a right to any patient information
other than that necessary to perform his or her job.
Although you may use confidential information to perform your function, it must not be shared with others
unless the individuals have the need to know this information and have agreed to maintain the
confidentiality of the information.
Patient or Confidential information should not be sent through our intranet or the Internet until such time that
its confidentiality can be assured. If it is necessary to send Patient information to a business associate (i.e.,
someone outside HCA), arrangements other than e-mail must be made.
Privacy
HIPAA and its implementing regulations set forth a number of requirements regarding ensuring the privacy
of protected health information (PHI).
HIPAA requires healthcare entities to appoint a facility privacy official (FPO). The FPO in our facility
oversees and implements the Privacy Program and works to ensure the facility’s compliance with the
requirements of the HIPAA Standards for Privacy of Individually Identifiable Health Information. The FPO is
also responsible for receiving complaints about matters of patient privacy.
HIPAA regulations do not prevent medical records from being maintained at the patient’s bedside or outside
the patient’s room; however, they do encourage reasonable safeguards be put in place to protect the
patient’s information from inappropriate uses or disclosures.
The HIPAA regulations contain a number of restrictions on the transmission of PHI; however, they do not
prevent faxing or mailing health information as long as certain precautions are taken. The regulations
mandate that health information may not be sold by a facility.
The Notice of Privacy Practices must be made available to all patients, posted on the facility’s Internet site
(unless the facility does not have a site) and the consent form language must refer to the notice. Facilities
must make a good faith attempt to have the patient sign an acknowledgement form confirming receipt of the
notice.
Patients have the right to access any health information that has been used to make decisions about their
healthcare at our facility. They can also access billing information. They may review the paper chart
(supervised) or be provided a hard copy. Access to the Clinical Patient Care System (CPCS) is not a
recommended method of providing access to PHI.
A patient may have access to all of the records in the designated record set. This record set includes any
information that is maintained, collected, used or disseminated by a facility to make decisions about
individuals. The paper record is the legal medical record and a copy should be provided upon request
(electronic access is not appropriate with our current systems.) A patient may be denied access under
47
certain circumstances (e.g., when a person may cause harm to him or herself or others, or when protected
by peer review). Our FPO has more information on the right to access.
A patient may add an amendment to any accessible record for as long as the record is maintained by the
facility. The request for amendment should be made in writing to the facility. Our FPO and the Health
Information Management (HIM) department have more information on the right to amend.
While patients have a right to amend their record that does not mean that health information can be deleted
from the record. The patient may submit an addendum correcting or offering commentary on the record,
but no information may be deleted from the record.
In order for the HIM department to track releases of patient information, patients (including employees)
should be directed to the appropriate personnel at the facility for access to any health information.
Everyone is responsible for protecting patients’ individually identifiable health information. Any piece of
paper that has individually identifiable health information on it must be disposed of in appropriate
receptacles. The paper must be handled and destroyed securely. The elements that make information
individually identifiable include: name, zip or other geographic codes, birth date, admission date, discharge
date, date of death, e-mail address, Social Security Number, medical record/account number, health plan
id, license number, vehicle identification number and any other unique number or image.
Any member of the workforce with a legitimate need to know to perform their job responsibilities may
access a patient’s health information. However, the amount of information accessed should be limited to
the minimum amount necessary to perform their job responsibilities.
Policies prohibit employees from accessing their own records in CPCS (also known as Meditech).
Typically, employees do not have a “need to know” for the performance of their job. Employees
may, however, fill out the appropriate Authorization in HIM and can obtain a copy of their records.
The hospital directory or listing of patients used by the PBX operator, information desk or volunteers should
contain only patient name, room/location and condition in general terms. Patient diagnosis or procedures
should not be released. Also, this information may not be released about confidential patients or patients
who ask not to be listed in the directory or have their whereabouts known.
Lists of patients may be provided to clergy. The current Conditions of Admission form explains that the
patient name may be released to local religious organizations. The lists should consist of the patient name,
room/location, and may include the condition in general terms. This list should be restricted by religion, and
confidential patients; confidential information such as Social Security Numbers should not be included.
Important Note: Patient records, electronic and/or paper format, cannot leave the facility.
This also includes the use of any external media, CD or jump drive, to download and
transfer information.
Any patient has the right to complain about a Privacy Violation.
Penalties for non-compliance to these Federal laws may include hospital sanctions up to and
including termination and Federal penalties of monetary fines and/or prison terms. We all
have an ethical obligation to protect the confidentiality of our patients and their protected
health information. Our clinical information systems should be used appropriately to access
information only as necessary to provide patient care.
48