Download Standards of Care “CARES”

STUDENT
ORIENTATION
HANDBOOK
Fort Loudoun Medical Center
550 Fort Loudoun Medical Center Drive
Lenoir City, TN 37772
865-271-6000
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Table of Contents
•
Welcome Letter
•
Purpose, Vision, Values
•
Organizational Structure
•
Phone List: Frequently Called Numbers
•
Patient Care Philosophy
•
Ethics Committee
•
Behavior Expectations
•
Care of Equipment & Supplies
•
Chaplain Services
•
Infection Control
•
Risk Management
•
National Safety Standards
•
Abandoned Baby-Surrender of Infant
•
Suicide Precautions
•
Safety & Security: Emergency Response / System Failure
CLINICAL STAFF INFORMATION
•
Nursing Standards of Care
•
Abuse
•
Restraints
FORMS & REQUIRED DOCUMENTATION
•
Receipt of Handbook Signature Form
•
Post-Test for Infection Control
•
Post-Test for Safety/Security
•
Post-Test for Clinical Content
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WELCOME !!!!!
…..to Fort Loudoun Medical Center. We are glad you’re here.
This orientation handbook was designed to help familiarize you
with our facility policies. Please take time to look through this
information. At the end of this booklet, you will find a test for
Infection Control and Safety/Security. All students are required to
complete these tests. The last section of this handbook is for
clinical staff and students only. All clinical staff and students are
required to complete the above mentioned tests and the postclinical test. You may use the information enclosed to help you
obtain the answers.
The completed tests and signed confidentiality agreement are
due before you begin your rotation. Please send them to your
clinical instructor, who will then forward to the Education
Department. If you have any questions, please feel free to contact
us @ 271-6508.
Again, welcome to Fort Loudoun!
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Our Purpose
We serve the community by improving
the quality of life through better health.
Our Vision
Through its people
Covenant Health will be recognized
as the premier health services system in Tennessee
Our Values
Working together in service to God, our values are:
Integrity
Quality
Service
Caring
Developing People
Using Resources Wisely
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Human Resources
Department
Ethel Owens
531-5066
We want your employment and/or clinical rotation here to
be satisfactory for both you and your manager. We are
here to help you with any concerns or problems.
Comment boxes are provided for all employees, visitors, or
patients to provide feedback on our organization and the services we
provide. Please complete the suggestion/comment card and drop in the
comment box.
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Most Frequently Called Numbers:
FLMC Main Line
271-6000
Administration
271-6500
Benefits Info Line
531-5469
Cardiac Rehab
271-6030
Cardiopulmonary
271-6284
Case Manager/Patient Representative
271-6509
CCU
271-6290
Chaplain
Notify Nursing Supervisor 417-4263
Dietician
271-6308
Dining on Call
271-6300
Engineering
271-6445
Employee Assistance Program
531-4500
Education / Employee Health
271-6508
Environmental Services
271-6440
Help Desk
374-4900
HIM (Medical Records)
271-6010
Human Resources
271-6040
Imaging
271-6045
Infection Control
271-6509
Laboratory
271-6050
Materials Management
271-6400
Med-Surg
271-6455
Pharmacy
271-6370
Quality / Risk
271-6507
Surgery Waiting
271-6085
While on campus, you must dial the number 5 and the last 4 digits of the
number.
HR cannot transfer personal calls except on an emergency basis.
If you use the main hospital number as your work number, be sure to indicate your
department. The hospital operator may not have this information.
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PATIENT CARE PHILOSOPHY
Every patient who enters a Covenant Health facility is to be treated with
courtesy, compassion, respect, and dignity. As an employee or student, you
have accepted the high and special challenge of providing advanced
technological care while maintaining a personal and close awareness of the
individual human needs of our patients. In any activity conducted by, for, or in
the organization affecting care and treatment of patients, there will be no
separation, discrimination or other distinction on the basis of race, color,
disability, or national origin. All cultural diversity is acknowledged and
incorporated into the patient plan of care.
In working with the sick and injured, it is important to remember that you are
dealing with persons in exceptional circumstances. You will discover that many
patients have fears and resentments that may manifest themselves as
irritability, lack of cooperation and apprehension. Courtesy, kindness, and
above all, sincere understanding are important steps in overcoming these
problems. Always remember that what is routine for you may be a great
emergency in the mind of the patient and his/her family. Your thoughtful
consideration will often be remembered long after the medical services
performed have been forgotten.
STAFF RIGHTS
Requests by a staff member not to participate in any aspect of patient care
where there is perceived conflict with the staff member’s cultural values or
religious beliefs will be addressed in the following manner:
1.The Ethics Committee is available to employees as a forum and source of
ideas for resolution of ethical conflict.
2.Employees may transfer to a position in another department, if available.
3.If the ethical conflict occurs when the employee is on duty, and the patient’s
need for care or treatment is imminent, the staff on duty should decide who will
care for the patient. If no decision can be reached, the staff member in charge
should refer the issue to the manager, Director, Administrative Supervisor, or
Administrator On-call to render a decision to ensure that the patient receives7
appropriate care.
These guidelines provide a mechanism to address
the concerns of staff while ensuring that a patient’s
care will not be negatively affected.
ETHICS COMMITTEE
Covenant Health is committed to the care of people
in a manner that ensures patient and family dignity,
privacy, and respect. Affirming the rights of the
patient to participate in the planning and decisionmaking processes affecting his or her treatment is
facilitated through the provision of a multidisciplinary
Ethics Committee at each facility. Access to the
Ethics Committee at Fort Loudoun regarding any
issue is available through contacting Quality Support
Services, Administration, or the Nursing Supervisor.
The objective of the Ethics Committee is to provide
education for its members, the staff, and the
patient/family; to be involved in the development of
policy and procedure issues concerned with ethical
issues; and to be available for case reviews. Any
individual, be it staff, patient, family, or the general
public, may request a review by the Ethics
Committee.
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CAFETERIA
The cafeteria is open Monday
through Friday for breakfast and
lunch.
Breakfast 7:30am-9:00am
Lunch 11:00am-1:30pm
LOST & FOUND
•All property found on the FLMC
campus must be turned over to
Security, who shall serve as a
central clearing point for all
personal articles, property, or
other valuables that are found.
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BEHAVIOR EXPECTATIONS
DRESS, APPEARANCE AND HYGIENE:
This policy is intended to provide guidelines regarding
appropriate appearance standards at Covenant Health. It
cannot address every potential item of clothing or accessory;
therefore, Managers are expected to apply good judgment in
maintaining professional and appropriate appearance of their
employees.
The image we portray through our dress and appearance is an
important reflection of our professionalism and commitment to
quality. Therefore, our employees should meet the following
guidelines regardless of where they work:
Clothing and Fit
All clothing, regardless of whether it is a uniform or other
dress, should be clean, fit properly, in good repair and pressed
or ironed as needed. Any article of clothing that portrays a
printed message, which could be offensive to the general
public, shall not be worn. Denim is not appropriate in the
workplace, although departments may occasionally allow
denim attire when the work being performed warrants it.
Uniforms
Students should adhere to the school uniform policy for clinical
rotations, except in areas where facility provided scrubs are
required, such as Surgery.
Tops/Blouses
Tops and blouses should not have a revealing neckline or midriff.
Sweatshirts, tank tops, and shirts with printed messages are not
permissible.
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Pants
Pants may be worn if appropriate; however, the following
styles should not be worn: overalls, warm-up or sweat
pants, clamdiggers, pedal pushers, tight stirrup pants, or
leggings. Capri pants may be worn by staff in the nonclinical departments; however, they must cover ¾ of the
leg or reach the bottom of the calf.
Skirts, Dresses, and Shorts
Skirts and dresses should be of appropriate length.
Culottes, city shorts, and skorts are not permitted.
Sundresses and tank tops are not permitted.
Shoes
Shoes must be appropriate to the dress and job for a given
department.
Clinical: white or black leather or canvas athletic shoes.
They are to be clean and polished. Colored athletic shoes
are not permitted. Athletic shoes may have a conservative
amount of color. Colored shoestrings must not be worn.
Non-clinical: Causal sandals are not to be worn; however
dressy open toe, open back, or sling back shoes are
acceptable.
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Undergarments
Appropriate undergarments (including hosiery/socks) will be worn to
present a neat and professional appearance.
Hair
Employees and students must keep their hair clean and in an orderly
fashion that does not present a safety hazard. Color, style, and length
should be appropriate; mustaches, sideburns and beards are to be neatly
trimmed. For employees who are required for safety reasons to wear a
respirator, beards may not be worn since they would interfere with the
proper fit of the respirator.
Hats
Hats may be worn only as part of an approved overall work uniform.
Jewelry
Jewelry may be worn but should not depict an insignia offensive to the
general public. Excessive or dangling jewelry may be a safety hazard to the
patient or employee. Male employees and students may not wear earrings
while on duty. Certain departments may have a “no jewelry” policy.
Females may wear a maximum of two earrings per ear. No tongue piercing
or any visible body piercing is permissible.
Makeup and Fragrances
Make-up and personal body fragrances, including perfume and aftershave may be worn but should not be overly strong. People who are ill may
be especially sensitive to odors, which may cause nausea or allergic
reactions. Certain departments may have a “no fragrance” policy due to
patient concerns.
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Fingernails
Non-clinical: All employees and students not having direct patient care
should keep fingernails clean and neatly trimmed. Artificial nails may be
worn but must be properly maintained. If nail polish is worn, it must be free
of cracks, chips, and peeling.
Clinical: All employees and students who assist in patient care or provide
services that come in contact with patients will maintain short, clean and
well manicured nails. Nails should be short enough to allow the individual to
thoroughly clean underneath them, not cause glove tears, and not cause
injury to patients when moving or positioning patients. Artificial nails will not
be worn. If nail polish is worn, it must be free of cracks, chips, or peeling.
Artificial nails are defined as substances or devices applied to the natural
nail to augment or enhance the nails. They include, but are not limited to,
bonding, tips, wrapping, and tapes.
Identification Badges
All employees and students are required to wear an identification
badge (name and picture facing out) at all times while on duty enabling
them to be readily identified by patients, visitors, physicians, and other
employees. Pins of a professional nature may be worn on the badge as long
as the pin does not cover or damage the printing, photo, or bar code on the
badge. No tape or stickers should be placed on the badge.
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CARE OF EQUIPMENT AND SUPPLIES
Medical equipment is one of the most important resources we
use in treating patients. It is vital that you be alert to any
malfunction or disrepair of any equipment and that you report
it to your Supervisor or Manager immediately. Remove the
malfunctioning equipment from service and tag apporpriately
for repair.
Do not attempt to use any equipment for which you have not
been properly trained. Always ask for assistance with
unfamiliar equipment.
Supplies are expensive, and you should try to prevent waste
and spoilage. If you should find that you could not
satisfactorily complete your duties because of inadequate
supplies, you should report the shortage immediately to your
Supervisor or Manager.
Cafeteria items such as trays, plates and silverware are not to
be removed from the cafeteria. If you wish to carry out food,
ask for and use paper plates and plastic utensils. If you
should find cafeteria utensils outside the cafeteria, please
return them to the Food Services Department.
As part of the organization’s involvement in and commitment
to the national cost containment program, we ask your help in
treating all equipment and supplies with extreme care. Losses
in these areas mean increased costs for the organization,
which result in increased costs for our patients.
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CHAPLAIN SERVICES
The Chaplains are here for
YOU,
our patients,
and
their loved ones.
•
Chaplain services are provided by Volunteer Chaplains who are on call
on a rotating basis.
•
The Chaplains are here to serve our patients, their loved ones, and our
employees. If you have questions or would like to speak with a
Chaplain, feel free page the nursing supervisor. The on-call Chaplain
will be contacted for you.
•
YOU are our most important asset…the Chaplains would like to stress
the importance of employees taking care of themselves as well as their
patients. You are welcome to visit the chapel at any time to enjoy a
quiet moment in a peaceful setting.
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INFECTION CONTROL
FLMC has an Infection Control / Exposure Control Plan to prevent the
transmission of blood borne pathogens such as: HIV, HBV, HCV, and other
potentially infectious agents by:
–Reducing reasonably anticipated exposure to blood and other
potentially infectious materials
–Establishing engineering and work practice controls
–Providing appropriate employee training and follow-up, and monitoring
of work practices
HANDWASHING IS THE SINGLE-MOST EFFECTIVE WAY TO
PREVENT THE SPREAD OF DISEASE / INFECTION.
IT IS OUR DUTY TO PROTECT THE PATIENTS!!!
The following pages will provide detailed information on disease-specific
pathogens.
–Standard Precautions
–Hepatitis B
–Hepatitis C
–HIV
–C Diff
–VRE
–MRSA
–Exposure Policy
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ISOLATION IMPLEMENTATION
Type of Isolation
Infections Isolated
What to do for each type of isolation
MAXIMUM CONTACT
MRSA, VRE, C. diff, major draining
wounds, Chicken Pox, Shingles,
multi-drug resistant gram negative
bacteria
PPE cart/cabinet stocked
Hand wash with soap/water or hand sanitizer
Glove before entry into room
Gown if potential contact with contaminated surfaces
Alert other departments of patient’s isolation status
Dedicated equipment (BP cuff, stethoscope, thermometer, etc)
AFB (Acid-fast bacilli)
Pulmonary Tuberculosis (TB)
*(Severe Acute Respiratory Syndrome
(SARS) –requires negative air room)
*(Smallpox –requires negative air
room)
*Contact Inf Control/Health Dept
Place patient in negative air pressure room (Med/Surg, CCU, ED,
and Recovery)
Employee fitted for the particulate respirator
Wear respirator to enter room
Keep door closed at all times (even when the patient is
temporarily out of the room)
Negative Air Pressure turned on
 Patient wears a surgical mask (if possible) to leave room
Visitors instructed to wear the particulate respirator
One hour after patient discharge for unprotected entry into room
Chicken Pox, Shingles – also requires
CONTACT isolation
Keep door closed at all times
Only immune-competent staff should be assigned to care for the
patient
Negative air pressure room recommended if extensive draining
lesions and in mouth or nares
Can be airborne transmitted if lesions are in nares and mouth or
from handling contaminated linen
Contact transmission from hands/items contaminated with
drainage from lesions
DROPLET
Flu, Pertussis (whooping cough),
Neisseria meningitidis, Mycoplasma
pneumonia, Parvovirus B19,
Haemophilus Influenza meningitidis,
Rubella, Adenovirus, pharyngeal
Diphtheria, mumps, Group A strep
Wear surgical mask to enter room
Eye protection as required
Patient wears surgical mask, if possible, to leave room
PROTECTIVE
Patients with WBC less than 1,000
Cancer patient receiving chemo
Organ transplant patient receiving
immunosuppressive steroids
Other immune conditions that
physicians feel need protective
isolation
All persons must wash their hands before entering the room.
No fresh fruits or plants in the room (no decorative leafy garnish
on the food tray)
Employees with respiratory infections, fevers, draining wounds,
herpetic lesions, or other potentially communicable conditions
may not enter the patient’s room.
All equipment that will come into contact with the patient must
be disinfected with alcohol prior to and after use.
Remove all soiled linen ASAP; do not keep hamper in the room
Do not remove ice pitcher from the room. Carry the ice to the
room in a closed paper or plastic bag.
Restrict visitors to immediate family; Restrict persons with
known infection.
Patient wears surgical mask upon leaving the room.
Implementation Checklist
1)Stock isolation cart/cabinet
2)Place isolation sign on door
3)Place isolation sticker on chart
4)Make sure alcohol hand sanitizer
dispenser has solution
1)Be sure to alert other departments of patient’s status
2)Appropriate hand hygiene
3)Explain isolation to family/patient
Additional information, fact sheets, etc available from infection
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control @ 271-6509
AIRBORNE / CONTACT
WHAT YOU SHOULD KNOW ABOUT HEPATITIS B
WHAT IS HEPATITIS B?
•Virus that causes inflammation of the liver—one of your body’s most vital organs
•Found in blood
HOW IS IT SPREAD? Mainly through blood
•Infected needles and sharps
•Shared personal care items
•Unprotected sex
•Membranous exposure (eyes, nose, mouth)
•Bites and wounds
•Perinatal transmission
HEPATITIS B CAN RESULT IN:
•No symptoms
•Mild illness
•Acute (severe) illness
•Chronic infection
•Liver damage, such as cirrhosis
•Liver Cancer
•Death due to liver failure
WHAT ARE THE SYMPTOMS? May appear 1-9 months later
•Asymptomatic
•Flu-like (vomiting, nausea, diarrhea, sore muscles and joints, mild fever,
headaches)
•Fatigue
•Stomach pain
•Loss of appetite/weight
•Jaundice
•Dark urine
HOW DO WE TEST FOR HEPATITIS B?
•Physical exam to check if liver is swollen
•Blood test for liver profile
•Liver biopsy
HOW DO WE TREAT HEPATITIS B?
•No treatment
PREVENTION Vaccine is very effective
•Health care workers: Use standard precaution, get vaccinated, exposure management
•HBV + individuals: Protected sex, don’t donate blood or organs, don’t share personal care
items
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WHAT YOU SHOULD KNOW ABOUT HEPATITIS C
WHAT IS IT?
•A virus that can cause serious liver disease
•Found in blood
HOW IS IT SPREAD? Mainly through infected blood
•Infected needles (IV drug, body piercing, and tattoo needles)
•Shared personal care items (razors and toothbrushes)
•Unprotected sex (less common cause)
•Blood transfusion before 1992
HOW DOES IT AFFECT YOUR HEALTH? Damages your liver
•Approximately 85% develop chronic disease found 20-30 years after initial infection
•Cirrhosis (30-40%)
•Cancer (2-4%)
•Liver failure
•Problems with your immune system
WHAT ARE THE SYMPTOMS? Usually acute infection is without symptoms
•Flu-like (fatigue, nausea, vomiting, diarrhea, sore muscles and joints, mild fever,
headaches)
•Loss of appetite
•Weight loss
•Right upper abdomen tenderness
•Jaundice
•Abdominal swelling
•Itching
•Dark urine
HOW DO WE TEST FOR HEPATITITS C?
•Physical exam to check if your liver is swollen
•Blood test for liver profile
•Liver biopsy
HOW DO WE TREAT HEPATITIS C?
•Avoid alcohol and non-prescriptive medications like acetaminophen
•Eat a well-balanced diet
•Get adequate rest
•Exercise
•Take medication as prescribed by your doctor
PREVENTION STEPS No vaccine or medication can prevent the spread of Hepatitis C
Health care workers:
Use standard precaution practices if there is risk of exposure
Follow hospital policy for exposure management
If you are Hepatitis C positive:
Use condoms during sex
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Don’t donate blood products, body tissue, organs
Don’t share needles, razors, toothbrushes, manicure tools, or other personal items
WHAT YOU SHOULD KNOW ABOUT HIV
WHAT IS IT?
Virus that enters bloodstream, invades immune system, overwhelms immune system
Causes AIDS (auto-immune disease syndrome)
HOW IS IT SPREAD?
Infected needles and sharps
Shared personal care items
Unprotected sex
Membranous exposure (eyes, nose, mouth)
Broken skin exposure
Perinatal transmission
HOW DOES IT AFFECT YOUR HEALTH? Stages of the disease
May not show symptoms for years
Swollen glands, lesser diseases
Inability to fight off life-threatening diseases
WHAT ARE THE SYMPTOMS?
Weakness
Fever
Sore throat
Nausea
Diarrhea
White coating on tongue
Weight loss
Swollen lymph glands
HOW DO WE TEST FOR HIV?
Antibody test
Western Blot
HOW DO WE TREAT HIV? No vaccine or cure
Anti-retroviral
Protease inhibitor
PREVENTION
Health care workers: Use standard precautions, exposure management
HIV + individuals: Protected sex, don’t donate blood or organs, don’t share
personal care items
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Clostridium difficile (C. difficile) Fact Sheet
What is C. difficile?
Anaerobic gram-positive spore-forming bacteria producing toxins that cause disease such as C. difficileassociated diarrhea (CDAD).
What causes C. difficile?
Diarrhea may occur as a result of antibiotic use for various reasons but is most severe if caused by C. difficile.
Types of diarrhea-associated C. difficile are a) Nonspecific diarrhea which is self-limited, and relatively
mild b) CDAD is an infectious diarrhea which is almost always acquired by patients who have taken
antibiotics recently (usually within 2 months). The mechanism by which antibiotics induce C. difficile
disease is not well understood and c) Pseudomembranous colitis (PMC) is a more severe form of CDAD
characterized by the presence of pseudomembranes that are yellow, white, or gray neutrophilic mucosal
plaques in the colon.
How is C. difficile transmitted?
The organism is most often transmitted via the hands of health care personnel who have had contact with
contaminated feces or contaminated environmental surfaces. Infection results from ingestion of C.
difficile spores, which survive the acid environment of the stomach, convert to the vegetative forms in the
colon, and produce toxins that result in the clinical symptoms. Commodes, baby baths, and electronic
thermometer handles are among the environmental sites implicated in the transmission of C. difficile.
What prevention and control measures can be taken?
•
•
•
•
•
•
•
•
Contact Isolation precautions. Isolation cart outside patient’s room.
Alcohol hand sanitizers will not kill C. difficile spores, therefore washing with soap and running water is
important to physically remove the kill-resistant spores. Alcohol hand sanitizers are effective for the
vegetative forms of C. difficile but not C. difficile spores.
Wear gloves before entering the isolation room. Gowns should be worn to prevent contamination to your
clothes.
Dedicate equipment for that patient’s use only.
Adequate disinfection of medical devices is important (especially items likely to be contaminated with
feces such as thermometers). Non-critical care items such as blood pressure cuffs and stethoscopes
should be bagged in clear plastic and sent to Sterile Processing for gas sterilization. Reusable critical
care equipment should be disinfected and steam or gas sterilized based on the manufacturer’s
recommendation. Wheelchairs, intravenous poles, and stretchers that are contaminated by infected
patient should be cleaned by vigorously wiping surfaces with an approved disinfectant/cleaner. Reusable
bedpans should be cleaned daily with disinfectant and terminally in the cart washer.
The environment of the room may be highly contaminated with C. difficile spores depending on the
severity of the diarrhea. Thoroughly clean and disinfect the isolation room. A sporicidal agent is
preferred. Areas for attention include toilets, reusable bedpans, furniture, floors (in the bathrooms,
patients’ rooms, and soiled utility room), sinks, bedrails, and telephones. Mops and water are changed
for each isolation room. Special cleaning attention should be given to areas around the toilet. Walls
should be spot cleaned for all visible soiled areas.
Used linen should be bagged in the patient’s room.
Minimizing or preventing anitmicrobial use in patients such as restricting Clindamycin use and controlled
use of extended-spectrum cephalosporins.
How is C. difficile disease treated?
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The first line of treatment is to discontinue the causative antimicrobials or select agents such as metronidazole,
vancomycin, aminoglycosides, or possibly fluroquinolones, which are less likely to cause CDAD.
Vancomycin-Resistant Enterococcus (VRE)
What is Enterococcus?
Enterococcus is gram-positive bacteria normally found in the gastrointestinal tract and female genital tract. It
can cause infection of the following: urinary tract, abscesses and wounds, decubitus ulcers, diabetic foot
ulcers, bloodstream infections, and endocarditis. Vancomycin is a drug that is frequently used to treat many
types of infections. If Enterococcus is resistant to vancomycin it is referred to as VRE (vancomycin-resistant
Enterococcus). Frequently, VRE is also resistant to many of the other drugs used to treat Enterococcal
infection. Therefore, infections caused by VRE can be life threatening.
How Does VRE Infection Occur?
Infection often results from the patient’s endogenous carriage (residing on or in the patient’s body). The
bacteria leave the area of colonization such as the GI tract or GU tract, enters a site, multiplies and causes an
infection (i.e., wounds or migration along a catheter).
VRE can also be transmitted from the contaminated hands of HCW’s (with or without gloves) or contaminated
items or contaminated environment to a patient.
How Do You Prevent Transmission of VRE?
Infections caused by VRE require enhanced precautions beyond Standard Precautions in order to prevent
transmission to a distant site on the colonized patient or transmission to another patient. Practicing good
patient care and maintaining required aseptic and sterile technique is important. Reasons for enhanced
precautions include the potentially serious outcomes of infection, the ease by which VRE contaminates the
environment and its ability to live for days on the environment, objects, and fabrics. Therefore these patients
are placed in Contact Isolation.
How Do You Implement Contact Isolation?
After you are alerted to the patient’s VRE status you will do the following:
•Obtain and place a contact isolation cart outside the patient’s door. The cart will be stocked with gloves,
gowns, disinfectant, and thermometer.
•Dedicate devices such as blood pressure cuffs and stethoscopes to prevent transmitting Enterococcus to
yourself and others. If reasons necessitate the use of such devices on another patient, you must clean and
disinfect the device with an appropriate cleaner/disinfectant such wiping with 70% isopropyl alcohol or other
FDA registered product.
•Post the contact isolation sign on the patient’s door or door frame so that it is noticeable to people who will be
entering the room.
•Place the contact isolation label on the front of the chart so that those who look at the chart can easily see it.
•Handwashing must be performed before and especially after leaving the room. 10-15 seconds of lathering
with soap and water. 15-20 seconds of rubbing with the alcohol hand sanitizer. Be sure to also focus under
and around the fingernails and jewelry if worn.
•Gloves must be worn in order to enter the room. Gowns must be worn if you anticipate contact with the
patient or the environment.
•Alert other departments if the patient is to be transferred for diagnostic testing (i.e., surgery and radiology) or
if transferred to a different unit.
•Whenever possible, communicate the VRE isolation to the physician, other clinicians, dietary and
housekeeping. Encourage and educate others to appropriately follow isolation precautions.
Family and Patient Fact Sheet for VRE
If the family requests information about VRE or if you determine that such information would be of benefit
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to the family, contact Infection Control at 271-6509.
Methicillin-resistant Staphylococcus aureus (MRSA)
What is Staphylococcus aureus?
Staphylococcus aureus is Gram-positive bacteria frequently found on the skin, nares, groin, and GI system. It
may cause infection in the sputum, blood, surgical wounds, burn wounds, decubitus ulcers, perineum,
rectum, tracheostomy, or grastrostomy sites. Methicillin is a drug frequently used to treat
Staphylococcus aureus. If Staphylococcus aureus becomes resistant to Methicillin it is called Methicillinresistant Staphylococcus aureus (MRSA). MRSA strains are frequently resistant to other classes of
drugs, therefore MRSA is very serious or may even be life threatening to your patient.
How Does Infection Occur?
MRSA is usually transmitted from patient to patient via hand carriage of Health Care Workers in the hospital
setting. Also, patients may be colonized (carries it somewhere on their body). Colonized patients may
become infected with their own bacteria, such as MRSA on the patient’s skin migrating into a Foley
catheter.
How Do You Prevent Transmission of MRSA?
Infections caused by MRSA require enhanced precautions beyond Standard Precautions in order to prevent
transmission to a distant site on the colonized patient or transmission to another patient. Practicing good
patient care and maintaining required aseptic and sterile technique is important. Reasons for enhanced
precautions include the potentially serious outcomes of infection, the ease by which MRSA contaminates
the environment and its ability to live for days on the environment, objects, and fabrics. Therefore these
patients are placed in Contact Isolation.
How Do You Implement Contact Isolation?
After you are alerted to the patient’s MRSA status you will do the following:
•
Place a contact isolation cart outside the patient’s door. The cart will be stocked with gloves, gowns
disinfectant, and thermometer.
•
Dedicate devices such as blood pressure cuffs and stethoscopes to prevent transmitting Staph aureus to
you and others. If reasons necessitate the use of such devices on another patient, you must clean and
disinfect the device with an appropriate cleaner/disinfectant such wiping with 70% isopropyl alcohol or
other FDA registered product.
•
Post the contact isolation sign on the patient’s door or door frame so that it is noticeable to people who
will be entering the room.
•
Place the contact isolation label on the front of the chart so that those who look at the chart can easily
see it.
•
Handwashing must be performed before and especially after leaving the room. 10-15 seconds of
lathering with soap and water. 15-20 seconds of rubbing with the alcohol hand sanitizer. Be sure to also
focus under and around the fingernails and jewelry if worn.
•
Gloves must be worn in order to enter the room. Gowns must be worn if you anticipate contact with the
patient or the environment (including activities such as holding clipboard in the room, dispensing meds to
the patient, etc.).
•
Alert other departments if the patient is to be transferred for diagnostic testing (i.e., surgery and
radiology) or if transferred to a different unit so that they can take the same precautions you are expected
to take with your patient.
•
Whenever possible, communicate the MRSA isolation to the physician, other clinicians, dietary and
housekeeping. Encourage and educate others to appropriately follow isolation precautions.
Family and Patient Fact Sheet for MRSA
23
If the family requests information about MRSA or if you determine that such information would be of benefit to
the family, contact Infection Control at 271-6509 to obtain a copy of the patient/family fact sheet.
NEEDLESTICK/BODY FLUID EXPOSURE POLICY
Policy Statement
Any work-related percutaneous (needlestick, laceration, bite) or permucosal
(ocular, mucous membrane) exposure to blood or body fluids MUST be
reported to Employee Health. CDC guidelines will be followed for
assessment and treatment.
Objective
To control transmission of hepatitis B (HBV), hepatitis C (HCV), and HIV
among health care workers.
Procedure
1.
WASH all exposure sites with soap and water. Eyes and mucous
membranes exposures should be flooded with water.
2.
Accidents must be reported immediately to the employee's supervisor
or the house supervisor and an Incident Report completed. The
employee will then go to Employee Health with the report. If the injury
occurs during a time in which Employee Health is closed, the employee
will contact the House Supervisor for evaluation and follow-up by
Employee Health.
3.
A tetanus booster is given per protocol, if indicated.
4.
Subsequent management of the employee depends on the
serological status of the source patient and the vaccination and/or
serological status of the employee
(see EOHS,
Blood/Body Fluid Exposures Policy and
FLMC Exposure Control Plan – Policy EC.SF.004).
Students will be managed and treated at their request . Insurance will be billed for costs
incurred.
24
RISK MANAGEMENT
Fort Loudoun Medical Center has adopted an occurrence reporting mechanism to enable the hospital to
carry out its responsibility for provision and continuous improvement of quality care in a safe environment.
DEFINITION: A reportable occurrence can be defined as any event that is not consistent with the normal
or usual operation of the hospital. Injury does not have to occur. The potential for injury and/or property
damage is sufficient for an occurrence to be considered reportable. Examples:
1. Any occurrence which could or does cause patient/visitor injury or harm
2. Testing and treatment errors or delays/omissions
3. Failure to follow policy and procedure
4. Failure to follow MD orders
5. Incorrect transcription of MD orders
6. AMA discharges
7. Problems with other departments
8. Equipment which malfunctions or is damaged
REPORTING RESPONSIBILITIES: Any employee who is involved in, observes, or hears about a
reportable event is responsible for reporting it to his/her manager/supervisor at the time of the incident and
for initiating the Systems Improvement Report. The manager/supervisor will assist in the completion of the
report if necessary.
A. Occurrences involving a patient will be reported immediately. If the occurrence has an extreme
outcome, the Risk Manager should be notified by telephone, day or night. A Risk Manager is always on call
for the Covenant System.
B. In case of personal injury to a visitor or volunteer on hospital property, the Risk Manager, Nursing
Director/House Supervisor should be notified immediately and a report completed.
C. In case of theft, disturbance, or soliciting, Security should be notified immediately any time day or
night. An officer will investigate and complete a Security Incident Report.
D. In case of equipment malfunction or damage, the Engineering Department should be notified. A tag
shall be filled out and attached to the piece of equipment. The piece of equipment shall be taken out of
circulation.
EXCEPTION: Essential equipment may be tagged and left in use as per decision of Engineering, Risk
Manager, or Administrator-on-Call.
25
National Safety Goals:
Improve the accuracy of patient identification:
–
Use at least two patient identifiers (the patient’s name and date of birth – NEVER use the
patient’s room number to identify the patient) whenever taking blood samples or
administering medications or blood products.
Prior to the start of any surgical or invasive procedure, conduct a final verification process,
such as a “timeout,” to confirm the correct patient, procedure and site, using active – not
passive – communication techniques.
–
Improve the effectiveness of communication among caregivers:
–
Implement a process for taking verbal or telephone orders that require verification “readback” of the complete order by the person receiving the order.
Standardize the abbreviations, acronyms and symbols used throughout the organization,
including a list of abbreviations, acronyms and symbols NOT to use.
Measure, assess and, if appropriate, take action to improve the timeliness of reporting, and
the timeliness of receipt by the responsible licensed caregiver, of critical test results and
values.
Implement a standardized approach to "hand off" communications, including an
opportunity to ask and respond to questions.
–
–
–
Improve the safety of using medications:
–
Standardize and limit the number of drug concentrations that are available in the
organization.
Identify and, at a minimum, annually review a list of look-alike/sound-alike drugs used in
the organization, and take action to prevent errors involving the interchange of these
drugs.
Label all medications, medication containers (e.g., syringes, medicine cups, basins), or
other solutions on and off the sterile field in perioperative and other procedural settings.
–
–
Eliminate wrong-site, wrong-patient, wrong-procedure surgery:
–
Create and use a preoperative verification process, such as a checklist, to confirm that
appropriate documents, (e.g., medical record, imaging studies) are available.
Implement a process to mark the surgical site, and involve the patient in the marking
process.
–
Reduce the risk of healthcare acquired infection:
–
–
Comply with current CDC hand hygiene guidelines
Manage identified cases of unanticipated death or major permanent loss of function
associated with a healthcare acquired infection as a sentinel event.
Accurately and completely reconcile medications across the
continuum of care-
-
Develop a process for obtaining and documenting a complete list of the patient’s current
medications upon the patient’s admission to the organization and with the involvement of
the patient. This process includes a comparison of the medications the
organization provides to those on the list.
A complete list of the patient’s medications is communicated to the next provider of service
when it refers or transfers a patient to another setting, service, practitioner or level of care
within or outside the organization.
Reduce the risk of patient harm resulting from falls.
-
Implement a fall reduction program and evaluate the effectiveness of the program.
26
Abandoned Babies:
•
FLMC will offer protective shelter, medical care and treatment in a
hospital setting to unwanted, unharmed infants aged seventy-two (72)
hours or younger.
•
An “unharmed condition” can be interpreted as meaning the infant was
not harmed through abuse or neglect after being born.
•
If medical assessment reveals injury or abuse to the infant or if the
assessment determines that the infant is greater than 72 hours old, this
policy will not be utilized and the appropriate authorities/agencies will be
notified.
PROCEDURE:
•
Any hospital employee or student will accept a newborn infant
presented for surrender and assure person surrendering newborn that
this is a safe haven.
•
Immediately notify the House Supervisor/designee.
•
House Supervisor will then obtain an Abandoned Baby-Surrender of
Infant Packet. Each packet is coded with a number that corresponds
with and ID band for the infant. This identifying number will be used to
track infant during hospitalization. Corresponding number appears on
self-addressed, stamped envelope provided for return of questionnaire.
(Completed packets will be given to the facility Risk Manager for
sequestering information necessary to maintain confidentiality.
•
House Supervisor will accompany parent/person to ER for infant triage
and medical screening exam. If the person refuses, a numbered
bracelet will be placed on the infant’s arm and leg.
•
House Supervisor will notify the Administrator on Call.
27
SUICIDE PRECAUTIONS
•
FLMC is obligated to exercise reasonable care in rendering
services to all patients, and this includes the protection of
suicidal or severely depressed patients from self-destructive
acts.
•
Suicide Precautions is a set of rules which may be placed into
effect by an RN concerned with the clinical care of a patient or
by the patient’s attending physician or medical consultants.
When ordered, the rules will be followed by all departments
involved in the clinical care or other services rendered to a
potentially suicidal patient.
•
Suicide Precautions will remain in effect until the patient is
declared “non-suicidal” by the psychiatrist or attending
physician and a written order to discontinue suicide
precautions is given.
•
The following shall be considered potentially suicidal:
–
Any patient admitted for an apparent suicide attempt
–
Any patient making a suicide attempt while hospitalized
–
Any patient voicing threats of suicide
–
Any patient who, in the joint professional judgment of the primary
nurse and appropriate nursing supervisor is considered suicidal
–
Any patient who, in the judgment of the attending physician,
consulting physician or psychiatrist, is suicidal
28
EMERGENCY RESPONSE QUICK REFERENCE CHART
SYSTEMS FAILURE AND BASIC STAFF RESPONSE
Failure of:
What to Expect:
Who to Contact:
Responsibility of User:
Computer systems
Systems down
Information systems
Use backup manual / paper system
Electrical Power Failure;
Emergency Generators
Work
Many lights are out.
Only RED plug outlets
work.
Plant
Ensure that life support systems are on
emergency power (red outlets). Ventilate
patients by hand as necessary.
Complete cases in progress ASAP. Use
flashlights.
Electrical Power Failure,
Total
Failure of electrical
systems
Plant and Respiratory
Therapy
Utilize flashlights and lanterns, hand
ventilate patients, manually regulate IV’s,
don’t start new cases.
Elevators Out of Service
All vertical movement
will have to be by
stairwells
Plant and all Managers
Review fire and evacuation plans,
establish services on first or second floor,
use carry teams to move critical patients
and equipment to other floors.
Elevator stopped
between floors
Elevator alarm bell
sounding
Plant and Security
Keep verbal contact with personnel still in
elevator and let them know help is on the
way.
Fire Alarm system
No fire alarms or
sprinklers
Plant
Institute Fire Watch, minimize fire
hazards, use phone, 2-way radios, or
runners to report fire.
Medical Gases
Gas alarms, no O2,
medical air, or Nitrous
Oxide
Plant and Respiratory
Therapy
Hand ventilate patients, transfer patients
if necessary, use portable O2, and other
gases, call respiratory for additional
portable cylinders.
Medical Vacuum
No vacuum, vacuum
system fail and in alarm
mode.
Plant
Call Central Supply for portable vacuum,
obtain portable vacuum from crash cart,
rush cases in progress, don’t start new
cases.
Natural Gas Failure or
Leak
Odor, no flames or
burners, etc.
Plant
Open windows to ventilate, turn off gas
equipment, don’t use any spark
producing devices, electric switches, etc.
Nurse Call System
No patient contact
Bio-Med
Use bedside patient telephone if
available, move patients; use bells,
assign a rover to check patients.
Patient Care, Equipment
systems including
Diagnostic Imaging
Equipment / system
does not function
properly
Bio-Med
Notify Bio-Med (through Engineering)
and tag defective equipment.
Sewer stoppage
Drains backing up
Plant
Do not flush toilets, do not use water.
Steam Failure
No building heat, hot
water, laundry; sterilizers
inoperative, limited
cooking
Plant
Conserve sterile materials and all linens,
provide extra blankets, and prepare cold
meals. Use chemical sterilization.
Telephones
No phone service
Plant
Use overhead paging, pay phones, use
runners as needed.
Water
Sinks and toilets
inoperative
Plant
Institute Fire Watch, conserve water, use
bottled water for drinking, be sure to turn
off water in sinks, use RED bags in
toilets. Use alternate hand washing
methods such as alcohol, foam and
wipes.
Water Non-Potable
Tap water unsafe to
drink
Plant, Food Services
and All Managers
Place “Non-Potable Water-Do Not Drink”
signs at all drinking fountains and wash
basins.
Ventilation
No ventilation; no
heating or cooking
Plant
Open windows (institute Fire Watch) or
obtain blankets if needed, restrict use of
odorous / hazardous materials.
29
EMERGENCY CODES AND BASIC STAFF RESPONSE
CODE
DESCRIPTION
INITIAL RESPONSE
SECONDARY
RESPONSE
CODE
BLACK
Notification of a bomb
on campus, usually by
an outside caller.
Suspicious package or
letter
Notify PBX Operator of a “Code
Black” situation. Obtain as
much info as possible.
Search the area for a
suspicious object.
DO NOT TOUCH
ANYTHING !
Report all
information to
security
CODE
RED
Fire and/or smoke
present
R.A.C.E.
Rescue those in immediate
danger
Activate the alarm; pull manual
alarm/call “Code Red” aloud
Contain fire (close doors)
Extinguish the fire (if safe to do
so)
Protect people from
smoke & fire. Secure
the area to prevent
fire responders,
visitors, and
physicians from
walking into a
hazardous situation.
Account for all
persons in the area.
HAZARDOUS
MATERIALS
SPILL
Chemical, radiation, or
infectious material spill
presenting hazard to
people and the
environment.
Remove persons from the
hazard. Review appropriate
spill plan in Safety Manual. Call
Environmental Services for
mercury spill. All other spills are
cleaned up by trained users of
the material.
Notify the Safety
Director.
Seek/coordinate
medical treatment of
decontaminated
victim.
Person cleaning up
the spill will
complete a
“Chemical Spill
Report” and send to
Safety Dept.
CODE
YELLOW
Notification of a
medical disaster in the
community.
Complete duties and report to
immediate supervisor of
availability to assist.
Call-in additional staff
as needed.
Communicate with
the Control Center
for needs, resources
& information.
CODE
YELLOW
Internal evacuation
Complete duties and report to
immediate supervisor of
availability to assist.
Account for all
persons who were in
evacuated area.
Communicate with
the Control Center
for needs, resources
& information.
CODE
PURPLE
Hostage Situation
An individual is being
held against their will
by an armed
perpetrator
Clear the area and establish
perimeter to prevent
unauthorized entry.
Report all pertinent
information to
Security and Police
in charge of
response.
Provide debriefing
for all affected staff.
CODE
WHITE
Spill or release of
radioactive substance
or identified source of
radiation
Isolate the spill area (evacuate).
Deny entry to others.
Notify Nuclear
Medicine who will
coordinate response.
Notify Radiation
Safety Officer.
Radiation Safety
Officer to complete
report of the incident
and send to Safety
Officer &
appropriate
agencies.
CODE
PINK
Abduction of an infant
Assess whether infant has been
removed from premises. Notify
immediate supervisor. When
code pink is announced, search
for the abductor.
Refer to
departmental
procedures
Marketing/ Public
Relations to
establish follow-up
plan.
CODE
BLUE
A person requiring
immediate medical
attention
Designated team responds to
area following PBX
announcement.
If needed, team
requests additional
assistance.
Review done by
Nursing Supervisor
and Medical
Director.
CODE
GREEN
An employee is in
immediate danger
Designated team responds to
area following PBX
announcement. De-escalate
violent behavior using verbal
intervention
Only after verbal
intervention fails
does team apply
physical intervention
techniques.
Evaluate the
response, complete
incident report and
route to Risk
Manager.
Notification of Severe
Weather in our area
Lower beds, close drapes,
remove articles from window
ledge, cover patients with extra
blankets, close doors &
windows
Assess damage;
assure that patients
and staff are safe
and unharmed.
Communicate all
building damage to
Plant Engineering
and/or Control
Center.
CODE
GRAY
FOLLOW-UP
30
Only clinical staff and
students need to
complete the following
section.
31
Standards of Care
“C.A.R.E.S.”
Comfort
All patients treated by the nursing staff of FLMC can
expect comfort to be optimized through effective
utilization of appropriate comfort measures.
heAling All patients treated by the nursing staff can expect
healing to be promoted through maintenance of
effective hydration and nutrition, appropriate medication
administration and the recognition, acceptance and
support of his/her psychosocial and spiritual needs.
Respect
All patients can expect to receive respect for his/her
rights as a patient and individualized nursing care
based on research findings, ethical principles and
continuous quality improvement, according to his/her
unique health care needs .
Education
Safety
All patients can expect to receive education specific to
his/her continuing health care needs.
All patients can expect care to be delivered in a safe
environment free of nosocomial infections and
injurious insults.
32
ABUSE: Adult & Child
DEFINITIONS:
• Abuse or neglect means the infliction of physical pain, injury or mental
anguish, or the deprivation of services by a caretaker which are
necessary to maintain the health or welfare of a dependent adult.
(See Tennessee Code 71-6-102.)
• Child abuse, brutality or neglect means any wound, injury, disability, or
physical or mental condition which is of such a nature as to reasonably
indicate that it has caused an adverse effect upon the physical or mental
health and welfare of a child.
• All known or suspected abuse cases MUST be reported to the Case
Manager.
33
ABUSE
“The five letter word no one wants to think about”
Identifying Victims of Abuse
• Forms of Abuse:
– Neglect: a form of physical abuse involving depriving the
person of needed medical services or treatment; failure to
provide food, clothing, hygiene, and other basic needs.
– Material: misusing a person’s personal property or finances for
personal gain.
– Emotional: humiliation, harassment, ridicule, and threats of
being punished; includes being deprived of needs such as
food, clothing, care, a home, or a place to sleep.
– Physical: grabbing, hitting, slapping, pushing, kicking,
pinch8ing, hair pulling, or beating; includes corporal
punishment – punishment inflicted on the body.
• Two steps to take if violent abuse is suspected:
1. RECOGNIZE IT
2. REPORT IT TO THE PRIMARY NURSE / CASE MANAGER
34
RESTRAINTS
Key Points:
1. The use of restraint should be the final choice for protecting a patient.
Alternative interventions should be evaluated prior to restraint use.
2. Alternative interventions may include but are not limited to:
2.1) review of administration, discontinuation, or alteration of
current medications
2.2) supervised activity as allowed
2.3) increased monitoring and supervision of the patient by staff
2.4) family or sitters staying with the patient
2.5) diversionary activities
2.6) modification of the patient’s environment
3. Frequent assessment of the patient’s psychosocial and physical status
and careful thorough explanation of environment, procedures, and
events should be implemented on admission and continue until
discharge. This measure may help to prevent the need for restraint.
4. If restraints are deemed necessary, soft restraints are to be used unless
the need for heavier restraint is indicated.
5. Restraint for infants and children:
5.1) Hospital policy requires that parents stay with infants and
children under age twelve (12). Restraints should not be used
unless the parent is unable or unwilling to assist with
preventing the child from injuring himself/herself.
5.2) If restraints are indicated for an infant or child, the same
procedures apply. Restraint should be the least restrictive that
will control the child and should be removed as soon as
possible.
6. Consider a constant attendant in addition to the restraint if patient is
actively non-compliant, i.e., removing the restraint device.
35
RESTRAINTS
DEFINITIONS:
–
A “physical restraint” is any manual method or physical or mechanical
device, material, or equipment attached or adjacent to the patient’s body
that he or she cannot easily remove that restricts freedom of movement or
normal access to one’s body.
–
A “drug used as a restraint” is a medication used to control behavior or to
restrict the patient’s freedom of movement and is not a standard treatment
for the patient’s medical or psychiatric condition.
–
Seclusion refers to the involuntary confinement of a person alone in a room
where the person is physically prevented from leaving.
–
Forensic and corrective restrictions for security, e.g., handcuffs, applied
by a police guard, are not defined as restraint.
–
Voluntary Restraint – instituted following consent from a cognitively intact
patient. Example: an elderly patient who has just taken a sleeping pill and
has agreed to have a halter type device applied for the evening as a
reminder not to get out of bed without pressing the call button to ask for
assistance.
–
Routine treatment restraint – utilized to assist in a specific treatment or
diagnostic procedure such as IV infusions, diagnostic x-rays,
catheterizations,etc. Routine treatment restraint is not utilized primarily to
involuntarily immobilize a patient. Treatment restraints may include
immobilization used during surgery and during non-cognitive states.
–
Postural/safety supports – utilized to assist the patient in achieving or
maintaining proper body position, alignment and balance or compensating
for a specific defect. These may be used to prevent non-cognitive patient
from falling out of bed or chair.
36
REQUIRED FORMS
TO BE TURNED IN
UPON COMPLETION
OF THIS ORIENTATION
SESSION:
All Students:
•Handbook Receipt
•Confidentiality Agreement
•Infection Control Post-Test
•Safety/Security Post-Test
37
ACKNOWLEDGEMENT CARD AND RECEIPT FOR HANDBOOK
The purpose of the Handbook is to provide employees with general information regarding
the personnel guidelines the organization attempts to follow in most cases, but NEITHER
THIS HANDBOOK NOT ANY PROVISION OF THIS HANDBOOK IS AN EMPLOYMENT
CONTRACT FOR ANY OTHER TYPE OF CONTRACT. Due to the nature of Covenant
Health operations and variations necessary to accommodate individual situations, the
guidelines set out in the Handbook may not apply to every employee or in every
situation. Covenant Health reserves the right to rescind, modify or deviate from these or
other guidelines, policies, practices or procedures relating to employment matters from
time to time as it considers necessary in its sole discretion, either in individual or
organization-wide situations with or without notice.
All employees at Covenant Health are employed for an indefinite term, and employment
may be terminated with or without cause, at any time, at the will of either the employee
or the organization. This status can only be altered by a written contract of employment
that is specific as to all material terms and is signed by both the employee and a Senior
Vice President of Covenant Health.
I have read and understand the above statement and agree to read the employee
handbook which I hereby acknowledge having received.
I also understand that Covenant Health is committed to providing a safe working
environment for the employees and the patients we serve. Accordingly, I consent to
undergo a drug and/or alcohol test if asked by a manager who has reasonable cause. I
understand that refusal of such test will constitute grounds for termination.
_________________________________________
Employee Signature
_________________________________________
Date
38
INFECTION CONTROL ORIENTATION POST-TEST
Name _______________________ School __________________ Date ___________
Circle the correct answer.
Page 1 of 2
Bloodborne Pathogen Standard/Isolation
1. According to the Exposure Control Plan, the choice and use of Personal Protective
Barriers is based primarily on specific patient diagnosis and not procedure or
expected risk.
a. True
b. False
2. In any procedure where “splash” is a risk, eye protection is always required along with
a mask.
a. True
b. False
3. Gloves –
a. Must be changed when contamination has occurred.
b. Can be used patient to patient if not visibly soiled.
c. Should be worn in the hall since surfaces may be contaminated.
d. Should always be worn when cleaning up a blood spill.
e. A and C
f.
A and D
g. All of the above
4. When Employee Health Services is closed, the Nursing Supervisor is always notified
following a blood exposure incident (needlestick, etc.)
a. True
b. False
5. Hepatitis immunization is offered free to all employees who are at risk of occupational
exposure to blood and other potentially infectious body fluids.
a. True
b. False
6. All “used” or dirty linen is considered potentially contaminated/infectious.
a. True
b. False
All dirty linen is placed in __________________ colored plastic bags.
7. Needles can only be recapped by using a recapping device or a one-handed
technique.
a. True
b. False
39
INFECTION CONTROL ORIENTATION POST-TEST
2 of 2
Name _____________________________School___________________Page
Date________
8.
Full needle disposal boxes are placed inside red lined infectious waste containers for
proper disposal and incineration.
a. True
b. False
9.
When Clorox is used as a disinfectant, it should be:
a. Diluted 1:10 – 1 part Clorox and 10 parts water
b. Used within 24 hours of reconstituting/preparation
c. Prepared for use in a labeled bottle
d. All of the above
10. Which of the following is the correct procedure for cleaning up a blood spill?
a. Notify environmental services immediately and secure the area
b. Absorb the spill, spray Clorox solution on the area, bag all waste in a red bag
and dispose of if the infectious waste container.
c. Put on gloves, absorb the spill, clean area with a detergent, disinfect the area
with either a Clorox solution or hospital grade germicide, and dispose of all
waste in a red bag as infectious
11. Isolation for known or suspected TB requires which of the following?
a. Negative pressure room, personal respirator (PR)
b. Positive pressure room, isolation mask
c. Any private patient room, as long as orange barrier masks are worn
12. TB skin test must be read 48 hours after placement.
a. True
b. False
13. In employee follow-up after exposure to blood or body fluid, it is not necessary to
report to Employee Health Services as long as an Employee Accident Report Form
is completed.
a. True
b. False
14. Standard Precautions” also known as Universal Precautions apply to all patients and
includes the use of personal protective barriers, when contact with blood, any body
fluids, non-intact skin and mucous membranes is anticipated.
a. True
b. False
15. Contact Isolation now includes the wearing of gloves upon entering the patient room.
a. True
b. False
40
SECURITY / SAFETY ORIENTATION POST-TEST
Name _________________________ School ___________________ Date ______
Page 1 of 2
Please answer the following questions. You may refer to your Orientation Handbook for
assistance. A score of 100% is required before you may provide patient care.
SECURITY
1.
What is a “no information” or “closed chart” patient?
2.
How will you know if a patient is a “no information” or “closed chart” patient?
3.
Weapons are allowed outside of facility (on facility grounds). True or False
4.
What should you do if a patient prisoner arrives?
5.
Security personnel may be called to escort you to your car. True or False
SAFETY
1.
What does R.A.C.E. mean?
2.
What should you do when you hear a fire alarm?
3.
The fire alarm should always be pulled during a real fire and during a fire drill.
True or False
4.
What can you do to protect yourself from body fluids and hazardous chemicals?
5.
What should you do if you discover that the equipment you are using is
defective and hazar4dous to a patient or user?
6.
You do not have to report accidents that do not result in injury. True or False
41
SECURITY / SAFETY ORIENTATION POST-TEST
Name _________________________________________
Page 2 of 2
SAFETY continued:
7.
What should you do if there is an accident?
Match the letter of the code with the correct response below:
A.
Code Black
B.
Code Purple
C.
Code Pink
D.
Code Blue
E.
Code Green
F.
Code Red
G.
Hazardous Material Spill
H.
Code Yellow
I.
Code White
8.
_____ Complete duties and report to immediate supervisor for release to personnel
staging area.
9.
_____ Isolate the spill area (evacuate). Call nuclear medicine for spill clean-up.
J. Evacuation
10. _____ Check for suspicious package and report to security. Immediately notify
staff and PBX when bomb treat is received.
11. _____ Clear the area to avoid others from becoming a hostage.
12. _____ Notify all in area of need to evacuate. Evacuate ambulatory, wheelchair,
then bedridden. Take records if safety permits. Notify PBX to activate internal
evacuation alert.
13. _____ Assess whether infant has been removed from premises. Notify immediate
supervisor. When code is announced, search for abductor.
14. _____ Potentially violent person exhibits anger or uncontrolled behavior toward
staff.
15. _____ RACE
16. _____ Remove persons from hazard. Trained user cleans up spill. If you can do it
safely, assist contaminated victims in decontamination process.
17. _____ Designated team responds to area following PBX announcement.
42
CLINICAL
POST-TEST
Name ____________________
School____________________
Date _________ Page 1 of 1
1.
Define the acronym: C.A.R.E.S
2.
The restraint policy states: Patients in restraints must be checked every ________.
3.
A ____________ _______________ is any manual method or physical or
mechanical device, material, or equipment attached or adjacent to the patient’s
body that he or she cannot easily remove that restricts freedom of movement or
normal access to one’s body.
4.
Select the correct age group who most needs education on a healthy life-style.
a.
Geriatric
c. Teen
b.
Adult
d. All of the above
5.
Individualized care based on patient needs and abilities generated by aging is
referred to as:
a.
The Aging Process
c. The Nursing Process
b.
Age Specific Care
d. Geriatric Nursing
6.
List the four types of abuse.
1.
________________________
2.
________________________
3.________________________
4. ________________________
7.
What are the two steps YOU take if violent abuse is suspected?
1.
______________________________________________________________
2.
______________________________________________________________
8.
The single most important tool a nurse can use to prove good nursing care is:
a.
Good hand washing technique
c. Physician orders
b.
Nursing care plan
d. Clinical documentation
9.
Complete the following list to show all the necessary steps for implementing an
Isolation set-up:
1.
Stock cart/cabinet
5. ____________________
2.
Place sign on door
6. Alert other departments
3.
________________________
7. appropriate hand hygiene
4.
Ensure alcohol hand cleaner is available 8. _____________________
10.
List the steps you would follow if you are exposed to HIV.
43