DCH Health System

DCH Health System
Orientation for Clinical Students
Welcome to DCH !
We are glad to have you here as a
clinical student in one of our
facilities:
• Regional Medical Center
• Northport Medial Center
• Fayette Medical Center
Your orientation today is provided at the
beginning of your clinicals to present required
information to you as you join the DCH team in
delivering quality care to our patients.
DCH Mission
• DCH Health System provides high quality
compassionate community-based health
services to the community we serve
through our employees, physicians,
and volunteers in a financially responsible
manner.
DCH Vision
• DCH Health System will be the best health
system in the nation for the patients to
receive care, employees and volunteers to
work, and physicians to practice medicine.
DCH Values
• The customer’s needs are critical.
• We will seek to improve processes without
focusing on blame.
• Quality is everyone’s job.
• The person doing the job knows it best.
• People deserve respect.
• Teamwork works.
• There is value in differences.
• Involvement builds commitment.
• Support, recognition, and open communication
build success.
• You make the difference.
DCH Behavioral Standards
• Be considerate and courteous to
everyone.
• Treat others like you want to be treated.
• Be supportive and cooperative with each
other.
• Display pride in your job.
• Demonstrate positive leadership qualities.
Dress Code
•
•
•
•
Approved school uniforms
No jeans
Close toe shoes
Name badge should be worn at all times
and visible
• Nails should be short, and clean
• No perfume/cologne in patient care areas
• No gum chewing
Confidentiality
• You cannot disseminate, discuss or relate the
contents of any patient record except as
necessary in the course of care for the patient.
• You are not to allow anyone else access to
patient information using your name or
password.
• You cannot disseminate, discuss or relate the
communications concerning a patient.
• Penalties for breach of patient confidentiality can
result in disciplinary, punitive and/or legal action
against you.
National Patient Safety Goals
• Since 2003, The Joint Commission has
developed NPSGs annually as ongoing
opportunities for improvement related to
patient safety. These are included for your
review as they relate to your role in
providing patient care. It is not meant for
you to memorize or know the goals by
number, only focus on the intent and take
action consistently to meet the Goals and
therefore improve patient safety.
Wristband Standardization
All DCH Facilities will use standard wristband colors to promote safety and decrease
healthcare worker confusion. These changes will take effect January 20, 2009.
Yellow wristband for
Fall Risk
Orange wristband for
Surgical Site Identification
White band with blue stripes is the new
Blood Bank Band. Each hospital will
have their name on the band.
Green wristband, green sticker on
chart and green sign on door for
Latex Allergies
Blue wristband for
Bloodless Medicine
Resuscitation physician order label and
DNR stickers for the chart will be
purple
DCH - Student and Instructor Parking
•Students and instructors are to park in lower end (back rows closest to UOC & the
U of A campus) of the DCH Laundry parking lot at the corner of Dr. Edward Hillard
Drive and Paul Bryant Drive East (across the street from the Fire Station). Walk to
the top of the hill of this lot and cross the street at the traffic light across from DCH
Trustee Hall (near the Easter Seals building) or cross the street at the light at Bryant Dr.
& Dr. Edward Hillard Dr.
•After crossing, continue to walk straight from the Bryant Dr. East light along the
sidewalk.
•Enter the Outpatient Center entrance and cross the lobby going toward the
hospital / physicians’ parking area.
•Walk through the physicians’ parking area. Upon re-entering the main hospital,
turn left and go straight to the center elevators.
•Shuttle Service is available M>F / 5:45am-10am and 2pm-6:30pm.
•DCH Security Office may be contacted for escort or vehicle assistance, such as flat
tires or dead batteries, by dialing 759-7320.
•Parking at Northport Medical Center is located at the back of the facility at
the emergency room entrance
DCH Health System
Environment of Care
4JCAHO term for physical environment of
hospital
– Building
– Equipment
– People
Environment of Care
4 Objectives:
– To provide a safe environment for patients, staff,
and others
– To minimize environmental hazards, risks, and
injuries
– To comply with standards and regulations
Safety is Everyone’s Job
4Authority:
Board of Directors
Administrators
Safety Officer
Environment of Care Committee
Individual Department
YOU
The Seven Environments of Care
Safety and Worker Safety
Security
Fire Safety
Emergency Management
Hazardous Materials and Waste
Medical Equipment
Utilities
Safety Activities
4Risk Assessment
4Employee education
4Inspection, preventive maintenance, and testing
of equipment
4Recalls
4Hazard Surveillance Rounds
4Policies and Procedures
4Incident Reporting
DCH is a smoke free
environment, except
Approved Employee Smoking Areas:
South and West Parking decks
*designated areas only
North Smoking Hut (adjacent to North
Entrance)
NMC – Smoking Court only
NO SMOKING INSIDE, PERIOD!
Security Activities
4Monitoring and surveillance - assigned
posts
4Risk Assessment
4Controlled access
4Camera surveillance
4Employee education
4ID badges
4Policies and procedures
Security Is Provided By:
The Wackenhut Corporation
Tuscaloosa Police Officers
Law Enforcement Agencies
DCH Employees - YOU
Reporting Security Concerns
RMC - 7320
Security Control
Code Strong-22
Code Blue-22
Code Red-22
NMC - 22 or 0
Identification Badges
Employees must wear ID Badges
Wear it high
Keep name visible
Badges are color coded
Volunteers, vendors, and contractors
are required to wear identification
Fire Prevention
4No Smoking
4Preventive Maintenance and Testing of
Equipment
Fire Response
Rescue
Reassure patients and visitors
Rescue horizontally, then vertically
Charge personnel will make decision about O2
Alarm
Pull nearest alarm box
Call out for help
Dial 22
Code Red
Confine
Close patient doors
Assure that fire and smoke doors are closed
“Compartmentalization” - Smoke and fire
compartments for protection
Extinguish
Pull the pin
Aim the nozzle
Squeeze the handle
Sweep nozzle side to side
Fire Tips - What Should I
Know?
4Know location of Fire Extinguishers
4Know Location of Pull Boxes
4Know Fire Response for your work area
4Drills conducted quarterly
4Fire Extinguishers checked monthly by
Security and annually by external
company
Emergency Management
4 Mitigation - prevention
4 Preparedness - training, policies, and
community interactivity
1. Internal Disasters
2. External Disasters
Emergency Management
4Response – hospital-wide and
department-specific response plans;
“scalable” to event.
4Recovery – return to “normal” activities;
recovery of lost expenses through FEMA
Emergency Codes
Code Red - Fire
Code Gray - Severe Weather
Code Strong - Show of Force
Code Blue -Medical Emergency
Code Purple - Medical Emergency/Child
Code Yellow Alert- An Emergency
to be implemented
Code Yellow Active - An Emergency is
implemented
Code White - Lock Down
Code Pink – Infant/Child Abduction Alert
All Clear - All clear repeated three times
Hazardous Materials and Waste
“Right to Know”
Proper Medical Waste Disposal
Sharps
Container
Red Bags for
Medical Waste
MSDS
Material Safety Data Sheets
Required for each Hazardous Material/Agent
Each Department/Unit Maintains Their Collection
Each Sheet Contains Information About:
- Properties
- Hazards
- Spill/Cleanup Procedures
- Disposal Instructions
MSDS
Hazardous Chemicals
Labeling and Chemical Information
Product Name
Manufacturer/supplier/im
porter name and address
List hazardous chemicals
contained within
Appropriate hazard
warning
Hazardous Materials
Hazardous Substances
Fire Hazards ~ Health Hazards ~ Other Hazards
Learn which materials are used in your job (medications,
cleaning agents, gasses, hazards, etc.)
Know the rules – MSDS
Proper Labeling
Know disposal requirements for medical waste
Safe Handling and storage
Know if PPE is required
Medical Equipment
Maintained by Clinical Engineering
Contact CE (7185) with Medical Equipment
Problems
Safe Medical Device Act (SMDA)
- Applies to healthcare professionals
- Legally imposed duty to report:
- unexpected outcomes
- reasonably linked to medical device
Emergency Power
EMERGENCY
Receptacles labeled
“Emergency” or “Critical”
are powered by a back up
generator
Receptacles should be
routinely used for critical
medical equipment
Receptacles are RED
Utilities
Report Utility Problems to Clinical
Engineering
DCH is on Auxiliary Electrical Power
- activated in less than 5 seconds
- critical medical equipment to be plugged into
RED plugs
Parking
RMC ONLY
DAY SHIFT EMPLOYEES:
South Parking Lot, Trustee Hall Lot, Laundry Parking Lot, and
West Parking Lots (by the West Deck).
Parking is FREE in all of these locations.
ABSOLUTELY NO PARKING IN PARKING DECKS
EVENING/NIGHT SHIFT EMPLOYEES:
Same as above. Also permitted to park on designated employee
levels in the South Parking Deck; $1 to exit the deck.
NO PARKING IN WEST DECK
PREPAID PARKING PARTICIPANTS:
Required to park on designated levels in the South
Parking Deck. Contact HR to apply for waiting
list.
Parking continued
Absolutely NO employee parking in
the West Parking Deck adjacent
to the Outpatient Center and
Medical Tower. Violators of
DCH’s parking policy are subject
to disciplinary action.
NORTHPORT MEDICAL CENTER
Employee parking in designated
areas outside ED/Outpatient
Entrance.
SAFETY QUIZ
Match the following codes to the appropriate
meaning:
1.
2.
3.
4.
5.
__ Medical Emergency A. Code Gray
B
__Lockdown
B. Code Blue
E
__Infant/Child
Abduction C. Code Red
D
__Fire
D. Code Pink
C
__Severe
Weather
E. Code White
A
Continued
• The RACE acronym stands for:
–R___________________
Rescue
–A___________________
Alarm
–C___________________
Confine
–E___________________
Extinguish
Infection Control and
Prevention
Infection Control Chain
Infectious Agent
Bacterium, Virus, Fungus,
Parasite
Infection Control Chain
Infectious Agent
Bacterium, Virus, Fungus,
Parasite
Susceptible
Host
Very young & elderly
Poor nutrition
Impaired immune system
Non-intact skin
Underlying disease
Infection Control Chain
Infectious Agent
Bacterium, Virus, Fungus,
Parasite
Susceptible
Host
Mode of
Transmission
Very young & elderly
Poor nutrition
Impaired immune system
Non-intact skin
Underlying disease
Bloodborne
Airborne
Droplet
Contact
Precautions to Prevent Transmission:
Standard Precautions:
 Bloodborne
Isolation Precautions:
 Airborne
 Droplet
 Contact
Bloodborne Pathogens
Disease causing microorganisms that are
present in human blood or other body
substances, which include but are not
limited to:
HIV
Hepatitis B
Hepatitis C


Work practice and environmental controls are used
to prevent exposure to bloodborne pathogens.
Barriers as appropriate for the patient care situation:
Gloves, Gowns, Goggles, Masks
Environmental Cleaning
CDC Hand Hygiene
Guidelines
 When hands are visibly dirty,
contaminated, or soiled, wash with nonantimicrobial or antimicrobial soap and
water.
 If hands are not visibly soiled, use an
alcohol-based handrub for routinely
decontaminating hands.
Guideline for Hand Hygiene in Health-care Settings. MMWR 2002;
vol. 51, no. RR-16.
Hand Hygiene
The most important way to prevent the spread of infection!
Hand Hygiene Reminder Stickers
.
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Body Fluids that may Pose Risk of BBP
Transmission
• Blood
• Peritoneal fluid
• Semen
• Pericardial fluid
• Vaginal secretions
• Amniotic fluid
• Cerebrospinal fluid
• Pleural fluid
• Synovial fluid
Body Substances that do Not Pose Risk of
BBP Transmission Unless Visibly Bloody
• Urine
• Nasal discharge
• Sputum
• Tears
• Saliva
• Sweat
• Emesis
Safety Sharps Devices
Sharps Disposal Container
Hepatitis B Vaccination >
Pre-exposure Protection
Protects you from Hepatitis B infection
if you have an exposure incident
You must take 3 shots over a period of
6 months to get best protection
Hepatitis B Post-exposure
prophylaxis
(If exposed person has not been vaccinated
and source of exposure is known positive)
HBIG x 1, as soon as possible
and within 24 hours
HBV vaccine series
What to do if you get
exposed . . .
1. First Aide
2. Fill out Work Injury Report & Notify
Supervisor
*(Include patient name and D# on
report)
3. Follow school policy for follow-up
Exposure Control Plan
(Located in the “*P/P Infection Control” in Meditech)
 Employer responsibilities
(testing to include System healthcare employees, physicians, medical staff, and
medical students)
 Employee responsibilities
 Who is at risk
 Procedures and practice to protect you
 What to do if you get exposed . . .
Occupational Safety and
Health Administration
OSHA Purpose:
To provide a safe workplace for
employees
Wrote the Bloodborne Pathogen
Standard which was designed to
limit exposure to bloodborne
pathogens in the work setting
Airborne Precautions:
For organisms which 'float' in the air, either
alone or attached to small droplets.
May be breathed in by visitors or health care
workers.
Masks are worn to prevent inhalation of these
organisms.
Electronically Monitored
Negative Pressure Room
Ruling out TB? Use Airborne Precautions
Droplet
Precautions:
For organisms that only travel a short
distance and don't stay in the air.
Droplets are generated during coughing,
sneezing, talking, and procedures
such as suctioning and bronchoscopy.
Note: Includes the diseases:
•Influenza
•Bacterial Meningitis
•Pertussis (whooping cough)
•German Measles
•Mumps
Contact
Precautions:
Diseases spread by contact:
Herpes
Clostridium difficile
Scabies
Head lice
MRSA
VRE
May be picked up by others when
touching infective material or
contaminated surfaces.
Gloves, & gowns are worn when
contact with the patient or the
patient’s environment is anticipated.
The Environment Can Facilitate Transmission
X represents germ culture positive sites
~ Contaminated surfaces increase cross-transmission ~
Abstract: The Risk of Hand and Glove Contamination after Contact with a VRE (+) Patient Environment. Hayden M, ICAAC, 2001,
Chicago, IL.
OR VISITATION
INFORMATION
I. Arrival
a. Report to the OR Control
Desk for identification and
assignment.
II. Confidential Information
a. Personal information concerning a
patient’s condition may never be
discussed either inside or outside DCH
RMC.
b. Admitting that a specific individual is a
patient is a violation of this policy.
III. Aseptic Technique
a. All operating room staff and visitors
will adhere to established aseptic
technique guidelines
b. If in doubt about the sterility of any
item, consider it unsterile.
c. Unsterile persons will not touch the
sterile field, reach over it, or allow
unsterile articles to come in contact
with it.
d. Unsterile persons never walk
between two sterile fields.
continued:
e. When passing a sterile field,
unsterile persons maintain at least
twelve (12) inches of distance.
f.
Unsterile persons always face the
sterile field.
g. If an unsterile person brushed
against an area designated as
“sterile”, it is considered
contaminated.
IV. Dress Code
a. All operating room staff and
visitors will adhere to the
established dress code.
b. Approved, clean and freshly
laundered scrub suits should be
worn by anyone entering the
procedural area. These will be
provided by the OR.
continued:
c. Warm up jackets or a long sleeved
T-Shirt worn under scrub top
should be worn in restricted
areas. Warm up jackets are
snapped and
any ties are tied to
prevent
flapping.
d. Personal Protection equipment
(PPE) should be worn when
exposure to blood or infectious
material is reasonably anticipated.
continued:
e. Protective eye/ face shield/ mask/
shoe covers should be worn
whenever activities could place
personnel at risk for spills,
splashing or spraying.
f. If shoe covers are worn, they
should be changed whenever they
become torn, wet or soiled and
should be removed before leaving
the procedural area.
continued:
g. All persons entering restricted
areas should wear a mask when
open sterile items and equipment
are present.
h. The mask must fit properly to
completely cover the entire mouth
and nose.
continued:
i. Masks are carefully removed and
discarded by handling only the ties.
Masks are not to be saved by hanging
around the neck or tucking into a
pocket for future use.
j. Hair coverings-head and facial hair,
including sideburns and neckline,
should be covered when in procedural
areas. Bouffant and hood style are
provided.
continued:
k. Disposable hair coverings should
be discarded immediately after
use.
V. Illness in the Operating Room
a. If you become ill during a procedure:
i. Inform the circulating nurse.
ii. Leave the room if possible.
iii. To avoid injury, if unable to leave
the room, sit down next to the
nearest wall.
VI. Fire Safety in the Operating
Room
a. All operating room staff and visitors will
adhere to the established policy for fire
safety in the procedural area.
continued:
b.
The DCH fire procedure is outlined
as follows:
R-rescue or remove any person in
immediate danger.
A-alarm or pull the alarm box then dial 22.
C-confine the fire
E-extinguish the fire if you can do so safely.
CODE RED indicates that a fire alarm has
been activated
VII. Exposure Prevention
a. The OR is a high risk area for blood
and body fluid exposure so it is very
important to take all appropriate
precautions for prevention.
b. Wear appropriate PPE
c. Always keep hands out of surgical site
unless asked to perform a function.
d. Let the Scrub Tech maintain the
instrumentation.
continued:
e. Always be aware of the location
and use of sharps.
f. Always handle and pass
instrumentation as you would use
it, tip away from you or the person
you are giving it to.
VIII. Exposure Protocol
a. “First aid” first. Immediately wash or
flush the area.
b. Fill out a Work Injury Report and notify
the Department Supervisor. (include
patient name and D# on the report)
c. Report to Employee Health or ED if
after office hours.
Thank you for your attention
during this orientation!
• If you have questions about the information
covered in this orientation, please talk with your
instructor / direct supervisor and they can refer
your concerns to the appropriate hospital
representative.
• We look forward to having you at DCH!