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Non-Employee Service Provider Orientation Purpose To provide information concerning resources and the organizational environment to identified individuals who are permitted by law and by Woman’s Hospital to provide care and services, within the scope of the individual’s license and consistent with individual granted clinical privileges or contracts. Instructions Read the enclosed information thoroughly. This information is yours to keep. Sign and date the two agreement statements. Detach the agreement statements and return them to Human Resources. CONTENTS PAGE 2 3 3 3 3 4 4 4 4 5 6 6 6 7 7 8 8 8 9 9 9 9 TOPIC Management Philosophy/Being Part of Our Team Abuse and Neglect Corporate Compliance Plan Cultural Diversity and Sensitivity Emergency Codes/Numbers Ethics Committee Harassment Free Workplace Hazard Communication Confidentiality Policy 275 Protected Health Information (PHI) Electronic Protected Health Information (EPHI) Permitted Uses and Disclosures Patient Rights Facility Directory Restrictions Involvement in the Individuals Care and Notification Purpose Verification Workstation Use and Security Policy Password Management Proper Use of Email and Fax Protection from Malicious Software Log-In Monitoring Safeguards Revised 3/2015 9 9 9 10 10 10 11 11 11 12 13 13 14 14 14 14 14 15 15 15 15 16-21 22 23 Disposal of Patient Information Photographs Auditing Access Breach of Protected Health Information Breach Requiring Notification to Patient Consequences for not complying with the law Reporting Violations Security Incident Infant Security Infection Control and Prevention Life Safety Lines of Communication Medical Equipment Organ Procurement Pain Management Patient Safety Program Performance Improvement Requests to be excluded from Patient Care Restraints and Seclusion Systems Failures Unusual Clinical Event Population-Specific Patient Care Non Employee Service Provider Agreement Non Employee Confidentiality Agreement 1 Management Philosophy/Being a part of the Woman’s Hospital Team Womans Hospital will achieve its mission through a management philosophy which values and supports: respecting each employee and recognizing his/her contributions as a valued asset to our team; continuously promoting the personal and professional development of each staff member; developing and supporting management practices that encourage individual initiative, sense of ownership, mutual respect, courtesy, and loyalty; recognizing the importance of our patients to our success; accepting and treating all patients with respect, courtesy, friendliness, and honesty; recognizing the significant contributions and loyalty of our physicians; respecting and treating our physicians as vital members of our service team; recognizing each volunteer and his/her contributions to our patients, visitors, physicians, and staff; presenting ourselves in the most professional manner at all times; building upon, not resting upon, our reputation; establishing and maintaining policies and practices, which support and ensure a safe and healthy environment; maintaining our commitment to community service through education, voluntarism, and goodwill; pursuing the highest levels of quality service while maintaining financial responsibility; continuously seeking to improve each individual’s performance; striving to utilize the most effective technology and management tools and techniques; and striving to develop leadership and teamwork throughout the organization. Revised 3/2015 2 Abuse and Neglect If you see signs/symptoms or suspect abuse and/or neglect of a patient, notify the area manager or his/her designee immediately. If you think the patient may be in immediate danger, report to the nurse in charge of the patient. For all age groups, the following list of signs and symptoms are objective indicators of abuse or neglect: injuries in areas usually covered by clothing; injuries that don’t match history given; cuts, bumps, bruises, or scratches indicating the use of force; changed or fearful behavior around partner; partner hovers and doesn’t want patient to be alone with healthcare provider; patient seems frightened, disoriented or depressed over a minor injury or minimizes the importance of a major injury. Corporate Compliance Plan It is the intention of Woman’s Hospital to comply with all applicable laws and regulations. Woman’s wants to ensure that patients are billed for services rendered, that these services meet patients’ medical needs, and that these services are properly documented. Any activity believed to be illegal, dishonest or jeopardizing to quality of care should be reported to Woman’s anonymous compliance hotline at (225) 924-8757. No retaliatory action will be taken for reporting such concerns. Concerns about safety of quality of care may be reported to Joint Commission at 1-800-994-6610 or complaint@jointcommission. Cultural Sensitivity & Diversity Woman’s Hospital maintains a practice of non-discrimination toward patients and their families, employees, students, volunteers, contract workers, and all other individuals; prohibiting discrimination because of age, race, color, creed, sex, national origin or handicap. Emergency Numbers/Codes The emergency assistance phone number is 8499. An example of an emergency would be cardiac or respiratory arrest of a patient, suspicion of infant abduction, or discovery of a fire. Various overhead page codes have been designated to identify specific hospital and/or community events. In the event of a paged code, you should complete the procedure you are performing and wait for specific direction from the area manager or his/her designee. Revised 3/2015 3 Ethics Committee Woman’s Hospital supports the right of the patient or her family to participate in the treatment plan/care decisions. If the patient or family disagrees with the proposed plan of care, she may contact her nurse, physician, social services, or pastoral services. The patient or family may request their case be presented to the Ethics Committee, which is available as needed to discuss ethical issues involving patient care (i.e., administration or cessation of lifesustaining procedures or issues related to the conception of life, reproductive technology, and ensuring legal and regulatory compliance related to the ethical issues). Questions or concerns about ethical issues involving a patient’s care should be discussed with the area manager or his/her designee. Harassment Free Workplace Woman’s Hospital provides a productive work environment free from verbal, written, or physical conduct that harasses and/or creates an intimidating, discriminating, or offensive hospital work environment. No person will be retaliated against for expressing a concern of harassment. Questions or concerns regarding harassment should be discussed with the area manager or his/her designee or can be reported to the Human Resources Department at 225 924-8655. Hazard Communication A Hazardous material is any chemical that may cause physical or health hazards. See area manager or designee for list of hazardous substances you may come into contact with in each specific work area. See area manager or designee for proper protective equipment you must use when working with specific substances. Use the specific equipment needed to perform the task. Confidentiality Policy 275 Information concerning employees, physicians, patients or hospital business shall be protected during its collection, use, disclosure, storage and destruction in accordance with the provisions of state and federal regulations. Information concerning employees, physicians, patients or hospital business may not be accessed, used, or released by unauthorized individuals; or discussed with anyone without written authorization. Revised 3/2015 4 The Health Insurance Portability and Accountability Act, (HIPAA) Privacy Rule sets national standards for the protection of patient information. The Privacy rule covers ALL forms of protected health information… oral, written and electronic. The HIPAA Security Rule sets standards for electronic patient information and ensures the confidentiality, integrity, and availability of all electronic protected health information (EPHI) the hospital creates, receives, maintains, or transmits. The Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009 strengthens the federal privacy and security rules, increases enforcement and penalties for HIPAA violations, requires the patient be notified when there is a breach of unsecured patient information and extends HIPAA security requirements to Business Associates. Protected Health Information (PHI) PHI is any individually identifiable health information (IIHI). Any of the following information can be used to identify a patient: name, address, date, telephone or fax number, social security number, medical record number, patient account number, insurance plan number, vehicle information, certificate/license number, medical equipment number, photograph, fingerprint, e-mail address, internet address, web universal resource locator (URL), and any other unique code, characteristic or identifier. Students, clinical instructors, and school representatives while at Woman’s Hospital for a clinical rotation or clinical experience as per an affiliation agreement in place with Woman’s Hospital understand the following: 1. Students shall not disclose PHI to teachers or other school officials who do not otherwise have the right to access such data. 2. The foregoing does not prevent disclosure of properly de-identified health information when and to the extent necessary in connection the student’s education or training. 3. Teachers and other officials may access PHI or receive PHI from students when they are: a. Providing healthcare in association with the student b. Are a member of Woman’s workforce c. Are a business associate of Woman’s, or a member of the workforce of such business associate, and the disclosure is consistent with the business associate’s functions on behalf of Woman’s. 4. Student’s shall be trained on this policy and on the information to be eliminated to meet the de-identification standard. 5. Students, clinical instructors, and school representatives should consult Woman’s Privacy Officer about questions or for assistance in implementing this policy. Revised 3/2015 5 Electronic Protected Health Information (EPHI) EPHI is individually identifiable health information that is transmitted by electronic media or maintained in electronic media. All information that can identify a patient must be protected. Permitted Uses and Disclosures Only authorized employees may disclose patient information. Non-employees (i.e. students, contractors, volunteers, advisory council members, etc.) providing services to Woman’s Hospital are not authorized to disclose patient information. HIPAA allows for the provider of care to use and disclose health information for Treatment, Payment and Operations (TPO). Other permitted uses and disclosures allowed include disclosures required by law, disclosures for public health purposes, etc. Patients must sign an authorization for the use of their health information for non-TPO or other permitted uses and disclosures. Woman’s Hospital has approved authorization forms. Under the Minimum Necessary Rule members of the workforce should only have access to the information they need to fulfill their assigned duties. (Workforce includes students, contractors, volunteers, advisory council members, as well as, anyone under the direct control of the health care provider, whether or not they are paid.) The hospital must make reasonable efforts to limit PHI to the minimum necessary when using, disclosing or requesting information. Minimum necessary does not apply when disclosing or requesting information for treatment. Patient Rights Patients have a right to know how their health information may be used or disclosed, and that they have certain privacy rights. These rights are communicated to our patients through a document called Notice of Privacy Practices (NPP). Our Notice of Privacy Practices is distributed upon registration and a signed acknowledgement is obtained. Patients have a right to know the names of their care providers. Wear your identification badge with your photo and name showing at all times. Patient rights allow patients to access and obtain a copy of their medical record, request to amend their medical record, obtain a list of who the hospital has disclosed their PHI to for up to the past six years, request communications of health information by alternative means and request restrictions on the use of their PHI. Revised 3/2015 6 Facility Directory Restrictions Patients must be given the opportunity to agree or object to be included in the facility directory (master patient index of patients treated at the hospital). If the patient chooses to be included in the directory, the location (room number or unit) may be given to individuals who ask for the patient by name. Religious affiliation of the patient can only be given to clergy. If the patient chooses not to be included in the directory, the patient’s name is marked as confidential (“CONF”) in the information system. Persons calling or visiting should be told, “I’m sorry, I don’t have any information for that name.” Involvement in the Individuals Care and Notification Purpose Patients must be provided the opportunity to agree to, prohibit or restrict the disclosure of protected health information (PHI) for involvement in their care and for notification purposes. Protected health information may be disclosed to a family member, close personal friend, or any other person named by the patient, if the information is relevant to that person’s involvement with the patient’s care or payment of the patient’s health care services. A family member, close personal friend, or any other person named by the patient may be notified of the patient’s location, general condition, or death, provided: the patient agrees to the disclosure(s); the patient has had the opportunity to object to the disclosure, and the patient did not express an objection; or the health care provider reasonably infers from the circumstances, using professional judgment, that the patient does not object to the disclosure. If the hospital suspects that a patient is a victim of domestic violence or abuse, the hospital should not disclose information if there is reason to believe that the information could cause harm to the patient. In the event that the patient does not have the opportunity to agree or object to the disclosure, the information can be disclosed using professional judgment, determining whether the disclosure is in the best interest of the patient and, if so, disclose only the PHI that is relevant to the person’s involvement with the patient’s health care Revised 3/2015 7 Verification Workforce members, who are authorized to disclose PHI, must verify the identity and authority of the person(s) requesting PHI if the identity is not known. Workstation Use and Security Policy All health information, no matter where it is, must be kept secure. This includes information stored on computers. Everyone who uses a computer has a duty to keep health information secure. Workstation Use Policy also applies to laptops, notebooks, hand-held devices, or other computers. Portable/Home computers Must not be left unattended unless they are In a secure area Must be placed in proper carrying cases when transporting Users of portable/home computers: Must immediately report any lost, damaged, malfunctioning or stolen equipment to the Security and Privacy Officers. Are responsible for securing the unit, associated equipment and data within their homes, cars and other locations May not permit anyone else to use the computer for any purpose, including family Workforce members must protect all patient information on computers by signing-on with individual IDs and passwords, signing-off of computers, protecting computer screens from unwanted viewing and never leaving printers unattended when printing confidential information. Password Management Woman’s Hospital Password Management policy requires logging on to systems only with valid user IDs passwords. Passwords must not be shared with any other person. Use of another person’s login ID or password is prohibited. Passwords must be changed whenever there is any indication of possible password compromise. New passwords may be requested from IS Help Desk or System Administrator. Passwords must be not be written down unless the paper the password is written on can be stored securely. Revised 3/2015 8 Proper Use of Email Woman’s Hospital email policy prohibits transmission of patient information in an e-mail message outside of the organization. Patient name is prohibited in the transmission of internal e-mails. Proper Use of Fax Faxing of patient information is only permitted in emergency situations. The Woman’s Hospital cover sheet should always be used. Protection from Malicious Software All information systems must have installation and regular updating of anti-virus software. If a virus or worm is suspected, the Information Security Officer should be notified by telephone, 8352 or e-mail. Log-In Monitoring The number of unsuccessful login attempts is limited. Unsuccessful login attempts may be recorded and monitored. Safeguards Documents, faxes, photocopies, reports, schedules, charts, patient boards, etc. must be hidden from unauthorized viewers. File rooms should never be left unattended or unlocked. Disposal of Patient Information Patient information must be disposed off carefully, such as using the “Shred-it” container instead of throwing patient information away. Patient information should never be disposed of in an open area trash bin. Photographs Photographing patients or visitors by hospital employees, students, contractors, volunteers, advisory council members, etc. without a valid, written authorization is prohibited. Auditing Access Most hospital computer systems have “audit trails” that identify specific computer transactions. Audit trails document the date, time, and the name of a user accessing a specific patient. Audit logs are reviewed on a routine basis. Access that appears to be inappropriate is investigated and sanctions are applied when violations are identified. Revised 3/2015 9 Breach of Protected Health Information Breach means the acquisition, access, use or disclosure of PHI in a manner not permitted under the HIPAA Privacy Rule. Breach Requiring Notification to Patient Breaches requiring notification by the Privacy Officer are those breaches determined after risk assessment that the security and or privacy of PHI is compromised (poses a significant risk of financial, reputational, or other harm to the patient). The patient must be notified by first class mail, without unreasonable delay and no later than sixty days after discovery of the breach. Examples of breaches: Employee accesses PHI of a friend, coworker, or neighbor in computer out of curiosity and without a business-related purpose. Stolen laptop, PDA, or flash drive with unencrypted PHI Employee posting patient photo or other PHI on Facebook or MySpace Misdirected fax containing patient information Sending, bills, records, etc. to the wrong person Nurse takes photo of baby with cell phone and transmits to friends Discussing patient information with others outside the hospital or without a need to know to perform their job Consequences for not Complying with the Law A breach of privacy may result in the cancellation of contract(s), loss of privileges, removal from committee(s), legal action and/or disciplinary action up to and including termination of employment. It has always been against hospital policy to improperly use, disclose, share, or dispose of patient information in the wrong way. Under HIPAA, there are fines and penalties for this. Wrongful and willful disclosure of health information can result in fines from $100 up to $1.5 million for multiple violations of an identical requirement during the calendar year. Criminal penalties for “wrongful disclosure” could result in jail sentences up to ten years and fines up to $1.5 million. Revised 3/2015 10 Reporting Violations It is EVERYONE’s responsibility to report violations. Any individual receiving an allegation of a breach or having knowledge or a reasonable belief that a breach of confidentiality of PHI may have occurred shall report it immediately. If complaints are from patient during visit, refer to the supervisor. If patient wants to file formal grievance, refer to Patient Relations Coordinator, Kathleen Bosch, 924-8380. If a former patient calls to file complaint, refer to Patient Relations Coordinator. All other allegations and suspected breaches, Refer to Director of Health Information Management/Privacy Officer, Danielle Berthelot, 924-8322 Security Incident An information security incident is defined as “the attempted or successful unauthorized access, use, disclosure, modification, or destruction of information or interference with systems operations in an information system.” An information security incident may be reported in one of the following ways: Submit an Information Systems Helpdesk ticket via the intranet If the Intranet is down or inoperable, call the IS Help Desk between the hours of 7:00am and 6:00pm, Monday through Friday If you do not reach an IS technician, call the IS on-call pager number at 934-2822 Call or email the Information Security Officer, Rhett Roy Visit the Information Systems office. Infant Security Infants are transported internally only in portable bassinets or in Mother’s arms, and escorted by hospital personnel. When Mother and baby are leaving the hospital, hospital personnel will escort them through the admitting entrance. To report any suspicious person or activity to Security, dial 8473. Report missing scrubs, uniforms, lab coats, name badges, etc to the area manager or his/her designee. Nursery staff abides by the Infant Security Badge Procedure. Be aware: a disturbance may be created as a diversion. Revised 3/2015 11 Infection Control and Prevention Hand washing is the single most effective measure to reduce spread of infection. Always wash your hands when there is contact with patients, before and after wearing gloves, between procedures on the same patient, after using the restroom, before and after eating, after contact with a patient’s intact/non-intact skin, before invasive procedures, and after contact with inanimate objects, including medical equipment, in the immediate vicinity of the patient. Artificial nails and long natural nails are prohibited for any worker assigned to patient care activities. Standard precautions are used on all patients when handling blood, body fluids and secretion/excretion (except sweat). Sharps: Do not recap needles. Place sharps only in sharps-specific containers found in each patient care area. Notify the area manager or his/her designee when the sharps container is ¾ full. Medical waste is separated into two types: Waste that has been contaminated (grossly soiled) with blood or body fluids, and is placed only in RED colored bags. Waste that is not contaminated with blood or body fluids is placed in the regular trash. All dirty linen is placed in BLUE colored bags. You should obtain the appropriate colored bag from the area manager or designee as needed. Close all bags securely. Leave the closed bag in the patient care area and notify the area manager or designee of its location and contents. The Exposure Control Plan is found in the Infection Control Manual via the intranet and on each patient floor. If you have questions, contact the Infection Control Coordinator by dialing 8962 or 8466. If you have an actual exposure, immediately contact the Employee Health Nurse by dialing 8144 or 8299. After 3 p.m. and on weekends, call the Operator, who will contact the Administrative Supervisor for instructions. Revised 3/2015 12 Transmission-based precautions (airborne, droplet, or contact) are added when infection or colonization with transmissible pathogens is known or suspected. Woman’s Hospital is identified by the Centers for Disease Control protocol as a low risk facility. Isolation rooms are located in the Assessment Center, 2nd floor rooms 2201, 2236, 2311 and 2512, 3rd floor rooms 3336, 3515, 3534 and 3566, 4th floor room 4436 and 5th floor room 5536. Always check with the area manager, his/her designee, or with the Infection Control Coordinator (x8862) before entering any area that is labeled as having Isolation or Transmission-based Precautions in effect. Life Safety Smoking is prohibited on Woman’s Hospital property at all times. If you become aware of, or suspect a fire, report it immediately to the nearest employee and wait for instructions. If no employee is present, pull the nearest fire alarm pull station (located at each stairwell entrance). If a fire is paged overhead (“Code Red”) and is identified as being in a location other than that in which you are working, continue with the procedure you are performing. Remain in your assigned area until the overhead paging announces an “all clear,” or you are directed to leave. If a fire is paged overhead and is identified as being in the same location of the hospital as that in which you are working, finish the procedure as quickly as possible and wait for direction from the employee in charge. In the event of evacuation, follow the directions of the employee in charge Lines of Communication The first line of communication for clinical information concerning a patient is the area manager or his/her designee. The first line of communication for hospital administrative information is the administrative supervisor, who may be reached by dialing 8399 from the phone in the patient’s room or from any house phone, or by dialing “0” for the Operator and asking him/her to page the administrative supervisor. Revised 3/2015 13 Medical Equipment Medical equipment is fixed or portable equipment used for the diagnosis, treatment, monitoring and care of patients. Contact the area manager or designee for information about the location and operation of the equipment you will use. If there is a problem with the equipment, notify the area manager or his/her designee. It is your responsibility to: identify the equipment you will use; know how to properly operate the equipment you will use; and/or know the location of the equipment you will use. Organ Procurement Woman’s Hospital provides all families of potential donors with the option of organ/tissue/eye donation upon the death of a suitable candidate. Woman’s Hospital contacts the Louisiana Organ Procurement Agency to evaluate every death for potential organ and tissue donation. Medical criteria for organ and tissue donation are available on every nursing unit. Pain Management Pain management is a collaborative interdisciplinary approach to eliminate or minimize pain. This process will begin prior to or upon admission and will continue while the patient is receiving services at Woman’s Hospital. Assessment and reassessment of the patient’s pain should be documented utilizing the appropriate pain scale and at the intervals identified by organizational policy. Clinical care providers will receive more specific information from their clinical area manager or designee. You should immediately report any unexpected complaint of pain or any unusual clinical event or incident to the area manager or designee. Patient Safety Program Woman’s Hospital’s Patient Safety program is organization-wide and is based on interdisciplinary team action, promoting open communication of all occurrences or near misses. Reported occurrences will be handled without threat of punitive action. In any adverse event, your first responsibility is to minimize harm to the patient or visitor. Following this initial response, you should report any incident to the area manager or his/her designee. Everyone has a responsibility to report any situation that seems potentially unsafe to the area manager or his/her designee. Performance Improvement Woman’s Hospital is committed and dedicated to using a systematic approach to continuous learning and improvement in the processes, services, and functions that influence the provision of exceptional care and a culture of safety. The Quality and Patient Safety Program Revised 3/2015 14 involves every department and every individual throughout the continuum of care and extends to all subsidiaries of Woman’s. Working in a safe, fair, and just culture means every individual shares a deep commitment to providing quality care and making safety a priority. Requests to Be Excluded From Patient Care It is the policy of Woman’s Hospital to consider your request to not participate in an aspect of patient care when the request is based on your cultural values, ethics, or religious beliefs. Further, it is our policy that no patient’s care will be compromised as a result of your request for exclusion of some aspect of patient care. Any request for exclusion in an aspect of patient care should be directed to the area manager or designee. Restraints and Seclusion Restraints are used only when other alternatives have been tried and are unsuccessful. Seclusion is not to be used. Questions or concerns about the use of restraints should be discussed with the area manager or designee. Systems Failures Notify the area manager or designee immediately if any of the following systems fail to operate: Telephone system: there will be no dial tone on most phones; Normal power: emergency generators will automatically begin to provide power for essential lighting and selected electrical outlets in the event of hospital-wide outage; Steam system: no building heat, inoperative sterilizers, no hot water; Medical gasses/vacuum systems: no oxygen or medical air; no vacuum and alarm; and/or Communications system: no nurse call button. Unusual Clinical Event An unusual clinical event or incident is defined as an unexpected or unplanned physical response noted in the patient. You should report any unusual clinical event or incident to the area manager or designee. Revised 3/2015 15 Population-Specific Patient Care You should demonstrate appropriate behaviors based on a patient’s age-specific characteristics, needs, and challenges. Review the following information on populationspecific patient care for the patients you serve. NEONATAL: BIRTH TO 28 DAYS General Appearance: hands fisted, random grasp; weak, mewing cry associated with extreme prematurity. General Information: internal and external world are not differentiated - all are experienced as a part of self. POPULATION-SPECIFIC CHARACTERISTIC The neonate will develop a sense of trust and security when his needs are met consistently and with predictability by parents and/or primary care givers. BEHAVIORS Encourage caregivers and parents to respond to physical needs consistently Involve parents in procedures and in education and training Encourage parents to cuddle/interact with neonate. Touch and stroke the infant as permitted by physical condition The neonate is unable to communicate their needs. Recognize that a furrowed brow, tightly shut eyes and a deepened nasolabial furrow are signs of pain The neonate’s skin is very fragile and at risk for injury and infection. Handle neonate gently Because of body system immaturity, the neonate startles easily and loses body heat quickly. Avoid loud noises and bright lights Speak in a soothing voice Keep neonate wrapped for warmth. The neonate is unable to support his head. Support infant’s head and neck when holding or moving him. Revised 3/2015 16 INFANCY: 29 DAYS TO ONE YEAR General Appearance: gains weight/height rapidly; doubles weight/length by 50% in 6 months; anterior fontanel closes at 12-18 months, posterior fontanel closes at 2 months; regular bowel and bladder patterns develops; should have approximately 8 teeth by end of first year; primitive reflexes (grasp, moro, rooting, sucking) diminish. General Information: recognizes bright objects and progresses to recognizing familiar objects and persons. POPULATION-SPECIFIC CHARACTERISTIC The infant will develop a sense of trust and security when his needs are met consistently and with predictability by parents and/or primary care givers. Sudden loud noises and bright lights startle infants Towards middle of the year, infant learns to raise head, turn, roll over, and brings hand to mouth. Towards end of the year, infant learns to crawl, stand alone, walk with assistance and grasps strongly. Towards end of the year, infant learns to speak two words, mimic sounds, obey simple commands and understand meaning of several words. Infants develop fear of strangers and become anxious when away from parents. BEHAVIORS Encourage caregivers and parents to respond to physical needs consistently Involve parents in procedures, education and training Encourage parents to cuddle/interact with neonate. Touch and stroke the infant as permitted by condition Avoid loud noises and bright lights Speak in a soothing voice Provide safe/protective environment Keep crib rails up at all times Make sure toys do not have removable parts and check for safety approval Give soft blocks and squeaky toys Do not leave unattended Use simple, familiar words and commands Use imitation to encourage desired response Limit number of strangers caring for infant Encourage parents to assist/stay in infant’s line of vision Allow infant to have unlimited access to “lovey” TODDLER: 1 - 3 YEARS General Appearance: all 20 deciduous teeth present by 2 1/2 to 3 years; abdomen protrudes; grows 2-2 1/2 inches and 4-6 lbs yearly. General Information: knows own gender and differences of gender. POPULATION-SPECIFIC CHARACTERISTIC May cry and become anxious when parents are not present. Revised 3/2015 BEHAVIORS Allow parents to stay with child at all times; Include parents in all interactions 17 Walks independently, progresses to running, jumping, and climbing; loves to explore. Newly learned bowel and bladder control may regress due to illness. Constructing 3-4 word sentences and is tying words to actions. Understands ownership (what is mine); sees things only from their point of view (strong sense of will). Maintain and provide for safety at all times Do not leave unattended Set limits Allow for bathroom/”accident” interruptions Has a short attention span; responds better to pictures than words. Give one direction at a time Prepare the child shortly before a procedure Use games, books, toys as distraction/communication techniques. Use simple directions and requests Allow child control over security objects and toys whenever possible Allow choice when possible Use firm, direct approach Give permission to express feelings (“It’s all right to cry, be sad) SCHOOL AGE CHILD: 3 - 6 YEARS General Appearance: gains weight and grows in height 2-21/2 inches a year; becomes thinner and taller. General Information: dresses/undresses independently; knows own phone number and address ; understands that the amount of something is the same regardless of shape or number of pieces ; prints first name; draws person with 6 major body parts; throws and catches a ball around 5 years; 5 year olds use sentences, knows colors, numbers, and alphabet. POPULATION-SPECIFIC CHARACTERISTIC Life centers around parents siblings, and peers. He gets lonely and wants to play with someone. Is physically energetic. BEHAVIORS Encourage siblings and peers to visit when possible Encourage parents to stay and hold child Major cognitive skill is conversation; he understands numbers and is able to classify objects. Encourage child to verbalize Talk directly to child Use counting and puzzles as distraction techniques Revised 3/2015 Maintain safety at all times Limit movement restrictions 18 Beginning to assert his independence; he Allow child to have some control likes to boast and tattle and may be Give permission to express feelings physically aggressive. His behavior may Make intentions clear to child before touching him be changed by reward. Praise for good behavior Offer “badge of courage” - stickers, etc. May have imaginary friend, has difficulty Use stories as distraction and/or teaching tool distinguishing real from imaginary; likes Listen to distinguish fact from fantasy stories; uses imagination in play. Do not deny imagination or imaginary friends Is inquisitive, always questioning “why”; Explain procedures, unfamiliar objects has a short attention span. Demonstrate use of equipment Focus on one thing at a time SCHOOL AGE CHILD: 6 - 11 YEARS General Appearance: permanent teeth erupt; starts pubescent changes; growth is slow and regular. General Information: starts to think abstractly and to reason; can handle and classify problems; able to test hypothesis. POPULATION-SPECIFIC CHARACTERISTIC Belonging and gaining approval of peers is important. Family and teachers are also important. Assume responsibility for own personal care; takes care of pets and assists with household chores. Capable of logical operation with concrete things; motor skills are increasing and is able to follow successive verbal directions. Focus is on concrete processes and operations; may view accident or illness as punishment for previous misdeeds and may have fear of body mutilation or harm. Behavior is controlled by expectations, regulations and anticipation of praise or blame. Revised 3/2015 BEHAVIORS Support visitation/phone calls from peers and siblings Continue school/schoolwork if possible Encourage self-help groups of peers for children with chronic health problems Allow the child to have some control Reinforce accomplishments Promote independence Explain procedures and equipment Allow the child to participate in care Explain which body part will be affected and how Give clear, simple, truthful explanations Explain procedures by comparing them to other less stressful procedures Always explain the reasons for medication and/or treatments Use rewards to encourage compliance Be concrete and specific Clearly define and reinforce behavior limits 19 ADOLESCENCE: 12 - 18 YEARS General Appearance: Awkward in gross motor activity; fine motor skills are improving. General Information: Beginning development of occupational identity (what I want to be); achieves new and more mature relationships. POPULATION-SPECIFIC CHARACTERISTIC Belonging to peer group is important and valued to the adolescent - may prefer friends to family. Because of the adolescent’s rapid skeletal growth, he may fatigue easily. Interested and confused by his own physical development; is critical of own features; concerned with physical appearance; interested in opposite sex. Has the ability to use abstract thought and logic; to examine own thoughts and feelings. Wants to appear in control yet needs to rely on adult/parent; accepts criticism or advice reluctantly. BEHAVIORS Reinforce parental guidelines Support visitation/phone calls from friends Provide rest and sleep periods Provide privacy Encourage questions regarding fears Consider adolescent’s choice of male or female caregiver when possible. Explain procedures to adolescent and parent using correct terminology and giving rationale Involve adolescent in decision making Talk to the adolescent, not about him Allow adolescent to make treatment decisions as much as possible Respond in non-defensive manner when adolescent resists therapy GERIATRICS: 65 YEARS AND OLDER General Appearance: bone mass begins to decrease; loss of skeletal height, atrophy of reproductive organs, thinning of hair; changes in skin pigmentation. General Information: atrophy of reproductive organs, decreased muscle strength, endurance declines; retirement; pursuing second career, interest, hobbies, community activities, leisure activities. POPULATION-SPECIFIC CHARACTERISTIC Decline in health and function often necessitates changes in physical living arrangements. Skin and skeletal structures are fragile. The patient may experience decreased mobility and balance. Revised 3/2015 BEHAVIORS Include family and individual in decision-making Assess resources for discharge Provide protective environment; maintain safety at all times. Use tape sparingly; remove Band-Aids carefully Handle body with the palms of your hands rather than 20 Decreased tolerance to heat and cold. Decreased peripheral circulation causes the patient to feel colder than may be expected. May be experiencing significant life changes such as death of spouse and friends and retirement. Experiences decreases in hearing, vision, memory, and mental function Revised 3/2015 with fingers Use caution when serving hot food and beverages and when using heat for treatments Be aware of the need for warmed environment (extra blankets, higher thermostat) Support feelings of value by encouraging individual to share experiences and wisdom Explore individual support system; involve support system in plan of care Emphasize relationships with children and grandchildren Speak distinctly and slowly Instruct about one item at a time Provide needed time to make decisions Repeat information frequently Provide adequate lighting and larger print 21 Non Employee Service Provider Agreement Printed Name: _______________________________________________________________ Position or type of service:_______________________________________________________ Organization: ________________________________________________________________ (affiliation/school/ company/and hospital department) Supervisor’s Name: ____________________________________________________________ I have thoroughly read and understand the attached information. I understand that I have a responsibility to request the proper protective equipment to perform my tasks safely. I understand that I have a responsibility to be aware of the location and the proper operation for all medical equipment I will use. I understand there is someone available to assist me and will request assistance when necessary. I understand that I have a responsibility to inform the area manager (or his/her designee) should a situation arise in which it is outside the scope of my ability/license to perform/participate. I have been provided information on Woman’s Hospital Health Information Privacy and Security policies and procedures (pages 6-10) and understand the contents. ________________________________________________ Signature Revised 3/2015 ___________________ Date 22 Non Employee Confidentiality Agreement Printed Name: ________________________________________________________________ Position: _____________________________________________________________________ Organization: _________________________________________________________________ (affiliation/school/ company/and hospital department) Supervisor’s Name: ____________________________________________________________ I understand that my association, duties or educational assignments with the above named organization may entail access to information from Woman’s Hospital that is not generally available or known to the public. Such information includes but is not limited to patient, customer, member, provider, group, physician, employee, financial, and proprietary information, whether oral or recorded in any form or medium. Woman’s Hospital has a legal and ethical responsibility to safeguard the privacy of all patients and to protect the confidentiality of their health information. In the course of my organization’s business relationship with Woman’s Hospital, I may access or be exposed to confidential patient information, even though it may not be directly involved with the services/assignments I am performing. In consideration of, and as a condition to, my organization’s business relationship with Woman’s Hospital, I will hold any and all information (“confidential information”) in strictest confidence. I hereby agree that such information is confidential and belongs to Woman’s Hospital. I further agree that information developed by me, alone or with others that uses information from Woman’s Hospital may also be considered confidential information that belongs to Woman’s Hospital. As an employee, student, agent, vendor, contractor, committee member, volunteer or visitor of the above named organization, I hereby agree that I will not access confidential information from Woman’s Hospital except when legitimately required in the performance of my assigned duties. No confidential information shall be disclosed except to the individual of the above named organization who needs to know to fulfill their obligations to Woman’s Hospital or to authorized representatives of Woman’s Hospital. I will not sell, share, discuss, assign, transfer, or otherwise disclose any confidential information outlined above with any other individuals or business entities during or beyond my affiliation with Woman’s Hospital. I will not use the confidential information for any purpose other than providing the mutually agreed upon services. I understand that any breach of confidentiality may result in disciplinary action, including immediate discontinuation of my use of the system or access to restricted areas, and termination of my engagement as an external resource at Woman’s Hospital and possible legal action. ________________________________________________ Signature ___________________ Date _______________________________________________ Witness ___________________ Date Revised 3/2015 23