Student Orientation 2010

1. Student Orientation 2010 Mission Statement Cartersville Medical Center is committed to treating all of our patients with compassion, kindness, and dignity. We will collaborate with our stakeholders to continuously improve patient care, evaluate and establish services beneficial to our community, and position our hospital as the preferred health care provider and a desirable business partner.

2. Welcome to Cartersville Medical Center

3. An Overview of Cartersville Medical Center 960 Joe Frank Harris Parkway Cartersville, GA 30120 (770) 382-1530 Hospital opened September 1, 1985 112 Total Beds 14 Intensive Care 88 Med/Surg 10 OB/Maternity beds 18 Beds in the Emergency Department 8 Operating Rooms Personnel 750 Employees 160 Physicians Volume (FY 2009) 6,402 Admissions 48,514 ER Visits 9,280 Surgeries 1,031 Births 67,376 Outpatient Visits

4. Cartersville Medical CenterExecutive Management Team Keith Sandlin, Chief Executive Officer Lori Rakes, Chief Operating Officer Benny McDonald, Chief Financial Officer Miriam Eide, Chief Nursing Officer Rebecca Battle, Associate Administrator

5. Vision At Cartersville Medical Center, building on a foundation of strong physician and community support, we will continue providing top-quality, patient-centered health care and remain the preeminent hospital in Bartow County.

6. Customer Service and HCAHPS Walking the Talk HCAHPS

7. Objectives • Increase awareness of HCAHPS and its impact on facility • Discuss how patient loyalty impacts satisfaction • Apply HCAHPS initiatives in your work setting to help “move the bar” on current results

8. What is HCAHPS? • Hospital Consumer Assessment of Healthcare Providers and Systems • The nation’s first standardized, publicly reported survey of patients’ perspectives of hospital care. Cliff Notes: It’s what our patients think about us after they leave our hospital.

9. Why is HCAHPS Important? The HCAHPS survey asks patients who have stayed at our hospital (inpatients) 27 questions, including 18 items about key aspects of their hospital experience. These are broken down into the following domains: • Communication with nurses and doctors • The responsiveness of hospital staff • Cleanliness and quietness of hospital environment • Pain management • Communication about medicine • Discharge information • Overall rating of the hospital • And recommendation of the hospital

10. Caring BehaviorsIt’s all about the things we do Our collective acts of all hospital staff have important consequences for patients, and directly affect their perceptions of the quality of care they received.

11. I C A R E Introduce yourself; explain your role Call the patient by his/her preferred name Appropriate touch Review care with patient daily or purpose of visit, sitting at eye-level with patient Each day compliment another caregiver/co-worker to the patient

12. T.E.A.M. • T- Together • E- Excellence and • A- Attitude • M- Matters “… Cartersville Medical Center is committed to treating all our patients with compassion, kindness, and dignity.”

13. Customer Service and HCAHPS continued Welcome to The Multi-Language Workplace

14. Learning Objectives • Describe the impact of the multi-language workplace on our facility • Identify your responsibility to respect different cultures in our organization and patient base • Identify your responsibility in ensuring that we do not exclude others just because English is not their first language • Describe how to apply a commonsense approach for addressing situations in which language might tend to exclude others • Identify other ways in which our behaviors might exclude others and strategies for demonstrating respectful, inclusive behaviors

15. Core Concepts and Definitions

16. Core Concepts and DefinitionsContinued

17. Ethics and Compliance Cartersville and HCA have a comprehensive, values based Ethics and Compliance Program, which is a vital part of the way we conduct ourselves. Because the Program rests on our Mission and Values, it has easily become incorporated into our daily activities and supports our tradition of caring – for our patients, our communities, and our colleagues. We strive to deliver healthcare compassionately and to act with absolute integrity in the way we do our work and the way we live our lives. All work must be done in an ethical and legal manner. It is your responsibility and your obligation to follow the code of conduct and maintain the highest standards of ethics and compliance.

18. Ethics and ComplianceContinued • If you have questions or encounter any situation which you believe violates the provisions of the code of conduct or the corporate integrity agreement, you should immediately consult your supervisor, another member of the management team, the VP of HR(Robbie Tatum ext 1141), the Ethics and Compliance Officers (Benny McDonald ext 1134 and Rebecca Battle ext 2206), or the HCA Ethics Line (1-800-455-1996). • Each employee and volunteer is required to attend two hours of initial code of conduct training and a one hour annual refresher training session. Leaders and individuals in key jobs have additional annual education requirements.

19. Georgia False Claims Laws • There is a federal False Claims Act, and there are also Georgia laws that address fraud and abuse in the Georgia Medicaid program. • Any person or entity that knowingly submits a false or fraudulent claim for payment of funds is liable for significant penalties and fines. • The False Claims Act has a “qui tam” or “whistleblower” provision. This allows a private person with knowledge of a false claim to bring a civil action on behalf of the US Government. If the claim is successful, the whistleblower may be awarded a percentage of the funds recovered. • For additional information please see the Georgia False Claims Statutes Policy.

20. Infection Prevention • Our goal is to identify and reduce risks of healthcare associated infections in patients, visitors, and healthcare workers. • Hand washing is the single most effective way to prevent the spread of infection. Routine hand washing involves a rigorous rubbing together of well lathered hands for 15-20 seconds followed by a thorough rinsing under running water. Must use soap and water if hands are visibly soiled. • Hand hygiene with an alcohol based product is acceptable as long as the hands are not visibly soiled. (Always wash hands with soap and water if the patient you are caring for has C. Difficile). • IC Champions monitor hand washing in our facility. The use of gloves does not eliminate the need for good hand washing.

21. Hand Hygiene • Wash hands at least in the following situations: • Before donning sterile gloves when inserting a central intravascular catheter • Before inserting indwelling urinary catheters, peripheral vascular catheters, or other invasive devices that do not require a surgical procedure • After contact with a patient’s intact skin (e.g. when taking a pulse or blood pressure, and lifting a patient) • After contact with body fluids or excretions, mucous membranes, non-intact skin, and wound dressings • If moving from a contaminated body site to a clean body site during patient care • After contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient • After removing gloves • Before eating and after using the restroom

22. Hand Hygiene Compliance • A comprehensive hand hygiene program involving the patient. • Signs have been placed in patient rooms “It’s OK to Ask”. Patients have a right to ask if you washed your hands before you take care of them Goal for Hand Hygiene is 100%

23. Artificial Nails • Artificial Nails, extenders, wraps, tips, etc. can not be worn by employees providing any services to a patient in accordance with the Center for Disease Control (CDC) guidelines. • Chipped nail polish should be immediately removed. Nails should be well-kept in appearance.

24. Ways Surgical Staff Help Prevent Surgical Site Infections • All healthcare workers wash hands before and after contact with patient • Appropriate skin prep • Clip hair instead of shaving hair • Antibiotics are given in timely manner for appropriate duration • Surgical team wears mask, cap, gown and gloves during surgery • Monitor for signs and symptoms of infection • Control of blood sugar • Surgical hand scrubs before procedure

25. Ways Cartersville Staff Help Prevent Blood Stream Infections • Wash hands prior to inserting line • Wash hands prior to touching line or giving medication through line • Follow bundle best practices for line insertion: • Special skin prep, wear gown, mask, gloves, and cap when inserting line, remove line when no longer needed, choose safe site for insertion, evaluate necessity of line daily.

26. Ways Cartersville Staff Help Prevent the Transmission of Multi-Drug resistant organisms like MRSA, VRE, and C Difficile • Hand washing before and after contact • Use contact precautions when caring for patient with history of these conditions (wear gown and gloves on entry to room) • Special room assignments • Screen patients at high risk when they are admitted • Patient Education • Carefully clean hospital equipment

27. Ways Cartersville Staff Help Prevent Urinary Tract Infections caused by a Foley Catheter • Hand washing prior to inserting foley catheter • Catheters are inserted only when necessary and removed when no longer needed • Only properly trained staff insert catheters • Sterile technique used while inserting foley • Skin prep prior to insertion • The foley bag is kept below the level of the bladder to prevent urine back flow • The foley bag is emptied regularly

28. Ways Cartersville Staff Help Prevent Ventilator Associated Pneumonia • Hand hygiene prior to care • Mouth care every two hours • Follow the bundle best practices: • Head of bed up 30 degrees unless contra-indicated • Evaluate daily need of ventilator • Peptic Ulcer Disease Prophylaxis • Deep Venous Thrombosis Prophylaxis

29. Personal Protective Equipment • Personal Protective Equipment (PPE) is provided at no cost to the associate • Worn when there is a chance of contact with blood or other potentially infectious body material (OPIM). • PPEs include, but are not limited to: gloves, gowns, goggles, pocket masks, and shoe coverings. PPEs are available in each department. • Wear gloves when it can be reasonably anticipated that there may be hand contact with blood or OPIM and when handling and touching contaminated items or surfaces. Replace them if torn or punctured or if their ability to function as a barrier is compromised. • Gloves must be removed before leaving the room. Hands must be washed after glove removal.

30. Personal Protective EquipmentContinued • Wear appropriate face and eye protection when splashes, sprays, splatters, or droplets of blood or OPIM may pose a hazard to the eye, nose, or mouth. • Remove immediately, or as soon as feasible, any garment contaminated by blood or OPIM. • PPEs may be disposed of in the regular trash unless contaminated with blood or other OPIM, if contaminated they must be disposed of in red biohazard bags. • Each department has a list of tasks and what PPE is recommended or mandatory to wear while performing those tasks. Ask your leader about this list.

31. Standard Precautions • Standard Precautions apply to all blood or body fluid which is considered potentially infectious. Very important to wear appropriate PPE when dealing with blood or body fluids. • By using standard precautions you will substantially reduce your risk of infection with a blood borne pathogen. • In addition to standard precautions, there are three types of transmission based precautions (isolation precautions) used for patients with documented or suspected transmissible pathogens that require more than standard precautions.

32. Isolation Precautions • Airborne (wear N 95 Mask) • Droplet (wear regular mask) • Contact (wear gown, gloves, sometimes mask) • Add sign “Wash hands with soap and water if patient has C difficile”

33. Contact Precautions • Used in addition to standard precautions • Bacteria transmitted by direct patient contact or by indirect contact by touching environmental surfaces. • Isolation gowns and gloves must be worn and sometimes a mask. • Private room for patient or placed with patient with the same bacteria. • Patients should wear an isolation gown and wash hands before leaving the room. • Environmental services should be notified on patient discharge to terminal clean room.

34. Airborne Precautions • Used in addition to standard precautions for illnesses transmitted by airborne droplets. • Patient is placed in a negative air flow room. • If patient must leave room, they are given a mask to wear. • Staff must be fit tested for an N 95 mask before entering this type of isolation room. Staff members who have not been fit tested may not go in this room. • Visitors are taught by the nurse how to wear the mask. • Persons not immune to measles or varicella (chicken pox or disseminated varicella) should not enter the room of patients with these illnesses.

35. Droplet Precautions • Used in addition to standard precautions for illnesses transmitted by large droplets. • A regular mask is worn in this room. • Patient must be placed in a private room. • If the patient needs to leave the room, they are given a mask to wear. • For patients with suspected H1N1, wear N 95 mask for aerosol generating activities (enhanced droplet precautions)

36. Examples of Multi-Drug Resistant Organisms (MDRO’s) 1. Methicillin-Resistant StaphAureus (MRSA) • Staph aureus are bacteria commonly found on the skin of healthy people. • MRSA can be present without causing disease. When there is no associated disease, we call their presence colonization. If MRSA is causing disease such as fever or pneumonia, we call it infection. • MRSA is spread by contact (direct contact with the pt or indirect contact with their environment) thus contact precautions are implemented (gown and gloves) • Good hand washing is the best prevention for the spread of MRSA. 2. Clostridium Difficile • Causes severe diarrhea • Can be spread by contact with patient or environment • Contact precautions upon entry to room • Good hand washing with soap and water 3. VRE • High risk patients are screened on admission • Most patients are colonized with VRE which means it is colonized (not bothering them) • Contact precautions upon entry to room

37. For all MDRO’s • Use disposable equipment, such a B/P cuffs as much as possible. • Any equipment taken in to the room must be disinfected prior to removing it from the room. • Education is given to patient/visitors by the nurse. The visitor may decide for themselves whether or not to wear a gown or gloves. • If the visitor will be visiting other patients during this visit, they must wear a gown and gloves • Notify receiving department that the patient is on contact precautions. • If possible, schedule procedures when there are fewer patients in the area. • The patient should wear an isolation gown and wash hands prior to transport. • Have the area where the patient has been terminally cleaned by Environmental Services

38. Screening for MRSA • Certain high risk populations are screened for MRSA on admission by having a nasal swab screening completed. • If they have MRSA in their nose, they are placed on contact precautions to reduce the risk of MRSA to others. • You may have noticed more patients on isolation precautions because of this process. • Patients who already have MRSA on admission to our facility have Community Acquired MRSA. This is different from MRSA acquired in a healthcare setting. • Usually it is a skin infection or MRSA colonization in the nose. • Community MRSA is increasing throughout the US.

39. Tuberculosis (TB) Update • Spread from person-to-person through the air droplets from someone who has TB • Symptoms of TB include: greater than three weeks of cough, unexplained fever, weight loss, and night sweats. • Infection is usually detected by a positive PPD skin test and an abnormal chest x-ray. • Patients suspected of having active tuberculosis are placed on airborne precautions in a private room with negative air flow. The door must remain closed at all times except when entering and exiting the room • A person can also have the TB germ which is dormant (not active TB). This person has a positive skin test but they are not ill. • They cannot spread the bacteria to others, however they do have an increased risk of eventually acquiring active TB.

40. Tuberculosis (TB) UpdateContinued • Upon hire, associates are required to have a PPD skin unless they have ever had a positive skin test. • CMC is a low risk facility for TB. This means we do not have to have annual skin testing except in histology, microbiology and the bronchoscopy department • Associates with active tuberculosis will be placed on a work furlough until cleared by the health department as no longer being a risk of transmission to others and healthy enough themselves to perform the tasks of their occupation. • Special masks (N 95) are worn by healthcare personnel when entering the room. • Contact Employee Health Services if your facial structure changes or your mask does not fit for any reason, or if you have problems wearing the mask. Personnel should fit check the mask before entering the patient’s room. The mask must be discarded if it becomes soiled or at the end of your shift. Masks are stored in the ante room.

41. How would the hospital handle an influx of infectious patients? • If a large number of infectious patients suddenly presented to the hospital, we would activate our emergency preparedness plan. • This plan addresses staffing, supplies, and other issues that might occur as a result of the increased patient load.

42. Blood Borne Pathogens • A copy of our plan is available to any associate. • The plan explains the processes we have in place to minimize exposures, and what we do if there is an exposure to a blood borne pathogen. • The following fluids are considered to be potentially infectious: blood, semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, amniotic fluid, or any other fluid that is visibly contaminated with blood and all body fluid where it is difficult or impossible to differentiate, saliva in dental settings, tissue and organs that are not fixed other than intact skin (from any human living or dead), HIV containing cell or tissue cultures or organs, and tissue from experimental animals infected with blood borne pathogens.

43. What is Hepatitis B (HBV)? • Hepatitis B is a serious liver disease. • Symptoms include jaundice, fatigue, fever, nausea and abdominal pain. • It can be transmitted by contact with infected blood and body fluids. • HBV is much easier to transmit than HIV and lives on surfaces for longer periods of time. • You can help protect yourself from acquiring Hepatitis B if you practice infection control guidelines and get vaccinated. • The Hepatitis B vaccination is given free of charge to associates. Generally people have few side effects from the vaccine. If you previously declined the vaccination, you may notify Employee Health Services if you choose to begin this series.

44. What is Hepatitis C (HCT)? • Hepatitis C is a disease that attacks the liver. • It is transmitted by contact with an infected person’s blood or blood products which enters the body of a person who is not infected. • HCV infection often occurs without symptoms or with mild symptoms. The symptoms are very similar to those of Hepatitis B. • There is no vaccine that offers protection from Hepatitis C.

45. What is HIV? • Human Immunodeficiency Virus (HIV) is the virus that causes the disease Acquired Immune Deficiency Syndrome (AIDS). • HIV damages the immune system and makes a person with AIDS more likely to get serious infections and other diseases. • To become infected with HIV, the virus must get into your body and enter your bloodstream. • Many people who are infected with HIV do not have symptoms for years. Persons who are HIV infected (with or without symptoms, diagnosed with AIDS, orrecently exposed with a negative HIV antibody test) can spread HIV to others. • It may be transmitted by contact with an infected person’s blood or body fluids which enter the body of a person that is not infected.

46. How to Reduce Transmission of Blood Borne Pathogens • Observe engineering controls; needle-less systems, safety devices, sharps disposal containers, biohazard waste containers, needle boxes at appropriate height. • Observe work practices; never recap needles, perform hand hygiene, use appropriate PPEs, do not bend or break needles, do not eat or drink in areas where there is potential for exposure, do not store food or drinks in a refrigerator that is used to store blood or other potentially infectious material (OPIM), use red biohazard bags for disposal of infectious wastes. • Know the job tasks in your department that may involve exposure to blood or OPIM and wear appropriate PPEs.

47. What is an Exposure? • Contact with another person’s blood or OPIM such as in needle sticks/sharps exposures, mucus membrane exposure, or exposure to non intact skin. • If you are exposed to blood or OPIM, you should clean the skin injury site with soap and water. If it is a mucous membrane exposure, flush the area with water. • Inform your supervisor or the designated charge person and go to Employee Health Services (may go to the Emergency Room during other hours) to be evaluated. • Complete occurrence form. • You will receive risk information, be evaluated by the ER physician or the Nurse Practitioner in Employee Health Services, be informed of recommendations of treatment, and receive care. • You should follow up after your initial evaluation the next day with Employee Health Services. • You will receive a written opinion for any future recommended follow up in approximately 15 days.

48. Prevent Blood Borne Pathogen Exposures • Use appropriate barriers such as gloves, eye protection, or gowns when contact with blood is expected. • Wash your hands with soap and warm running water as quickly as possible after contact with blood or potentially infectious materials. • Don’t eat, drink, smoke, apply cosmetics or lip balm, or handle contact lenses in area with possible exposure to bloodborne pathogens. • Do not store food in refrigerators, freezers, cabinets, shelves, or on countertops where blood or other body fluids are present.

49. Blood Borne Pathogen Exposure • Report to Employee Health Services or the E.R. immediately after a Bloodborne Pathogen Exposure. If you go the E.R., then follow-up with Employee Health Services as soon as the office opens. • Following a bloodborne pathogen 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 • The following factors were associated with an increased risk of HIV seroconversion: • deep injury (deep puncture wound) • visible blood on source patient device causing injury • procedure involving needle placed in a vein or artery of source patient • endstage AIDS in source patient

50. Questions OSHA might ask about Blood Borne Pathogens • What is standard precautions? All blood and body fluids are treated as if potentially infectious by wearing appropriate PPE when dealing with them. • What do you do when there is a blood spill? Wear PPE, locate spill kit, follow directions, dispose of properly in red bag and disinfect area where spill occurred. • What do you do with contaminated sharps and laundry? Used sharps go in designated sharps containers made of hard plastic that are puncture resistant, soiled linen goes in a blue linen bag inside a soiled linen hamper and held inside the soiled utility room. • Have you been offered the hepatitis B vaccination free of charge? Yes by employee health services (all employees have opportunity to receive the vaccine) • Where is the Blood borne pathogen plan? On the intranet under IC policies, in the nursing office or can be obtained through employee health services