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MSU Nursing MSU Nursing Students MDG Students MDG Orientation Orientation

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Page 1: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

MSU Nursing Students MSU Nursing Students MDG OrientationMDG Orientation

Page 2: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

WelcomeWelcome

We are excited to have students at theWe are excited to have students at the

5 Medical Group (5 MDG) and would5 Medical Group (5 MDG) and would

like to extend a warm welcome to you.like to extend a warm welcome to you.

The following slides are a compressedThe following slides are a compressed

MDG orientation. Please read through themMDG orientation. Please read through them

carefully and if you have questions, don’tcarefully and if you have questions, don’t

hesitate to ask a staff member when youhesitate to ask a staff member when you

arrive at the MDG. arrive at the MDG.

Page 3: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

Informing Patients of Student StatusInforming Patients of Student Status

It is required that all students working at aIt is required that all students working at a

medical facility ALWAYS inform patients thatmedical facility ALWAYS inform patients that

they are students PRIOR to asking the patientthey are students PRIOR to asking the patient

any questions, conducting any type of assessment,any questions, conducting any type of assessment,

or providing any type of treatment. Most patientsor providing any type of treatment. Most patients

are happy to have students help them out and willare happy to have students help them out and will

gladly accept you as a member of their care team. gladly accept you as a member of their care team.

So, let the patient know at the beginning of theSo, let the patient know at the beginning of the

encounter that you are a student. encounter that you are a student.

Page 4: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

55thth Medical Group Medical Group

CHAPERONESCHAPERONES

Page 5: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

DefinitionsDefinitions Chaperone – A person, especially an older or married Chaperone – A person, especially an older or married

woman, who accompanies a young unmarried woman in woman, who accompanies a young unmarried woman in public; an older person who attends and supervises a public; an older person who attends and supervises a social gathering for young people. {Webster’s II New social gathering for young people. {Webster’s II New Riverside University Dictionary} Riverside University Dictionary}

Medical Chaperone – A third party, usually the same Medical Chaperone – A third party, usually the same gender as the patient, who maintains a presence during an gender as the patient, who maintains a presence during an exam or treatmentexam or treatment• Promotes patient/provider comfort and safetyPromotes patient/provider comfort and safety• Guards against professional impropriety and/or Guards against professional impropriety and/or

unethical treatment unethical treatment

Page 6: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

Who Can Chaperone?Who Can Chaperone?

All patient care staff members, including All patient care staff members, including administrative personnel, can serve as administrative personnel, can serve as chaperones.chaperones.

The chaperone should, in most cases, be the The chaperone should, in most cases, be the same gender as the patient.same gender as the patient.• If a same-gender chaperone is not available, If a same-gender chaperone is not available,

the patient may consent to an opposite-the patient may consent to an opposite-gender chaperone. Document consent gender chaperone. Document consent thoroughly. thoroughly.

If required chaperone is not available during If required chaperone is not available during duty hours, contact the flight commander.duty hours, contact the flight commander.

Page 7: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

When Is a Chaperone Needed?When Is a Chaperone Needed? Any time a minor is examined or treated Any time a minor is examined or treated

(parent/legal guardian is acceptable)(parent/legal guardian is acceptable)• A parent/legal guardian must be present A parent/legal guardian must be present

except during emergencies or life-threatening except during emergencies or life-threatening situations, or if the visit concerns sexually situations, or if the visit concerns sexually transmitted diseases.transmitted diseases.

Any time a provider exposes, examines or treats Any time a provider exposes, examines or treats the genitalia or rectum of a patient of the the genitalia or rectum of a patient of the opposite sexopposite sex

Any time a male provider exposes, examines or Any time a male provider exposes, examines or treats a female’s breaststreats a female’s breasts

Upon patient or provider requestUpon patient or provider request

Page 8: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

Duties of ChaperoneDuties of Chaperone

Ensure patient privacyEnsure patient privacy Be present at all times during exam or treatmentBe present at all times during exam or treatment Identify and report suspected misconductIdentify and report suspected misconduct

• Suspected misconduct (and any other Suspected misconduct (and any other concerns regarding chaperones) will be concerns regarding chaperones) will be reported to the flight commander.reported to the flight commander.

• If warranted, the flight commander will report If warranted, the flight commander will report the suspected misconduct to the Chief, the suspected misconduct to the Chief, Medical Staff (SGH), and to the squadron Medical Staff (SGH), and to the squadron commander. commander.

Page 9: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

Suspected Misconduct?Suspected Misconduct? The nature/purpose of the exam or treatment The nature/purpose of the exam or treatment

and extent/purpose of disrobing not fully and extent/purpose of disrobing not fully explained to the patient prior to the procedureexplained to the patient prior to the procedure• Explain what the patient can expect and feel Explain what the patient can expect and feel

during exam or treatment; avoid surprising during exam or treatment; avoid surprising patientpatient

Patient not provided privacy during undressing Patient not provided privacy during undressing and dressingand dressing• At a minimum, draw privacy curtain; shut door At a minimum, draw privacy curtain; shut door

if possibleif possible The extent of required disrobing inconsistent The extent of required disrobing inconsistent

with exam or treatment with exam or treatment • A patient need not disrobe (usually) for a foot A patient need not disrobe (usually) for a foot

examexam

Page 10: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

Suspected Misconduct? Suspected Misconduct? (cont.)(cont.)

Exam inconsistent with patient’s complaint or Exam inconsistent with patient’s complaint or purpose of visitpurpose of visit• Every woman does not need a breast exam Every woman does not need a breast exam

every visitevery visit Provider’s comments unprofessional Provider’s comments unprofessional

• Comments should not be obscene or Comments should not be obscene or demeaningdemeaning

• Off-colored jokes or comments about patient’s Off-colored jokes or comments about patient’s anatomy inappropriateanatomy inappropriate

• Excessive flattery about patient’s body/body Excessive flattery about patient’s body/body parts inappropriateparts inappropriate

Page 11: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

Patient Misconduct?Patient Misconduct?

Chaperones protect provider as well as patientChaperones protect provider as well as patient Provider responsible for managing inappropriate Provider responsible for managing inappropriate

patient behaviorpatient behavior• Serious consideration should be given to Serious consideration should be given to

documentation of patient behaviordocumentation of patient behavior Recommend documenting name of chaperone Recommend documenting name of chaperone

when presentwhen present• Concerns may arise long after issue (and Concerns may arise long after issue (and

name of witnessing chaperone) forgottenname of witnessing chaperone) forgotten

Page 12: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to
Page 13: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

Infection Control:Infection Control:

It establishes prevention, control and It establishes prevention, control and reduction interventions for reduction interventions for NOSOCOMIALNOSOCOMIAL, community acquired , community acquired and clinic acquired infections.and clinic acquired infections.

Infection control practices minimize the Infection control practices minimize the risk and spread of infection risk and spread of infection throughoutthroughout the hospitalthe hospital

Goals of infection control within 5 MDG

Page 14: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

BLOODBORNE PATHOGENSBLOODBORNE PATHOGENS

HEPATITISHEPATITIS&&

HIVHIV

Health care facilities are concerned about the Health care facilities are concerned about the occupational (work related) exposure of their occupational (work related) exposure of their employees to diseases transmitted through employees to diseases transmitted through

contact with blood or body fluids. The two blood contact with blood or body fluids. The two blood borne diseases that hospital employees are most borne diseases that hospital employees are most

at risk for developing are :at risk for developing are :

Page 15: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

The single most important aspect of effective infection control is handwashing

Page 16: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

Proper TechniqueProper Technique Wet hands to reduce irritation from the soapWet hands to reduce irritation from the soap Keep hands lower than elbows to keep Keep hands lower than elbows to keep

contaminants from running onto clothingcontaminants from running onto clothing Use antiseptic soapUse antiseptic soap Wash vigorously for 10 secondsWash vigorously for 10 seconds Rinse under running water to remove Rinse under running water to remove

contaminantscontaminants Use paper towels to dry handsUse paper towels to dry hands Use towels to turn off water to prevent cross Use towels to turn off water to prevent cross

contamination and so you don’t re-contamination and so you don’t re-contaminate hands on dirty faucet handlescontaminate hands on dirty faucet handles

Page 17: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

STANDARD PRECAUTIONSSTANDARD PRECAUTIONS

treat everyone as if treat everyone as if they are infectious.... they are infectious....

Page 18: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

TRANSMISSION BASED ISOLATION TRANSMISSION BASED ISOLATION -- AIRBORNE AIRBORNE

-- DROPLET DROPLET -- CONTACT 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.

Page 19: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

PPEPPE

Just

do

Just

do

it !!!

it !!!

. . .

PPE = Personal Protective Equipment.

Also known as: PPA = Personal Protective Attire

Page 20: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

WHAT “PPE” TO WEAR?WHAT “PPE” TO WEAR?

WEAR GLOVES -WEAR GLOVES - any time contact with any time contact with blood or other body fluids may occur. blood or other body fluids may occur. For example:For example:

when touching any mucous when touching any mucous membranes or broken skinmembranes or broken skin

when handling items or surfaces soiled when handling items or surfaces soiled with blood or other body fluidswith blood or other body fluids

when drawing bloodwhen drawing blood

Change glovesChange gloves if they’re torn, and after if they’re torn, and after contact with each patient. Do contact with each patient. Do NOT NOT reuse disposable gloves.reuse disposable gloves.

Washing hands with gloves on is not an acceptable practice.

Gloves are cheap compared to the cost of treating an infection!

Page 21: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

MORE PROTECTION!!MORE PROTECTION!!USE MASKS AND EYE PROTECTIONUSE MASKS AND EYE PROTECTION - - or protective face shields if or protective face shields if

there’s any chance that blood or other body fluids may splash there’s any chance that blood or other body fluids may splash into your mouth, nose or eyes.into your mouth, nose or eyes.

WEAR A GOWNWEAR A GOWN - - or apron if splashing of blood or other body fluids or apron if splashing of blood or other body fluids is likely.is likely.

AND REMEMBER TO WASH YOUR HANDS AND OTHER SKIN AND REMEMBER TO WASH YOUR HANDS AND OTHER SKIN SURFACES IMMEDIATELY AFTER:SURFACES IMMEDIATELY AFTER:

direct contact with blood or other body fluidsdirect contact with blood or other body fluids removing gloves, gown or other protective removing gloves, gown or other protective

clothingclothing handling potentially contaminated itemshandling potentially contaminated items all patient interactionsall patient interactions

PPE is only effective if it is used appropriately. It is not a totalprophylactic. Hand washing is still necessary

Page 22: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

USE SHARPS CONTAINERS FOR USE SHARPS CONTAINERS FOR DISPOSALDISPOSAL

REPORT INCIDENTSREPORT INCIDENTS DON’T SCRUB INSTRUMENTS AT DON’T SCRUB INSTRUMENTS AT

USER LEVELUSER LEVEL DON’T RECAPDON’T RECAP

Basics of sharps/needle safety

Page 23: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

Needlestick ProtocolNeedlestick Protocol

Wash area immediatelyWash area immediately Report to Public Health; if after hours Report to Public Health; if after hours

report to after hours clinicreport to after hours clinic Supervisor completes incident reportSupervisor completes incident report

• AF Form 765AF Form 765 Prophylactic medication if patient is Prophylactic medication if patient is

infected with HIV/Hepatitisinfected with HIV/Hepatitis Follow-up careFollow-up care

Needlestick protocol to be followed in the 5 MDG

Page 24: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

Take CARE when using sharpsTake CARE when using sharpsNOT CHANCES!!NOT 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.

Page 25: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

RED BAG WASTERED BAG WASTERed 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, outerwrappers go in regular trash.

VERY EXPENSIVE to dispose of!

Page 26: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

Either complete the Nosocomial Infection Either complete the Nosocomial Infection Report Form ACC 323 or inform the ICO of Report Form ACC 323 or inform the ICO of a known infection and ICO will fill out the a known infection and ICO will fill out the form.form.

If you fill out the form, turn into Infection If you fill out the form, turn into Infection Control OfficerControl Officer• within 24 hours of suspicionwithin 24 hours of suspicion

Whenever a suspected nosocomial infection is discovered, fill out a report form.

Page 27: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to
Page 28: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

SAFETY-RELATED SAFETY-RELATED INCIDENTSINCIDENTS

Page 29: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

BACKGROUNDBACKGROUND

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

Page 30: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

PREVENTIONPREVENTION

DoD requires analysis of processes that place DoD requires analysis of processes that place patients and staff at-riskpatients and staff at-risk

Failure Mode and Effects Analysis (FMEA) is one Failure Mode and Effects Analysis (FMEA) is one the tools the MDG uses to proactively reduce the tools the MDG uses to proactively reduce and prevent injuries and incidents.and prevent injuries and incidents.

MDG Safety Committee tracks and trends MDG Safety Committee tracks and trends incidents that occur.incidents that occur.

Page 31: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

REPORTINGREPORTING

Use AF Form765, Medical Facility Use AF Form765, Medical Facility Incident ReportIncident Report• FormFlow version on LANFormFlow version on LAN

Turn in to Quality Services within 24 Turn in to Quality Services within 24 hourshours

Seek medical care for injuriesSeek medical care for injuries Report exposures to Public HealthReport exposures to Public Health

Page 32: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

Incidents are unexpected occurrences such as:

sharps injuries

medication errors

patient falls

exposures to blood-born pathogens

equipment failures during patient care episodes

Page 33: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

INCIDENT EVALUATIONSINCIDENT EVALUATIONS

Reviewed by supervisor, flight/squadron Reviewed by supervisor, flight/squadron leadership, and Risk Managementleadership, and Risk Management

Non-attributional except in cases of gross neglect Non-attributional except in cases of gross neglect or intentional misconductor intentional misconduct

Presumed to be a system error unless proven Presumed to be a system error unless proven otherwise – errors and accidents cannot be otherwise – errors and accidents cannot be completely eliminated and thus are treated as a completely eliminated and thus are treated as a workplace process that can be improvedworkplace process that can be improved

Page 34: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

55thth Medical Group Medical Group

MANAGEMENT MANAGEMENT OF VIOLENT OF VIOLENT PERSONSPERSONS

Page 35: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

Governing DirectiveGoverning Directive(The 5(The 5thth MDG is a restraint free facility!) MDG is a restraint free facility!)

5 MDGI 44-121, Management of Violent Persons5 MDGI 44-121, Management of Violent Persons

This instruction establishes the policy for This instruction establishes the policy for managing persons with specific behavioral managing persons with specific behavioral health needs/issues (e.g., psychotic and/or health needs/issues (e.g., psychotic and/or violent behavior).violent behavior).

Nonviolent, restraint-free intervention is Nonviolent, restraint-free intervention is emphasized and safety of all personnel is emphasized and safety of all personnel is primary concern.primary concern.

Page 36: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

Staff EducationStaff Education (The 5 (The 5thth MDG is a restraint free facility!) MDG is a restraint free facility!)

5 MDGI 44-121, Management of Violent 5 MDGI 44-121, Management of Violent Persons, mandates orientation and Persons, mandates orientation and annual training on use of nonviolent annual training on use of nonviolent interventionintervention

It discusses expected outcomes (goals) of It discusses expected outcomes (goals) of nonviolent intervention and steps for nonviolent intervention and steps for implementing nonviolent interventionimplementing nonviolent intervention

Page 37: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

DefinitionsDefinitions Restraints fall into three categories:Restraints fall into three categories:

Protective Devices – devices used to protect patient, or Protective Devices – devices used to protect patient, or posturally support or assist to obtain/maintain normative posturally support or assist to obtain/maintain normative bodily functions; such as bedrails, halter restraints, bodily functions; such as bedrails, halter restraints, orthopedic devices, braces, etc.; not considered restraintsorthopedic devices, braces, etc.; not considered restraints

Medical Immobilization – mechanisms employed during Medical Immobilization – mechanisms employed during procedures, without which patient could suffer harm; such procedures, without which patient could suffer harm; such as body restraint during surgery or soft restraints to prevent as body restraint during surgery or soft restraints to prevent dislodgement of intravenous lines; associated with dislodgement of intravenous lines; associated with normalnormal behavior; not considered restraintsbehavior; not considered restraints

Restraint – use of physical or mechanical devices used to Restraint – use of physical or mechanical devices used to involuntarily hinder movement of all or portion of person’s involuntarily hinder movement of all or portion of person’s body to control physical activities, thereby protecting body to control physical activities, thereby protecting person or others from injury; key is the person or others from injury; key is the intent intent for its use; is for its use; is person’s behavior itself that determines the needperson’s behavior itself that determines the need

Page 38: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

Definitions Definitions (cont.)(cont.)

Dr. Strong – a code for requesting an immediate Dr. Strong – a code for requesting an immediate showshow of force to subdue a of force to subdue a potentially potentially hostile or hostile or violent person or to defuse a violent person or to defuse a potentially potentially dangerous situationdangerous situation THE USE OF FORCE BY 5 MDG WILL BE THE USE OF FORCE BY 5 MDG WILL BE

AVOIDED IF AT ALL POSSIBLEAVOIDED IF AT ALL POSSIBLE

Code Black – a code used during a general state Code Black – a code used during a general state of duress at a location within the confines or of duress at a location within the confines or surrounding grounds of 5 MDG; announced surrounding grounds of 5 MDG; announced location is to be avoided by all personnel because location is to be avoided by all personnel because of presence of possibly dangerous personof presence of possibly dangerous person

Page 39: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

ResponsibilitiesResponsibilities Manage person using nonviolent interventionsManage person using nonviolent interventions Consult Life Skills Support Center regarding persons Consult Life Skills Support Center regarding persons

suspected of being violent or psychoticsuspected of being violent or psychotic Contact Ambulance Services when behavior suspicious of Contact Ambulance Services when behavior suspicious of

becoming violentbecoming violent May assist in transfer of person in need of care to May assist in transfer of person in need of care to

appropriate (e.g., psychiatric) facilityappropriate (e.g., psychiatric) facility Document all care on progress notes in medical recordDocument all care on progress notes in medical record Physicians may administer medications to address targets Physicians may administer medications to address targets

behavioral symptoms based on clinical judgement and the behavioral symptoms based on clinical judgement and the person’sperson’s

Ambulance Services will announce Code Black/Dr. Strong Ambulance Services will announce Code Black/Dr. Strong and location via overhead paging system and Will contact and location via overhead paging system and Will contact Security Forces for assistance managing violent persons Security Forces for assistance managing violent persons who cannot be managed effectively using nonviolent who cannot be managed effectively using nonviolent meansmeans

Page 40: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

Procedures/InterventionsProcedures/InterventionsEgress immediate area ASAP; behind locked doorsEgress immediate area ASAP; behind locked doorsif possibleif possible

DO NOT ATTEMPT TO APPREHEND OR SUBDUEDO NOT ATTEMPT TO APPREHEND OR SUBDUE If you cannot egress area safely, lock all personnel into If you cannot egress area safely, lock all personnel into

a room, avoiding doors and windowsa room, avoiding doors and windows Primary Care Staff will clear the atrium of personnel Primary Care Staff will clear the atrium of personnel

and lock them in clinic areaand lock them in clinic area

Notify Ambulance Services or activate automatedNotify Ambulance Services or activate automatedalarm when safe to do soalarm when safe to do so

Ambulance Services will announce twice, “CodeAmbulance Services will announce twice, “CodeBlack/Dr. Strong in (Black/Dr. Strong in (locationlocation).”).”

Page 41: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

Procedures/InterventionsProcedures/Interventions (cont.) (cont.)

Drop cage windows immediatelyDrop cage windows immediately

Lock hallway doors once personnel evacuated Lock hallway doors once personnel evacuated from main hallwaysfrom main hallways

Lock all interior doors once all personnel safely Lock all interior doors once all personnel safely insideinside

Ambulance Services will contact Security Forces Ambulance Services will contact Security Forces and inform them of situation and location of and inform them of situation and location of aggressor(s) if possible. If it is not safe to do so, aggressor(s) if possible. If it is not safe to do so, they will activate the duress alarm.they will activate the duress alarm.

Page 42: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

Procedures/InterventionsProcedures/Interventions (cont.) (cont.)

Remain in secure locations until given “All Remain in secure locations until given “All clear!”clear!” Ambulance Services will announce “All clear!” Ambulance Services will announce “All clear!”

overhead when assured the situation safe.overhead when assured the situation safe. Ambulance Services will authenticate “All clear!” in Ambulance Services will authenticate “All clear!” in

following manner: “This is Ambulance Services control. following manner: “This is Ambulance Services control. Code Black/Dr. Strong is terminated at this time (by Code Black/Dr. Strong is terminated at this time (by Security Forces).”Security Forces).”

Will announce authentication twiceWill announce authentication twice

In event of casualties, Ambulance Services will In event of casualties, Ambulance Services will activate Medical Group Control Center (MGCC) activate Medical Group Control Center (MGCC) and implement Disaster Casualty Control Plan and implement Disaster Casualty Control Plan (DCCP).(DCCP).

Page 43: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

Procedures/InterventionsProcedures/Interventions (cont.) (cont.)

Facility Management will survey premises andFacility Management will survey premises anddetermine any structural damage that mightdetermine any structural damage that mightjeopardize safety and if necessary, will activatejeopardize safety and if necessary, will activatealternate facility planalternate facility plan

Ambulance Services will document events in theAmbulance Services will document events in theshift logshift log

If the MCC was activated, documentation will beIf the MCC was activated, documentation will beconsistent with MDG’s DCCP.consistent with MDG’s DCCP.

Page 44: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

Expected OutcomesExpected Outcomes

The person will regain control of his/her The person will regain control of his/her behavior.behavior.

The person will not harm patients, community The person will not harm patients, community members or staff.members or staff.

The dignity of all will be maintained.The dignity of all will be maintained.

Page 45: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

FIRE SAFETYFIRE SAFETY

Page 46: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

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

Page 47: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

Fire SafetyFire Safety

The 5The 5thth Medical Group is on a fire zone Medical Group is on a fire zone

system. When a fire alarm is activated, thesystem. When a fire alarm is activated, the

system generates two series of rings. Thesystem generates two series of rings. The

first series indicates on which floor the firefirst series indicates on which floor the fire

alarm has been activated. This is followedalarm has been activated. This is followed

by a brief pause, followed by a series ofby a brief pause, followed by a series of

rings that indicates where on the floor therings that indicates where on the floor the

alarm has been pulled.alarm has been pulled.

Page 48: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

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.

Fire SafetyFire Safety

Page 49: MSU Nursing Students MDG Orientation Welcome We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to

Where are alarm stations Where are alarm stations and pull station located?and pull station located?

All alarm stations are located near the ceiling in All alarm stations are located near the ceiling in hallways.hallways.

All pull stations are located in hallways near All pull stations are located in hallways near doorways at about shoulder height. doorways at about shoulder height.

Both have printed on them the floor and zone Both have printed on them the floor and zone that you are in. Such as (1-4, or 2-1 or 3-2). that you are in. Such as (1-4, or 2-1 or 3-2).

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Fire ExtinguishersFire Extinguishers

If the fire is small and you feel youIf the fire is small and you feel you

have the ability to extinguish it using anhave the ability to extinguish it using an

extinguisher, remember the acronymextinguisher, remember the acronym

PASSPASS. .

PP - Pull pin - Pull pin: : you will need to pull hard on the you will need to pull hard on the pin to break the sealpin to break the seal

AA - Aim - Aim: : at the base of the fire, ensure you at the base of the fire, ensure you do not stand too close or the force of the do not stand too close or the force of the extinguisher may spread the fireextinguisher may spread the fire

SS - Squeeze - Squeeze: : the triggerthe trigger

SS - Sweep - Sweep: side to side at the base of the : side to side at the base of the fire fire

Fire extinguishers in the facility are of the "ABC" variety. Fire extinguishers in the facility are of the "ABC" variety. These extinguishers can be used on ALL types of fires.These extinguishers can be used on ALL types of fires.

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If at any time you doubt whether you have the ability to If at any time you doubt whether you have the ability to put out the fire using an extinguisher, leave, ensure the put out the fire using an extinguisher, leave, ensure the fire alarm is activated and the Fire Department is fire alarm is activated and the Fire Department is notified. notified. Life safety takes precedence over Life safety takes precedence over anythinganything. It is everyone's responsibility to know the . It is everyone's responsibility to know the locations of fire alarm pull stations and fire locations of fire alarm pull stations and fire extinguishers in their work arextinguishers in their work ar

Evacuate upper floors via the four corner stairways, leave Evacuate upper floors via the four corner stairways, leave the atrium stairs for upcoming traffic--NEVER USE THE the atrium stairs for upcoming traffic--NEVER USE THE ELEVATORS DURING A FIRE.ELEVATORS DURING A FIRE.

In case of fire at the 5 MDG you would call In case of fire at the 5 MDG you would call 9-9119-911..

Fire SafetyFire Safety

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Fire SafetyFire Safety

Listen for the location of the fire throughListen for the location of the fire throughthe overhead. If you are located adjacentthe overhead. If you are located adjacentto the fire area, close all doors to roomsto the fire area, close all doors to roomsand wait for further instructions. If the fireand wait for further instructions. If the fireis in your area begin is in your area begin RACERACE procedures. procedures. RR- - REACTREACT by shouting by shouting FIREFIRE & & RESCUERESCUE AA - - ACTIVATE ACTIVATE the fire warning/ alarm the fire warning/ alarm

system-system-KNOW KNOW location of nearest location of nearest alarm pull box alarm pull box

CC - - CLOSECLOSE all doors in affected fire zone all doors in affected fire zone EE - - EVACUATE ALL PERSONNELEVACUATE ALL PERSONNEL

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Questions?Questions?

Contact Carrie Mullin at 723-5260Contact Carrie Mullin at 723-5260

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Hospital Employee Hospital Employee Health ProgramHealth Program

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Initial ScreeningInitial Screening

Recent (within past year) TB skin testRecent (within past year) TB skin test Hepatitis B VaccinationHepatitis B Vaccination

• Required for all Active DutyRequired for all Active Duty• Offered to Civilian employeesOffered to Civilian employees

HIVHIV• Required for personnel potentially Required for personnel potentially

exposed to blood/body fluidsexposed to blood/body fluids Evidence of immunity to chickenpox, Evidence of immunity to chickenpox,

rubella, and rubeola (measles)rubella, and rubeola (measles)

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Annual Screening Annual Screening

TB skin testTB skin test• Required for everyoneRequired for everyone

HIVHIV• Required for personnel potentially Required for personnel potentially

exposed to blood/body fluidsexposed to blood/body fluids

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Sick employeesSick employees

Must see PCM to determine duty Must see PCM to determine duty restrictions needed to prevent restrictions needed to prevent transmission to patients and coworkerstransmission to patients and coworkers

PCMs should complete Quarters PCMs should complete Quarters Authorization form and provide a copy to Authorization form and provide a copy to Public HealthPublic Health

Public Health reports numbers to Infection Public Health reports numbers to Infection Control CommitteeControl Committee

Should see PCM upon return to work if still Should see PCM upon return to work if still sicksick

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Bloodborne Pathogens Bloodborne Pathogens ExposureExposure

If you get exposed do the following:If you get exposed do the following:• Fill out an incident reportFill out an incident report• Get the name of the patient you were Get the name of the patient you were

exposed to if at all possibleexposed to if at all possible• Go to Public Health with the incident Go to Public Health with the incident

report and patient if possiblereport and patient if possible Public Health will order lab work Public Health will order lab work

(HIV/Hepatitis Panel) on you and the (HIV/Hepatitis Panel) on you and the patient and have you seen by your PCM.patient and have you seen by your PCM.

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Bloodborne Pathogens Bloodborne Pathogens Exposure Follow-up LabsExposure Follow-up Labs

3 Months and 6 Months3 Months and 6 Months• HIVHIV• Hepatitis PanelHepatitis Panel

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TB Exposure ControlTB Exposure Control

Active TB risk for Minot is lowActive TB risk for Minot is low No isolation facilities available hereNo isolation facilities available here Suspected or confirmed cases should Suspected or confirmed cases should

be referred downtownbe referred downtown If you suspect an active case:If you suspect an active case:

• Mask the patient and yourselfMask the patient and yourself• Isolate as much as possibleIsolate as much as possible• Contact Infection Control & Public HealthContact Infection Control & Public Health

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55THTH MEDICAL GROUP HEALTH MEDICAL GROUP HEALTH INSURANCE PORTABILITY and INSURANCE PORTABILITY and ACCOUNTABILITY ACT (HIPAA) ACCOUNTABILITY ACT (HIPAA)

TRAININGTRAINING

HELP ME UNDERSTAND

HIPAA.

HOW DOES HIPAA APPLY

TO ME?

WHAT ARE THE HIPAA RULES?

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TABLE OF CONTENTSTABLE OF CONTENTS

Why HIPAAWhy HIPAA Notice of Privacy Practices (NOPP)Notice of Privacy Practices (NOPP) AuthorizationsAuthorizations Patient RightsPatient Rights PenaltiesPenalties ContactsContacts

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Why HIPAA?Why HIPAA?1996 – In Tampa, a public health worker sent to two newspapers a computer disk containing the names of 4,000 people who tested positive of HIV.

2000 – Darryl Strawberry’s medical records from a visit to a New York hospital were reviewed 365 times. An audit determined less than 3% of those reviewing his records had even a remote connection to his care.

2000 –An Atlanta truck driver lost his job in early 1998 after his employer learned from his insurance company that he had sought treatment for a drinking problems. (USA Today, 23 Mar 2000)

2001 - Elli Lilly accidentally sent e-mail to Prozac users on an informational list server revealing identities of numerous other Prozac users.

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Cast of CharactersCast of Characters Amn Notsofarfrumpukin – Our Military Amn Notsofarfrumpukin – Our Military

PatientPatient

Mrs Imsik – Our Civilian PatientMrs Imsik – Our Civilian Patient

Ms Lookemup – Our Records TechnicianMs Lookemup – Our Records Technician

Mr Doody – Our Front Desk ClerkMr Doody – Our Front Desk Clerk

Mr Shhh – Our Privacy Officer (HPO)Mr Shhh – Our Privacy Officer (HPO) (HIPPA PRIVACY OFFICER)(HIPPA PRIVACY OFFICER)

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Protected Health InformationProtected Health InformationWhat is

Protected Health

Information?

It is a subset of individually

identifiable health information

(click)

Basically, any information pertaining

to an individual’s treatment

Including payment for the provision of

health care

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Amn Notsofarfrumpukin reports to your clinic and you notice that the Amn Notsofarfrumpukin reports to your clinic and you notice that the Notice of Privacy Practices (NOPP) has not been signed.Notice of Privacy Practices (NOPP) has not been signed.

Per DOD 6025.18 and MDGI 41-10, Per DOD 6025.18 and MDGI 41-10, clinics are required to check the clinics are required to check the medical records for signature.medical records for signature.• Ask if he has received the NOPPAsk if he has received the NOPP

If not, give him one and have him sign the If not, give him one and have him sign the sticker.sticker.

If he has, and has not signed the sticker, have If he has, and has not signed the sticker, have him sign and give him another NOPP if he wants him sign and give him another NOPP if he wants one.one.

• Refusal to sign will not impede medical Refusal to sign will not impede medical care.care.

• Front desk clerk will initial the NOPP on Front desk clerk will initial the NOPP on appropriate line if the patient refuses to appropriate line if the patient refuses to sign.sign.

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Amn Notsofarfrumpukin’s 1Amn Notsofarfrumpukin’s 1stst Sgt calls and wants to Sgt calls and wants to know if he made his appointment know if he made his appointment and the nature of the appointment.and the nature of the appointment.

Under the Military Command Authority Under the Military Command Authority (MCA) rule, Commanders, 1(MCA) rule, Commanders, 1stst Sergeants Sergeants and those designated in writing by the and those designated in writing by the Commander may receive Protected Commander may receive Protected Health Information (PHI).Health Information (PHI).• We must verify positionWe must verify position• Give only minimum information necessaryGive only minimum information necessary

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Amn Notsofarfrumpukin’s Amn Notsofarfrumpukin’s supervisor calls for information supervisor calls for information

on the appointment.on the appointment.

Since the supervisor is not the 1Since the supervisor is not the 1stst Sgt or Sgt or Commander, he is not entitled to the Commander, he is not entitled to the information.information.• You can tell him that if the Amn is available, You can tell him that if the Amn is available,

you will have him return the call oryou will have him return the call or• Ask him to have the 1Ask him to have the 1stst Sgt call. Sgt call.

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DISCLOSURE REPORTSDISCLOSURE REPORTS

When Personal Health Information When Personal Health Information (PHI) is accessed, used or disclosed (PHI) is accessed, used or disclosed without patient authorizations without patient authorizations (except for those purposes that are (except for those purposes that are exempted) a signed and completed exempted) a signed and completed PHI Disclosure Report must be PHI Disclosure Report must be completed and forwarded to the completed and forwarded to the HIPAA Privacy Office for filing.HIPAA Privacy Office for filing.

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Lets’s look at some other Lets’s look at some other examplesexamples

I received a phone call from the base legal office for records on an Amn, can I give it to them?

Yes, under HIPAA, if there is an ongoing investigation we can release Information

However, we will need the request in writing and only minimum information should be given, and the legal office should be specific about what they are looking for.

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AuthorizationsAuthorizations

Will I have to do a disclosure report?

Yes, disclosures that do not have written authority

to release, require a

disclosure report.

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AuthorizationsAuthorizationsWe have a patient that

came from another state. We need her

records to continue her care. Does she need to

request them?

No, under Treatment,

Payment, and Healthcare

Operations (TPO)

we can request the records without authorization.

However, if the patient is available, it is always a good idea to get a signature.

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There are other occasions where There are other occasions where authorizations are not required.authorizations are not required.

To Public Health AuthoritiesTo Public Health Authorities To Military Command Authority (i.e., Commanders and First To Military Command Authority (i.e., Commanders and First

Sergeants)Sergeants) Judicial and Administrative ProceedingsJudicial and Administrative Proceedings Required by lawRequired by law Victims of abuse, neglect or domestic violenceVictims of abuse, neglect or domestic violence Health oversight committeeHealth oversight committee Law enforcementLaw enforcement Identification and location purposesIdentification and location purposes Reporting crime in emergenciesReporting crime in emergencies Corners, Medical Examiners and Funeral DirectorsCorners, Medical Examiners and Funeral Directors Research involving minimal riskResearch involving minimal risk Avert serious threat to health and safetyAvert serious threat to health and safety Worker’s CompensationWorker’s Compensation

Remember a disclosure report isRemember a disclosure report is requiredrequired

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Lets take a look at Patient Rights Lets take a look at Patient Rights under HIPAA.under HIPAA.

Under DOD 6025-18R and MDGIS 41-10 and 41-12, patients have a right to inspect or have copies of their medical records.

I would like a copy of my

medical records

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Patient Rights – Medical Patient Rights – Medical Records Records

We must comply with the We must comply with the request within 30 days.request within 30 days.

A one time extension of 30 A one time extension of 30 days may be granted.days may be granted.

A one-time copy will be A one-time copy will be prepared without cost to the prepared without cost to the patient. Other copies can be patient. Other copies can be provided at a fee determined provided at a fee determined by the Business Operations by the Business Operations Flight.Flight.

There are circumstances There are circumstances where access is denied. If you where access is denied. If you have any questions contact have any questions contact the Privacy Office at ext 5134 the Privacy Office at ext 5134 or 5206.or 5206.

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Patient Rights -continuedPatient Rights -continued To file a grievance or To file a grievance or

complaint about any complaint about any aspect of their PHI or aspect of their PHI or the MTF’s practices the MTF’s practices and policies.and policies.

They have a right to They have a right to designate a personal designate a personal representative with representative with authority to act on authority to act on their behalftheir behalf

Un-emancipated minors, under ND law, may only consent to treatment for drug and alcohol abuse, treatment for sexually transmitted diseases and medical emergencies.

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Patient Rights - ContinuedPatient Rights - Continued

I have a problem with a notation in my records and I

would like it amended.

Under HIPAA a patient has the right to request an amendment or correction. The physician needs to review the records. The request may be denied if:

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Patient Rights-Reasons for Patient Rights-Reasons for denialdenial

The information was not created by The information was not created by the 5the 5thth Medical Group. Medical Group.

The information is not part of the The information is not part of the record set (medical records)record set (medical records)

The information is accurate.The information is accurate.

The Privacy Officer will be consulted The Privacy Officer will be consulted prior to any denial to the Patient. prior to any denial to the Patient.

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Other Patient Rights Include:Other Patient Rights Include:

The right to full disclosure of release The right to full disclosure of release of disclosures, except for those that of disclosures, except for those that have been authorized.have been authorized.

RequestRequest restrictions of the uses of restrictions of the uses of PHI, but the MTF is not necessarily PHI, but the MTF is not necessarily required to follow the request (i.e. required to follow the request (i.e. would there be a mechanism in place would there be a mechanism in place to monitor the restriction).to monitor the restriction).

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PenaltiesPenaltiesWhat if I mess up and release PHI to the wrong individual?

Document it on an AF Form 765, Medical Facility Incident Report and forward to the Risk Manager within 24 hours

Notify the Privacy Officer immediately

Persons making intentional unauthorized disclosures will be referred to their unit commander for appropriate administrative or disciplinary action.

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What are the Medical OIs

concerning HIPAA?

MDGI 41-10 – Implementation of Privacy Practices

MDGI 41-11 – Accounting of

Disclosures of PHI

MDGI 41-12 – Patient’s Rights Under HIPAA.

Located on the “U” drive; Shared folder; HIPAA

Compliance folder

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Points of contactPoints of contact If you have any questions please contact:If you have any questions please contact:

Lorenda Poissant-Salling (Privacy Officer)Lorenda Poissant-Salling (Privacy Officer)• ext 5206 ext 5206

OROR

Kim Lemley (Privacy Assistant)Kim Lemley (Privacy Assistant)• ext 5134ext 5134

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ResponsibilitiesResponsibilities

Remember, everyone Remember, everyone who works with or who works with or comes in contact with comes in contact with protected health protected health information (PHI) or information (PHI) or any medical any medical information is information is responsible to responsible to maintain the maintain the confidentiality of that confidentiality of that information.information.

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Patient RightsPatient Rights

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ACCESSACCESSPatients have the right to Patients have the right to receive care within a receive care within a reasonable period of time reasonable period of time

What is considered What is considered reasonable depends on reasonable depends on the type of care requiredthe type of care required

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ACCESSACCESS The access to care standards at the 5The access to care standards at the 5thth

Medical Group are as follows:Medical Group are as follows:

Acute/Urgent appointments within 24 Acute/Urgent appointments within 24 hourshours

Routine Care within 7 daysRoutine Care within 7 days

Wellness appointments within 30 daysWellness appointments within 30 days

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TREATMENTTREATMENTPatients have the right to receive thePatients have the right to receive the

appropriate care required to achieve orappropriate care required to achieve or

maintain the highest possible quality of maintain the highest possible quality of life.life.

That may include not only physical care That may include not only physical care

but….. but…..

psychosocialpsychosocial

spiritualspiritual

culturalcultural

end of lifeend of life

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Patients have the right to be Patients have the right to be involved in any decision that involved in any decision that involves their care including:involves their care including:

Advance DirectivesAdvance Directives

Conflict ResolutionConflict Resolution

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ADVANCED DIRECTIVESADVANCED DIRECTIVES

Advance Directives are written or Advance Directives are written or verbal Statements made by the verbal Statements made by the patient indicating his or her patient indicating his or her treatment wishes in the eventtreatment wishes in the event

the patient becomes incapacitated. the patient becomes incapacitated.

Patients must be given the Patients must be given the opportunity to make these opportunity to make these provisionsprovisions

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Advanced DirectivesAdvanced Directives may may include include living wills,living wills,,, durable durable powers of attorneypowers of attorney, or similar , or similar documents or documentation documents or documentation conveying the patient’s conveying the patient’s preferences.preferences.

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Advance DirectivesAdvance Directives

Patients may obtain advance Patients may obtain advance directives from their attorneysdirectives from their attorneys

For Active Duty members this service For Active Duty members this service is provided for free at the base legal is provided for free at the base legal officeoffice

If you do have an advance directive, If you do have an advance directive, please ensure that a copy of it gets please ensure that a copy of it gets placed in your outpatient medical placed in your outpatient medical recordrecord

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PATIENT ADVOCACY PROGRAMPATIENT ADVOCACY PROGRAM

A patient has a A patient has a rightright to voice to voicecomplaints about his or hercomplaints about his or hercare and to have thosecare and to have thosecomplaints reviewed, and whencomplaints reviewed, and whenPossible, resolved. Possible, resolved.

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PATIENT ADVOCACY PATIENT ADVOCACY PROGRAMPROGRAM

5th MDGI 41-18 - Patient Relations 5th MDGI 41-18 - Patient Relations Program outlines the mechanism for Program outlines the mechanism for investigation and resolution of patient investigation and resolution of patient complaints/concernscomplaints/concerns

Each section involved in patient care has Each section involved in patient care has an appointed Patient Advocate, as does an appointed Patient Advocate, as does the Medical Groupthe Medical Group

The goal is to resolve the issue at the The goal is to resolve the issue at the lowest level, whenever possiblelowest level, whenever possible

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Patient AdvocatePatient Advocate

The 5The 5thth Medical Group’s primary Patient Medical Group’s primary Patient Advocate is Mrs. Jean Cadell (723-5109)Advocate is Mrs. Jean Cadell (723-5109)

The 5The 5thth Medical Group’s alternate Medical Group’s alternate Patient Advocate is Mrs. Lorenda Patient Advocate is Mrs. Lorenda Poissant-Salling (723-5206)Poissant-Salling (723-5206)

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RESPECTRESPECTPatients have the right to be treated with respect in allPatients have the right to be treated with respect in all

interactions. Respect involves numerous issuesinteractions. Respect involves numerous issues

including:including:

Confidentiality/PrivacyConfidentiality/Privacy-only those needing specific information in order to-only those needing specific information in order to

provide care are allowed access to patient informationprovide care are allowed access to patient information -sharing patient information is restricted to staff involved -sharing patient information is restricted to staff involved

in the patient’s care and is limited to information essential in the patient’s care and is limited to information essential to that careto that care

SpatialSpatial-Patients have the right to physical privacy during-Patients have the right to physical privacy duringinterviews, procedures, etc.interviews, procedures, etc.

SecuritySecurity-Patients have the right to a safe, secure-Patients have the right to a safe, secureenvironment, for themselves and their property. environment, for themselves and their property.

CommunicationCommunication-Patients have the right to be treated as -Patients have the right to be treated as valued individuals in all interactions.valued individuals in all interactions.

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ETHICSETHICS

MDGI 37-1 outlines the facility’s Ethics MDGI 37-1 outlines the facility’s Ethics policy and provides the mechanism policy and provides the mechanism for obtaining assistance in making for obtaining assistance in making ethical decisions involving patient ethical decisions involving patient carecare

The EthicsThe Ethics Committee meets on an as Committee meets on an as needed basis to discuss ethical needed basis to discuss ethical issues. Members are available to issues. Members are available to assist in the decision making process.assist in the decision making process.

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Questions?

Contact Mrs. Lorenda Poissant-Salling at 723-5206 or Mrs. Jean Cadell at 723-5109

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CODE BLUE CODE BLUE PROCEDUREPROCEDURE

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DEFINITIONDEFINITION

CODE BLUE: Code name for CODE BLUE: Code name for cardiopulmonary arrest or any cardiopulmonary arrest or any situation in which a cardiopulmonary situation in which a cardiopulmonary arrest is imminent.arrest is imminent.

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BLS AND ACLSBLS AND ACLS

A – AirwayA – Airway B – BreathingB – Breathing C – CirculationC – Circulation D – DefibrillationD – Defibrillation

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INITIATING A CODE BLUEINITIATING A CODE BLUE

Dependent on 4 factors:Dependent on 4 factors:• ? Normal duty hours? Normal duty hours• ? Non-duty hours? Non-duty hours• ? Adult? Adult• ? Pediatric? Pediatric

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INITIATING A CODE BLUEINITIATING A CODE BLUE

ADULT – NORMAL DUTY HOURSADULT – NORMAL DUTY HOURS• FIRST PERSONFIRST PERSON

Assess the patientAssess the patient Overhead Page by dialing 2-0 and announce Overhead Page by dialing 2-0 and announce

“CODE BLUE and LOCATION” twice.“CODE BLUE and LOCATION” twice. Initiate CPR by using the ABCD assessments Initiate CPR by using the ABCD assessments

of BLS and ACLSof BLS and ACLS

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INITIATING A CODE BLUEINITIATING A CODE BLUE

ADULT – NORMAL DUTY HOURSADULT – NORMAL DUTY HOURS• SECOND PERSONSECOND PERSON

Activate the code if necessaryActivate the code if necessary Assist with CPR until team arrivesAssist with CPR until team arrives

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INITIATING A CODE BLUEINITIATING A CODE BLUE

PEDIATRIC – NORMAL DUTY HOURSPEDIATRIC – NORMAL DUTY HOURS• FIRST PERSONFIRST PERSON

Assess the patient using the ABCD of BLSAssess the patient using the ABCD of BLS Perform CPR for 1 minute if necessaryPerform CPR for 1 minute if necessary Overhead Page by dialing 2-0 and announce Overhead Page by dialing 2-0 and announce

“Pediatric Code Blue and Location” twice“Pediatric Code Blue and Location” twice Resume CPRResume CPR

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INITIATING A CODE BLUEINITIATING A CODE BLUE

PEDIATRIC - NORMAL DUTY HOURSPEDIATRIC - NORMAL DUTY HOURS• SECOND PERSONSECOND PERSON

Activate code if necessaryActivate code if necessary Assist with CPR until team arrivesAssist with CPR until team arrives

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INITIATING A CODE BLUEINITIATING A CODE BLUE

ADULT OR PEDIATRIC AFTER HOURSADULT OR PEDIATRIC AFTER HOURS• Dial 9-911 and report if the coding Dial 9-911 and report if the coding

patient is adult or pediatric and the patient is adult or pediatric and the location of the patient.location of the patient.

• Ambulance services will be the sole Ambulance services will be the sole responders.responders.

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WHO RESPONDS TO A CODE WHO RESPONDS TO A CODE BLUE??BLUE??

Normal duty hours:Normal duty hours: All available credentialed providersAll available credentialed providers Ambulance Services paramedic and Ambulance Services paramedic and

techniciantechnician X-ray, pharmacy and laboratory technicians.X-ray, pharmacy and laboratory technicians. Pediatrician or PALS-trained Pediatric Nurse Pediatrician or PALS-trained Pediatric Nurse

Practitioner for children under age 16 Practitioner for children under age 16 (pediatric code)(pediatric code)

Available clinic nursing staff and two clinic Available clinic nursing staff and two clinic technicianstechnicians

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WHO RESPONDS TO A CODE WHO RESPONDS TO A CODE BLUE??BLUE??

NON-DUTY HOURSNON-DUTY HOURS• Ambulance Services Paramedic and Ambulance Services Paramedic and

TechnicianTechnician• Patient will be transferred downtownPatient will be transferred downtown

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LOCATION OF ADULT CRASH LOCATION OF ADULT CRASH CARTSCARTS

LOCATION LOCATION Dental ClinicDental Clinic Internal MedicineInternal Medicine

COVERAGECOVERAGE 22NDND Floor Floor 11stst Floor Clinics Floor Clinics All areas of the All areas of the

facilityfacility

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LOCATION OF PEDIATRIC LOCATION OF PEDIATRIC CRASH CARTSCRASH CARTS

LOCATIONLOCATION Pediatric Clinic Pediatric Clinic

(GREEN TEAM)(GREEN TEAM)

COVERAGECOVERAGE Clinic areas of Clinic areas of

MDOSMDOS

All areas of the All areas of the facilityfacility

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AFTER A CODE BLUEAFTER A CODE BLUE

Pharmacy will restock the drugsPharmacy will restock the drugs Unit personnel should inventory and Unit personnel should inventory and

restock all other suppliesrestock all other supplies Pharmacy will issue a new lock for Pharmacy will issue a new lock for

the crash cartthe crash cart

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WORDS OF WISDOM FOR WORDS OF WISDOM FOR CODE BLUESCODE BLUES

Most Pediatric Codes start with the airway, Most Pediatric Codes start with the airway, so remember the ABCDs. Airway is always so remember the ABCDs. Airway is always first.first.

Don’t wait too long to call a code. If you Don’t wait too long to call a code. If you think a patient is in trouble, call a code. It think a patient is in trouble, call a code. It is the fastest way to get help.is the fastest way to get help.

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SUMMARYSUMMARY

KNOW THE LOCATION OF YOUR KNOW THE LOCATION OF YOUR CRASH CARTS AND BE FAMILIAR CRASH CARTS AND BE FAMILIAR WITH THE CONTENTSWITH THE CONTENTS

REVIEW THE USE OF THE LIFEPACK REVIEW THE USE OF THE LIFEPACK 12 DEFIBRILLATOR12 DEFIBRILLATOR

REMEMBER TO DIAL 2-0 FOR HELP REMEMBER TO DIAL 2-0 FOR HELP DURING THE DAY AND 9-911 AFTER DURING THE DAY AND 9-911 AFTER HOURSHOURS

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Questions?Questions?

Education & Training #723-5662Education & Training #723-5662

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MEDICAL EQUIPMENTMEDICAL EQUIPMENTMAINTENANCEMAINTENANCE

5 MDSS/SGSLR5 MDSS/SGSLR723-5256723-5256

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Training ObjectivesTraining Objectives

User ResponsibilitiesUser Responsibilities Medical Device Related IncidentsMedical Device Related Incidents Service/Calibration LabelService/Calibration Label Medical Maintenance Services Medical Maintenance Services Electrical SafetyElectrical Safety Emergency ProceduresEmergency Procedures

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Overview Overview

Equipment operators (YOU) have a Equipment operators (YOU) have a key role in managing the equipment key role in managing the equipment in the facilityin the facility• Insuring the equipment is used for its’ Insuring the equipment is used for its’

intended purposeintended purpose• Insuring any staff members using Insuring any staff members using

medical group equipment are trainedmedical group equipment are trained

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Medical DeviceMedical DeviceRelated EventRelated Event

A medical device related event is A medical device related event is when a medical device (supply or when a medical device (supply or equipment):equipment):• Has caused or may have contributed Has caused or may have contributed

to the injury, illness, or death of a to the injury, illness, or death of a patient, visitor or staff memberpatient, visitor or staff member

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Medical Devices EventMedical Devices Event Common Causes Common Causes

Equipment malfunctionEquipment malfunction Operator errorOperator error Poor device design or inadequate labelingPoor device design or inadequate labeling Defects in laboratory or imaging equipmentDefects in laboratory or imaging equipment Sterilizer spore tests inaccurately indicating proper Sterilizer spore tests inaccurately indicating proper

sterilizationsterilization Utility problems (electricity, medical gases, Utility problems (electricity, medical gases,

plumbing)plumbing)

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Operator Preventive Operator Preventive MaintenanceMaintenance

Preventive Maintenance ChecksPreventive Maintenance Checks

- Check case/housing for damage- Check case/housing for damage

- Replace leads/hoses/tubing, as required - Replace leads/hoses/tubing, as required

- Replace batteries/bulbs if accessible without tools- Replace batteries/bulbs if accessible without tools

- Perform function checks; report deficiencies- Perform function checks; report deficiencies

- Reference manufacturer’s operator manuals - Reference manufacturer’s operator manuals

- Keep equipment clean- Keep equipment clean

- Ensure battery-operated devices are plugged - Ensure battery-operated devices are plugged

in to maintain charge & prevent internal damagein to maintain charge & prevent internal damage

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Medical Devices Event Medical Devices Event User ResponsibilitiesUser Responsibilities

Remove item(s) from serviceRemove item(s) from service Do not change settingsDo not change settings Keep accessories with unitKeep accessories with unit Recover any accessory packaging Recover any accessory packaging

(lot number/date information) (lot number/date information) Notify section supervisorNotify section supervisor Notify Medical Maintenance and Notify Medical Maintenance and

Quality Control Quality Control immediatelyimmediately

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Service/CalibrationService/CalibrationVerification LabelVerification Label

Visual reminder that equipment is certified to Visual reminder that equipment is certified to operate within manufacturer’s design parametersoperate within manufacturer’s design parameters

You are responsible for checking the “Date Due” You are responsible for checking the “Date Due” PRIOR TO use of equipment to assure equipment PRIOR TO use of equipment to assure equipment is calibratedis calibrated

If expired service label is found, If expired service label is found, do notdo not use the use the equipment. equipment. • Contact Medical Maintenance at 723-5256Contact Medical Maintenance at 723-5256

Service Due Date

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Services Provided byServices Provided byMedical MaintenanceMedical Maintenance

Provide or arrange for all Provide or arrange for all maintenance services for medical maintenance services for medical equipmentequipment

Assembly and installation of Assembly and installation of equipmentequipment

Operator training on equipment Operator training on equipment during initial issue or upon requestduring initial issue or upon request

Hazard surveillance for medical Hazard surveillance for medical equipmentequipment

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Equipment Supported byEquipment Supported byMedical MaintenanceMedical Maintenance

Medical, Dental, Lab, Radiological, and Veterinary Medical, Dental, Lab, Radiological, and Veterinary devices used in the diagnosis, treatment or devices used in the diagnosis, treatment or rehabilitation of patientsrehabilitation of patients

Not supported: Ice makers, coffee pots, Not supported: Ice makers, coffee pots, refrigeration systems, televisions, typewriters, refrigeration systems, televisions, typewriters, computers not connected to medical equipment, computers not connected to medical equipment, nurse call system, desk lamps, beepers, or locksnurse call system, desk lamps, beepers, or locks

When in doubt, please call us at 723-5256. When in doubt, please call us at 723-5256.

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Electrical SafetyElectrical Safety

Extension cords, outlet strips, and Extension cords, outlet strips, and outlet adapters are prohibited from outlet adapters are prohibited from use with medical equipmentuse with medical equipment• Tripping HazardsTripping Hazards• Fire HazardsFire Hazards• Electrical Safety HazardsElectrical Safety Hazards

If a longer power cord is necessary to If a longer power cord is necessary to operate equipment, contact us for operate equipment, contact us for assistance.assistance.

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SummarySummary

User ResponsibilitiesUser Responsibilities Medical Equipment EventsMedical Equipment Events Service/Calibration LabelService/Calibration Label Medical Maintenance ServicesMedical Maintenance Services Electrical SafetyElectrical Safety

723-5256723-5256 MSgt Jim BrittMSgt Jim Britt

SSgt Chasity ForceSSgt Chasity ForceSrA Patryk GasiewskiSrA Patryk Gasiewski