Annual Review 2007 Safety & Health Hazards

Annual Review 2007 Safety & Health Hazards

Resource Guide Safety & Health Hazards 2013 Contributing Departments include: Staff Development, Safety Committee, Safety Officer, Infection Control, Risk Management, HIM, Security, IS, HR, RT, Plant Ops, Radiology, and other sources. 1 2013 Safety & Health Hazards Index Abuse & Neglect 95-97 Hand Hygiene 77-78 Protected health Information-PHI 69-73 Bioterrorism 53

Harassment / Workplace Violence 22 RACE 35 Blood Borne Exposure Event 84 Hazardous / Cytotoxic Drugs 47 Radiation Safety 39 Blood Borne Pathogens 75 Hazardous Material

15 & 40-47 Rapid Response Team 54-56 Bomb Threat 53 Healthcare-Associated Infection 74 Respirator Mask Fit 88 CAUTI Prevention 92 HICS 50

Respiratory Viruses Influenza 89 C-diff 86 HIPAA/Pt Rights/Confidentiality 66-70 Restraints 101-102 Central Line Infection - Prevention 93 Infant Abduction / Drill 57 Risk Management

58-63 Chemical Spill Event 46 Influenza Vaccine 89 Safe Line 2-SAFE (27233) 5 Clean to Dirty Principle 85 Injuries are Preventable 8 Safety Communication (MOX/email) 5

Close Calls/Occurrences/Sentinel 61-62 Identification Color Alert Bands 98 Security 12 & 21 Code Blue / Medical Emergency 54-56 Infection Prevention / Exposure 74-80 Sentinel Event / Close Call / Occurrence 61-62 Computer Use & Workstation

73 Introduction-Safety Top Priority 3-4 Sharps Safety 45 Cultural Diversity Impaired Provider Recognition 7 Slips, Trips, & Falls 27 De-Escalation 9 23-26

Joint Commission How to Contact 5 Smoke Free Environment 30 Electrical Safety 38 Labels 46 Standard Precautions 81 Emergency Management 17 & 48-53 Latex Allergy

100 Surgical Site Infections Prevention 91 Employee ID / Badge 20 Medical Gases / Shut Off 36 System Failures-Basic Staff Response 15 -16 EMTALA 64-65 Environment of Care 10-18

MRSA 87 Team Communication/Work/Training 6 Equipment Management 16 MSDS Sheets 46 Transmission Based Precautions 82 Ergonomics 28-29 National Patient Safety Goals

104 Tuberculosis (TB) 90 Egress / ExitsKeep Clear 13 & 32 Oxygen Safety 37 VRE 87 Fall Prevention 99 Patients Rights 67

Waste Management 40-45 Fire Drill 34 Personal Protective Equipment 79-81 Weather Plan 52 Fire Safety 31-35 Population Appropriate Care 9 Wesley Intranet Policies & Procedures

103 2 Culture of Safety Everyone is responsible to promote a culture of safety! 2013 3 Top Priority Wesley Medical Center considers the practice for safety, infection control, emergency & risk management as top priorities for their patients, employees, and customers. 4 Safety Suggestions If you see an opportunity for the hospital to reduce injuries to employees, or a safety concerndont keep it to yourself: Safety Officer

962-2046(WMC) 858-2935(GHH) Send a MOX to: WHR.SAFETYCON Send e-mail to: Wesley.DL Safety Concerns The Joint Commission encourages anyone who has concerns or complaints about the safety and quality of care to bring those concerns or complaints first to the attention of the health care organizations leaders. Mail: Office of Quality Monitoring The Joint Commission One Renaissance Boulevard Oakbrook Terrace, IL 60181 E-Mail: [email protected] Safe Line 2-SAFE 962-7233 5 Work Safe Wesley Cares Team Communication / Team Work / Team Training Every employee is accountable for their own safety and that of each other, therefore: We observe our work place and each other for conditions or behaviors that affect safety. We ask for help when we recognize a risky situation.

We acknowledge our colleagues when we hear or see them working safely & thank them for working safely. We talk to our co-workers when we think they might be at risk because we care about them and dont want to see anyone getting hurt! 6 Recognizing an Impaired Provider ? What is an impaired provider? Healthcare provider impairment refers to the inability to practice according to accepted standards as a result of substance use, abuse, or dependency, as well as impairment related to mental or physical illness. What to do? Notify your manager and/or house supervisor of your concerns about the co-worker. 7 OUCH!

Injuries are preventable! Injuries to employees of Wesley Medical Center happen. Most injuries are preventable!! The injuries we see most often are due to human behaviorlike rushing, taking shortcuts or not following safety procedures. 8 Celebrating Our Cultures Population Appropriate Care Refers to our ability to meet the distinct needs of patients, families, and co-workers with respect to cultural, spiritual and developmental needs. Knowledge & considerations for each population includes: Communication approaches Personal space Time orientation Social organization Safety / environmental interventions

Cultural Diversity Refers to the differences between people based on shared ideology and valued set of beliefs, norms, customs, and meanings. Cultural awareness: Diversity is an important part of life Strive to foster a culture of inclusion Be sensitive to distinct needs of patients, families, and co-workers with respect to cultural, spiritual and developmental needs Dont stereotype peoplerespect their beliefs, even when they may 9 appear strange to you Environment of Care (EOC) Each of the 7 plans have components that help identify risk, plan for education of the risk, teach, monitor results, and evaluate the outcomes. EOC standards stress the need for everyone in the organization to participate

in the processes & activities that make the environment safe & effective for all. Safety Security Fire & Life Safety Utilities Mgmt Hazardous Waste Equipment Mgmt Emergency Mgmt 10 Environment Of Care Safety Management Plan Expectations of Staff: Components: Safety policies Hospital Wide Safety committee Education & Training Risk Management Quality

Infection Control Safety Officer 962-2046(WMC) 858-2935 (GHH) Each person & department have the responsibility to know the safety procedures that pertain to the hospital & their department Responsible for being alert for & reporting any unsafe acts or conditions Assist in monitoring & evaluation of current practices for effectiveness 11 Environment Of Care Security Plan Components: Assesses risk and the activities to minimize

risk Expectations of Staff: Assist security by reporting suspicious people or situations Abide by the parking, smoking Responds to situations and safe workplace rules that could be harmful to our patients, visitors, and staff 12 Environment Of Care Fire & Life Safety Plan Expectations of staff: Components: Oversees the fire detection & suppression system in all our buildings System testing & monitoring

Fire drills Comply with fire procedures & drills Keep fire pull stations, extinguishers, and fire doors clear for easy access Do not go through closed fire doors during drill/fire Keep exits & hallways clear 13 Environment Of Care Hazardous Waste Plan Expectations of staff: Always use PROPER handling and usage techniques with all waste materials to protect ourselves, patients, and visitors. Components include:

Evaluation Education Proper handling Disposal of chemicals 14 Environment Of Care Utilities Management Plan Components include: Expectations of staff:

Communications systems Familiarization of approved Infection Prevention alternative procedures when Negative Pressure systems systems are down Environmental support systems Equipment support systems Emergency power Life support systems 15 Environment Of Care Equipment Management Plan Expectations of staff: Components include: Safety, upkeep, and operation of our patient care equipment Equipment recalls & alerts Clinical Engineering plays a vital role Comply with routine maintenance

schedules; Look for preventive maintenance sticker with current date prior to use of equipment Take pride in and care of our equipment Monitor equipment cleanliness to prevent cross-contamination Report faulty or mal-functioning equipment and take out of service 16 Environment Of Care Emergency Management Plan Components: Procedures & preparation for internal & external disasters Expectations of staff: Comply with management for internal disasters Participate in community emergency interventions www.fema.gov/areyouready/

17 Environment Of Care Look around your EOC with new critical eyes! How would we measure up as of today? What could we do right now to create a safer EOC? What monitoring systems can we design to keep our EOC a safe & cleaner place 24 hours / 7days a week? 18 SAFETY 19 Employee Identification Wear your employee ID Badge Question those that dont! It is very important for your own protection as well as that of our patients and guests to be able to identify potential threats to our security. YOU have every right to request identification from anyone in your work area who does not seem to belong there, or

who arouses your suspicions in any way. If you do not feel comfortable challenging someone Call Security #23333 (Main campus) GHH Security #2940 20 Security #23333 (Main Campus) Galichia Security is #2940 Wesley security staff are here to provide the best possible service for a safe environment. Security Tips: When leaving work (especially at night): 1. Walk in groups as much as possible 2. Be aware of your environment and who is around you 3. Security will escort to your car if you are leaving at a time that you could be alone 21 Harassment & Workplace Violence Safety Wesley Medical Center employees can expect to work in an

environment free of harassment and disruptive behavior. As part of our commitment to a safe workplace, possession of firearms, other weapons, explosive devices, or other dangerous materials on the medical center premises is strictly prohibited. Report incident to any of the below: Management Human Resources Ethics Compliance Officer 22 Reasons for Aggressive or Violent Behavior in Hospitals Alcohol, drug abuse Revenge (for real or imagined slights) Stress Frustration (long waits, sick child/family) Family Problems, financial problems Mental illness-paranoia, depression Gang or criminal affiliation A need for power and control over health problems

23 Escalation of Emotions Concern Sick family/self, work schedule, busy/stress Frustration Long wait times, no answers, no one cares, behind the scenes, no one is listening to me Anxious Anger Time is ticking, still no answers, whats going on?! Ill yell until they listen! I will be heard! Rage 24 6 Steps for De-Escalating Emotions

1. Remain calm. Breathe deeply. Keep your voice low. 2. Demonstrate respect for yourself and for the other person. Be gentle, but firm. I understand youve been waiting. I will 3. Watch body language, both yours and your patients. Avoid sudden moves. Use slow and gentle hand movements. Use nonthreatening eye contact. 4. LISTEN Pay attention to what the person is telling youand what they arent 5. Keep your emotions in check avoid being pulled in

to the conflict they are experiencing 6. Know when to say when! Call another Manager or Security 25 Things NOT to Do Avoid allowing long waits check in when possible Dont raise your voice Dont take action without explaining whats happening Dont engage in power struggles Avoid telling the other person that you know how he or she feels Do not attempt to intimidate a hostile person Crowding someones personal space Dont criticize or lecture Turing your back on someone during a conversation 26 WMC covers a lot of ground! Prevent Slips, Trips, & Falls

Watch for water or debris on the floors and hallways or uneven surfaces Clean up spills or debris immediately by doing it yourself or calling the appropriate service Watch for dangling cords or cords on the floor Please help everyone stay safe! 27 Ergonomics Education & Prevention Ergonomics is the science of working smart & learning to move and position your body to reduce stress on muscles, tendons, and ligaments. Musculoskeletal Disorders are injuries that are caused by poor postures, prolonged position, repetitive movements, and not using the resources needed to do the job. 28 Ergonomics Work Practice Techniques

Learn & practice techniques to move & position your body safely. Never transfer patients when off balance Lift loads close to the body Never lift alone, particularly fallen patients, use team lifts or use mechanical assistance Avoid heavy lifting especially with your spine (back) rotated Get training in how & when to use the mechanical assist devices 29 Smoke Free Environment Tobacco-Free Campus Wesley Medical Center It is the responsibility of every employee of WMC to support and comply with the tobacco-free policy. If any employee observes anyone using tobacco products while on Wesley property, they should politely inform the individual of the tobacco-free policy. Cards with policy information are available for distribution from human resources. 30 Fire Triangle Prevent fires by keeping these sources separate: Heat anything that can cause a spark Fuel anything that can burn

Oxygen/Air oxygen or air 31 Exits / Egress Be Aware Be Responsible Always keep one side of hallways clear for a quick and effective exit if needed. Any hall used for evacuation requires an 8 foot coming or going space AT ALL TIMES. Look around & be vigilant about putting items away; Parking any piece of equipment in the hall greater than 20 minutes is considered an obstruction and is not acceptable. Keep EXIT paths, fire alarms, & fire extinguishers free of equipment & supplies. Do not go through closed fire doors during a fire or fire drill. 32 Alarms / Extinguishers Be Aware & Be Responsible Know the location of: Fire alarm boxes Fire extinguishers Medical Gas Shut off Exit routes Fire Extinguisher: PASS

Review procedures to follow in the event of a fire drill or actual fire. 33 Fire Drill A drill should be responded to as if it were a real fire situation. Dial #23131 (Main Campus) Dial #2940 (Galichia) Tell operator who you are, where your are, and report a Dr Red Drill Dr Green is the all clear signal announced over the public address system. 34 Fire Event: RACE

Call 23131(Main Campus) Call 2940(Galichia) Rescue remove anyone in immediate danger Alarm call #23131(Main Campus) or #2940(GHH) state who you are, your location, & what the situation is; If no phone is available pull the nearest fire alarm Contain the fire if possible / close doors and windows Extinguish / Exit use PASS if you can safely do so Pull pin Aim Squeeze Sweep 35 Medical Gases / Shut Off Valve 1. In the event of an emergency, who is authorized to turn off a piped in oxygen supply to an identified medical gas zone area? Answer: A shared decision between respiratory care and nursing will be made to authorize the actual shut off of any piped in oxygen zone valves in the identified area. 2. What action needs to be taken if an oxygen zone valve is to be closed?

Answer: Locate patients who are currently on oxygen in the identified zone and provide an oxygen cylinder and/or arrange transfer to another area. All zone valves are identified with the rooms/areas that are controlled by that valve. 36 Oxygen Cylinder Safety Secure and safely store all oxygen cylinders (full or empty) by placing inside the rack or a 2-wheeled carrier in your units cylinder storage area. If rack is full, call Respiratory Therapy to pick up. When transporting a patient, secure the oxygen tank i.e. in provided hollow storage area of the transport cart, or in the wheelchair mounted carrier. Laying on floor in patient room or hallway Standing alone without being secured in an approved carrier In the cylinder storage area but NOT placed in the rack

Standing in a wheelchair/cart carrier (ones without wheels) Laying on patient bed Stacked on other equipment If you see an oxygen cylinder that is not secure or contained, DONT WALK ON BY take immediate action. Secure the unsafe tank. Notify the manager! 37 Electrical Safety Minimize electrical hazards by: Checking electrical equipment before each use Checking plugs and cords for exposed wire or damage Disconnecting cords by pulling on the plug not the cord Using only 3-prong plugs when possible Water and electricity do not mix! Keep hands dry & keep areas surrounding electrical equipment dry Keeping cords from kinking while equipment is in use Call Clinical Engineering #22560 for medical equipment Call Plant Operations #22770 for all other electrical equipment Call for After Hours EMERGENCY #22712 38 Radiation Safety

Contact the Radiation Safety Officer at 962-3030 (operator page). Radiation producing machines and radioactive materials are operated by specially trained physicians & technologists for diagnosis & treatment of disease. Minimizing radiation exposure: Recognize the hazard signs & proceed with caution & permission Maximize distance between you & the source of radiation Wear approved radiation protection Signage, indicating type & level of hazard, is posted where radiation is being used; these rooms are shielded with lead or concrete to minimize radiation levels to meet regulatory standards. Caution: X-rays Radioactive Material High Radiation Area garments (i.e. lead apron) when assisting with diagnostic studies

Step back a few feet from the radiation machine or patient during the actual exposure Limit your time/exposure around radiation equipment & materials Staff who could be exposed to greater then 10% of annual exposure limits are assigned personnel radiation monitors to assess their level of exposure 39 Waste Management Types 3 kinds of waste found in health facilities: 1. General 2. Medical 3. Hazardous chemical General waste non-hazardous waste that poses no risk of injury or infections. This is similar in nature to household trash. Examples include paper, boxes, packaging materials, bottles, plastic containers, and food-related trash. Medical waste material generated in the diagnosis, treatment, or immunization of patients including:

Blood, blood products, and other body fluids (fresh or dried blood or body fluids such as bandages & surgical sponges) Organic waste such as human tissue, body parts, the placenta, and the products of conception Sharps (used or unused), including hypodermic and suture needles, scalpel blades, blood tubes, pipettes, and other glass items that have been in contact with potentially infectious materials Hazardous chemical waste is potentially toxic or poisonous and includes cleaning products, disinfectants, cytotoxic drugs, pharmaceutical waste (drugs/wrappers) and radioactive compounds 40 Waste Management Identification & Safe Handling Think safety Use appropriate PPE - gloves, facemasks, protective face shields, and protective clothing. Utilize appropriate waste management containers for sharps, biohazard substances, solid waste, etc. Hazardous Chemical Infectious Cytotoxic

Gas Exposure can occur through inhalation (breathing), ingestion (swallowing), skin contact or absorption, and injection. If exposed: Seek immediate treatment / Notify manager / Complete a HNS report 41 IT DOES NOT BELONG IN THE RED BAG It does not belong in a red bag, if the item would NOT release infectious fluid (blood or other potentially infectious material) when compressing the bag It does not belong in the red bag, if the item has the potential to poke through the bag When removing waste from a patients room, ALWAYS separate the biohazard

waste from the regular waste. 42 Biomedical Waste Bag (Red Bag) Closure Procedure Step 1: Place all biomedical waste into appropriately marked bag. Do not fill bag more than full. Step 2: Gather and twist the top of the red bag. Step 3: Twist bag closed with tie or single hand knot. Step 4: Place properly closed bag into biomedical waste container located in the soiled utility room. THINGS TO REMEMBER: Always close bags properly before placing in biomedical waste container NO RABBIT EAR TIEING 43 Healthcare Rx Waste Stream Management LQ: Generator Status

Sort Code Description and examples of Wastes Waste Class No Waste Code Dispose of med in black container Non-Hazardous Rx Waste Hazardous Rx Waste No Code No Code Incompatible Rx Waste Maintenance

Sharps/ IV Solutions Infections Waste Return to Pharmacy/place in Aerosol bin When medication is left that is hazardous: Dispose in Aerosol Container All Rx waste without a waste code defaults to the blue container unless it is in a syringe or ampoule. Any waste with the potential to leak must be placed in a Ziploc bag. It is not permitted by the Department of Transportation (DOT) to transport free

fluids. Examples of Hazardous Waste: Vaccines Bulk (more than 3%) Chemo Nicotine Gums & Lozenges (+wrappers) Toradol, Digoxin (liquid) Nasal Spray, Sore Throat Sprays,Lozenges Unused Multi-Vitamins (no wrappers) Insulin and Insulin Drips HFA Inhalers Compressed Propellants NO capsule powder inhalers place in blue containers Examples of Non-Hazardous Waste: I.V. Antibiotics Tylenol, Aspirin Lidocaine,Bupivacaine,Xylocaine Dobutamine, Dopamine, Pitocin Nitro drips/tablets Injectable Contrast, Barium

Solu-Medrol,Solu-Cortef, Diphenhydramine TPNs Heparin Approximately 95% of all medications Blood Products or infections waste Syringes or ampoules Blue Container Place wrapper and med in Ziplock then black container waste code Capture Full, partial plus empty packaging for: Nicotine/Nicotrol Coumadin/Warfarin Partial syringes/sharps acceptable in small 2 gallon black container. Black

Container Other waste Streams RCRA Waste: Return to Rx When medication is left in a vial, IV, pill: Not permitted: Container Labeled/Identified Hazardous by Pharmacy Aerosols Return corrosive and Oxidizing meds to Pharmacy (Send to Pharmacy Code) Corrosives (Example) Sporanox Zinc Sulfate

Unused Ammonia Inhalants Oxidizers (Examples) Potassium Permanganate Unused Silver Nitrate Dispose in baggie and use hospital approved return to pharmacy process. NO CONTROLLED SUBSTANCES in any of the above containers. (No Medications) Items that can be cut and poured down the drain. Maintenance IV Solutions Containing: -Potassium Chloride

-Potassium Phosphate -Sodium Phosphate -Calcium - Sodium Bicarbonate - Dextrose - Saline -Lactated Ringers Needles Empty Syringes Empty Ampoules Saline/ Syringe Blood/ Syringe No partial medication bottles, IVs, or syringes with

medications added Empty Items Empty/Trace vials and IV bags Dispose your empty/trace containers per your hospital policy Empty Vials Empty IV bags Empty IV Tubing Empty syringes and ampoules in red sharps container No IVs with medications added.

Discard down the drain Discard in regular trash receptacle SHARPS Place in Red Containers. 44 44 Sharps - Be Aware & Be Responsible Sharps Management Communicate with team members & utilize a safe zone during procedures. Use available safety sharp devices. Sharps Injury Event

Wash site with soap & water Notify manager & Employee Health There is a 2 hour window for treatment of potential HIV / AIDS exposure Complete HNS report Needles/sharps shall be disposed of in an approved container to minimize the risk for injury. A Bio-System staff member replaces sharps containers in all patient care areas on a routine basis. 45 Chemical Spills .. Labels .. MSDS LABELSall substances will be identified In original or approved labeled containers. Chemical Spill If chemical spills are too large to handle safely, report immediately to emergency operator at 23131(Main Campus) And 2940 (GHH) Check with your manager concerning

assigned chemicals on your unit. Material Safety Data Sheets available 24/7 by calling Security at 23333 (Main Campus) And 2940(Galichia) The most detailed and comprehensive information about substances are found on the MSDS sheets . 46 Hazardous Drugs/Cytotoxic Drugs (HDCDs) ok it o l w Ne pill K S o Chem 47

Emergency Management 48 Emergency Management Plan Wesley Medical Center under The Joint Commission (TJC) facilitates a flexible All Hazards approach to emergency management that can be adapted to a variety of catastrophic emergencies. The Emergency Management Plan (EMP) applies to any internal or external disaster. All employees have a role in the EMP. Emergency Management (EM) addresses the four phases of disaster response: 1. Mitigation 2. Preparedness 3. Response 4. Recovery There are six critical areas of emergency management: 1. Communications 2. Resource and Asset Management Details of the Emergency 3. Safety and Security Preparedness Plan are located 4. Staff Responsibilities on the Wesley Intranet under 5. Utilities Management Department . 6. Patient Clinical and Support Activities

49 HICS Hospital Incident Command System HICS is a program developed to assist in the operation of hospitals during times of a planned drill or an unplanned event (internal or external). Provides an identifiable, responsibilityoriented chain of command Provides a common mission & language Provides a method for prioritizing duties 50 Systems Failure Basic Staff Responses Examples: Electrical Power but the Emergency Generators Work

Electrical Power Total Failure including emergency generators Telephones Ensure that life support systems are on emergency power (RED Outlets). Ventilate patients by hand as necessary. Complete cases in progress ASAP. Use flashlights. Monitor patients according to severity. Utilize any battery operated lights available, hand ventilate patients, manually regulate IVs as needed. Dont start new cases. Monitor patients. Provide for visitor safety.

Use cellular phones & overhead paging; Use runners as needed. 51 The NEW Wesley Severe Weather Plan has 3 Levels of activation Level I Severe Thunderstorm/Tornado WATCH Staff Responsibilities: -Locate and place patients shoes at bedside -Explain to patient and/or family actions being taken are precautionary only. -Ensure visitors in waiting rooms are aware of alter and of safe locations Level II Severe Thunderstorm/Tornado WARNING Staff Responsibilities -If equipped, window shades or blinds are to be pulled over windows -Ensure patient and/or family members are informed and reassured -Place an extra blanket on each patients bed Level III Severe Thunderstorm/Tornado WARNING of Immediate Danger (Wesley is in the path of danger) Staff Responsibilities -Immediately move all patients to the inside hallway -If patient absolutely cannot be moved to hallway, move as far away from windows as possible and cover with blankets -Close all doors

-As is possible, ensure waiting rooms are alerted to danger -Do not leave the building An ALL CLEAR will be announced when conditions are not longer a danger 52 Bomb Threat / Bioterrorism Bomb Threat If you receive a phone call - Bioterrorism or. See a suspicious package Environmental contamination includes chemical, biological, or radiological events that put visitors, patients, customers and employees in danger. For questions, operator page our regional bioterrorism coordinator. An excellent resource is

http://www.cdc.gov/ Take it seriously! Call 23131 (WMC) or #2940 (GHH) for any threat! 53 Emergency Teams RAPID RESPONSE (ADULT & PEDIATRIC) The purpose of the team is to bring critical care expertise and support to the patient outside of the Emergency Department or Intensive Care Units Main campus team: Consist of: MICU (senior RN) Resident; if requested by team Respiratory Therapist Primary RN caring for patient

Can be activated by calling 2-3131 Galichia team: Consist of: House Supervisor Respiratory Therapist Primary RN caring for patient Can be activated by calling 695-9999 No pediatric team available Patient Action Line (PAL): allows patients/family direct contact for voicing concerns and/or emergency help Can be utilized when medical attention/concerns are not being addressed Activated by family or patient by calling: 962-7377 (WMC Main Campus) 858-2965 (Galichia) Director on call will respond and activate a team if necessary at either location Any employee can call that is concerned about a patient! 54 Emergency Teams (Continued) Code Blue

(Adult , Pediatric or neonatal) The purpose of the team is to initiate emergency care and resuscitative action Main campus activation: 2-8540 (Neonatal, BR, 3 & 4 WH) 2-8848 (Neonatal BCC) 2-3131 (Specify Adult/Pediatric ) Main campus team consists of: Critical care RN & Respiratory Therapist Resident & Pharmacist (Adult/Peds) EKG Technician & Chaplain Galichia activation: Dial #0 Announce Code Blue w/ specific location, repeat once Medical Emergency (Adult or Pediatric) The purpose of the team is to initiate emergency care for any non-patient Main campus will call 2-3131 and announce Medical Emergency

Galichia will call house supervisor 858-2965 or activate EMS WMC Team consists of: ECT or RN from ED or Trauma Security Chaplain 55 56 56 Infant and Pediatric Abduction Maternal Child staff will determine possible abduction and Call #23131 Public Address System enacts announcement Security will respond & assist staff in securing all exits of Womens Hospital & BirthCare Center Unaffected departments will assign an employee to their closest exit to monitor & detain suspicious persons if needed Drills will be conducted; respond appropriately 57

Risk Management 58 Ask: What / Why / How We as an organization must establish and maintain a culture by asking. - What happened? - Why did it happen? - How can we prevent it from happening again? 59 Your Responsibility with the Risk Management Program Be constantly alert for occurrences that might cause undesirable effects Communicate the positive and/or negative aspects of the occurrence Document the occurrence on HNS for further tracking and monitoring Report unsafe conditions/situations to your manager, risk management at 962-7274, or to the SAFE line (2-SAFE, 962-7233) If the unsafe condition/situation poses an IMMEDIATE threat or

harm, consider what immediate actions you can take (Note: use your chain of command to assist with actions needed to provide a safe environment) 60 What is an Occurrence? -an unusual event, situation, incident or unexpected outcomeExamples: Medication or other treatment errors Patient, visitor, or employee injuries Patient or family dissatisfaction Malfunctioning equipment Unintentional lacerations or perforation of an organ or body part Unexpected death 61 Sentinel Event / Close Call Sentinel event is defined as an unexpected occurrence involving death or serious physical or psychological injury or the risk thereof Notify Risk Management ASAP 962-7274 You may be asked to participate in a Joint Commission required Root Cause Analysis of the event to develop a corrective action plan that would prevent recurrence The Joint Commission periodically releases Sentinel Event Alerts with recommended practices

Close call is defined as an unplanned incident that does not cause injury, but under different circumstances could have; it was prevented due to insight of a healthcare provider who acted to prevent it Close call events need to be investigated and an action plan developed to ensure everyones safety & to prevent recurrence 62 Hospital Notification System Risk management law requires all employees and healthcare providers to report occurrences, sentinel events, and close calls. Report immediately to manager: Occurrences Sentinel Events Close Calls Document ALL within 24 hours with an HNS

63 EMTALA (Emergency Medical Treatment and Active Labor Act) EMTALA States: The Emergency Department must provide to any individual that comes to the emergency department : (includes Main ED, West ED, Birth Care Center, Birth rooms, GHH ED) Appropriate medical screening exam and stabilization within the capability and capacity of the facility, regardless of the ability to pay. Stabilizing treatment prior to an appropriate transfer to another medical facility. Appropriate transfer requires the completion of the EMTALA Memorandum of Transfer form. 64 EMTALA When is an EMTALA obligation triggered? When an individual or a representative acting on the individuals behalf requests an examination or treatment for a medical condition. A prudent layperson observer would conclude from the individuals appearance or behavior that the individual needs an examination or treatment of a medical condition. The individual can request emergency medical care ANYWHERE ON HOSPITAL PROPERTY which includes : Main Campus, West ED, GHH, or within 250 yards of the main buildings, but does not include Wesley Care Clinics.

EMTALA policies are found on the intranet under polices and procedures. 65 HIPAA / Patient Rights / Confidentiality 66 HIPAA Privacy Rule Health Insurance Portability & Accountability Act of 1996 ALL healthcare employees are obligated to protect patient privacy rights! (patient & non-patient care areas, physicians, residents, volunteers, & students) Patients Rights Federal Regulation Protected Health Information -using & disclosing any form of PHI via any type of media. If there is a HIPAA concern: Notify your manager or the facility privacy official & complete a HNS report. 67 Patient Privacy Rights

The right to access their PHI (Protected Heath Information) The right to request amendment of PHI The right to an accounting of disclosures The right to opt out of the patient directory The right to confidential, alternate communication The right to restrict access The right to receive the notice of privacy practices 68 Protected Health Information (PHI) What is PHI? It is ANY health-related information that can be directly linked to the patientsuch as name, address, any number identification (i.e. medical record, x-ray, drivers license), etc Relates to the physical or mental condition of individuals (past, present or future); and the treatment or payment of

their care Transmitted or maintained in any form (electronic, paper or verbal representation) 69 Tips to Safeguard Patients PHI Electronic health information: Log off the computer when finished Do not share computer passwords Do not text or post PHI to social media. Do not access PHI without a need to know to perform the job (i.e. Meditech information)

Password protect personal recording devices with patients PHI (i.e. PDA, laptop, flash drive) If lost or stolen, report immediately to manager and security. Call 27800 Do not leave printed or electronic patient information exposed where visitors or unauthorized individuals can view it Encrypt emails contain PHI, confidential or sensitive information. Use of personal recording devices (i.e. cell phones, digital camera, PDA, etc) personal photograph or recording devices are prohibited from use to protect privacy of Wesley Medical Center physicians, employees, patients, and visitors Written health information: (patient work lists, medical record & billing records) Do not discard PHI in trash can (PHI no longer needed MUST be disposed of by shredding!) Do not post PHI on bulletin boards or leave exposed in public areas Be sure to blacken out patient names on Thank You cards posted in public areas Do not label patients full name on tracker boards and chart backs

Do not leave medical records open or unsecured 70 Tips to Safeguard Patients PHI Oral/Verbal/Written health information: Use patient curtains Lower your voice Black out patient names on Thank You cards posted on public bulletin boards Do not speak of patient information in public areas with coworkers or non-authorized persons Limit voice mail to name, facility, call back number & brief purpose for call unless quality or safety of care will be impacted Obtain patients pass code when discussing results on the telephone Ask visitors to leave patient room when health information is being discussed Obtain patients permission to discuss health information in front of visitors and/or family members present Report HIPPA violations through Hospital Notification System, Facility Privacy Officer or the Ethics and Compliance Officer. Report the loss of any portable electronic device to the IT

director, Facility Privacy Officer, or by calling 27800 within 24 hours. 71 Violations All violations are reported to HCA Corporate & to the Office of Inspector General (OIG) What are the most commonly reported HIPAA Privacy Violations at Wesley? Not Safeguarding PHI: _ Placing patient information on Facebook, Twitter, or other social media sites. Errors in faxing reports, assigning the wrong physician mnemonic therefore results are sent to the wrong physician, e-mailing PHI without encryption, placing patient information in trash bins and taking photos with cell phone or personal recording device Inappropriate Access to information: Use and disclosure of patient PHI without a need to know (i.e. patients not in your care) Access of Meditech to view PHI of newsworthy patients, friends, family members, coworkers Care & Notification:

Inappropriate verbal disclosures without patient permission (i.e. sensitive diagnosis shared with family without patient permission / calling report over cell phone in public area / social media / cell phone photos) Remember: Only those employees with a legitimate need to know may access, use or disclose PHI. Each employee must access only the minimum information necessary to perform their job regardless of the extent of access provided to them. 72 Computer Use & Workstation An employee accessing the computer system is responsible for any activity performed under his/her USER ID. Never share your password Each users computer activity is audited at least once a year. BEFORE LEAVING A COMPUTER or PYXIS: SIGN OFF & SECURE any information This action helps to ensure the protection of the information as well as prevent any activity occurring under your user ID in your absence.

Open computer screens and charts sitting in public places should not be left unattended. This is not only a quality concern, but carries the potential of fines should protected health information fall into the wrong hands. Protect your patient and yourself by securing charts and turning off computer screens promptly. 73 Infection Prevention - HAI Healthcare-Associated Infection (HAI) An infection that develops in a health care setting that is related to receiving care in that setting. Infection Prevention is everyones business 74 Infection Prevention STOP GERMS! Attention to hand hygiene, use of PPE (personal protective equipment), use of standard & transmission-based precautions are all essential! Prevention of infection is an important part of what you do everyday! Bloodborne Pathogens It is critical for healthcare workers to

consider & treat all blood/body fluids as potentially infectious. 75 Single Most Effective Way to prevent the spread of communicable diseases! Hand Hygiene: Just DO IT! Every Patient / Every Time Perform Prior to donning gloves Immediately after removing PPE (includes gloves) Before & after each patient contact Before you eat After you use the restroom Any other time you think of it!

76 Hand Hygiene - Wash First, wet your hands with warm running water and then add soap. Use friction by rubbing your hands together, making a soapy lather. Do this away from the running water for at least 15 seconds. Wash the front and back of your hands, wrists, as well as between your fingers and under your nails. For rinsing, position hands/fingers down towards sink. Rinse your hands well under warm running water. What is good hand washing technique? By rubbing your hands vigorously with

soapy water, you pull the dirt and the oily soils free from your skin. The soap lather suspends both the dirt and germs trapped inside and they are then quickly washed away. Dry hands thoroughly with a clean paper towel. Turn off the water with a dry paper towel and dispose in a proper receptacle. 77 Hand Hygiene - Foam Waterless Hand Antiseptic Hand De-Germing Place adequate amount of foam/gel in one palm to cover all surfaces of both hands and wrists; then rub the hands

together until the hands/ wrists are dry. These products are only intended to kill germs, not to remove visible dirt. FOAM IN AND FOAM OUT 78 Personal Protective Equipment PPE Personal protective equipment (PPE) is defined by the Occupational Safety and Health Administration (OSHA) as specialized clothing or equipment, worn by or used by an employee for protection against infectious materials. EACH OF YOUlocate & use the PPE & bio-hazard disposal containers in your work areaunderstand the type of PPE required for protection from the activities you will be performing. Know how to put PPE on and take it off correctly for your protection. Gloves protect the hands

Gowns or aprons protect the skin and/or clothing Masks and respirators protect the mouth and nose The respirator has been designed to also protect the respiratory tract from airborne transmission of infectious agents Goggles/special eyewear protect the eyes Face shields protect the entire face 79 Personal Protective Equipment How to Use Respirator Mask How to Use PPE: Keep gloved hands away from face; Avoid touching or adjusting other PPE; Limit surfaces and items touched Remove gloves if they become torn; perform hand hygiene before putting on new gloves Discard gloves near the exit inside the room; foam out Discard disposable gown & mask after

each useDO NOT REUSE OR SAVE! When wearing a disposable mask, make sure it is secured properly on your face. When finished, remove mask by touching only the ties or the elastic bands and discard in waste container (never leave around your neck or in a pocket for re-use!) How to Use Respirator Mask: Place over nose, mouth and chin; fit flexible nose piece over nose bridge Secure on head with elastic bands; adjust to fit Perform a fit check Inhale (mask should collapse); Exhale (check for leakage around face) Removing respirator mask:

Front of mask/respirator is contaminated DO NOT TOUCH! Grasp elastics and remove Discard in waste container Perform hand hygiene 80 Standard Precautions A group of infection prevention practices that apply to all patients, regardless of suspected or confirmed diagnosis or presumed infection status. Standard precautions require putting a barrier between you & the source of infection. When there is a risk of exposure to blood borne infections, work safely by applying the Principle of Standard Precautions! 81 Expanded Precautions-Transmission Based Contact Precautions All staff to always wear gloves when entering a contact precautions room

Strict hand washing compliance Gowns are needed when you want to prevent contamination of your clothing from contact with the patient or the patients environment Patient has an open or draining wound Dressing changes / bathing or repositioning of patient Droplet Precautions All staff to always wear a surgical mask whenever they enter the room, and eye protection while providing direct patient care and gloves and gowns if they will come in contact with surfaces contaminated by respiratory secretions Recognize the alerts Observe signage on doors defining type of precaution; Rose Pink identification band on patient Follow the evidence-based practice - Use appropriate PPE (personal protective

equipment) Monitor & Correct those who dont follow acceptable practice Surgical mask to be worn by the patient if patient leaves room or is transported outside of patients hospital room Airborne Precautions Negative pressure room Staff to wear N95 respirator mask for TB or if susceptible to other disease indications Surgical mask for patient during transportation DO NOT RE-USE/SAVE disposable PPE 82 Use Barrier Devices If you think it will: Burp or

-Squirt or -Splash Be prepared PRIOR to dealing with it, put on protective equipment! (eye goggles or a mask with a face shieldgown or apronand gloves) 83 Event of an Exposure If you are exposed through splashes, needle stick puncture wounds, or other sharps injury from any potentially infectious material: immediately locate a hand-washing facility & wash your skin with soap & water if eyes, mouth or nose, flush with lots of water Notify your manager & seek immediate treatment & evaluation! -(WMC)Employee Health #22656 or Emergency Department -(GHH) Employee Health # 2610 or Emergency Department. if treatment is necessary for HIV, the medication should be started within 2 hours of exposure document event with an HNS by the end of the work shift 84

SAFE WORK PRACTICES CLEAN to DIRTY Principle Touch clean body sites or surfaces before you touch dirty or heavily contaminated areas. Be aware of environmental surfaces and avoid touching them unnecessarily with contaminated gloves. These examples of touch contamination can potentially expose you to infectious agents: Surfaces such as light switches, door handles, and cabinet knobs can become contaminated if touched by soiled gloves. Dont drag dirty linen/trash on the floor or down the hallways. The chance of contamination of the environment is very high. Use roller devices for moving. How many times do you see someone adjust their glasses, rub their nose, or touch their face with gloves that have been in contact with a patient or something on your unit considered dirty? 85 C-Diff BE INFORMED

C-Diff is spread between patients by health-care workers and others on hands, clothes and shared equipment. Barrier Precautions are required to control C-Diff wear gloves and gown EVERY TIME YOU ENTER A C-DIFF PRECAUTION ROOM Cleaning of shared equipment (e.g. stethoscope, glucometer, BP machine) between patients or using dedicated equipment in CONTACT precaution rooms is required to control C-Diff. Wipe equipment with disinfectant wipe per manufacturers directions Vigilant environmental cleaning by environmental services as well as by all patient care providers is required to control C-Diff. *Decrease clutteronly keep supplies at the bedside you currently need *Wipe surfaces with disinfectant wipe each shift Terminal Clean upon dismissal We must all speak up when we see others not following vigilant hand washing, barrier precautions (Gown & Gloves) in CONTACT precaution rooms or lack of cleaning of shared equipment. We will not win the fight against C-Diff unless every one who comes in contact with our patients follows and practices the same guidelines. 86 VRE / MRSA Be Aware & Practice Infection Prevention

Vancomycin-Resistant Enterococci VRE Transmission: VRE is usually passed to others by direct contact with stool, urine or blood containing VRE It can also be spread indirectly via the hands of healthcare providers or on contaminated environmental surfaces Infection Prevention Practices: Contact precautions Dedicated equipment; Disinfect ALL Equipment before it leaves patient room Terminal Clean upon dismissal (TEAL Alert on door) Methicillin Resistant Staph Aureus MRSA Transmission: MRAS is spread by hands direct or indirect contact with contaminated surfaces Infection Prevention Practices: Contact precautions

Disinfect ALL Equipment before it leaves the patient room; MRSA can live for hours on environmental surfaces Perform hand hygiene Screening for MRSA-nasal swab on high risk patients Identified with pop-up box on admission 87 Respiratory Viruses A regular procedure mask is what is needed to protect you from all respiratory viruses, including Influenza. Health Care Workers and visitors should wear a mask when in the patients room. The patient should wear a mask when they are in the hallway or in waiting areas. An N-95 respirator or PAPR should be worn by the healthcare worker when they are involved in aerosol generating activities such as CPR, sputum induction, bronchoscopy, or open 88 suctioning. Influenza Vaccine

Vaccination is the best protection against contracting the flu. Yearly influenza vaccination generally begins in September and continues throughout the influenza season which generally peaks in January or later. Healthcare personnel are among the priority groups that the CDC recommends be the first to receive influenza vaccines each year. Infections among healthcare workers can be a potential source of infection for vulnerable patients. Also, increased absenteeism among healthcare professionals could reduce healthcare system capacity. Vaccines change each year based on which types and strains of viruses may circulate. About 2 weeks after vaccination, antibodies that provide protection against influenza virus infection develop in the body. 89 Tuberculosis (TB) When a person with active TB of the lungs shouts, coughs or sneezes, the TB germs may spread into the air. Anyone nearby can breathe the germ into his or her lungs. A TB patient should be in a negative pressure room.

When not in this room, they should be wearing a surgical mask. Healthcare workers & visitors should wear a N-95 respiration mask when caring for or visiting the patient. Employees are required to complete TB skin testing every year. 90 Surgical Site Infections: Prevention is the Key! SURGICAL-SITE INFECTION (SSI) An infection that occurs after surgery in the part of the body where the surgery took place. Redness and pain around the surgical site; drainage of cloudy fluid from the surgery site; fever. Nurses must be aware of guidelines and practice evidence-based care. By working together with the patient and the other healthcare professionals, you can take specific steps to help decrease SSIs. Do your part by becoming educated and remaining alert as new information for treatment and care become available. PREVENTION STRATEGIES:

Aseptic technique helps decrease infection incidence Infection prevention practices including sterilization methods, operating room ventilation, surgical technique, and antibiotic availability 91 CAUTI Prevention Cath only when necessary Avoid routine irrigation Technique is always sterile Height of the catheter bag-always below waist Education for staff Tubing and bag off floor and free of kinks Education to patients Remember to maintain a closed system Secure properly 92 Central Line Care Bundle Perform hand hygiene prior to touching line. Scrub the hub for 15 seconds prior to every access. Friction is necessary to remove germs.

Dressing changes every 7 days or if dressing is loose or soiled. Apply Bio-patch for anyone over the age of 2 months. Change caps every 7 days Assess necessity of lines daily-discuss with physician for removal. Assess every shift for signs of infection: 93 Clinical Topics 94 Abuse and Neglect - Identifying Victims Abuse: evidence of bruising, bleeding, malnutrition, burns, bone fractures, subdural hematomas, soft tissue swelling or death (and the condition is not justifiably explained or the history given does not fit with the degree or type of injury/condition) See WMC Clinical Practice policy D-90 and D-91 for more info Neglect:

caregiver fails to take the same actions to provide adequate food, clothing, shelter, medical care or supervision that a prudent caregiver would give. 95 Abuse & Neglect..Adults & Children! Kansas Law requires that all health professionals report suspected abuse or neglect in adults and children Hospital policy requires that suspected abuse or neglect be reported immediately. Initial interventions must include the collection of and safeguarding of any evidentiary material. (use WMC Security 23333 as resource as well as GHH Security at 2940). 96 Abuse & Neglect - Reporting Report any suspected or alleged abuse/neglect to Case Management (seven days a week, 8 a.m. 5 p.m.). The Case Manager may assist you in reporting to the appropriate agency.

At all other times, the House Supervisor is notified and they will contact Wesley Security as necessary. Security will contact law enforcement as appropriate. For more information on signs, symptoms, and follow-up for victims of abuse and neglect: Go to the WMC Intranet, choose Departments, choose Case Management, look for Adult Abuse and Child Abuse information 97 Color Coded Patient ID bands The Kansas Hospital Association (KHA) uses 5 standardized alert colors Purple for do not resuscitate Red for allergies Yellow for fall risk Green for latex allergy Pink for limb alert Know Your Wristband Alert Colors! Wesley Inpatient Wristband (Always use 2 identifiers prior to placing on patient)

Kansas Standardized Wristband Alert Colors Do Not Resuscitate Allergy Fall Risk Latex Allergy Limb Alert (place band on limited extremity) Wesley Specific Wristband Alerts Wesley identifies 3 additional alert colors: Bright lime green for pacemakers or internal defibrillators Orange for hazardous drugs Rose pink for infection prevention Pacemaker or ICD Patient Receiving Cytotoxic or Hazardous Drugs Infection Prevention (rose color insert into clear band) Paper Armband Paper Armband - -

Emergency Department Outpatient 98 Falls How do I know if a patient is at risk for falls? A magnetic star is placed on the patients doorway A yellow armband is placed on the patients wrist You are walking by a room with a Falling Star magnet on the doorway and see the patient up out of bed and no one is assisting them. What should you do? Immediately enter the room and assist the patient. After the patient is back in bed safely, contact the primary RN and make them aware of the situation. You are on your way to lunch and hear an alarm sound (i.e. bed alarm). What should you do? Immediately enter the room and assist the patient. After the patient is back in bed safely, contact the primary RN and make them aware of the situation. If a patient falls.Complete the following: Post Fall Debriefing form - #NS611 (Any staff member)

Stabilize then complete immediately RN will also need to complete/document: Post Fall Assessment Patient Assessment Re-evaluation of fall risk Fall in medical record Notification of patients attending physician Notification of patients family Hospital Notification System (HNS) 99 Latex Management Latex allergy develops from exposure to natural rubber latex & is a serious medical problem for a growing number of patients and healthcare workers Reactions may include: sore, red, itchy, cracked or irritated skin; runny nose, sneezing, cough, rash or hives that happen after exposure to latex

There is no treatment for a latex allergy except avoidance Patients are identified with a dark green identification bracelet & signage on door Providing a latex-safe environment is our responsibility! 100 Restraints Patients have been seriously hurt and even died trying to escape from restraints. Restraints should be tied to parts of adjustable beds that will move with the patient, and not the frame of the bed. Never tie a restraint to the side rail of the bed. Restraints can restrict circulation and injure skin at the application site.

Restraints may cause pressure ulcers by limiting patient mobility. The lack of mobility also makes the patient more vulnerable to hospital acquired infection and increased patient falls. Patients are rendered helpless to protect themselves from fires and other environmental hazards. The loss of control patients feel may aggravate disorientation or confusion. Alert patients find the experience humiliating and demoralizing, and restraints may cause embarrassment when seen by visiting relatives and friends. If you ever see a patient in restraints that appears to be in trouble, immediately assist the patient then notify the nurse about the situation. 101

Restraint Alternatives Alternatives to restraint use can include the following Monitoring Environmental Measures Comfort Measures Interpersonal Skills Staffing Education Diversion Activities Medication/Nutrition Occupational Therapy/Activities Regular Toileting When restraints are necessary, it is everyones responsibility to: Ensure their safe use Use alternatives whenever possible Use restraints ONLY as a last resort Always respect the patients rights and autonomy Prevent the patient fromPhysical harm Psychological harm 102

Wesleys Intranet Get detailed information Policies & Procedures Infection Prevention Practices Management of Waste Materials Safety PowerPoint Presentation Locate this Icon on a work computer desktop! Intranet.url 103 The Joint Commission National Patient Safety Goals 1 Improve the accuracy of patient identification 2 Improve the effectiveness of communication among caregivers 3

Report critical results of tests and diagnostic procedures on a timely basis Improve the safety of using medications 7 Use two patient identifiers (patient name and birth date) when providing care, treatment, and services Eliminate transfusion errors related to patient misidentification Label all medications, med containers, (syringes, medicine cups, and basins), and other solutions on & off the sterile field in perioperative and other procedural settings Reduce the likelihood of patient harm associated with use of anticoagulation therapy Reconcile patient medications on Admission, Transfer and Discharge Reduce the risk of health care associated infections Current hand hygiene guidelines from Centers for Disease Control & Prevention or World Health Organization Prevent health care-associated infections due to multidrug-resistant organisms

Prevent central line-associated bloodstream infections Prevent surgical site infections Prevent catheter associated urinary tract infections. 15 The organization identifies safety risks inherent in its patient population Risk for suicide Universal Protocol - The organization meets the expectations of: Pre-procedure Verification, Mark Procedure Site, and Time Out immediately before procedure or incision December 2012 104 The End! Thank you for your participation and cooperation in completing the 2013 Safety Program. 105

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