Student Packet 2008

1. ABOVE ALL ELSE, WE ARE COMMITTED TO THE CARE AND IMPROVEMENT OF HUMAN LIFE. IN RECOGNITION OF THIS COMMITMENT, WE STRIVE TO DELIVER HIGH QUALITY, COST EFFECTIVE HEALTHCARE TO THE Communities WE SERVE. Student Packet 2008 ·During the time you are completing this module, you may call 802-3382 for any questions. Also the Infection Control nurse is here Monday through Friday 8-4:30 at ext. 4969. During other times, the nursing supervisor is available for questions.

2. A TRADITION OF CARINGWe believe the following value statements are essential and timeless: • We recognize and affirm the unique and intrinsic worth of each individual. • We treat all those we serve with compassion and kindness. • We act with absolute honesty, integrity and fairness in the way we conduct our business and the way we live our lives. • We trust our colleagues as valuable members or our healthcare team and pledge to treat one another with loyalty, respect, and dignity.

3. Care Values • Redmond Regional Medical Center has a set of organizational values that express to everyone who enters our facility what we stand for as a leading health care provider. • These values are: • Customer …………………….... Always First • Actions ….. Speak Louder Than Words • Respect ……………...…. The Golden Rule • Excellence ……………... Is Our Standard •  These values are basic elements of our strategy to “exceed customer expectations” in providing service to our patients and other guests.

4. Ethics and Compliance • Redmond and HCA have a comprehensive, values-based Ethics and Compliance Program, which is a vital part of the way we conduct ourselves. Because the Program rests on our Mission and Values, it has easily become incorporated into our daily activities and supports our tradition of caring – for our patients, our communities, and our colleagues. We strive to deliver healthcare compassionately and to act with absolute integrity in the way we do our work and the way we live our lives. All work must be done in an ethical and legal manner. It is your responsibility and your obligation to follow the code of conduct and maintain the highest standards of ethics and compliance.

5. Ethics and Compliance • If you have questions or encounter any situation which you believe violates the provisions of the code of conduct or the corporate integrity agreement, you should immediately consult your supervisor, another member of the management team, the Human Resources Director (Patsy Adams ext 3023), the Ethics and Compliance Officer (Deborah Branton ext 3036), or the HCA Ethics Line (1-800-455-1996). • Each employee and volunteer is required to attend two hours of initial code of conduct training and a one hour annual refresher training session. Leaders and individuals in key jobs have additional annual education requirements.

6. Georgia False Claims Laws • There is a federal False Claims Act, and there are also Georgia laws that address fraud and abuse in the Georgia Medicaid program. • Any person or entity that knowingly submits a false or fraudulent claim for payment of funds is liable for significant penalties and fines. • The False Claims Act has a “qui tam” or “whistleblower” provision. This allows a private person with knowledge of a false claim to bring a civil action on behalf of the US Government. If the claim is successful, the whistleblower may be awarded a percentage of the funds recovered. • For additional information please see the Georgia False Claims Statutes Policy.

7. EMTALA • The Emergency Medical Treatment and Active Labor Act is commonly known as the Patient Anti-Dumping Statute. • This statute requires Medicare hospitals to provide emergency services to all patients, whether or not the patient can pay.

8. EMTALA • When a patient comes to the emergency department, the hospital must screen for a medical emergency. • If an emergency medical condition is found, the hospital must provide stabilizing treatment. • Patients with emergency medical conditions may not be transferred out of the hospital for economic reasons.

9. Medical Ethics: End of Life Care • Palliative Care • The goal of palliative care is not to cure the patient. The goal is to provide comfort. • Understand the importance of addressing all of the patient’s comfort needs near the end of life. This includes psychosocial, spiritual, and physical needs. • Stay up-to-date on the legality and ethics of using high-dose opiates for physical pain.

10. Medical Ethics: End of Life Care • End-of-Life Decisions • Patients have the right to refuse life-sustaining treatment. • Respect this right and this decision. • Withdrawing Life-Sustaining Treatment • Withdrawing and withholding life-sustaining treatment are ethically and legally equivalent. Both are ethical and legal when the patient has given informed consent.

11. Sexual Harassment • You should promptly report the incident to your supervisor, who will investigate the matter and take appropriate action, including reporting it to the Human Resources Department. • If you believe it would be inappropriate to discuss the matter with your supervisor, you may bypass your supervisor and report it directly to the Human Resources Department, which will undertake an investigation. • Or you may call the Ethics Line at 1/800-455-1996. The complaint will be kept confidential to the maximum extent possible.

12. SERVICE EXCELLENCE • Redmond’s Service Standards are ways for you to fulfill the CARE values. By practicing these, you will be better able to meet and exceed the needs of all of our customers. • Display a service attitude that is courteous and caring. • Anticipate the wants and needs of the people we serve. • Present a professional image. • Maintain a safe and clean environment • Use good elevator manners.

13. SERVICE EXCELLENCE • Positively represent Redmond Regional Medical Center in the workplace and the community. • Listen to one another and to the people we serve, then respond promptly and reliably. • Keep the people we serve informed about their care and treatment. • Respect the privacy and confidentiality of the people we serve. • Strive to master the skills needed to do your best for the people we serve. • Utilize communication tools to assist us in responding to our guests.

14. What is teamwork? • A cooperative effort by members of a group or team trying to achieve a common goal • The concept of people working together

15. To make teamwork happen… • Communication is a necessity • Must have interaction with others even when things aren’t going as planned • Get Feedback from other associates and managers • Share the responsibility

16. Skills for teamwork: • Listening • Questioning • Respecting and supporting ideas • Helping • Sharing • Participation

17. Why will Teamwork work for you? • Increases productivity and output. • Boosts morale. • Increases customer satisfaction. • Actively involves everyone.

18. Benefits of Team Work • You have more minds working on a project • You can improve product quality • You are able to improve associate morale • You can improve productivity • You have more cross functional skills

19. HCA Mission and Values Statement • We trust our colleagues as valuable members of our healthcare team and pledge to treat one another with loyalty, respect and dignity.

20. Employee Health ServicesINJURIES AND ILLNESSES Non-Work Related EHS will provide care for non-work related injuries and illnesses as an immediate care program. Our goal is for all employees to have their own primary care provider (PCP), however, when an employee is unable to see their PCP and they are ill at work, EHS is available for evaluation and treatment as appropriate. Employees may be referred to their PCP for further evaluation, treatment, and/or follow-up. EHS stocks many over-the-counter medications; these are available for employees as needed.

21. Employee Health ServicesINJURIES AND ILLNESSES Work Related Paula Dunwoody with EHS is Redmond’s Injury Coordinator. This role involves employee safety and prevention of work injuries as well as follow-up of all work related injuries. All work related injuries must be evaluated in EHS as soon as possible after the injury.

22. What To Do If You Are Injured On The Job • If you are injured on the job, report the injury to your supervisor, no matter how minor. Your supervisor should be notified prior to the end of your shift. • Redmond policy requires a notification (incident) report for an injury no later than 24 hours after the incident occurs. This report is completed in our Meditech computer system. If you do not have access to Meditech, your supervisor or Employee Health Services can assist you with this report.

23. What To Do If You Are Injured On The Job (continued) • All employee on-the-job injuries must be evaluated in Employee Health Services. • Management and/or treatment of the injury may be completed in Employee Health Services. If the extent of the injury warrants a physical evaluation, the employee must choose a panel physician. The physicians panel is updated periodically and is posted on the HR bulletin board, across from the timeclock on the first floor, and in Employee Health Services.

24. What To Do If You Are Injured On The Job (continued) • In an emergency situation, employees may go directly to Redmond’s Emergency Room. Please discuss this with your supervisor. • If you have a work-related injury and your condition changes (for example: new onset of difficulty walking or worsening pain), report to Employee Health Services immediately. If this office is closed, then contact your immediate supervisor and notify EHS when the office opens. • For any questions or concerns about a work-related injury, contact Employee Health Services 706-236-4968.

25. What Can You Do To Prevent Sharps Injuries? Be Prepared • Complete your Hepatitis B vaccine series and titer in Employee Health Services free of charge. • Organize your work area with appropriate sharps disposal containers within reach. • Receive training on how to use sharps safety devices. • Wear gloves if you expect to come in contact with blood or body fluids.

26. What Can You Do To Prevent Sharps Injuries? Be Aware • Keep the exposed sharp in view. • Be aware of people around you. Stop if you feel rushed or distracted. • Focus on your task. • Avoid hand-passing sharps and use verbal alerts when moving sharps. • Watch for sharps in linen, beds, on the floor, or in waste containers.

27. What Can You Do To Prevent Sharps Injuries? Follow Policies • Don’t recap needles. • Never use needles with the needleless IV system. • Be responsible for every device you use. • If you identify a sharps without a safety device, discuss this with your supervisor and/or Employee Health Services.

28. What Can You Do To Prevent Sharps Injuries? Dispose of Sharps with Care • Don’t remove contaminated sharps with your hands unless medically required (i.e. caps off used needles, scalpel blades). If necessary, use a mechanical device or forceps. • Always activate safety devices immediately after using a sharp. Never remove safety devices. Keep your hands behind the needle at all times.

29. Disposal of Sharps With Care • Place all used sharps in biohazard containers, see policy IC-45. • Securely close biohazard containers when ¾ full and notify Environmental Services to change the sharps container. • Do Not overfill sharps containers. • Do Not reach by hand into containers where sharps are placed.

30. Additional Sharps Injury Prevention for the OR • Use a neutral zone when passing sharps instruments. Pass sharps on a tray, not directly to another individual. Use verbal alerts when moving sharps. • When suturing, use blunt sutures for muscle and fascia. • Stay focused on your task. Stop if you feel rushed or distracted. • Use mechanical devices such as tongs to handle contaminated reusable sharps. Do Not use your hands.

31. Prevent Bloodborne Pathogen Exposures • Use appropriate barriers such as gloves, eye protection, or gowns when contact with blood is expected. • Wash your hands with soap and warm running water as quickly as possible after contact with blood or potentially infectious materials. • Don’t eat, drink, smoke, apply cosmetics or lip balm, or handle contact lenses in area with possible exposure to bloodborne pathogens. • Do not store food in refrigerators, freezers, cabinets, shelves, or on countertops where blood or other body fluids are present.

32. Bloodborne Pathogen Exposure • Report to Employee Health Services or the E.R. immediately after a Bloodborne Pathogen Exposure. If you go the E.R., then follow-up with Employee Health Services as soon as the office opens. • Following a bloodborne pathogen exposure, the risk of infection may vary with factors such as these • the pathogen involved • the type of exposure • the amount of blood involved in the exposure • the amount of virus in the patient’s blood at the time of exposure • The following factors were associated with an increased risk of HIV seroconversion: • deep injury (deep puncture wound) • visible blood on source patient device causing injury • procedure involving needle placed in a vein or artery of source patient • endstage AIDS in source patient

33. Needle Stick/Sharps InjuryWhat is the risk of infection after exposure? • HBV • Healthcare personnel who have received hepatitis B vaccine and developed immunity to the virus are at virtually no risk for infection. • For a susceptible person, the risk from an exposure can range from 6 – 30% and depends on the status of the source individual.

34. Needle Stick/Sharps InjuryWhat is the risk of infection after exposure? • HCV • The average risk for infection after a needlestick exposure to HCV infected blood is approximately 1.8%. • There is a small risk associated with exposure to the eye, mucous membranes, or nonintact skin.

35. Needle Stick/Sharps InjuryWhat is the risk of infection after exposure? • HIV • The average risk of infection after a needlestick exposure is 0.3% (or about 1 in 300). • The risk after exposure of the eye, nose, or mouth is about 0.1% (1 in 1,000). • The risk after exposure to nonintact skin is less than 0.1%.

36. Needle Stick/Sharps InjuryTreatment For The Exposure • HBV • Hepatitis B vaccine for all healthcare personnel who have a reasonable chance of exposure to blood or body fluids. • Hepatitis B immune globulin (HBIG) alone or in combination with vaccine (if not previously vaccinated or no immunity developed after vaccination).

37. Needle Stick/Sharps InjuryTreatment For The Exposure • HCV • There is no vaccine against hepatitis C and no treatment after exposure that will prevent infection. • Following recommended control practices to prevent percutaneous injuries is imperative.

38. Needle Stick/Sharps InjuryTreatment For The Exposure • HIV • There is no vaccine against HIV. • Postexposure prophylaxis (PEP) with retroviral drugs is recommended for certain occupational exposures that pose a risk of transmission of HIV. • PEP is not recommended for exposures with low risk for transmission of HIV. • PEP should be started as soon as possible after exposure, preferably within 2 hours.

39. Respirator and Respirator Fit Testing to Prevent Transmission of Airborne Illnesses • N-95 Respirator • A respirator is designed to provide respiratory protection for the wearer. • An NIOSH approved N-95 mask has a filter efficiency level of 95% or greater against particulate aerosols free of oil. • It is fluid resistant, disposable, and may be worn in surgery. • It can fit a wide variety of face sizes.

40. Respirator and Respirator Fit Testing • Intended Use • RRMC’s N-95 Respirators reduce the wearer’s exposure to certain airborne particles in a size range of 0.1 to 10.0 microns, including those generated by electrocautery, laser surgery, and other powered medical instruments. • The masks are designed to be fluid resistant to splash and splatter of blood and other infectious materials. • These masks are not designed for industrial use.

41. Respirator and Respirator Fit Testing • Employees Wearing Respirators • Any employee with the possibility of exposure to airborne illness will participate in the respiratory protection program. • This includes all employees who could enter a patient care room when a patient is placed in airborne precautions.

42. Respirator and Respirator Fit Testing • Medical Evaluation • A medical evaluation questionnaire is required for all employees wearing a respirator in the workplace. • This evaluation will determine whether or not an employee is medically able to wear a respirator. All employees may not pass this evaluation. • Employees who do not pass the medical evaluation cannot wear a respirator and should not enter rooms were a patient is on airborne precautions.

43. Respirator and Respirator Fit Testing • FitTesting • All employees must be fit tested with one of the masks available here at RRMC before they can wear a respirator. • 3M 1860 Regular and Small (blue mask) • Tecnol Fluidshield Regular and Small (orange duck-bill) • Some employees may not pass fit testing. These employees cannot wear a respirator. • Compliance with OSHA standards requires fit testing completion with hire and repeat fit testing annually thereafter. • Fit testing will be completed in Employee Health Services during month-of-hire annual evaluation.

44. Respirator and Respirator Fit Testing • Mask Size • Every employee fit tested for a respirator is responsible for knowing what size mask they wear. • Employee will have a sticker with mask brand and size placed on the back of their ID badge at the time of fit testing. • Employee Health Services and department supervisors will have documentation of mask size for employees that have been fit tested. • Problems • Any employees with medical problems, respirator problems (such as fit seal difficulty), or any concerns should contact Employee Health Services.

45. Latex Allergies • Latex allergies pose a serious problem for nurses, other health care workers, and for 1% to 6% of the general population. Anaphylactic reactions to latex can be fatal. Health care workers’ exposure to latex has increased dramatically since universal precautions against blood borne pathogens were mandated in 1987. Latex can trigger three types of reactions: irritant contact dermatitis, allergic contact dermatitis, and immediate hypersensitivity. Many medical devices contain latex that might trigger serious systemic reactions by cutaneous (skin) exposure, (i.e. ECG electrodes, masks, bandages, catheters, gloves, and tape.) There are some diagnostic tests to determine if a person has an allergy to latex. If a patient tells you they are allergic to latex, notify Materials Management and they will provide a cart with latex-free products. Need more information? Contact the Nursing House Supervisor at ext. 3037. For associates with latex allergies, contact Employee Health Services ext. 4968.

46. Ergonomic Safety • Ergonomic Safety is adapting the equipment, procedures and work areas to fit the person in order to help prevent injuries and improve efficiency. Musculoskeletal disorders (MSDs) affect muscles, nerves, tendons, ligaments, joints or spinal discs. Injuries can include strains, sprains, and repetitive motion injuries. • Signs and symptoms: pain, tingling, numbness, swelling, stiffness, burning sensation, etc. May experience decreased gripping strength, range of motion, muscle function, or inability to do everyday tasks. Risk factors: repetition, forceful exertions, awkward postures, contact stress, and vibration. Common MSDs: Carpal tunnel syndrome, rotator cuff syndrome, trigger finger, tendonitis, herniated spinal disc, and back pain.

47. Ergonomic Safety • Apply these tips to your job: Adjust chair height and backrest (feet should be flat on the floor, knees level with hips, and lower back supported). Sit an arm's length away from the computer screen. Keep wrists straight and elbows at right angles. Alternate tasks. Use proper body mechanics when lifting, transferring, etc. Avoid reaching and stretching overhead. • You may recommend ways to reduce the chance of developing musculoskeletal disorders to your supervisor. Your work space may be evaluated for ergonomic safety by notifying Paula Dunwoody at ext. 4968. Your departmental safety representative may assist with body mechanic in-services. Report signs, symptoms, illnesses ,and injuries to your supervisor, complete an occurrence report, and obtain medical treatment in Employee Health Services.

48. 12 Principles of Ergonomics • Keep everything in easy reach • Work at proper heights • Reduce excessive forces • Work in good postures • Reduce excessive repetition • Minimize fatigue • Minimize direct pressure • Provide adjustability and change of position • Provide clearance and access • Maintain a comfortable environment • Enhance clarity and understanding • Improve work organization

49. ErgonomicsThe “Do Nots” • Upper Extremity • Shoulder • Reaching over 90 degrees (vertical flexion) • External rotation of greater than 45 degrees • Elbow • Avoid static hold time of flexion • Lower Extremity • Sitting position • The hip, knee, and ankle should be placed at 90 degrees • Body positions to avoid • Deep knee bends • Constant standing in hip and knee extension • Walking with feet externally rotated

50. Ergonomics • Self Care • Ice THEN heat • Stretch regularly • Use good posture • Exercise!!!!! • Work smart • Play smart