Welcome to Elmhurst Memorial Hospital

1. Welcome to Elmhurst Memorial Hospital • Presented by Education & Quality Department 2008, 3/09

2. Highlights on Patient Care • Patient Identification Process • Full name and DOB • Compare against a printed copy

3. Visiting Hours • Open hours: recommend 9a-9p (6yrs & older) • FBC: Health screening for children • Behavioral Health: 18 yr & older • 1 - 2 pm & 6:30 – 7:30 pm • After 9 pm, visitors wear temporary visitor badge.

4. Medications Administration • Instructors receive Pyxis Code • Not allow to give oral or IV chemotherapy • Policy 3.18 IVP Medication • Double check insulin & Heparin • MDI • 4 West • 9 a.m. Administration

5. DNR/PDNR • Yellow ID Bands (used IN ADDITION to the white Meditech ID Band) Kkk Kkk

6. Restraints • Check with RN caring for the patient, or the Team Leader

7. Assignment Board & Navicare • Staff Assignments • Patients data • Schedule Tests • X-ray • Rehab

8. Fall Prevention • 3 levels of care • Low Fall Risk Interventions (for all patients) • Bed in low position, wheels locked • Adequate lighting • Room Clutter free • Personal items and call light within reach • Patient is reminded to “Ask for Help” if needed • Staff is to ask “Is there anything else you need” before leaving the room • Rooms have “Help Us Keep You Safe” sign

9. Medium Fall Risk • Identify chart and room with “Falling Star” • Make sure call light is answered promptly, Medium Fall Risk Alert note is automatically on Meditech profile. • Use all Low Fall Risk Interventions and add Medium Fall Risk Interventions: • Check patient more frequently, offer toileting assistance, stay with patient when up. • Educate Patient and Family about fall precautions, encourage to ask for help, provide with Preventing Falls at Home and in the Hospital handout • Consult with Pharmacist and MD, if needed, request rehabilitation consult. • Optional use of mat, alarm, anti-slip footwear • Communicate Medium Fall Risk to all disciplines.

10. High Fall Risk • Identify chart and room with 2 “Falling Stars” • Utilize all the Medium Fall Risk Precautions, include High Fall Risk note in Meditech (automatic), check patient more frequently and provide patient/family education. • High Fall Risk Interventions: • Place bed against the wall, if possible. • Place floor mat next to bed. • Obtain and use bed alarm. • Communicate High Fall Risk to all disciplines.

11. Lift Equipment • Mechanical lift equipment or static lifting aids will be utilized in all patient care handling situations. • Sit to stand device • Total lift device • Lateral transfer device • Utilize staff to transfer patient.

12. Miscellaneous • ID Badges • Parking (carpool prefer) • No smoking environment • Conference room scheduling • (DVD players) • Observation schedules • Nurse Recruiter

13. Communications • Outside call • Paging • Emergency number-66 • Voice activation • Manual retrieval

14. Safety • Safety Hot Line for unsafe practices or safety concerns • #866-623-1407 • Medical Errors • Inform team leader/manager. Patient Care Quality Report needs to be completed

15. Accidents/Injuries • Accident/Injury • Inform Team Leader • Employee Accident Form is to be completed even if you do not choose to go to the Emergency Department • Blood and body fluid exposure • Wash the exposed area immediately • Report the incident to an immediate supervisor • Report to Employee Health (M-F, day shift) or page CRN (offshifts)

16. Emergency Codes • Intranet - Emergency info • Flip Charts • Announced overhead

17. EmergencyInformation • Emergency #, dial 66 • Code Blue- • Medical Emergency • staff on unit respond, bring crash cart • Code Pals-Pediatric Medical Emergency (< 12yrs) • staff on unit respond, bring crash cart, Peds or ED RN also responds with pediatric sized equipment

18. Rapid Response Team • The Rapid Response Team is used to bring the house MD, a CCU RN and a Respiratory Therapist to the inpatient bedside to assist in intervention and communication. • Activate RRT: • Call 66 • Request team, provide unit and room number • Team will be notified via pager system and overhead announcement

19. It is used for inpatients that experience acute changes such as but not limited to • HR<40 • HR sustained >130 • Symptomatic SBP < or = to 88 • RR<8 • RR>28 and labored • SpO2<90% • Altered Mental Status • Chest pain • Acute significant bleeding • Siezures • Documentation form is obtained thru Meditech or Ondemand

20. Emergency Information • Dr. Strong • Combative patient • Code Rove-Missing Patient • first name and location announced • be alert for patient on your unit • Code Black-Severe Weather • 1 “Watch”-be alert • 2 “Warning”-move pts into hall or cover with blankets away from window in room • 3 “Take Cover”-staff and visitors in hall or bathrooms, remain until “All Clear”

21. Emergency Information • Code Pink • number announced after “Code Pink” indicates age of child in years • hospital will lock down and control exits, be alert for people leaving with packages, duffel bags or clothing. • Code Gray-Bomb Threat • listen to what caller says and note any noises or other info, ask where located, when it will go off, why, etc. • alert another staff person and have them call “66” • staff will visually search their area, do not touch suspicious objects

22. Emergency Information • Code Orange-Hazardous Material • only trained Hazmat personnel will respond to ED • Code Purple-Evacuation • relocation dependent upon severity and type of emergency • keep chart with patient • horizontal relocation first and then vertical

23. Emergency Information • Code Triage (formally known as Code Yellow)-Mass Casualty Disaster • will be re-announced on each unit to increase audibility • each unit will complete an “Emergency Discharge List” and send to Admitting • each unit will complete a “Staff Availability List” and send to the Staffing Office. Do not send staff to Ward, unit will be notified if staff needed • Ward area will be set up by Facilities by yellow elevators

24. Emergency Information • Code Red-Fire • Race • Remove, Alarm, Contain, Extinquish • Extinguishers: • PASS: Pull, Aim, Squeeze, Sweep • keep all patients and visitors in rooms, close all doors • at least one staff person is to be in each smoke compartment (between the closed doors) • staff are to remove fire extinguishers from wall compartments • respiratory is in charge of the O2 valves • Do Not breach fire doors

25. Emergency Information • Utilities Failure • power-electricity, steam heat • water-leaks, contamination, loss • medical gases/vacuum • natural gas leak • computer system • fire alarm, fire detection, fire suppression • elevators • ventilation

26. Infection Control • Handwashing • Artificial nails • Hospital scrubs • Isolation-contact • PPE

27. Chemo Sign • Chemotherapy Precautions: • During administration and for 48 hours following completion. • Start Date/Time:________ • End Date/Time:_________

28. Chemo Safe Handling • Special Handling for: • Urine, stool, emesis • Chemo meds and packaging • Contaminated disposable items • Contaminated linen • All staff to be aware of precautions • Chemo Precaution sign on chart and above bed • Communication with other involved departments

29. Chemo Safe Handling • Safe Handling Precautions • used in preparing and administering chemo medications • used in handling excreta from patients getting these drugs within the past 48 hours

30. Safe Handling Practices • Urine Precautions • All patients are encouraged to use toilet rather than commode or urinal • Men are encouraged to SIT on toilet to void to decrease chance of splashing • Toilet only needs to be flushed ONE TIME • Incontinent Patients • Appropriate preventative skin care • Use disposable underpads • Use disposable diaper, if indicated

31. Safe Handling Practices • Soiled Linen • Contaminated (wet) linen is to be placed in a clear plastic bag and then in a regular laundry bag • Other linen can also be placed in the laundry bag and then sent to laundry in the usual way • Laundry personnel know how to handle these items with special care

32. Equipment/supplies • MSDS

33. Electrical Safety Stickers • All electrical equipment, used in patient care areas, must have one of three stickers. May be be used in patient area, check outdate before use Not for use in patient areas May be used in all areas By____ Due___ Tested Outdate sticker

35. All patient care equipment TAG

36. Tuberculosis Mycobacterium tuberculosis is the causative agent of tuberculosis. This bacteria has been found in the lungs, bladder, bone, blood, reproductive organs and other areas of the body. This is a serious and fatal disease.

37. Occurs when an untreated person with pulmonary or laryngeal tuberculosis: Sneezes Coughs Speaks Sings Droplets are airborne Susceptible host breathes in the infected particles Transmission

38. Signs/Symptoms • Chronic cough > 3 weeks • Fever, chills, night sweats • Bloody sputum • Weight loss, anorexia • Weakness or fatigue • Chest pain

39. Active TB vs. Latent TB Infection • Active TB • Bacteria is active • Person is contagious • Show signs/symptoms • Positive TB skin or blood test • Latent TB Infection • Bacteria are made inactive by the body’s immune system and can remain inactive for many years. • Person is not contagious • Doesn’t show signs/symptoms • Usually has a positive skin or blood test • May develop TB later in life

40. Diagnosis, Prevention, & Treatment • Diagnosis • Complete History & Physical • 3 consecutive morning sputums for Acid Fast Bacilli (AFB) smear & culture • Chest x-ray • Mantoux TB skin test or QuantiFeron TB Gold blood test • Prevention • Key is to detect early and treat • Healthcare employees are required to have an annual TB skin test

41. Treatment Multiple TB medications for 6 -12 month period Hospitalized Patients known or suspect TB Placed on Airborne Isolation in a negative pressure ventilation room Staff is fit tested for the N95 Respirator or PAPR (powered air purified respirator). The N95 respirator mask or PAPR is to be used by all staff interacting with a patient in Airborne isolation.

42. Exposure to BloodWhat Healthcare Personnel Need to KnowDepartment of Health & Human Services (HHS) HBV and HCV • For additional information about hepatitis B and hepatitis C, call the hepatitis information line at 1-888-4-HEPCDC (1-888–443-7232) or visit CDC’s hepatitis website at www.cdc.gov/hepatitis. • Any reaction or adverse health event after getting hepatitis B vaccine should be reported to your healthcare provider. The Vaccine Adverse Event Reporting System (1-800-822-7967) receives reports from healthcare providers and others about vaccine side effects.

43. HIV • Information specialists who staff the CDC National AIDS Hotline (1-800-342-2437) can answer questions or provide information on HIV infection and AIDS and the resources available in your area. • The HIV/AIDS Treatment Information Service (1-800-448-0440) can also be contacted for information on the clinical treatment of HIV/AIDS. For free copies of printed material on HIV infection and AIDS, please call or write the CDC National Prevention Information Network, P.O. Box 6003, Rockville, MD 20849-6003, telephone 1-800-458-5231, Internet address www.cdcnpin.org. • Additional information about occupational exposures to bloodborne pathogens is available on CDC’s Division of Healthcare Quality Promotion’s website at www.cdc.gov/ncidod/hip or by calling 1-800-893-0485 and on CDC’s National Institute of Occupational Safety and Health’s website at www.cdc.gov/niosh or call 1-800-35 NIOSH (1-800-356-4674).

44. HBV-HCV-HIV • PEPline (the National Clinicians’ Post-exposure Prophylaxis Hotline) is a 24-hour, 7-day-a-week consultation service for clinicians managing occupational exposures. • This service is supported by the Health Resources and Services Administration Ryan White CARE Act and the AIDS Education and Training Centers and CDC. • PEPline can be contacted by phone at (888) 448-4911 (toll free) or on the Internet at http://pepline.ucsf.edu/pepline.1

45. Exposure to BloodWhat Healthcare Personnel Need to KnowOCCUPATIONAL EXPOSURES TO BLOOD Introduction • Healthcare personnel are at risk for occupational exposure to bloodborne pathogens, including hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Exposures occur through needlesticks or cuts from other sharp instruments contaminated with an infected patient's blood or through contact of the eye, nose, mouth, or skin with a patient's blood. • Important factors that influence the overall risk for occupational exposures to bloodborne pathogens include the number of infected individuals in the patient population and the type and number of blood contacts. Most exposures do not result in infection. Following a specific exposure, the risk of infection may vary with factors such as these: • The pathogen involved • The type of exposure • The amount of blood involved in the exposure • The amount of virus in the patient's blood at the time of exposure

46. Exposure to BloodWhat Healthcare Personnel Need to KnowOCCUPATIONAL EXPOSURES TO BLOOD • Your employer should have in place a system for reporting exposures in order to quickly evaluate the risk of infection, inform you about treatments available to help prevent infection, monitor you for side effects of treatments, and determine if infection occurs. This may involve testing your blood and that of the source patient and offering appropriate post-exposure treatment. • How can occupational exposures be prevented? • Many needlesticks and other cuts can be prevented by using safer techniques (for example, not recapping needles by hand), disposing of used needles in appropriate sharps disposal containers, and using medical devices with safety features designed to prevent injuries. Using appropriate barriers such as gloves, eye and face protection, or gowns when contact with blood is expected can prevent many exposures to the eyes, nose, mouth, or skin.

47. IF AN EXPOSURE OCCURS What should I do if I am exposed to the blood of a patient? 1. Immediately following an exposure to blood: • Wash needlesticks and cuts with soap and water • Flush splashes to the nose, mouth, or skin with water • Irrigate eyes with clean water, saline, or sterile irrigants • No scientific evidence shows that using antiseptics or squeezing the wound will reduce the risk of transmission of a bloodborne pathogen. Using a caustic agent such as bleach is not recommended. 2. Report the exposure to the department (e.g., occupational health, infection control) responsible for managing exposures. Prompt reporting is essential because, in some cases, post-exposure treatment may be recommended and it should be started as soon as possible. Discuss the possible risks of acquiring HBV, HCV, and HIV and the need for post-exposure treatment with the provider managing your exposure. You should have already received hepatitis B vaccine, which is extremely safe and effective in preventing HBV infection.

48. RISK OF INFECTION AFTER EXPOSUREWhat is the risk of infection after an occupational exposure? • HBV • Healthcare personnel who have received hepatitis B vaccine and developed immunity to the virus are at virtually no risk for infection. For a susceptible person, the risk from a single needlestick or cut exposure to HBV-infected blood ranges from 6-30% and depends on the hepatitis B e antigen (HBeAg) status of the source individual. Hepatitis B surface antigen (HBsAg)-positive individuals who are HBeAg positive have more virus in their blood and are more likely to transmit HBV than those who are HBeAg negative. While there is a risk for HBV infection from exposures of mucous membranes or non-intact skin, there is no known risk for HBV infection from exposure to intact skin. • HCV • The average risk for infection after a needlestick or cut exposure to HCV infected blood is approximately 1.8%. The risk following a blood exposure to the eye, nose or mouth is unknown, but is believed to be very small; however, HCV infection from blood splash to the eye has been reported. There also has been a report of HCV transmission that may have resulted from exposure to non-intact skin, but no known risk from exposure to intact skin.

49. RISK OF INFECTION AFTER EXPOSUREWhat is the risk of infection after an occupational exposure? HIV • The average risk of HIV infection after a needlestick or cut exposure to HlV-infected blood is 0.3% (i.e., three-tenths of one percent, or about 1 in 300). Stated another way, 99.7% of needlestick/cut exposures do not lead to infection. • The risk after exposure of the eye, nose, or mouth to HIV-infected blood is estimated to be, on average, 0.1% (1 in 1,000). • The risk after exposure of non-intact skin to HlV-infected blood is estimated to be less than 0.1%. A small amount of blood on intact skin probably poses no risk at all. There have been no documented cases of HIV transmission due to an exposure involving a small amount of blood on intact skin (a few drops of blood on skin for a short period of time).

50. How many healthcare personnel have been infected with bloodborne pathogens? • HBV • The annual number of occupational infections has decreased 95% since hepatitis B vaccine became available in 1982, from >10,000 in 1983 to <400 in 2001 (CDC, unpublished data). • HCV • There are no exact estimates on the number of healthcare personnel occupationally infected with HCV. However, studies have shown that 1% of hospital healthcare personnel have evidence of HCV infection (about 3% of the U.S. population has evidence of infection). The number of these workers who may have been infected through an occupational exposure is unknown. • HIV • As of December 2001, CDC had received reports of 57 documented cases and 138 possible cases of occupationally acquired HIV infection among healthcare personnel in the United States since reporting began in 1985