2009 - 2010 Safety Fair

1. 2009 - 2010 Safety Fair House Staff Edition

2. Overview • What is Safety Fair? • All hospitals are required to provide annual reviews of safety and quality information for all employees. At GCH, this is called “Safety Fair.” • This presentation has been customized from the GCH Safety Fair material to provide information most relevant to house staff • What’s new this year? • GCH is preparing for its annual AOA-HFAP* accreditation survey. This is a three-day site visit anticipated to occur in early 2010. • Information relevant to our accreditation standards and to quality and safety has been compiled in a Safety and Survey Handbook. Copies have been distributed to your mailbox in the House Staff Lounge. House staff who are out-of-state may request a Handbook by mail. (*Healthcare Facilities Accreditation Program)

3. Safety and Survey Handbook • Check your mailbox in the House Staff Lounge for your copy of the Safety and Survey Handbook. • Keep the handbook with you – you can refer to it if asked questions by an inspector. • Follow along in the handbook as you view this presentation. Handbook page numbers are referenced throughout. 2 in your Handbook

4. Safety and Survey Handbook • Look for these symbols: • “«” Means this section if critical for HFAP accreditation • “t” Means this section is critical for Fire Marshal visits • Dashed boxes (like this) are to be filled out with information specific to your training program or Medical Education. These are typical questions asked of employees during a survey or inspection and will be detailed in this presentation.

5. To meet your Safety Fair requirement Option 1: View this presentation online Complete the online quiz by November 15, 2009 Option 2: Attend a Safety Fair session – dates and times are posted and have been sent by email.

6. Part I:Healthcare FacilitiesAccreditation Program (HFAP) Anticipated Survey: Jan-March 2010 4 in your Handbook

7. HFAP inspection: Keys for House Staff The HFAP inspection will evaluate patient care, facilities, policies, etc. anything and everything related to running a hospital. Key issues for all physicians and house staff are listed below. • Delinquent Medical Records • All medical records must be complete within 30 days of discharge. This is required by HFAP and by the Centers for Medicare and Medicaid (CMS). Now is the time to get your charts in order and maintain compliance. • H&P’s • Must be documented within 24 hours of admission • Must be complete, including osteopathic structural exam (OSE) • Orders and Progress Notes • Must include date and TIME! • Must be signed – including telephone orders • Include printed name and pager number • Legible! 4 in your Handbook

8. HFAP inspection: Keys for House Staff Key issues for all physicians and house staff, continued • Informed Consent • Must include all required elements: • Date and TIME • Signature of patient, person obtaining consent, and witness • Restraint Orders • Required for all patients • Must be completed according to policy (more on this later in this presentation) 4 in your Handbook

9. Interacting with Surveyors and Inspectors • Be friendly, helpful, and honest. • Answer the question asked, then stop! Don’t volunteer additional information, thoughts or concerns. • Focus on the positive – describe what we do, not what we don’t. • Refer to your handbook if you need to. • Ask for the question to be re-stated or said differently if you don’t understand it. 5-6 in your Handbook

10. Patient Rights and Responsibilities • These apply to every patient. • A list of patient rights and responsibilities may be found in your handbook. They are also posted throughout the hospital and given to patients. • Read and familiarize yourself with them. Be sure to respect them in your work. • Know how patient rights are protected • Special Policies • The Uniform Standard of Care 6-9 in your Handbook

11. Patient Satisfaction GCH measures patient satisfaction for all inpatient and outpatient encounters. All employees need to know: • How do we measure patient satisfaction? • Our satisfaction survey is conducted by the NRC Picker company. Patients receive a survey in the mail. • How do we make improvements in patient satisfaction? • We call our satisfaction effort C2E or Commitment to Excellence • Specific tools used include AIDET (described on next slides) 10-11 in your Handbook

12. AIDET • AIDET is a proven tool to facilitate respectful and effective communication during a patient encounter. • Use of AIDET has been shown to improve patient satisfaction. House staff are to utilize this approach when interacting with patients.

13. A = Acknowledge

14. I = Introduce

15. D = Duration

16. E = Explain

17. T = Thank

18. Patient Satisfaction • GCH measures patient satisfaction for all inpatient and outpatient encounters internally using a paper survey sent to patients by the NRC Picker company • We are also measured by the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey. This is a national, standardized, publicly reported survey of patients' perspectives of hospital care. • HCAHPS (pronounced “H-caps”), is a standardized survey instrument and data collection methodology for measuring patients’ perceptions of their hospital experience. • HCAPS satisfaction data for GCH and other hospitals are publicly reported at www.hospitalcompare.hhs.gov. 10-11 in your Handbook

19. Patient Satisfaction House staff should be aware of the HCAHPS satisfaction measurements relevant to physicians. As you are often on the front line of patient care, your interactions with patients are reflected in these questions. Patients answer on a scale from “Never” to “Always” – we need you to help earn “Always!” During this hospital stay, how often did doctors Treat you with courtesy and respect? Listen carefully to you? Explain things in a way you could understand? Did you have confidence and trust in the doctors treating you? Did your family or someone else close to you have enough opportunity to talk to your doctor? 10-11 in your Handbook

20. Part II:Patient & Environmental Safety 11 in your Handbook

21. What is Patient Safety? • The prevention of harm to patients using a system that… • Prevents errors • Learns from errors that do occur • Is built on a culture of safety that involves health care professionals, organizations, and patients 11-12 in your Handbook

22. GCH Patient Safety Initiatives • Hospital wide initiatives • Patient Safety Rounds – Talking to employees • Environmental Rounds – Visual inspection • Purchase of New Beds – To reduce fall rates • Medication Administration: • New Medication Reconciliation Form • Bedside Bar Coding for Medication Administration • New Surgical Center • Pressure Ulcer Team • Falls Team • Moving towards Electronic Medical Record 11-12 in your Handbook

23. GCH Patient Safety Initiatives • Examples of Medical Education initiatives - enter in your handbook on page 12 • Rapid Response Team • Code Blue Peer Review Forms • Feedback on use of standard orders • unauthorized abbreviations, etc. 11-12 in your Handbook

24. Your Role in “Playing it Safe” • Report immediate dangers to Medical Education or to Security • Report non-urgent concerns to • Medical Education • Your attending physician • The Safety Officer, Greg Harrison (x4234) 11-12 in your Handbook

25. What is Environmental Safety? • Oxygen safety • Spill safety • Hazardous chemicals safety • Electrical safety • Medical device safety • Emergency Preparedness • Sharps safety • Infection Control 12 in your Handbook

26. Oxygen Safety • Oxygen tanks should be stored: • 5 feet away from combustibles in a sprinkler protected room • 20 feet away from combustibles in a non-sprinkler protected room • Oxygen tanks cannot be stored in corridors • Tanks must be stored in an approved holder. If you see a loose tank, notify a manager in that area to secure the tank. 12-13 in your Handbook

27. Hazardous Materials/Spill Safety • The basic elements— • Hazardous chemicals are present in virtually all areas • Every employee has the right to know the dangers of the chemicals used where they work • Every employee also has responsibility to ask for further information and to follow hazardous chemical precautions 14-15 in your Handbook

28. Hazard Communication Every employee has the right to know the dangers of the chemicals used where they work. Every employee also has responsibility to ask for further information and to follow hazardous chemical precautions. MSDS stands for Material Safety Data Sheets Provide chemical hazard information These references are available in the ED for all chemicals used in hospital in case of exposure

29. Spills If you find it – make sure it is cleaned up! • Clean up simple spills (see the table in your handbook on page 15) • Communicate spill hazards • Report contaminated or large chemical spills by calling the operator and asking for Security or the Housekeeping Supervisor • Learn about proper disposal for different medical wastes (handbook page 17) 15,17 in your Handbook

30. Electrical Safety Basics • Make sure that all equipment has a grounded plug • Don’t overload outlets • Don’t use damaged equipment 16,18 in your Handbook

31. Medical Devices • A medical device is anything that is used in the care of the patient that is not a drug • In case of malfunction of a medical device: • If nobody is injured contact Biomed Department (x4297) for repairs • If a patient or employee may have been injured • Assure the safety of the patient/employee • Secure the device – do not change settings • Contact Biomed (x2829) and Risk Management (x3403) • EXAMPLE: malfunctioning defibrillator; vent that didn’t alarm  Contact Biomed 18-20 in your Handbook

32. Baxter Infusion Pumps • Keep It GREEN, Plug it in! • Keep the pump plugged in at all times when not transporting • Ensure GREEN PLUG icon is illuminated next to the on/off button • Prior to transport, always check the Battery Charge Level icon • See instructions in your handbook, page 20 20 in your Handbook

33. Codes and Disaster Protocol The following codes may be called overhead: • CodeBLUE: cardiac and/or respiratory arrest • Code RED: fire • Code PINK: infant abduction • Code BLACK: severe weather/tornado warning • Code TRIAGE: disaster (internal or external) (has replaced Code Yellow) • Code ALPHA: administrative team alert

34. Code RED: Fire Alarm Signal • Code RED page and/or alarm can occur in response to: • A phone report of smoke or fire • An alarm “pull” • An automatic smoke detector signal 21 in your Handbook

35. In the event of a code RED: DO keep all doors shut DO remain in your area DO listen for overhead pages with further instructions DO move patients and visitors to behind fire doors DO treat all Code Reds as “the real thing” DO NOT go through closed fire doors DO NOT use elevators DO NOT assume a Code Red is a drill CodeRED: Fire Alarm Signal 21 in your Handbook

36. Fire Response: R.A.C.E. A fire marshal or inspector may ask you how you would respond to a fire. Remember the acronym R.A.C.E.  What does R.A.C.E. stand for? • Rescue - Persons in immediate danger • Alarm - Activate the fire alarm system and call 3333 • Contain - Contain the fire by closing doors. Never open a door to check on a fire • Extinguish - Attempt to extinguish the fire but only if it is safe to do so 21 in your Handbook

37. Fire Response: P.A.S.S. A fire marshal or inspector may ask you how to use a fire extinguisher. Remember the acronym P.A.S.S.  What does P.A.S.S. stand for? • Pull – the pin to activate the trigger • Aim – the nozzle at the base of the fire • Squeeze – the trigger firmly • Sweep – the nozzle from side to side 21 in your Handbook

38. Violent or Threatening Behavior • First, keep yourself safe • Contact Security for help (x3333) • Do what you can to avoid problems— • Wear your badge • Maintain locked entrances – no propped open doors • Report suspicious individuals or circumstances • Lock up valuables, purses, etc. 23-24 in your Handbook

39. Code PINK - Infant Abduction Code PINK is the signal for a potential infant abduction. All staff are expected to assist in monitoring stairs and exits. • Stop all non-critical work. • Guard all interior stairwell doors, elevator areas and exit doors. • Do not allow anyone (including employees) to exit the building that is carrying a child or package/bag that could contain an infant. • Wait for all-clear message. 26 in your Handbook

40. CodeBLACK: Severe Weather Code BLACK is the signal for severe weather. Employee actions include: Remain on assigned duties Move patients and visitors to internal corridors if possible If patients cannot be moved out of room, move them away from windows, close windows, draw curtains and blinds. Help to reassure patients and visitors 26 in your Handbook

41. Code TRIAGE – Disaster • Code TRIAGE is the signal for an internal or external disaster. (Note: This was previously called Code Yellow.) • The guidelines on the next slide indicate the appropriate actions by specialty or assignment. This applies to those individuals on duty or at home on pager call. Note this on page 28 of your handbook. • In most cases, house staff should report to the labor pool in the auditorium to sign in. If you are not immediately needed, you may leave the pool and resume your usual duties. 26-28 in your Handbook

42. Code TRIAGE – DisasterHouse Staff Actions

43. Employee Response in Disasters • Each one of us must consider our commitment to the safety and welfare of our patients, and co-workers when planning how we will respond to the disaster needs of the hospital • Planning should include discussing your hospital commitment with your family and preparing your family to respond effectively to disaster events 24-25 in your Handbook

44. Weapons of Mass Destruction • “WMDs” include: • Chemical • Biological • Radiation • Nuclear weapon • Explosives 28 in your Handbook

45. WMD: Scenarios & Factors • WMD incidents could result in two primary scenarios: • A large number of burn or blast trauma casualties • An increasing number of infectious illness, chemical poisoning or radiation disease victims • WMD incident may include complicating factors for the delivery of hospital care • Region-wide evacuation or quarantine • Contaminated victims: biological, chemical or radiation 28-30 in your Handbook

46. WMD: Hospital Preparation • GCH has prepared for contaminated victims through… • Stockpiling of personal protective equipment, antibiotics and other medications • Planning for regional isolation of hospital areas in the event of contamination • Participation in region-wide disaster drills • Mutual aid agreements with community agencies • ED: decontamination tent and use of high level personal protective equipment 29 in your Handbook

47. Part IV: Preventing Illnesses and Injuries on the Job 30 in your Handbook

48. Hand Washing • The single most important procedure for preventing infections for • Patients • Co-workers • Yourself • Review proper techniques • Page 30 of your handbook • Wash your hands before and after examining patients – they expect this and will notice if you don’t! 30-31 in your Handbook

49. Influenza • Seasonal and H1N1 Influenza vaccinations (flu shots) have been administered by Employee Health. If you missed getting yours, watch for updates on community based immunization clinics. • The flu can cause life-threatening illness in some individuals, especially the young, old and ill • Even if you have never had the vaccine or felt you were ill with flu, you may still be a carrier infecting— • Patients • Family • Co-workers • Save lives, get vaccinated! 31 in your Handbook

50. Blood Borne Pathogens (BBP) BBP’s are infectious agents, such as hepatitis B, hepatitis C, and HIV, that can be transmitted by blood & other body fluids. All personnel who have direct patient contact – e.g. all house staff – will be tested for immunity against HBV. Vaccination is available through Employee Health. 31 in your Handbook