MSU Nursing Students MDG Orientation

1. MSU Nursing Students MDG Orientation

2. Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to you. The following slides are a compressed MDG orientation. Please read through them carefully and if you have questions, don’t hesitate to ask a staff member when you arrive at the MDG.

3. Informing Patients of Student Status It is required that all students working at a medical facility ALWAYS inform patients that they are students PRIOR to asking the patient any questions, conducting any type of assessment, or providing any type of treatment. Most patients are happy to have students help them out and will gladly accept you as a member of their care team. So, let the patient know at the beginning of the encounter that you are a student.

4. 5th Medical Group CHAPERONES

5. Definitions • Chaperone – A person, especially an older or married woman, who accompanies a young unmarried woman in public; an older person who attends and supervises a social gathering for young people. {Webster’s II New Riverside University Dictionary} • Medical Chaperone – A third party, usually the same gender as the patient, who maintains a presence during an exam or treatment • Promotes patient/provider comfort and safety • Guards against professional impropriety and/or unethical treatment

6. Who Can Chaperone? • All patient care staff members, including administrative personnel, can serve as chaperones. • The chaperone should, in most cases, be the same gender as the patient. • If a same-gender chaperone is not available, the patient may consent to an opposite-gender chaperone. Document consent thoroughly. • If required chaperone is not available during duty hours, contact the flight commander.

7. When Is a Chaperone Needed? • Any time a minor is examined or treated (parent/legal guardian is acceptable) • A parent/legal guardian must be present except during emergencies or life-threatening situations, or if the visit concerns sexually transmitted diseases. • Any time a provider exposes, examines or treats the genitalia or rectum of a patient of the opposite sex • Any time a male provider exposes, examines or treats a female’s breasts • Upon patient or provider request

8. Duties of Chaperone • Ensure patient privacy • Be present at all times during exam or treatment • Identify and report suspected misconduct • Suspected misconduct (and any other concerns regarding chaperones) will be reported to the flight commander. • If warranted, the flight commander will report the suspected misconduct to the Chief, Medical Staff (SGH), and to the squadron commander.

9. Suspected Misconduct? • The nature/purpose of the exam or treatment and extent/purpose of disrobing not fully explained to the patient prior to the procedure • Explain what the patient can expect and feel during exam or treatment; avoid surprising patient • Patient not provided privacy during undressing and dressing • At a minimum, draw privacy curtain; shut door if possible • The extent of required disrobing inconsistent with exam or treatment • A patient need not disrobe (usually) for a foot exam

10. Suspected Misconduct? (cont.) • Exam inconsistent with patient’s complaint or purpose of visit • Every woman does not need a breast exam every visit • Provider’s comments unprofessional • Comments should not be obscene or demeaning • Off-colored jokes or comments about patient’s anatomy inappropriate • Excessive flattery about patient’s body/body parts inappropriate

11. Patient Misconduct? • Chaperones protect provider as well as patient • Provider responsible for managing inappropriate patient behavior • Serious consideration should be given to documentation of patient behavior • Recommend documenting name of chaperone when present • Concerns may arise long after issue (and name of witnessing chaperone) forgotten

13. Infection Control: • It establishes prevention, control and reduction interventions for NOSOCOMIAL, community acquired and clinic acquired infections. • Infection control practices minimize the risk and spread of infection throughout the hospital Goals of infection control within 5 MDG

14. HEPATITIS & HIV Health care facilities are concerned about the occupational (work related) exposure of their employees to diseases transmitted through contact with blood or body fluids. The two blood borne diseases that hospital employees are most at risk for developing are : BLOODBORNE PATHOGENS       

15. The single most important aspect of effective infection control is handwashing

16. Proper Technique • Wet hands to reduce irritation from the soap • Keep hands lower than elbows to keep contaminants from running onto clothing • Use antiseptic soap • Wash vigorously for 10 seconds • Rinse under running water to remove contaminants • Use paper towels to dry hands • Use towels to turn off water to prevent cross contamination and so you don’t re-contaminate hands on dirty faucet handles

17. treat everyone as if they are infectious.... STANDARD PRECAUTIONS

18. TRANSMISSION BASED ISOLATION - AIRBORNE - DROPLET - CONTACT Types of isolation used in 5 MDG (two-tiered) Standard Precautions: apply to blood, body fluids, secretions and excretions, nonintact skin and mucous membranes. Standard precautions are used for each and every patient. Transmission-based precautions: used for patients with known or suspected infections by epidemiologically important pathogens spread by airborne, droplet transmission or by contact with dry skin or contaminated surfaces.. MDGI 44-15 attachment 4 lists specific precaution and discusses type and duration of precautions needed for selected infections and conditions. ALL personnel are responsible to comply with the requirements of isolation or precautions.

19. PPE  Just do it !!! . . . PPE = Personal Protective Equipment. Also known as: PPA = Personal Protective Attire

20. WHAT “PPE” TO WEAR? WEAR GLOVES -any time contact with blood or other body fluids may occur. For example: • when touching any mucous membranes or broken skin • when handling items or surfaces soiled with blood or other body fluids • when drawing blood Change gloves if they’re torn, and after contact with each patient. Do NOT reuse disposable gloves. Washing hands with gloves on is not an acceptable practice. Gloves are cheap compared to the cost of treating an infection!

21. MORE PROTECTION!! USE MASKS AND EYE PROTECTION - or protective face shields if there’s any chance that blood or other body fluids may splash into your mouth, nose or eyes. WEAR A GOWN - or apron if splashing of blood or other body fluids is likely. AND REMEMBER TO WASH YOUR HANDS AND OTHER SKIN SURFACES IMMEDIATELY AFTER: • direct contact with blood or other body fluids • removing gloves, gown or other protective clothing • handling potentially contaminated items • all patient interactions PPE is only effective if it is used appropriately. It is not a total prophylactic. Hand washing is still necessary

22. USE SHARPS CONTAINERS FOR DISPOSAL • REPORT INCIDENTS • DON’T SCRUB INSTRUMENTS AT USER LEVEL • DON’T RECAP Basics of sharps/needle safety

23. Needlestick Protocol Needlestick protocol to be followed in the 5 MDG • Wash area immediately • Report to Public Health; if after hours report to after hours clinic • Supervisor completes incident report • AF Form 765 • Prophylactic medication if patient is infected with HIV/Hepatitis • Follow-up care

24. Take CARE when using sharpsNOT CHANCES!! Take care when using sharps, NOT CHANCES! Pay attention to what you are doing when handling sharps. Do not jeopardize coworkers or your own safety.

25. RED BAG WASTE Red bag is for potentially infectious, contaminated material ONLY. Must be saturated with body fluids before qualifying for disposal in red bag. Non-saturated dressings, band aids, outer wrappers go in regular trash. VERY EXPENSIVE to dispose of!

26. Either complete the Nosocomial Infection Report Form ACC 323 or inform the ICO of a known infection and ICO will fill out the form. • If you fill out the form, turn into Infection Control Officer • within 24 hours of suspicion Whenever a suspected nosocomial infection is discovered, fill out a report form.

27. Infection Control Officer Leisa Johnson, PRP Clinic 723-5199

28. SAFETY-RELATED INCIDENTS

29. BACKGROUND Safety-related incidents are those that directly pose a health threat to staff and patients, can directly impact the mission, and that are generally considered preventable. The most common safety-related incidents in the 5th Medical Group are medication errors, needlestick/sharps injuries, falls (both patient and staff), and exposures to blood-borne pathogens and chemicals.

30. PREVENTION • DoD requires analysis of processes that place patients and staff at-risk • Failure Mode and Effects Analysis (FMEA) is one the tools the MDG uses to proactively reduce and prevent injuries and incidents. • MDG Safety Committee tracks and trends incidents that occur.

31. REPORTING • Use AF Form765, Medical Facility Incident Report • FormFlow version on LAN • Turn in to Quality Services within 24 hours • Seek medical care for injuries • Report exposures to Public Health

32. Incidents are unexpected occurrences such as: sharps injuries medication errors patient falls exposures to blood-born pathogens equipment failures during patient care episodes

33. INCIDENT EVALUATIONS • Reviewed by supervisor, flight/squadron leadership, and Risk Management • Non-attributional except in cases of gross neglect or intentional misconduct • Presumed to be a system error unless proven otherwise – errors and accidents cannot be completely eliminated and thus are treated as a workplace process that can be improved

34. 5th Medical Group MANAGEMENT OF VIOLENT PERSONS

35. Governing Directive(The 5th MDG is a restraint free facility!) • 5 MDGI 44-121, Management of Violent Persons • This instruction establishes the policy for managing persons with specific behavioral health needs/issues (e.g., psychotic and/or violent behavior). • Nonviolent, restraint-free intervention is emphasized and safety of all personnel is primary concern.

36. Staff Education (The 5th MDG is a restraint free facility!) 5 MDGI 44-121, Management of Violent Persons, mandates orientation and annual training on use of nonviolent intervention It discusses expected outcomes (goals) of nonviolent intervention and steps for implementing nonviolent intervention

37. Definitions • Restraints fall into three categories: Protective Devices – devices used to protect patient, or posturally support or assist to obtain/maintain normative bodily functions; such as bedrails, halter restraints, orthopedic devices, braces, etc.; not considered restraints Medical Immobilization – mechanisms employed during procedures, without which patient could suffer harm; such as body restraint during surgery or soft restraints to prevent dislodgement of intravenous lines; associated with normal behavior; not considered restraints Restraint – use of physical or mechanical devices used to involuntarily hinder movement of all or portion of person’s body to control physical activities, thereby protecting person or others from injury; key is the intent for its use; is person’s behavior itself that determines the need

38. Definitions (cont.) • Dr. Strong – a code for requesting an immediate show of force to subdue a potentially hostile or violent person or to defuse a potentially dangerous situation • THE USE OF FORCE BY 5 MDG WILL BE AVOIDED IF AT ALL POSSIBLE • Code Black – a code used during a general state of duress at a location within the confines or surrounding grounds of 5 MDG; announced location is to be avoided by all personnel because of presence of possibly dangerous person

39. Responsibilities • Manage person using nonviolent interventions • Consult Life Skills Support Center regarding persons suspected of being violent or psychotic • Contact Ambulance Services when behavior suspicious of becoming violent • May assist in transfer of person in need of care to appropriate (e.g., psychiatric) facility • Document all care on progress notes in medical record • Physicians may administer medications to address targets behavioral symptoms based on clinical judgement and the person’s • Ambulance Services will announce Code Black/Dr. Strong and location via overhead paging system and Will contact Security Forces for assistance managing violent persons who cannot be managed effectively using nonviolent means

40. Procedures/Interventions Egress immediate area ASAP; behind locked doors if possible • DO NOT ATTEMPT TO APPREHEND OR SUBDUE • If you cannot egress area safely, lock all personnel into a room, avoiding doors and windows • Primary Care Staff will clear the atrium of personnel and lock them in clinic area Notify Ambulance Services or activate automated alarm when safe to do so Ambulance Services will announce twice, “Code Black/Dr. Strong in (location).”

41. Procedures/Interventions (cont.) • Drop cage windows immediately • Lock hallway doors once personnel evacuated from main hallways • Lock all interior doors once all personnel safely inside • Ambulance Services will contact Security Forces and inform them of situation and location of aggressor(s) if possible. If it is not safe to do so, they will activate the duress alarm.

42. Procedures/Interventions (cont.) • Remain in secure locations until given “All clear!” • Ambulance Services will announce “All clear!” overhead when assured the situation safe. • Ambulance Services will authenticate “All clear!” in following manner: “This is Ambulance Services control. Code Black/Dr. Strong is terminated at this time (by Security Forces).” • Will announce authentication twice • In event of casualties, Ambulance Services will activate Medical Group Control Center (MGCC) and implement Disaster Casualty Control Plan (DCCP).

43. Procedures/Interventions (cont.) Facility Management will survey premises and determine any structural damage that might jeopardize safety and if necessary, will activate alternate facility plan Ambulance Services will document events in the shift log If the MCC was activated, documentation will be consistent with MDG’s DCCP.

44. Expected Outcomes • The person will regain control of his/her behavior. • The person will not harm patients, community members or staff. • The dignity of all will be maintained.

45. FIRE SAFETY

46. ITEMS EVERYONE SHOULD KNOW 1. Know the location of the nearest alarm pull station. 2. Know the location of the nearest fire extinguisher. 3. Know by heart the number for the Ambulance service. (5627) 4. Know by heart the number of Facility Management. ( 5260) 5. Know who your safety monitor for your section is. 6. Know who your area fire marshal is. 7. Know the fire escape plan for your area. 8. Select an area that everyone meets to have a head count. 9. Always use the outside stairs to evacuate the building. 10. Your 5th Medical Group Primary safety officer is Ms. Carrie Mullin

47. Fire Safety The 5th Medical Group is on a fire zone system. When a fire alarm is activated, the system generates two series of rings. The first series indicates on which floor the fire alarm has been activated. This is followed by a brief pause, followed by a series of rings that indicates where on the floor the alarm has been pulled.

48. Fire Safety Know what fire zone you are in at all times. Reason: If you are in a zone that has a fire in it, you only need to go to the next fire zone to have more time to escape. Unless Fire Dept evacuates whole building How do I know what fire zone I am in???? You need only to look at the fire alarm bells it is printed on each one also it is on each pull station.

49. Where are alarm stations and pull station located? • All alarm stations are located near the ceiling in hallways. • All pull stations are located in hallways near doorways at about shoulder height. • Both have printed on them the floor and zone that you are in. Such as (1-4, or 2-1 or 3-2).

50. Fire Extinguishers If the fire is small and you feel you have the ability to extinguish it using an extinguisher, remember the acronym PASS. P - Pull pin: you will need to pull hard on the pin to break the seal A - Aim: at the base of the fire, ensure you do not stand too close or the force of the extinguisher may spread the fire S - Squeeze: the trigger S - Sweep: side to side at the base of the fire Fire extinguishers in the facility are of the "ABC" variety. These extinguishers can be used on ALL types of fires.