Southern NH Medical Center Specific Mandatory Orientation Module

1. Southern NH Medical CenterSpecific Mandatory Orientation Module For Student Nurse Academic Year 2013-2014

2. Communication: Communication is clear, timely and respectful. Showing Respect and Earning Trust: Respectful, cooperative and trusting behaviors are the hallmarks of providing a higher level of care. Spending Quality Time: Employee's interactions with others are always meaningful and of high quality regardless of our time limits. Organizational Pride: Organizational pride means making a commitment to the organization and constantly striving to support the culture. Our Standards of Behavior at SNHHS

3. Emergency Codes: Medical Center & West Campus Refer to your “Red Card of Courage” attached to your ID badge for a code listing or the Emergency Code Manual located in your Medical Center or West Campus unit/department. The most common emergency codes include: Red: Fire/fire alarm activation (R.A.C.E) Medical Alert: Medical assistance Blue: Cardiac/respiratory arrest, unresponsive person Grey: Unruly patient/visitor/staff • Important reminders: • CodeGold (Controlled Access or Egress): You must have your name badge to enter the Medical Center. You may be ask to secure an exit. • Code White (Internal/External Disaster): Report to your department or practice. • Code Silver (Hostage Situation/Weapon): Stay away from/leave area. If you can’t leave, seek secure area (office with lockable door), turn off lights and remain quiet. Call x4100 in Medical Center or 911 for off-site locations as soon as it is safe. • Code Amber (Missing Patient/Person) Monitor exit as assigned. A common method of kidnapping is for a person to dress as a health care worker and carry a child. SNHMC staff are not authorized to transport patients by carrying them between departments or on discharge.

4. Emergency Telephone Numbers

5. Our Culture of Quality and Safety at SNHHS How do we achieve the Right Care for the Right Patient at the Right Time – EVERY TIME? #1 Promote teamwork through respectful and effective communication at all levels. #2 Know how, who, and when to call for help in unsafe or urgent situations, and teach your patients how to call for appropriate help. #3 Use checklists that contain evidence based standards to guard against missing steps or making errors in critical procedures such as surgery or in hand-off communications. #4 Partner with patients and families for safety, such as keeping patients safe from falling and harming themselves or others. #5 Use at least 2 ways to identify the right patient before taking him or her anywhere, conducting tests or giving medications.

6. Promoting Safety Through Respectful Dialogue Safety “takes a village”, and we like to say that we “have each others’ backs”. That means we take every opportunity to point out missed opportunities through direct and respectful communication. If there is a chance that the patient may be harmed; then an immediate, respectful discussion is appropriate. Examples: when not using two patient IDs, not maintaining hand hygiene or skipping steps in the Medical Center’s safety checklist. It isn’t always easy to speak up this way, but we continue to foster a culture of gratitude for this partnership. If you ever encounter a barrier to communicating a safety concern, speak with your faculty person or resource nurse and they will bring this to SNHMC leadership.

7. Our “Just Culture” Recognizes that… • Even caring and competent professionals make mistakes. • Most humans working in a complex environment like health care will make a mistake at some point. Some key risk factors that promote mistakes are listed, and we should have a heightened awareness of these: • Interruptions or multi-tasking • Fatigue • Unnecessary complexity or number of steps • Blaming someone for an error can drive mistakes “underground”. • The best way to eliminate events that harm patients and staff is to encourage reporting of all errors andnear misses (close calls), so that they can be analyzed for opportunities for improvement – especially since most patient harm can be eliminated by these steps: • Providing and promoting standardized training • Designing systems, procedures (like checklists) and processes that take into account the risks and “guard against error”. • Paying careful attention to factors that shape performance such as interruptions, which can promote error. • Constantly scanning the environment for and correcting risky behaviors: like drifting away from best practices. (Do you wash your hands every time?) • A culture of safety can only exist when people are held accountable for blatant disregard for policies or procedures.

8. Occurrence Reporting An occurrence is any circumstance, accident or unusual happening, which is not consistent with the routine care of the patient or routine(hospital) operations that results in actual or potential personal injury, property loss or property damage. Examples of occurrences include: Occurrence Reporting: Provides information for investigation and to prevent future occurrences. Alerts Risk Management and Administration of possible claims. Helps identify trends and high-risk areas requiring corrective measures.

9. Responsibilities: Occurrence Reports As part of the SNHHS Quality Programs, we recognize our responsibility to: • Provide a safe environment for patients, visitors, students and employees (Malfunctioning equipment). • Strive to minimize and eliminate or prevent such occurrences (such as medication errors, falls, delays in care, unexpected outcomes of care) • Provide immediate, honest and meaningful communication with the patient and his/her family after an occurrence. • Allow any person who has concerns about safety or quality of care provided at SNHMC that have not been addressed, to report these to the Joint Commission without fear of retribution.. If an Occurrence should occur, you should: • Notify your instructor and the resource nurse • Notify the patient’s nurse and physician/provider if a patient is involved. • Include circumstances, interventions and treatment in the patient’s medical record. • Assist in making a report as soon as possible. You should not: • State in patient’s medical record or inform patients/visitors that an Occurrence Report has been completed or that Risk Management has been notified. Occurrence Reports are quality assurance documents, and the information is considered privileged.

10. Material Safety Data Sheets (MSDS) Material Safety Data Sheets (MSDS) are supplied by the manufacturer and contain more information than will fit on a label. They include physical, health and fire hazards as well as first aid measures and recommended personal protection. MSDS copies are located in each department’s/ practice’s MSDS binder. The master copy is located in the Environmental Services Department. They can also be found on the Environmental Services intranet homepage by clicking the link for msdsonline.com.

11. Remove patients or staff in room/area from immediate danger. Close door (if applicable) to the room/area involved. Minor and Major Spill criteria and follow-up. Minor Hazardous Spills (Less than one Gallon and Unlikely to Produce a Harmful Concentration in Air). Contact nursing leadership and/or resource nurse. Trained individuals will use spill kits located on their units Major Hazardous Chemical Spills (One Gallon Or More; Or Any Amount Likely To Produce a Harmful Concentration in Air). All major spills will be addressed through outside resources which will be facilitated by Security. (Call X4100- Code Orange). Obtain the Material Safety Data Sheet prior to Security’s arrival. For Formalin spills, if feasible, neutralize the spill by using formalin polymizer. Off-Site Locations--- Call 911 if you are unable to manage the spill with on-site spill kit. If a Chemical Spill Occurs… At the Medical Center report major hazardous chemical spills to Security not Environmental Services.

12. Hazardous Waste Tips • Never use any hazardous materials without proper training. • Never mix chemicals. • Always keep chemicals tightly secured in original containers. • Always keep different chemicals segregated. • Keep flammable materials in flameproof closed containers away from sources of ignition and high temperatures. • Use the least hazardous material appropriate to the job. • Dispose of hazardous substances according to the MSDS or SNHMC Waste Segregation Chart or the procedure for your Practice. • Know where your eye wash station is. • Always use proper protective equipment.

13. Waste Segregation Chart(Refer to Waste Segregation Chart in your area for examples of each type of waste.)

14. Medical Center Waste Segregation Chart(Refer to Waste Segregation Chart in your area for examples of each type of waste.)

15. Password Guidance Password Requirements Minimum of 8 characters Must change at least every 90 days Suggestions for a STRONG password: Don’t use something that is easy for others to guess such as your birthday or child’s name. Use mix of upper/lower case letters, numbers and other characters. Use a phrase with numbers and punctuation such as “I Like 2 Eat Ice Cream”. Don’t use words in a dictionary (easy to hack). Don’t write your password down; commit it to memory. Recommendation: Change passwords for different systems together, so you don’t forget.

16. Confidentiality Tips Refrain from talking about confidential patient information in public areas even in general terms. Some general information can be enough to identify a patient. Friends and acquaintances of yours arepatientswhen they are here. Treat their privacy and confidentiality with the same respect. Computers shouldn’t be left unattended or visible to others when PHI is up on the screen. “Lock” or log-off when leaving your computer to prevent unauthorized access and maintain patient confidentiality. Do not leave PHI on desks, fax machines or copiers. It can be picked up by unauthorized individuals. Always dispose of PHI properly. Recycle bins or shredders are located throughout the Health System. Do not throw PHI in the trash. SNHHS allows PHI to be transmitted by e-mail using a secure method of transmission. PHI by e-mail is not preferred (only done as necessary by staff and providers).

17. Electronic Systems and PHI Did You Know? Lost laptops cause the most security breaches in health care each year. • SNHHS reports should not contain PHI unless absolutely necessary. • Reports with PHI should have the absolute minimum number of unique patient identifiers. All reports (paper or electronic) remain the property of SNHHS. BEST PRACTICE: • Keep all PHI in core applications such as Soarian and Centricity (Picis/Logicare). • If you must move data from these systems, store the data on corporate servers. Do not save data to CDs, ZIP drives, USB sticks, Smart Phones, iPads or local drives (especially if you have a laptop) without consulting IT.

18. System Auditing: Electronic Systems and PHI All of our clinical systems have extensive audit capabilities: Regular audits are performed on our IT systems. Dismissal will occur if a patient’s privacy is violated. The audit trail is the official record of your activity. Log out or lock screen when you walk away and don’t leave PHI on screen. Do not share your password with anyone. Call the Helpdesk (x2222) immediately if you think your password has been compromised. Best Practice: Curiosity is the enemy. Proactively report mistakes. Access only the information you “need to know” to do your job.

19. Harassment Harassment is broadly defined as a repeated pattern of unwanted or unwelcome behavior. The perception of the victim is the most important factor in considering a complaint; the intent of the harasser does not matter. A victim can be the person to whom the inappropriate behavior is directed, or someone who witnesses or hears it. Harassment can take many forms, including: • Unwelcome physical conduct such as rubbing, touching, grabbing or brushing against another person’s body. • Inappropriate pictures • Swearing • Dirty jokes • Making offensive comments about someone’s race, color, ethnic background, religion or sexual orientation

20. It is the policy of SNHHS to prohibit harassment of any person by any other student, employee, patient, volunteer or visitor. Any claim of harassment will be investigated as soon as possible and management will determine appropriate action to be taken. Corrective action, up to and including termination (or dismissal from your clinical rotation) may be taken. We will not allow any form of retaliation against any individual who reports harassment or is involved in the investigation. If you believe you are being harassed, you can speak directly to the harasser if you are comfortable doing so. You may also contact Human Resources, your faculty member, the resource nurse or any member of administration with whom you feel comfortable. Students can also report harassment complaints anonymously by calling the Corporate Compliance Hotline at 888-414-2743. SNHHS Harassment Policy

21. COMMUNICATION IS THE CORNERSTONE OF PATIENT SAFETY COMPLIANCE It is the law, SNHHS Policy, and our responsibility to provide equal access to healthcare services for limited English & non English speaking patients. Mandated by: • American Disabilities Act (ADA) • Title VI of Civil Rights Act • SNHMC Interpreter Services Plan

22. Interpreter Services & Auxiliary Aids are Free of Charge to the Patient…

23. Toolkits are located in the following areas: Emergency Department All nursing units’ medication rooms Security office Practices West Campus Call Center Communication Service Toolkits

24. Communication Access IMMEDIATE Communication Access Options 24/7: • Language Line – Non-English speaking (DT Interpreting 1-866-237-0173) 2. NexTalk – Deaf/Hard of Hearing (ASL) Use NexTalk computer/video remote interpreter when no live Interpreter is available for Deaf or Hard of Hearing patients. 3. Page Interpreter Services On-call 221-0650 for all ASL and urgent interpreter needs Long Term Solutions Be proactive and anticipate interpreter needs in advance….submit your request online….Go to the internet homepage…Look in the center under “Care Resources” click “interpreter Request or Cancellation”. DOCUMENT daily all communication resources utilized for patient

25. Tips for Working with an Interpreter • Speak directly to the patient, notthe interpreter. • Use first-person dialogue. • Remember, everything you say will be interpreted to the patient. • Interpreters are trained professional staff. They may ask for clarification for better patient understanding. Coordinate testing, assessments, MD visits when using live interpreters, NexTalk, or the Language Line

26. Interpreter Waiver • Document that the patient has declined the use of hospital interpreter services and prefers to use his/her own interpreter. • Waiver forms are on the intranet. Use the Language Line or NexTalk for Patient to understand and sign (not family). • SNHMC will need to provide an interpreter when the person whom the patient identified is not available.

27. Medical Center Security • Security is on duty 24 hours a day/ 7 days a week. The Security Office is located on the ground floor of The Medical Center off the Emergency Department lobby and in the main lobby of the West Campus. • You can immediately contact Security by cell phone at all times. Cell phone numbers are listed on the Red Emergency Card attached to your ID badge. • Your ID badge must be worn at waist height at all times while on Health System property according to State Law. Some exceptions are allowed in sterile areas. Temporary badges are available from Security. • In the unlikely event of electronic door system access failure, the Blue Emergency Pull Stations can be used for emergency door access. Emergency Pull to Exit

28. Escort Service: Employee, student and visitor escorts are available upon request at any time for any reason at The Medical Center and West Campus. If unavailable, leave with others or have someone watch for you. Car problems: If possible, Security will assist with jump starts, but please try to arrange for other assistance. Visitor Control: After 9 pm in The Medical Center, all visitors are required to sign in at Emergency Department lobby. With clinical approval, visitor badges are issued. Patient Valuables: Patient safes are available in each room in The Medical Center. High value items can be stored in Security. Lost and Found: Security manages lost and found items. Emergency Call Boxes: Located in the parking garage outside the elevators and in some parking lots. Security Mirrors: Located in garage elevators and stairwells. Exterior Lighting: All exterior light fixtures are numbered. Please notify Security of non-working lights. Security Services(Main and West Campus)

29. What to Do with a Combative Person Plan an escape route in advance. At the Main Campus, initiate a “Code Grey” by pushing the Code Grey button or by calling x4100. At the West Campus, initiate a “Code Grey” by calling x72. If off-site, call the police at 911. Periodic training on workplace violence prevention is offered at SNHHS. Department training can be requested through the Security Department. Code Grey alarm in select Medical Center departments

30. Corporate Integrity (Compliance) Program At SNHHS, we operate in accordance with all applicable laws, regulations and standards. The Corporate Integrity Program (CIP) puts into writing these standards - in its Code of Conduct handbook and related policies Every student must agrees to understand and comply with all aspects and principles of the Program. If something doesn’t feel right, each of us has the ethical and legal responsibility topursue it.If you’re not sure about what to do, ask the question. As our partner, you, too, are committed to honor the SNHHS mission. You understand your responsibility to: • Conduct yourself with honesty and integrity and in accordance with the highest ethical standards. • Perform your duties in accordance with the principles set forth in the SNHHS Code of Conduct and CIP policies and program. • Follow the laws and regulations under which SNHHS operates. • Report or disclose any questionable situations promptly.

31. To Access more information on the Corporate Integrity Program access via our internet: http://intranet.snhmc.org/snhhs/groups/mc_risk-mgt/corp-integrity-program.html • To whom should you direct your Corporate Integrity Program questions or concerns? A.We encourage you to talk to your faculty member and/or nursing leadership. However, if for any reason you do not feel comfortable talking to either of them or if your question was not fully answered; contact the Corporate Compliance Officer or designee.   If you feel your concerns about the safety or quality of care provided at SNHHS have not been addressed, refer to SNHHS policies addressing reporting such concerns, including to the Joint Commission, for further guidance. Q. How can a student report corporate compliance concerns anonymously? A. Students may call the Compliance Reporting Hotline at 1-888-414-2743 or file a Compliance Report Form. The hotline is a secure voice mailbox designed to allow anyone to report concerns confidentially and anonymously.

32. Q.Can I post pictures and/or amusing stories about patient encounters on Facebook or other social media sites? • Probably not. Good professional judgment must be applied. Under no circumstances can any information identifying the patient be published. This may include not just names, but personal attributes such as distinctive tattoos or specific events in the local news. A patient’s family is angry about the patient’s treatment. What should I do? • Patients and/or family members may express or submit complaints or grievances to any SNHHS staff member or directly to Administration. Any student who receives a patient complaint should immediately address the concern, either individually or by accessing appropriate resources such as the patient’s nurse, the resource nurse, other members of nursing management or social services. Patient complaints that cannot be resolved quickly to the patient’s reasonable satisfaction should be forwarded to Administration to assure a timely and fair review of the grievance. Patients also have a right to contact the State of New Hampshire Department of Health and Human Services.

33. Q. What should I do if I suspect my patient has been abused? • There are mandatory reporting requirements for health care providers to report any potential victims of child and elderly abuse, if they have reason to suspect that child or elderly abuse has occurred. Refer to the Abuse Policy for regulatory requirements and guidance on reporting. Hospital reports are coordinated by social workers from our Patient and Family Services Department. If you have reason to suspect a patient has been abused at SNHMC or a Foundation practice site, you must contact your faculty, resource nurse, supervisor or a member of senior administration immediately. Human Resources and the Compliance Hot Line may also be used to report, but since these options are only available Monday-Friday during business hours, it is important to make immediate reports through managers who are on site. • A patient with a chronic health condition is frequently seen for treatment at SNHMC. He routinely offers to tip the healthcare workers and/or to give them gifts. May the staff or students accept any gifts? A. No. Students and staff may not accept cash or gifts from anyone with whom we have a business relationship.