Mercy & Unity Hospitals

Mercy & Unity Hospitals Agency and Travel Non-Employee Orientation Program

Welcome to Mercy & Unity Hospitals Non-Employee Orientation Program • The following slides will aid you in preparing yourself to provide an excellent healthcare experience for our patients. • To progress through the orientation information use the action buttons at the bottom right of the screen to proceed forward (right button) or backward (left button) by clicking on it with the mouse. • While you are reading through these slides check-off your progress on the “Non-Employee Patient Care Staff Orientation Checklist” This form can be obtained from the site you found this program on or your agency. It is then to be returned to your agency upon completion of this program. • We hope you find this information helpful and look forward to having you join our exceptional health care team.

Contents • Who Are We • Mission, Vision & Values • Allina Hospitals Customers • Accessing the Allina Knowledge Network • Confidentiality / HIPAA • Extraordinary Workplace with Extraordinary Employees • Safety Awareness • Infection Control • Your Role in Restraint Use • Vital Patient Care Issues • Advanced Directives • Medication Safety • Documentation Overview • Information Services and Clinical Systems

Who We Are • Mercy & Unity Hospitals are part of Allina Hospitals & Clinics • Allina is a not-for-profit healthcare organization serving Minnesota and western Wisconsin • Although we are not-for-profit, it is still necessary to watch the financial bottom line. We need to be able to meet the current and future needs of the communities we serve. We reinvest profits in new equipment and advanced technologies to better care for our patients. • Allina Hospitals & Clinics • 13 hospitals • 42 clinics • Medical transportation services serving 70 Minnesota communities • Home care, Hospice, and Palliative Care • Metro Hospitals: • Mercy • Unity • Abbott Northwestern • United • Phillips Eye Institute • Regional Hospitals • Buffalo • Cambridge • Owatonna • St. Francis • River Falls • New Ulm

What we strive for... • Allina 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. Allina Vision • Put the patient first, • Make a difference in people’s lives by providing exceptional care & service, • Create a healing environment where passionate people thrive & excel, and • Lead collaborative efforts that solve our community’s health care challenges. • Allina Values: • Integrity - Match our actions with our words. We live our values and mission in all decisions and actions. • Respect - Treat everyone with honor, dignity and courtesy. Respect values, cultures, beliefs and traditions of others. Value each others talents and contributions. • Trust - We act in the best interests of out patients, physicians, communities and one another. • Compassion - Dedicated to creating a healing and caring environment to support the emotional, physical & spiritual well-being of all. • Stewardship - Use our resources wisely. Commit to being thoughtful stewards of time, energy and talent.

Living the Values • Why is it that some patients can have poor outcomes and still say that they wouldn’t go anywhere else for their healthcare? • The difference is the relationships that we create with our patients. • It’s the customer service we provide. • People come back to our hospitals because we live out our values and walk the talk-not just give them lip service. Customer Service Basics • Creating an excellent experience where patients feel assured, included and appreciated. • While much of our work is of a high tech nature, we know the importance of connecting with our customers on a human/emotional level when beginning and ending any interaction. • Who are our customers? • External Customers: • Patients • Families • Physicians • Internal Customers: • Coworkers • Other departments

The impact of body language, voice, tone and words Are the words you are saying congruent with your body language and our tone of voice? • Do we say one thing but project the opposite? • Do we ask “What else can I do for you?” each time before we leave their room? When we breakdown communication, we realize that: • 55% of the message is our body language • 38% of the message is our tone of voice • 7% of the message is the actual words we use. To make the biggest impact, you’re actions must match your words

How to access policies on the Allina Knowledge Network (AKN) • All policies are located on the AKN, an intranet site which can be accessed using our network computers. Ask the charge nurse to show you this site during your first shift.

Confidentiality HIPAA’s Privacy Law

Confidentiality • Maintaining a patients privacy and confidentiality is not only the ethical thing to do, it’s the law. • We are committed to preserving the confidentiality of patient information. • The inappropriate use and or release of information will result in disciplinary action and possible legal action. HIPAA - The Health Insurance Portability and Accountability Act • This revised “Privacy Law” places strict regulations around the privacy and security of patients health information. • The law also mandates that we train everyone in the rules and provisions of this law.

Protected Health Information • PHI is basically any information that identifies an individual or could reasonably be used to identify an individual. • This includes, but is not limited to: • Name, address, age or SSN • 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 Minimum Necessary Rule • Minimum Necessary Rule: We must only use and disclose the minimum amount of patient information needed to do our jobs. • Simply put: You may only ask for, use and disclose patient information as needed for legitimate patient care or business purposes.

Curiosity Killed the Cat – Don’t let it get you! • Sharing with others that you saw someone at the hospital or sharing of their health information may seem harmless to you- but it can be very harmful to the patient-and it’s illegal! • You might be curious to look up information on a family member that is a patient here. Unless you need that information to do your job, you are prohibited from accessing that info. • If in doubt, caution on the side of maintaining patient privacy. Release of Health Information • We must have consent from the patient before giving any information to others, including spouse, family members, or friends. • The inappropriate release of protected health information is illegal and we must address any harm that occurs because of its inappropriate release. • You are held legally accountable to maintain a patients privacy and confidentiality.

An Extraordinary Workplace with Extraordinary Employees A Culture of Caring

An Environment for Healing When patients see how well we treat one another, they will know this is a good place for healing. • We cannot provide to patients what we are unable or unwilling to provide each other. • If they see or hear uncaring behaviors, they will not find the healthy, healing environment they need. Create a Respectful and Professional Workplace Where You Would Want to Give and Receive Care

Diversity Defined as all the differences and similarities that exist among people - including race, gender, age, sexual orientation, job status, physical differences, political affiliations and religious beliefs. We value the differing points of view, varied experiences and the talents of each and every person! • Harassment Free Workplace • We have a zero tolerance policy for harassment in all of its forms. Including, but not limited to, harassment based on: • Sex • Race • Age • National Origin • Religion • Sexual Orientation • Political Preference

Key Points on Harassment • It’s the impact, not the intent. • Whether or not you intended harm doesn’t change the fact that someone was impacted by your actions or behavior. • Direct or indirect, subtle or obvious • Employees expect to work in an environment that is not hostile or intimidating. This includes jokes, slurs, pictures, comments – anything that could be felt as harassment. • It can take place at the workplace or at off duty related activities such as social gatherings or calls to your home. • Act early and talk to the accused. Ask them to stop the behavior. If not resolved, escalate this situation by discussing with your leader or manager who will then investigate the activities with the assistance of human resources. If you are uncomfortable talking with the person contact your manager. If it is your manager that is the cause of the problem then speak with an human resource generalist.

Safety Vision To make Mercy & Unity Hospitals a safer place to give and receive care

Minnesota Employee Right to Know Act (ERTK) 1983 The law was passed to make sure employees are told about the dangers associated in working with hazardous substances and harmful physical orinfectious agents. The law outlines both employer and employee responsibilities for safety from work related injury or illness. What does “exposed to” mean? You are considered routinely exposed to a substance or agent if there is a reasonable possibility you’ll be in contact with one of the items during the normal course of your assigned work.

Employer Requirements Education of staff and new employees on: • The types of hazardous materials, agents and equipment in your work area. • How to properly handle and work safely with the products. • Where information about hazardous materials is located. Education specific to the materials/agents in your work areas will need to be covered during unit specific orientation. Material Safety Data Sheets can be located on the AKN, but clicking on the “Safety” button. Employee Requirements • The law gives you the right to refuse to work under imminent danger conditions or if information or training about how to safely proceed with your job is not provided. • Use personal protective equipment (PPE) available on each unit you will be assigned to. It is your responsibility to use this equipment when situations require protection. Ask the charge nurse if you have questions about the PPEs for that unit.

What if I’m asked to work in an unsafe situation? • Tell the unit charge nurse if you feel a work situation may be dangerous • Tell the unit charge nurse if you don’t know how to use or handle hazardous materials and/or equipment. • Report faulty equipment so it can be repaired or replaced. • Don’t put yourself in any situation where you could be injured or harmed. You have the right to refuse to work under dangerous conditions. What Happens Next? • The unit charge nurse will: • Evaluate the situation for safety and the presence of hazards. • Teach you how to safely use the product, direct you to the appropriate resource, provide you with learning materials, give you the appropriate Personal Protective Equipment. • Reassign you to an alternate job until a hazardous condition can be corrected or eliminated.

Chemical Spills/Release • Each department maintains procedures for the safe handling and spill clean-up of the hazardous products used in their areas. • You need to receive unit specific orientation on the hazards found in your area. • With any chemical spill, you should notify the supervisor and maintenance.

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 on the Allina Knowledge Network (AKN).

Emergency Codes You might hear these emergency codes paged overhead, so it is important to know their meanings. Ask the charge nurse for your role when one of these codes is paged. • Red Alert Fire Alarm • Pink Alert Infant Abduction • Code Blue Cardiac and/or Respiratory Arrest (All ages) • Green Alert Restraint Personnel Respond • Orange Alert Disaster Plan in effect • Yellow Alert Bomb Threat

Severe Weather Codes • Severe Thunderstorm Warning-conditions are favorable for severe weather • Tornado Warning (phase 1) - a tornado has been sighted. Close windows, blinds and curtains. Keep corridors clear. • Tornado Warning (phase 2) - hospital is in the path of the tornado. Move patients and visitors away from windows to interior corridors closing all doors. Visitors should stay with the patients and staff should move the the best shelter in the department. • 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 x63333 • The stations main oxygen shutoff valve(s) • Evacuation plans and routes

R.A.C.E. • Rescue: Move anyone in danger to a safe area. • Alert: Pull fire alarm box and call x63333 to report the fires location. • 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. Rescue Alert Confine Extinguish

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.

Patient Safety Initiatives To provide our patients with a safe healing environment we have initiated safety goals around the care of the patient. Some of the goals you should become familiar with include: • 2 Patient Identifiers • Unacceptable abbreviations • Clinical Alarms • Time Out & Surgical Site Marking • Reduce hospital acquired infections: hand hygiene • Fall Risk Reduction • Increased Patient Involvement in their own Care • Suicide/Violence Risk Assessment • Verbal Order Read Back and Telephone Order Read Back • Sound-alike and Look-alike Medications • Hand Hygiene • Medication Reconciliation We will discuss several of these initiatives on subsequent slides. Please talk to your preceptor or charge nurse about the remaining initiatives.

It Takes 2 • Matching the right patient to the right treatment or service: • When obtaining blood samples or administering medication or applying the patients armband, two patient identifiers will be used to compare to the same two printed identifiers on the lab request, medication record, or patient’s medical record. • Patient Identifiers Include: • Patient’s stated name and date of birth are compared against the printed name and DOB on the medication record, specimen label, or medical record. • Patient’s unable to state their name and DOB: • Verification by a family member • Verification by carefully matching the name and DOB on the wristband with the same info on the medical record, specimen label. • A patient room number will never be used as a method of patient identification or verification. • Exception to above is the administration of blood products. In this instance, use patient name, birth date and social security number.

Unacceptable Abbreviations • We have developed a list of abbreviations that are not approved for use within the medical record (documentation, notes or orders). • Orders written with an unacceptable abbreviation will not be accepted or executed. • Unacceptable orders will be clarified by the nurse and documented as a verbal order before executing. • Ask the unit charge nurse for more information regarding unacceptable abbreviations Clinical Alarms Goal: Improve the effectiveness of clinical alarms. • Examples of clinical alarms are : cardiac monitor alarms, fetal monitor alarms, apnea alarms, door alarms, elopement / abduction alarms, infusion pump alarms, bed alarms, bathroom alarms or respirator alarms Clinical Alarm Considerations: • Clinical alarms are basically all patient care equipment containing alarm functions • Alarm functions should be managed/adjusted by the assigned staff RN or other hospital designee. Collaborate with the charge nurse if you are having difficulty setting/adjusting alarm parameters with your patients. • Alarm policies are practiced • If an alarms fails, a Patient/Visitor Safety Report is completed, Risk Management is notified, and the equipment is immediately sent to Clinical Equipment Services (CES) for evaluation

“Time Out” Goal: Eliminate wrong site, wrong patient, wrong procedure/surgery. Done prior to local injection/incision/start of procedure – • Surgical Site Marking: The surgical site is marked for correct site and laterality, per policy. • “Time Out”: The circulating RN reads the patient’s full name and procedure including site / side, from the consent form. All members of the surgical team listen and confirm the correct procedure, patient, surgical site and side (laterality).

Safety & Ethical Situations • If you encounter a potential hazard or unsafe situation in our hospital or if you have an ethical concern regarding our practices or a patient care situation, you should discuss this with the charge nurse. • We encourage reporting of safety concerns, incidents, hazards and ethical concerns. • We have committees and processes in place to address these issues and make changes when appropriate. • Concerns reported to the charge nurse may be escalated to the unit leadership. • You may be asked to complete a “Patient/Safety Visitor Report” or “Area of Concern Form” to document the events. • When in doubt – fill it out!

Safety Contacts • Security Manager • Employee Safety Specialist • Patient Safety Director • 763/236-SAFE Phone Numbers can be found on each unit.

Infection Control

Environment surfaces floors gardens People skin intestines Equipment Water Flowers/plants Where do germs come from? Chain of Infection All links must be complete for an organism to spread from one place to another. Our goal is to break the chain in one or more links.

Risk of Transmission • Intact skin is a good barrier to organisms but remember that organisms can enter through non-intact skin (cuts, scrapes, eczema) • Mucous membranes allow transmission, such as through: • eyes • nose • mouth • Most transmission occurs through contact: • Direct contact- touching patient • Indirect contact - touching a contaminated surface • Spray/splashes: Fluids, sputum, etc • Most contact is with our hands

Hand Washing Hand washing is the single most effective way you can break the chain of infection. Hand Washing Basics • Soap - Use only hospital approved soaps, lotions & foam products. • Warm running water • 15 seconds – sing the ABCs song or “Happy Birthday” twice • Use friction • Turn off faucet with paper towel. Waterless Hand Washing (Quik-Care Alcohol foam) • Preferred method of hand cleaning if hands are not visibly soiled or contaminated with blood or body fluids. • Dispense a walnut size amount and rub hands and under nails until dry. • Use before and after every patient contact or contact with contaminated equipment. • Contains emollients, therefore is better for your hands and is less drying to hands than soap and water. • The emollients can build up on the hands after repeated use, so, wash with soap and water occasionally. Lotion • Accent Plus is the hospital approved lotion which is compatible with hospital microbial soap and gloves. • Use at least 3-4 times each shift.

Artificial Nail Restriction • This restriction must be followed by everyone who has direct patient contact, cleans rooms, handles patient supplies, prepares or serves food/drinks, handles medications or blood products. • Artificial nails including tips, wraps, overlays, acrylics, gels, any appliques, nail piercing, nail jewelry or any other artificial nail enhancements of any kind are not allowed in our facility. • Natural nails must be kept 1/4 inch or less. Blood Spills • Potential exposure to blood or body fluids could occur at any work site • There is a plan in place for each work site • Guiding principles of each plan: • Avoid direct contact with body fluid. • Wear gloves. • “Cleanup Twice” – once for the spill and once to disinfect the area. • Remove gloves • Wash hands. • Allow area to air dry e.g.; 10 minutes

Standard Precautions Standard Precautions considers all patients as potentially infectious. Prevent exposure to infectious organisms by wearing Personal Protective Equipment (PPE) when contact with the following is anticipated: • blood • body fluids, secretions and excretions • non-intact or broken skin • mucous membranes Personal Protective Equipment (PPE) PPE is located in all patient care areas. Exact location should be sought out during unit specific orientation. • Gloves - to keep hands clean • Gowns - to protect uniform from getting splashed or wet • Facial protection - to protect mucous membranes from getting splashed or sprayed

Other Infection Control Issues

Location of Exposure Control Plan and Infection Control Policies The Allina Knowledge Network (AKN) Ask your charge nurse about access to the AKN.

Patient Care Orientation

Your Role In Restraint Use The restraint event begins with the RN assessment. Other disciplines contribute data to this assessment. • Alternatives to Restraints • Each department has its own set of restraint alternatives that they have chosen for use with their patient populations. Alternatives must be trailed and documented before restraints can be considered. Each policy has a list of restraint alternatives. • Mercy and Unity have 3 types of restraints – • Waist Restraint – disposable • Velcro Tying Restraints – disposable • Velcro Locking Restraints – cleaned and reused • There are 7 points of restraint taught to the staff as well as positioning the patient on the bed. • 1 point – waist restraint • 2 points – most frequently are the two wrists • 3 points – waist and wrists • 4 points – ankles and wrists • 5 points – ankles, wrists and waist • 7 points – ankles, wrists, waist and biceps The patient can be positioned face up or face down based on status. When ankles are in restraints they should be anchored straight to the bottom of the bed and not “spread eagle” to the sides of the bed.

Restraints Continued… Safe discontinuation – Restraints will be removed one at a time as the RN assesses the patient’s readiness for restraints to be removed. The patient must never be in one point of restraint unless that is a waist restraint. When a patient is in four point restraints the RN should remove an ankle or wrist first. The next restraint removed must be the opposite limb – for example if the right wrist is removed the next restraint removed is the left ankle. The time of discontinuation must be charted. There are two restraint policies (AKN) • Restraints for Non-Behavioral or Acute Medical & Surgical Care • Restraint/Seclusion for Behavioral Management of Patients There are basically 3 exclusions to the policies: • Devices used to aid with positioning and/or keep immobilized during medical, dental, diagnostic or surgical procedures. • Adaptive/supportive devices, such as braces, orthopedic appliances which are used for voluntary support to achieve proper body position or alignment. • Use of forensic restraints (such as handcuffs or shackles) applied by law enforcement officials.

Restraints Continued… Restraints for Non-Behavioral or Acute Medical Surgical Care – (AKN) This policy is used for anticipated situations when there is a need to restrict the patient’s free movement and access to the tubes, drains, etc. (Restraint during detoxification is to follow the medical/surgical restraint policy.) • The order is for 24 hours and the preprinted order set must be used. The MD will authenticate the order within 24 hours along with their face to face assessment of the patient and the need for continued restraint on this preprinted order set. • The patient will receive the following cares at a minimum: • Q hour – CMS • Q 2 hours – Fluid, elimination and repositioning • TID and PRN – Food • Q12 hours – ADLs and hygiene • Cares are documented on the flow sheet. • The MD will complete a face to face assessment for continued need every 24 hours. • RN re-assessments are done q 8 hours. • If after a period of time without restraints the patient needs to have them re-applied, a new order must be obtained.

Restraints Continued… Restraint/Seclusion for Behavioral Management of Patients – (AKN) This policy is for unanticipated situations of sudden aggressive behavior that could result in harm to self or others. • The order is age dependent – there are order sets for each age group. The MD will authenticate the order within 24 hours. • A MD Face to Face Assessment is completed within 1 hour after the restraints have been applied. • Care for the patient includes 1:1 staffing the entire time they are in restraints and cares given the same as the acute med/surgical policy. The patient will be checked every 15 minutes and those checks documented. • The order renewal and face to face MD reassessment are guided by the age of the patient as follows: • Order Renewal: • Adult (18 yr.-older) • Adolescent (9-17 yrs) • Child (under 9 yrs.) • Face to Face Assessment: • Adult Q 8 hours • Adolescent and child Q 4 hours • Once restraints are released the patient will have a debriefing with the staff and it will be documented in the chart. The family, patient and staff will also have a debriefing and it will be documented as well. The only exception is if the patient does not want the family involved.

Final Restraints Comments • Notify hospital leadership if the patient remains in restraints for more than 12 hours. They will be involved in reassessment of the need for restraints. During the day it is the Nurse Manager, on other shifts it is the Administrative Supervisor. • If the order for restraint was obtained from an MD that is not the attending physician, then the attending must be notified. The attending will have more information about the patient that may impact the continued use of restraints. • Remember to document and get credit for all the alternatives that you attempt before during and after restraint are utilized.

Vital Patient Care Issues Patient Bill of Rights “Patients have the fundamental right to receive considerate healthcare that safeguards their dignity and respects their cultural, psychological and spiritual values…” The Patient Self-Determination Act of 1990 What is it? • A Document based on a law that states the rights that patients have while in a facility • Available in 6 languages and Braille. Why is it Important? • The law requires that all patients or their proxy receive this information upon admission. • Patient Registration Department gives the patient the document. What do I do? • Verify and Document that the patient or proxy received the document. • Explain that these are their rights as a patient. • Ask them to read it. • Document on medical record that you did this. • Answer any questions they may have.

Vital Patient Care Issues Grievances What is it? • A verbal or written complaint that cannot be promptly resolved to the patient’s satisfaction by staff present Why is it important? • It is a patient right • It is a customer service issue. What do I do? • Try to promptly resolve the issue by the staff present (with-in your scope of practice). • If not resolved, give patient the options of talking to the Patient Rep, Manager, or Administrative Supervisor, or to the Office of Health Facility Complaints (OHFC) listed in the Patient Bill of Rights Vulnerable Adult What is it? • All patients in a health care facility are considered to be vulnerable. Why is it important? • It is a MN Statute/ law. What do I do? • If patient alleges Abuse, Neglect, Harassment or Maltreatment while hospitalized- • Assure patient safety immediately • Report to Patient Rep., Manager, or Admin. Supervisor • Complete Patient Safety Report • Give report to Admin. Supervisor or the Internal Reporter (Social Services) • If Domestic Violence refer to Social Services or Advocate

Vital Patient Care Issues Informed Consent What is it? • Informed decision making and consent is required for all medical procedures and treatments with more than slight risk, or that may change the patient’s body structure. Why is it important? • To assure that the patient has adequate information in order to engage in informed decision making regarding their treatment. Use of the Verification of InformedConsent Form is required to verify all surgical, invasive cardiac, endoscopic procedures and any procedure requiring biopsy of tissue or use of sedation that results in loss of protective reflexes. What do I do? • Hospital staff preparing the patient for the procedure will verify the procedure, site or side, and the patient’s understanding of the proposed procedure and document on this form. The form is a two sided form – one side is completed by the MD (informed consent), the other side is signed by the patient and witnessed by hospital staff (verification of informed consent).

Mercy & Unity Hospitals