Allina Clinical Student Orientation Spring 2010

1. Allina Clinical Student OrientationSpring 2010

2. Welcome! Allina Hospitals & Clinics is excited to provide an environment where our professional staff and quality healthcare lend itself to an excellent learning experience for you. You are the future of healthcare!

3. Orientation Program • This orientation program is intended for non-employees who are completing academic experiences at our hospitals. This includes: Clinical instructors/ faculty, and students completing clinicals, interns, capstones, synthesis and others as required. • Completing this orientation is required in order for you to work at Allina Hospitals & Clinics.

4. Contents • Mission, Vision & Values • Confidentiality/HIPAA • Emergency Codes • Vulnerable Persons • ERTK (Employee Right To Know) • MN Patient Bill of Rights • Populations-served • NPSG (National Patient Safety Goals) – Unacceptable Abbreviations • Individual Learning Tracks for Clinical Students

5. Profile of Allina Hospitals & Clinics • Largest health system in Minnesota • Diverse organization • 4 metro, 7 regional hospitals • 39 Allina Medical Clinic locations • 11 Aspen Medical Clinic locations • 5 Quello clinic locations • 22 hospital-based clinics • 15 community pharmacies • 4 ambulatory care centers • 1,658 staffed beds • More than 22,500 employees and 5,000 physicians

6. Allina’s Mission and Vision Mission: • We serve our communities by providing exceptional care, as we prevent illness, restore health and provide comfort to all who entrust us with their care. Vision:We will: • Put the patient first, • Make a difference in people’s lives by providing exceptional care and service, • Create a healing environment where passionate people thrive & excel, and • Lead collaborative efforts that solve our community’s health care challenges.

7. Allina Values Integrity Respect Trust Compassion Stewardship • Match our actions with our words. We live our values and mission in all decisions and actions. • Treat everyone with honor, dignity and courtesy. Respect values, cultures, beliefs and traditions of others. Value each others talents and contributions. • We act in the best interests of our patients, physicians, communities and one another. • Dedicated to creating a healing and caring environment to support the emotional, physical and spiritual well-being of all. • Use our resources wisely. Commit to being thoughtful stewards of time, energy and talent.

8. Customer Service Basics • Create a positive experience where patients feel assured, included and appreciated. • It’s important to connect with patients on a human/emotional level when beginning and ending any interaction, as appropriate.

9. Confidentiality • Maintaining a patient’s privacy/confidentiality is not only the ethical thing to do, it’s the law. • Allina is committed to preserving the confidentiality of patient information. • Inappropriate release of information will result in disciplinary action and possible legal action.

10. What is HIPAA? • The Health Insurance Portability and Accountability Act (HIPAA). • This “Privacy Law” places strict regulations around maintaining the privacy and security of patients’ health information. • Allina is mandated to train employees in the rules and provisions of this law.

11. Protected Health Information (PHI) • PHI is any information that identifies an individual or could reasonably be used to identify an individual. • Including, but not limited to: • Name, address, age or social security number • Health history and conditions, treatment or meds • Hospital or clinic bill or payment record • Any identification that an individual is a patient. • It can be in any form: • Verbal, written or electronic • Past, present or future medical information

12. Minimum Necessary Rule • Employees/non-employees must only use and disclose the minimum amount of patient information needed to do their jobs.

13. Upholding Confidentiality • Sharing that you saw someone you know or a celebrity at the hospital or divulging their health information is illegal. • Unless you need the information to do your job, it is illegal to look up information on a patient. • Consequences to violating these laws are strict. If in doubt, use caution on the side of maintaining patient privacy.

14. Release of Health Information • Consent from the patient must be received any information is given to others, including spouses, family members or friends. • The inappropriate release of protected health information is illegal and Allina will address any harm that occurs due to inappropriate release. • You are held legally accountable to maintain a patient’s privacy/confidentiality.

15. Emergency Codes/Alerts Emergency codes/alerts are paged overhead. Following are what they mean: • Red Fire • Pink Infant/pediatric abduction • Blue (Code 99) Cardiac/Respiratory Arrest, Adult, Neonatal, Pediatric • Green Restraint Personnel Requested • Yellow Stay away from area • Orange Disaster Plan • Gray Patient Wandering/Adult Elopement

16. Emergency Codes/Alerts • If an emergency code/alert is called in your area, defer to the RN assigned to the patient, preceptor, or instructor for information/directions on what you need to do next.

17. Vulnerable Persons • All persons receiving medical care within Allina, both inpatient and outpatient, are defined as “vulnerable.” • Any maltreatment of a vulnerable person by a staff member or visitor must be reported. • Maltreatment consists of abuse, neglect, or financial exploitation. • Report any suspicions/confirmations of abuse, neglect, or exploitation of a patient immediately to the RN assigned to your patient or the Charge Nurse.

18. Vulnerable Persons • As a clinical/nursing student, you are in a unique position of spending time alone with your patient during which they may share sensitive/private information. • Report any suspicions/confirmations of abuse, neglect, or exploitation of a patient immediately to the RN assigned to your patient or the Charge Nurse.

19. Employee Right to Know (ERTK) • Personal Safety (MSDS) • Fire Safety • Hand Hygiene • Blood Spills

20. Locating information on Hazardous Substances & Chemicals Material Safety Data Sheets (MSDS) provide information on the effects and properties of hazardous substances. These can be accessed online on the Allina Knowledge Network (AKN). Ask the unit educator/Charge Nurse to access these sheets.

21. Heath Care Waste Streams • Non-Hazardous Recyclable Waste (cardboard, paper, pop cans) • Trash (non-hazardous solids, Styrofoam cups) • Sewer (milk, soda, Stock IV solutions and TPN’s that only contain electrolytes, sugars, amino acids or other maintenance IV solutions w/o drug additives ) • Sharps (All sharps; needles, empty syringe with needle attached, broken glass, scalpel blades, broken rigid plastic, staples, wire; no dual sharps) • Infectious Waste (Solid waste plus blood and/or body fluid, saturated or grossly soiled disposables; bloody gauze, tubes with body fluids, blood, or blood products not discarded or flushed) • Hazardous Waste (Spray paint, concentrated cleaners, rubbing alcohol, Pharmaceutical waste: epinephrine, insulin, pills, P-listed drugs and empty containers/packaging, empty medicationvials)

22. Hazardous Waste • Waste is considered hazardousif it possesses one or more of the following properties / characteristics: • Ignitable (burns easily - gasoline) • Corrosive (causes chemical burns – drain cleaner) • Toxic (poisonous in small amounts - antifreeze) • Oxidizer (supports burning…like oxygen does - bleach) • Reactive (unstable or explosive - dynamite) • Identified by regulators as hazardous

23. Health Care - Hazardous Waste • Pharmaceutical Waste • Any unused or partially used drug • Examples: ampules or bottles, partially used vials, tablets or capsules dropped or spit out by a patient • Pharmaceutical Waste Disposal - Black hazardous waste container must be • Labeled as hazardous waste • Include a collection start date • No evidence of leaks or spills • Kept closed at all times • Questions? – contact the Charge Nurse

24. Fire Safety Essentials in Your Department You will need to locate this information in the areas you work. • Location of the fire alarm pull boxes • Location and type(s) of extinguishers • Emergency phone number • The stations main oxygen shutoff valve(s) • Evacuation plans and routes

25. R.A.C.E. Fire Procedure Rescue • Rescue:Move anyone in danger to a safe area. • Alert:Pull fire alarm box and call operator to report location of fire. • Confine: Close doors & windows in area, clear corridors and fire exit areas. • Extinguish: Fight the fire only if it will not place you in danger. Blankets can be used to smother the flames of small fires or waste basket fires as well as using extinguishers. Alert Confine Extinguish

26. How to Use Extinguishers Know the types of extinguisher in your work area. Choose the appropriate extinguisher for the type of fire. Then: • P Pull-the pin • A Aim-the extinguisher • S Squeeze-the handle • S Sweep-the extinguisher hose at the base of the fire

27. Hand Hygiene The singlemost effective way you can break the Chain of Infection

28. Hand Hygiene • Students/Faculty may not wear any artificial/acrylic nails. • Please keep natural nails less than ¼ inch to prevent the tearing of gloves and to decrease the potential of microorganism transmission to patients. • Fingernail polish is permitted only if not chipped or cracked.

29. Perform Hand Hygiene • Before patient contact • Before an aseptic task • After body fluid exposure risk • After patient contact • After contact with patient surroundings Consider: Hand hygiene can be performed with soap and water or by using an alcohol based hand rub. Some areas have additional hand hygiene requirements.

30. Hand Hygiene & Alcohol Hand Rub Alcohol-based hand rubs have several advantages over soap and water, are recommended by the Centers for Disease Control and Prevention (CDC) for routine hand hygiene, and are available in all patient care areas, including patient rooms. • How to use: • Dispense a walnut-size amount of foam to palm of one hand • Rub hands together covering all surfaces of hands and fingers until dry. • Let hands completely dry before donning gloves, opening doors, or touching electrical equipment.

31. Handwashing Wash hands when visibly soiled or emollient build-up from alcohol-based hand rubs is felt. • Wet hands before applying soap • Use warm running water • Wash hands for 15 seconds(The amount of time it takes to sing Happy Birthday, for example) • Use friction • Turn off faucet with paper towel

32. What Is My Role in Preventing Infections for my Patients? • Stop the Spread • Multidrug resistant organism (MDRO) and C.diff infections are often transmitted in the healthcare setting • Follow Isolation & Contact Precautions • Follow signage on patient door • Provide infection education to visitors and patients • Keep high touch surfaces clean • Hands act as vehicles of transmission Wash hands before & after all patient contact

33. Example of Isolation Signs **These signs are used only in the hospital setting.

34. Blood Spills • Potentially could occur at any work site • Plan in place for each work site • Guiding principles: • Avoid direct contact with body fluid. • Use proper PPE, clean up spill and then disinfect area. • Perform hand hygiene. • Notify the Charge Nurse/Nurse Leader of the spill.

35. MN Patient Bill of Rights • Allina is committed to honoring the rights and dignity of all patients. • Patients are given a copy of the Bill of Rights upon admission to the hospital. • Copies of the Patient Bill of Rights are displayed in patient care areas.

36. Population-Specific Care • Population-specific care means that we adapt the care provided to each patient based on their unique needs. • Each person is an individual and needs to be treated as an individual in the healthcare setting, depending on their age, diagnosis, culture and ethnicity, personal performances, etc.

37. Differences • Understanding or being aware of differences, whatever they are, can help to: • Alleviate frustration • Prevent taking differences personally or making premature judgments • Enhance our ability to make adjustments

38. Unacceptable Abbreviations • There is a list of abbreviations that are not approved for use within the medical record (documentation, notes or orders). • Orders written for an unacceptable abbreviation/practice will not be accepted or executed. • Unacceptable orders will be clarified by the nurse and documented as a verbal order before executing.

39. Abbreviation/Practice U ug (microgram) Eliminate trailing Zeros after a decimal (2.0 mg) Require leading zero before a decimal (0.5 mg) AZT (Zidovudine) AZA (Azathioprine) HCT (Hydrocortisone) MS (Morphine Sulfate) MSO4 (Morphine) MgSO4 (Magnesium Sulfate) Nitro & NTP (Nitroglycerine or Nitroprusside) 6MP (6-Mercaptopurine) Chemotherapy Abbreviations QD, QOD, AS/AD/AU/OS/OD/OU Correct Practice Write the word “units” Use “mcg” Never use a zero after a decimal point (2 mg) Always use a zero before a decimal (0.5 mg) Write the full drug name for each example Write the full words (every day, every other day, right ear, etc.) Unacceptable Abbreviations

40. Allina’s Workplace Policies • Respectful Workplace • We believe that all persons have a responsibility to maintain respectful behavior during all their interactions at Allina facilities. • Harassment Free Workplace • We have a zero tolerance policy for any type of harassment, including sexual harassment. • Violence-Free Workplace • No individual may engage in any verbal or physical conduct which causes or threatens to cause harm to persons or property. • Key Points • Whether or not you intended harm doesn’t change the fact that someone was impacted by your actions or behavior. • Polices extend to any off duty work related activities. • Each of these policies describes behaviors that are unacceptable, and how to report concerns. • Copies of these key workplace policies and other Allina policies are available on MyAllina. If you have questions or concerns, please contact the department manager or a Human Resources Representative.

41. Select your Role below: • Hospital Clinical Students & all Therapy Students • Ambulatory Clinical Students (Allina Medical Clinic, Aspen Clinic, Quello Clinic) • Home & Community Services (Homecare, Hospice, Palliative Care) • Transportation

42. Fall Prevention Interventions • Provide a Safe environment • Over-bed table with call light, telephone and personal items in reach • Room free of clutter • Ambulatory aids such as cane or walker • Lock the wheelchair when doing transfers • Assist to and stay with the fall risk patient in the bathroom.

43. Fall Prevention Interventions Use Visual identifiers Red socks and magnet or sign on doorframe identify patients at risk for falls.

44. Safe Patient MovingRisk Factors for Injury • Many patients are becoming heavier every year— requiring more force to move them • Lack of space in care rooms and asymmetric, bulky load (i.e., the patient) foster awkward postures • High repetition of tasks – injuries cumulative in nature

45. 20+ years of experience show that body mechanics education and training in lifting techniques DON’T WORK Consistent, proper use of mechanical patient moving devices DOES reduce injuries How can these injuries be prevented?

46. Low Lift • Mechanical lifting equipment and/or other approved patient moving aids should be used in all circumstances when lifting/ moving patients • except when absolutely necessary, such as in a medical emergency or as part of the patient’s care plan.

47. Full Lifts • Full lifts are used with patients who have very limited ability to support their own weight and those who are disoriented or un-cooperative

48. Lateral Transfer Devices • SLIPP Sheet • AirPAL

49. Standing aids & lifting/moving assistance • Encourages patients to stand independently • Enhances lives • Makes tasks easier and safer • Improves care and efficiency Sit-to-stand Used with patients who have some ability to support their own weight and are cooperative Often used for pivot transfers between chair or toilet to bed

50. Safe Patient Moving Equipment If using any safe patient moving equipment, be sure to ask the hospital staff: • To demonstrate the correct use of the piece of equipment. • Directions on proper cleaning and storage of the piece of equipment once you are done.