academic affiliate clinical orientation...

Clinical Learning DepartmentHarris Regional Hospital

Swain County Hospital

WESTCARE HEALTH SYSTEMACADEMIC AFFILIATE CLINICAL

Revised 02/19/2014

WestCare health system

TABLE OF CONTENT

Welcome……………………………………………………………………………………………………………………………4Instructions…………………………………………………………………………………………………………………………..4Tobacco-Free Campus…………………………………………………………………………………………………………..4Accreditation………………………………………………………………………………………………………………………4Diversity……………………………………………………………………………………………………………………………...5Workplace Behavior………………………………………………………………………………………………………………5General Safety……………………………………………………………………………………………………………………..6

Safety………………………………………………………………………………………………………………………6Lifting and Carrying……………………………………………………………………………………………………..6

Needle Stick, Sharps Injury, Bloodborne Pathogens Prevention……………………………………………….6Infection Control…………………………………………………………………………………………………………………..7 Standard Precautions………………………………………………………………………………………………….7 Personal Protective Equipment………………………………………………………………………………………7

Hand Washing…………………………………………………………………………………………………………...8Nails………………………………………………………………………………………………………………………..9

Isolation Procedures………………………………………………………………………………………………………………9Contact Precautions…………………………………………………………………………………………………...9Droplet Precautions…………………………………………………………………………………………………….9Airborne Precautions…………………………………………………………………………………………………..9

Corporate Compliance and Risk Management………………………………………………………………………….10Code of Conduct……………………………………………………………………………………………………..10Patient Rights……………………………………………………………………………………………………………

10EMTALA (Emergency Medical Treatment Active Labor Act)……………………………………………………………11HIPPA (Health Insurance Portability and Accountability Act)…………………………………………………………...11Ethics………………………………………………………………………………………………………………………………..12Occurrence Reporting………………………………………………………………………………………………………….12Advance Directives……………………………………………………………………………………………………………...12

Living Will/Declaration of a Desire for a Natural Death………………………………………………………...12

Healthcare Power of Attorney………………………………………………………………………………………12Medical Order for Scope of Treatment (MOST)....………………………………………………………………

13Recognizing and Reporting Abuse and Neglect………………………………………………………………………….13Medical Abbreviations – Do Not Use List…………………………………………………………………………………….14Pain………………………………………………………………………………………………………………………………….14Patient Complaints and Grievances…………………………………………………………………………………………14

Complaint……………………………………………………………………………………………………………….14Grievance……………………………………………………………………………………………………………….15

Your Role in Quality and Patient Safety……………………………………………………………………………………..152014 Hospital National Patient Safety Goals……………………………………………………………………………….15Emergency Codes………………………………………………………………………………………………………………17Security and Safety Review……………………………………………………………………………………………………18

Personal Protection……………………………………………………………………………………………………18Property Protection……………………………………………………………………………………………………18Facility Protection…………………………………………………………………………………………………….. 18Parking and Traffic

Control…………………………………………………………………………………………..18Information Security……………………………………………………………………………………………………………..18Computer Access……………………………………………………………………………………………………………….18Password…………………………………………………………………………………………………………………………..19

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Log off the Computer Station…………………………………………………………………………………………………19Utilities Interruption……………………………………………………………………………………………………………….19Radiation Safety………………………………………………………………………………………………………………….19Hazardous Materials – Material Safety Data Sheets (MSDS)…………………………………………………………….20Lost and Found…………………………………………………………………………………………………………………...20Corporate Image………………………………………………………………………………………………………………..20Organizational Guidelines……………………………………………………………………………………………………..20

Identification Badges…………………………………………………………………………………………………20Grooming……………………………………………………………………………………………………………….20Tattoos……………………………………………………………………………………………………………………21Hair………………………………………………………………………………………………………………………..21Artificial

Nails…………………………………………………………………………………………………………....21Dress and

Uniforms…………………………………………………………………………………………………….21Shoes……………………………………………………………………………………………………………………..21Jewelry/Make-Up/Fragrances………………………………………………………………………………………21Attendance…………………………………………………………………………………………………………….21Cell Phones……………………………………………………………………………………………………………..21Tablets……………………………………………………………………………………………………………………21

Electrical Safety…………………………………………………………………………………………………………………..21Policies and Procedures………………………………………………………………………………………………………..22Medical Waste Disposal………………………………………………………………………………………………………...23Appendix A: Privacy and Confidentiality Statement…………………………………………………………………….24Appendix B: Compliance Agreement………………………………………………………………………………………25Appendix C: Academic Affiliation Clinical Orientation Post – Test……………………………………………………26Appendix D: Academic Affiliation Clinical Orientation Manual Evaluation Form…………………………………29Appendix E: Information System Student/Faculty Assess Form (only if charting in the medical record)……...30

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WELCOME

Welcome to WestCare Health System comprised of two hospitals: Harris Regional Hospital located in Sylva and MedWest Swain located in Bryson City; and WestCare HomeCare, WestCare Hospice, and the MedWest Physicians Network including many physician office practices. WestCare is committed to providing students with excellent clinical experiential training and sponsors multiple academic affiliation agreements with many in-state and out of state colleges and universities covering a wide variety of specialties. As is our mission, we are dedicated to provide personalized, compassionate, and quality healthcare to our patients and the communities we serve. Additionally, we aim to provide a high level of service for all of our customers. During the time you are guests of the WestCare Health System, you will be treated as one of us, and accordingly you are responsible for the safety and welfare of our patients and visitors. Knowledge of the material covered in this manual is vital to assure that safety.

This orientation manual provides important information that will assist you during your clinical rotation and acquaint you with facility policies and procedures. If you have questions related to any of the information included in this manual, please direct them to your faculty or any staff member who can assist you.

INSTRUCTIONS

In order to facilitate your on-site clinical experience with WestCare you must review this entire orientation manual and complete the required documents prior to your arrival at your designated facility. Please follow the instructions below. This manual and appendices may be printed for your personal use.

Completion of this orientation package is mandatory for all faculty and students participating in clinical site rotations at any WestCare facility. Please review the information carefully; then print, sign and/or complete the following:

Appendix A. Confidentiality and Privacy Statement Appendix B. Sign Agreement of Compliance Appendix C. Orientation Competency Exam Appendix D. Online Orientation Manual Evaluation Form Appendix E. Information Systems Student/Faculty Access Form

Present all completed or signed forms to your instructor. Faculty will forward the completed forms to the WestCare Student Liaison prior to the start of the clinical rotation. Failure to complete this orientation and submit required documents may delay the start of the clinical experience.

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All students must submit to a complete background check at minimum 4 weeks in advance of the start of the clinical experience. Your instructor can provide you with information on how to complete this requirement. Failure to meet this requirement will result in delayed or denied clinical rotation.

TOBACCO-FREE CAMPUS

WestCare Health System is tobacco-free. Smoking and the use of smokeless tobacco is prohibited anywhere on any campus, including private vehicles while on the premises. Please ask your faculty advisor or a staff member about the facility’s policy if you have any questions.

ACCREDITATION

WestCare facilities are accredited by the Joint Commission on Accreditation of Healthcare Organizations and licensed by the State of North Carolina.

DIVERSITY

Many factors make each of us unique as individuals including appearance; ethnicity and culture; family life; religious, spiritual, philosophical beliefs; income or social status; physical and mental abilities; and life experiences and education.

Prejudices and stereotypes hurt everyone and often contribute to barriers to quality care for patients. When making judgments about an individual without getting to know them, we pre-judge or contribute to prejudicial behaviors. Stereotyping is assuming everyone in a certain group is the same and results in the inability to provide individualized care.

In order to deliver high quality care to our diverse patient population and maintain a respectful and healthy work environment, the following recommendations are offered:

Remain open to differences among us Treat each person as they want to be treated – ask their preferences Be respectful Avoid stereotyping Learn and understand each person’s unique views Seek information about the diversity among patients that seek care at WestCare Health System Don't assume anything Don't tell inappropriate or off color jokes

Celebrate diversity! Take pride in your own uniqueness and welcome others as individuals with special qualities. If you fail to respect diversity recognize that mistakes can happen - especially when people are under stress. And always remember service excellence - apologize if you have offended or been guilty of prejudicial behaviors.

WestCare has language line services for non-English speaking patients. Do not interpret for patients or use family members as interpreters. Ask staff in the department where you are assigned how to obtain and use the language line equipment. Nursing Supervisors are also available 24/7 at Harris to assist you.

WORKPLACE BEHAVIOR

WestCare Health System is committed to providing a work environment that respects the rights, dignity and cultural differences of its employees, contractors and agents. Harassment or abuse of any form (i.e. physical, mental, or verbal) is inappropriate and will not be tolerated. Any individual who feels he/she has been harassed or is aware of this type of behavior should report the alleged act immediately to

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his/her faculty and the supervisor in the department. If you are uncomfortable in reporting this to the supervisor, contact Human Resources.

All allegations of harassment will be investigated promptly, impartially and discreetly. On completion of the investigation, appropriate action will be taken. No individual will suffer retaliation for reporting instances of harassment. Any individual who believes they have suffered from any form of discrimination including sexual, religious, racial, color, nationality, disability, or age please notify your faculty and the supervisor in the department.

All faculty, students and staff are required to maintain professional decorum when serving patients, families, and colleagues. Please ensure you align with WestCare policies and procedures regarding personal interactions and professional attire. Failure to abide by facility policy may result in dismissal from the clinical environment.

GENERAL SAFETY

It is the goal and intent for all faculty, students, and staff to do all that is reasonable to provide a safe and healthy environment for delivery of patient care. To attain and maintain this goal cooperation and commitment at all levels is necessary. Safety is a shared responsibility of all team members of WestCare Health System. Know the hazards that you may encounter on the job.

Safety

Maintain a positive safety attitude Practice safe work habits Maintain safe work conditions Know the WestCare facility emergency codes listed in this manual and policy manuals Know your duties and responsibilities during an emergency situation (Your clinical preceptor can

inform you of your responsibilities) Follow approved procedures for all job functions Report all accidents/incidents to the appropriate person Obey all safety signs and notices Keep work areas neat and clean When in doubt, ask

Lifting and Carrying

The practice of good body mechanics is required for all. The following recommendations will assist you in utilizing proper techniques when lifting to avoid injury. Remember it takes the same amount of time to use safe lifting techniques as it does poor techniques.

ALWAYS:

Think about the load you will be lifting and ask these questions: (1) Can you lift it alone? (2) Do you need mechanical assistance? (3) Is the item too awkward for one person to handle?

Keep your feet apart Tuck in your pelvis by tightening your stomach muscles which will help your back stay in balance

while you lift Bend your knees instead of your waist. This assists in keeping your center of gravity and uses

your strong leg muscles do the lifting Keep your chin up Keep the load as close to your body as possible Avoid twisting - Keep hips, shoulders and torso pointed in the same direction Make multiple trips instead of one heavy one

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Get assistance if you need it Make sure you have firm footing and a clear path Use same technique to set your load down as you used to pick it up Use a gait belt Push rather than pull

Needle Stick, Sharps Injury, Bloodborne Pathogen Prevention

Sharps are instruments that are capable of breaking the skin such as needles, scalpels, broken glass, guide wires, etc. Every sharp should be treated as if it is a dangerous instrument and capable of transmitting a bloodborne disease. To avoid being injured by a sharp:

Handle sharps as little as possible Do not bend or break contaminated sharps Always direct the sharp away from you Be aware of others around you when you are handling sharps Use syringes and needles with safety devices Do not recap needles Dispose of needles in the proper container immediately. Sharps containers should be changed

when they are ¾ full Be alert for sharps that may have been discarded in the trash, linen hamper or lying around on

the floor, bed or bedside table Do not reach inside a waste container or push trash down with your foot or hand Handle all linen and trash bags with caution Dispose of infectious waste in an appropriate manner Environmental surfaces and patient care items are cleaned and disinfected with the hospital

approved germicide after all patient contact, following the manufacturer’s directions. Blood and body fluid spills are cleaned immediately with the approved germicide. Spill cleanup is the responsibility of everyone.

Linen and trash is placed in appropriate leak-proof bags and are tied in such a manner as to prevent spilling of contents. Bags should not be overfilled. Linen is checked for patient care items prior to placing in a laundry bag.

Communicable diseases or suspicion of communicable diseases reportable to the Health Department and any infectious processes are to be reported to the Infection Control department, and appropriate control measures implemented. Specific situations that require notification include:

o Any physician-diagnosed or suspected infection at the time of admission (e.g. hepatitis, meningitis, tuberculosis, encephalitis)

o Any infection that develops after admission (e.g. pneumonia, UTI, surgical site, sepsis, IV site infections)

o Positive cultures for MRSA, VRE, VRSA, or other multi-drug resistant pathogens.

INFECTION CONTROL

Bloodborne pathogens are small organisms that maybe present in human blood and can cause disease. Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV) are two examples of bloodborne diseases that occur frequently when infected blood/ body fluids or infected tissue enter your blood stream. Your exposure while in the workplace is prevented through the use of Standard Precautions, wearing of personal protective equipment (PPE), engineering controls and following policy and procedures. Leave all isolation precaution signage in place when patient is discharged and notify environmental services of contaminating organism for appropriate cleaning.

Standard Precautions

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Standard precautions are work practices that assist in preventing contact with patient blood and other body fluids. Standard Precautions assumes that certain areas of the body are colonized with disease – causing microorganisms that, if transmitted to others, could cause disease. The intent of standard precautions is to prevent the healthcare worker and all patients/visitors from any germ- causing diseases.

Personal Protective Equipment Standard Precautions require the use of protective barriers, called Personal Protective Equipment, to prevent contact with infectious agents that may be present in blood and body fluids. PPE are your best protection against bloodborne pathogens and should be used whenever you anticipate contact with blood or other infectious agents.

PPE includes the use of gloves worn as a protective barrier. The wearing of gloves does not replace hand washing. Gloves may contain small imperceptible defects, may be torn during use, or hands can become contaminated when being removed. Gloves must be changed between patient contacts and hand hygiene must be performed after gloves are removed.

Face and eye protection include various types of masks, goggles, and face shields. These can be worn in combination and are designed to provide a protective barrier for mucous membranes that must be covered during procedures that are likely to produce splashes, sprays of blood, body fluids, secretions or excretions.

Gowns and protective apparel are worn to provide a protective barrier to prevent contamination of clothing and to protect the skin from contact with blood or body fluid exposure. Protective clothing—including gowns, shoe covers, boots, and leg covers—should be utilized when splashes or large quantities of infective materials are present or anticipated.

You must use the appropriate PPE for each task and each time you perform the task. All PPE is changed between patients, when grossly contaminated, after each patient contact and prior to leaving the work area. Do not reuse PPE and ensure that all PPE is disposed of in the appropriate container. PPE will be provided to protect against contact with blood and potentially infectious materials. It is your responsibility to ask for, correctly use, and dispose of PPE.

Any exposure must be reported immediately to your faculty or supervisor for occurrence reporting and treatment.

Hand Washing Bacteria can be transmitted by hospital personnel from patients with infections to other patients. Hand washing is the single most important and effective way to prevent the spread of infection in healthcare facilities. The spread of hospital-acquired or nosocomial infections can be prevented by all care providers and personnel washing their hands:

prior to coming to work before and after contact with each patient, the patient’s environment and items that have come

in contact with the patient when moving from a contaminated site to a non-contaminated site when providing care when hands are visibly dirty after removing gloves after going to the bathroom before and after eating after covering your mouth or nose when you sneeze before leaving work

Two recommended methods for cleaning hands:

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Soap and water: Use vigorous motion and friction for minimum of 15 seconds making sure you cover all parts of your hands. Rinse under running water and dry thoroughly with paper towel. Turn off the faucet with a paper towel.

Waterless Agent/Hand Sanitizers (alcohol based): Apply product to palm of one hand. Rub hands together covering all parts of the hands. Rub until hands are dry or minimum of 15 seconds. Recommend use with no visible contamination (example: after covering of nose or mouth post sneezing).

Provide visitors education and information on appropriate hand hygiene while visiting.

Nails No artificial nails or extenders are worn when working in a patient care area or when having direct patient contact. Nail polish must be intact, no chips or cracks.

ISOLATION PROCEDURES

There are three major categories of precautions: 1) contact precautions, 2) droplet precautions, and 3) airborne precautions.

Contact Precautions: Contact precautions are required for patients known or suspected to have serious illnesses easily transmitted by direct patient contact or by contact with items in the patient environment. Examples include gastrointestinal, respiratory, skin or wound infections, or colonization of multi-resistance to antimicrobial drugs, including MRSA (Methicillin resistant staphylococcus aureus), ESBL (Extended-spectrum beta-lactamase), and PRSP (Penicillin- resistant streptococcus pneumonia). Healthcare workers could become infected or carriers and spread the infection to other healthcare workers or patients/visitors. Immediate response to bloodborne exposure:

Immediately cleanse the area Flush mucous membranes with a large volumes of water Wash exposed skin with soap and water Report the exposure to your faculty or preceptor Receive evaluation and follow-up

Droplet Precautions: Droplet Precautions are implemented for patients known or suspected to be infected with pathogens transmitted by respiratory droplets (i.e. large particle droplets greater than 5 microns in size) that are generated when the patient is coughing, sneezing, or talking and during certain procedures. Transmission via large particle droplets occurs usually within 3 feet of the source. Examples include meningitis, pneumonia, epiglottitis, sepsis, diphtheria, pertussis, scarlet fever, adenovirus, influenza, mumps, and rubella.

Tuberculosis (TB) is a bacterial infection, which can be transmitted by droplet. A TB skin test can be performed to determine if a person has been exposed to the TB bacteria. All patients known or suspected to have TB are placed in a negative pressure room. A droplet isolation sign is placed on the closed door room to indicate the type of isolation precautions required and anyone who enters the room must wear the hospital-approved respirator (fit-tested N-95 mask) each and every time when entering the room.

If you are exposed to TB or other diseases:

Contact your faculty or preceptor immediately Have required treatments and follow-up procedures as recommend by this facility

Airborne Precautions: Airborne Precautions are required for patients known or suspected to be infected with microorganisms transmitted by airborne droplet nuclei. Examples: chicken pox, measles, tuberculosis, and shingles. If chicken pox, measles, or shingles is suspected—and you have had the

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disease or vaccination (documented by a positive titer)—wear standard precautions – gloves, gown and a mask to enter the patient room. If you have not had the disease or vaccination, you should not be assigned to care for that patient.

If TB is known or suspected, you must use the hospital-approved air purifying respirator (N- 95 fit tested mask) to enter the room in addition to the standard precaution of gloves and gown. Students/faculty are not assigned to care for any patients requiring the use of fit tested N-95 masks.

Close the door to isolation room to establish negative airflow. Notify the Engineering Department to verify negative airflow. All patient room doors are to remain closed. Patients should not be transferred to the medical unit until a negative airflow room is established, and the nursing staff has obtained their PPE.

Once a TB diagnosis is confirmed, the door to the isolation room is left closed for a full hour after the patient is discharged in order for the droplet nuclei to be cleared from the air. Notify environmental services for appropriate room cleaning.

If risk of contacting contaminated body fluid, i.e. sputum, add standard precautions. Remember to place appropriate precaution signage on the patient’s room and follow the precautions as indicated in the Infection Control procedures for transmission based Isolation precautions.

CORPORATE COMPLIANCE AND RISK MANAGEMENT

Code of Conduct WestCare Health System is committed to conducting its business lawfully and ethically. As the Health System's reputation is the sum of the reputations of its parts, it is critically important that all personnel meet the highest standards of legal, ethical, and moral conduct. All Health System guests must comply with the Code of Conduct in order to ensure that their conduct conforms to the highest standards and is in accordance with all applicable laws, rules and regulations as a condition of completing a clinical experience in a WestCare facility.

WestCare, in accordance with Federal and State regulations, has adopted and implemented a Corporate Compliance Program. This program ensures that individuals abide by the health system’s code of conduct policy and promotes the prevention of fraud, abuse, and waste.

In compliance with the Federal False Claims Act, the WestCare Health System Corporate Compliance program has the following procedures for detecting and preventing fraud, waste, and abuse:

Code of Conduct Reporting of potential issues and areas of noncompliance The Federal False Claims Act establishes that anyone who knowingly (directly or indirectly)

submits a false claim to the federal government is liable for damages and will be charged a penalty fee up to $11,000 for each false claim. An example of a false claim is:

o billing for a treatment, medication or procedure not ordered o billing for a treatment, medication or procedure which doesn’t have documentation to

support its completion o charging or billing inconsistently between different payers

The Federal False Claims Act also protects the right of the individual who reports suspicions of fraud, waste or abuse. The facility compliance hotline may be called at 1-888-540-7247 to make an anonymous report about a potential compliance issue.

Do not solicit or accept personal gifts, favors, loans, cash, uncompensated services, or other types of gratuities or hospitality from organizations doing business with WestCare, co-workers, families of patients, patients, or referral sources. If you have any doubt in regards to gifts, please contact the Compliance Officer or the compliance hotline.

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Patient Rights Patients and/or family members are offered a patient information booklet on admission to the hospital that outlines patient rights and responsibilities. This information is also posted in many areas throughout the facility. Every member of the care delivery team has a moral, ethical, and legal responsibility to respect patient rights. These rights include, but are not limited to, the following:

emergency medical screening and treatment (COBRA/EMTALA) care that safeguards patient dignity (privacy and confidentiality) safety and protection appropriate assessment and management of pain care that respects developmental, cultural, psychosocial and spiritual values ability to direct their own medical care

EMTALA (EMERGENCY MEDICAL TREATMENT AND LABOR ACT)

The Emergency Medical Treatment and Labor Act protect patients who need emergency medical care regardless of their ability to pay. When an emergency medical situation exists, treatment must be provided by the nearest hospital so the patient’s condition does not worsen. If the patient requires emergency medical care stabilizing treatment is provided before discharge. (Exception: if medical care that is not available at the facility is needed, the patient may be transferred to a hospital that can provide the higher level of care required by the patient)

HIPAA (HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT)

Patients at WestCare Health System are given assurance that all information is held in strict confidence. All information, written, verbal, or electronic is confidential information pertaining to patients and must not be discussed with other Health System personnel unless “need to know” exists and is relevant to the patient's care. All individuals with knowledge of a potential violation of confidentiality must notify and report the violation to their faculty/preceptor, the WestCare Corporate Compliance Officer, Deb Bennett at 828-586-7286, or the Compliance Hotline (1-888-540-7247).

HIPAA regulations define the minimal amount of necessary medical information, protected health information, to be disclosed for continued treatment, payment, and certain health care operations. Any other disclosures must have written authorization from the patient or legal representative. Faculty and students are expected to access only the protected health information required to deliver care to assigned patients.

Protection of confidential patient information is paramount. Ensure that computer screens revert to screen savers when away from the monitor. Logoff your session when not actively using the computer to deliver care. Do not share passwords! Do not leave patient documents in publicly accessible locations. Do not photocopy or print patient information and remove it from the care unit/facility. Do not download or save patient information to personal or portable computer devices including laptops, tablets, PDAs, or jump drives. Never text or post patient information on any social media, i.e. Facebook, Twitter, etc.). Photos of patients or any portions of a patient or the facility are strictly prohibited without written consent. Do not discuss patient care or circumstances in public areas such as the cafeteria or elevator. Do not discuss patient care or circumstances with unauthorized family members or friends of the patient. Audio or video recordings of patient care interactions are strictly prohibited without written permission from Risk Management and the consent of the patient. Remember: YOU protect the patient’s privacy and confidentiality.

All faculty/students shall:

Indicate understanding of these procedures through a signed statement (Appendix A) Notify their faculty/preceptor of any known violations to privacy and confidentiality procedure When in doubt seek clarification about release of protected health information

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For further information related to HIPPA, contact Risk Management and review the Privacy and Confidentiality Procedure. Failure to abide by HIPAA regulations will result in immediate discharge from the clinical rotation.

ETHICS

The WestCare Health System is a place where courtesy, cheerfulness, empathy, honesty, integrity, and understanding are important at all times. It is often difficult to assess the total therapeutic value of these characteristics, but they can be of great importance to the speedy recovery of our patients.

Personal conversations with fellow employees or discussion of the internal affairs of the Health must not be carried on in the presence of patients and visitors. Personal affairs or problems must not be discussed with patients or others while on duty. Never argue with patients. If difficulties arise, your faculty/preceptor should be called to settle the problem. The image of the facility is reflected in your conduct and all caregivers are expected to maintain professional decorum at all times. If an ethical question/dilemma occurs, the facility ethics committee can be accessed by contacting the hospital operator (dial ‘0’).

OCCURRENCE REPORTING

An occurrence is any event which is not consistent with the routine operation of the facility or the routine care of a particular patient. It may be an accident or a situation which might result in an accident and may involve a patient, visitor, or volunteer. A “near miss” is any variation in procedure or routine care that is intercepted before reaching the patient, but had the potential for injury or unexpected outcome. A sentinel event is a serious injury or illness that is life-threatening, results in permanent impairment or damage, or necessitates medical or surgical intervention to preclude permanent impairment or damage. If an occurrence is the result of a medical device, the Medical Device Reporting (MDR) Regulation is a Federal law that requires the reporting of any medical device that has caused a death, serious injury or illness to a patient.

Any faculty, student, medical staff member or volunteer who is involved, observes or discovers an occurrence or near miss is responsible for initiating an occurrence report. Occurrence reports should be completed at the time of occurrence. Consult facility or staff for direction on obtaining and filing of occurrence reports. The form should be completed legibly and objectively. Avoid speculation, opinion, or extraneous comments on the occurrence form. Complete all fields that correspond to the occurrence type.

Documentation: After the physician has been notified and interventions have been completed, the event and subsequent care must be documented in the medical record and the occurrence report completed. The event is documented in the medical record with no reference to the occurrence report. For example, “Patient found on floor”...... and other objective statements about the condition of the patient and actions taken to care for the patient after the occurrence. Do not write “An occurrence report was completed.”

ADVANCE DIRECTIVES

WestCare Health System recognizes and supports the rights of a competent adult patient to consent to or refuse medical procedures and treatment. WestCare maintains compliance with the Patient Self- Determination Act of 1990, which states that “ . . . all adult patients will be given written information about their right to prepare advance directives, which includes the Living Will, Health Care Power of Attorney and Medical Order for Scope of Treatment (MOST)”.

Living Will/Declaration of a Desire for a Natural Death 12


A living will expresses the desire of an individual that life prolonging measures not be used if the attending physician determines he or she is in a terminal and incurable condition, or sustains a permanent loss of consciousness.

Healthcare Power of Attorney A healthcare power of attorney is a written document in which an individual grants another person the right to make health care decisions on his or her behalf.

Medical Order for Scope of Treatment (MOST) A Medical Order for Scope of Treatment is a portable advanced directive order. Care will be provided to all patients whether they have or have not prepared an advance directive. The patient shall have the terms of his/her advance directive complied with by healthcare providers of WestCare Health System to the extent permitted by law. WestCare Health System is not responsible for assuring the validity of the patient’s advance directive if it is otherwise properly signed. The patient may be transferred to another physician or health care facility if the patient’s physician(s) or agent cannot honor the patient’s advance directive requests based on their own conscience.

Advance Medical Directive forms are available for any patient/community member wishing to execute a directive. Advance Medical Directives created in states other than North Carolina are valid if they are valid under the law of North Carolina or the State where they were created.

If the patient does not have an Advance Directive and requests additional information, contact your faculty or preceptor or a staff member in Admitting.

Patients wishing to execute a new directive are to be referred to Risk Management/Corporate Compliance during normal business hours.

These documents are legal and must be notarized or certified by a clerk or assistant clerk of a Superior Court of NC. These documents must be written, signed, and dated by the patient while still able to understand their condition and treatment choices and require 2 qualified witnesses. A qualified witness is not a direct relative of the principal or their spouse; does not expect to inherit anything from the principal; is not the attending physician; is not employed by the physician or the healthcare facility where the principal is patient, and does not have a claim against the principal’s estate. A facility volunteer may act as a witness as long as they meet the above criteria. Notary service is provided internally.

REGOGNIZING AND REPORTING ABUSE AND NEGLECT

Abuse or neglect may be inflicted on any age person. Possible signs of abuse or neglect could be: scratches, cuts, burns, welts, scale injury or gag marks, multiple or symmetrical bruises, contusions, injuries inconsistent with patient or caregiver explanations, malnourished appearance, sprains, punctures, broken bones, bedsores, unkempt appearance, or other. Abuse can also include acts such as teasing; speaking harshly, rudely, or irritably to the patient; laughing at, ridiculing, scolding the patient and indifference to the patient.

Healthcare providers have the responsibility to report suspected abuse or neglect. If you have reasonable cause to suspect abuse, please report it immediately to your preceptor/faculty and or supervisor.

Professional conduct and adherence to patient rights and responsibilities is expected of all.

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MEDICAL ABBREVIATIONS – DO NOT USE LIST

DO NOT USE ABBREVIATIONS RATIONALE CORRECT FORMAT

U (unit) Mistaken for “0” (zero), the number “4” (four) or “cc”

Write “unit”

IU (International Units) Mistaken for IV (intravenous) or the number “10” (ten)

Write “International unit”

Q.D., QD, q.d., qd (daily)Q.O.D., QOD, q.o.d., qod (every other day)

Mistaken for each other. Period after the Q mistaken for “I” and the “O” mistaken for “I”

Write “daily”Write “every other day”

Trailing zero (X.0 mg)

Lack of leading zero ( .0 mg)

Decimal point is missing Write “X mg”

Write “0.X mg”

MS

MSO4 and MgSO4

Can mean morphine sulfate or magnesium sulfate. Confused for one another

Write “morphine sulfate”

Write “magnesium sulfate”

µg (microgram) Mistaken for mg (milligrams) resulting in one thousand fold overdose

Write “mcg” or “micrograms”

PAIN

WestCare is committed to prompt recognition, continual assessment, treatment and prevention of any patient's pain with compassion. Care providers must respect the patient’s perception of pain and treat appropriately as per physician orders.

Definition:

Pain is an unpleasant sensory and emotional experience with actual or potential tissue damage. Pain can affect daily functioning, sleep, appetite, mood and relationships. Pain may be acute or chronic and the pain level is subjective and is what the patient indicates it is. Pain management is integral to patient care and is a patient's right. Pain is assessed and reassessed as appropriate and the patient's self-report is the most reliable indicator of pain. Pain intensity scales are used by staff to assess a patient's pain level. Always document assessment and treatment of pain accurately and completely in the patient’s medical record.

PATIENT COMPLAINTS AND GRIEVANCES

WestCare Health System acknowledges that all patients receiving services have the right to comment on their care, including filing a complaint or grievance regarding any aspect of the care and treatment experience.

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Everyone is responsible for responding in a prompt, professional, and courteous manner to a customer’s suggestion, concern, or grievance.

Complaint A complaint is a concern voiced by a patient or patient representative (in the hospital), that can be resolved promptly by the staff present.

Grievance A grievance is a formal/informal, written/verbal complaint made to the hospital by the patient or patient’s representative that cannot be resolved by the staff present. Any complaint received after discharge is considered a grievance, except those related to billing, which are handled through the patient financial services department.

Faculty/students should communicate complaints or concerns with the staff member directly responsible for patient care in a prompt fashion. All resources to resolve the complaint are utilized.

YOUR ROLE IN QUALITY AND PATIENT SAFETY

All caregivers are responsible for providing a safe environment. This includes, but is not limited to, ensuring the following:

Clutter is removed from patient rooms and work areas Over-flowing trash cans are emptied and bed tables are cleared of clutter Spills are cleaned from surfaces and floors 4. Egress is unrestricted Waste is disposed of in the appropriate container Defective/malfunctioning equipment is reported and removed from use for repair Furniture is maintained in good repair Lighting is adequate Cords are arranged as to not be a trip hazard Access to emergency equipment is unrestricted Storage areas are maintained free of clutter to allow for free movement All safety concerns are reported and documented

Any individual who provides care, treatment, and services can report concerns related to safety or the quality of care to the Joint Commission without retaliatory action from the facility when the hospital has not adequately prevented or corrected problems that can have or have had a serious adverse impact on patients. There will be no formal disciplinary actions (for example, demotions, reassignments, or change in working conditions or hours) or informal punitive actions (for example, harassment, isolation, or abuse) in retaliation for reporting concerns to The Joint Commission.

2014 HOSPITAL NATIONAL PATIENT SAFETY GOALS

Goal: Identify patients correctly

WestCare Health System has determined that the two patient identifiers are name and date of birth

Label all containers used for blood and other specimens in the presence of the patient. Make sure that the correct patient gets the correct blood when a blood transfusion is ordered.

Goal: Improve the effectiveness of communication among caregivers

WestCare requires specific timeframes for reporting critical test or study results and documentation of this communication. Your preceptor can assist you in understanding this procedure. Get important test results to the right staff person on time.

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WestCare has standardized a list of abbreviations, acronyms and symbols that are not to be used throughout the organization.

WestCare uses a standardized communication format in many departments including SBAR, and “Trip Ticket”. Your preceptor can assist you in understanding the process in the department where you are assigned.

Goal: Improve the safety of using medications

All medications must be labeled when it is prepared WestCare has implemented specific procedures for patients receiving anticoagulant therapy to

reduce their likelihood of harm. Your preceptor can assist you in understanding the procedures in place for the department where you are assigned.

Standardize and limit the number of drug concentrations available in the organization. WestCare has identified a list of look-alike/sound-alike drugs used in the organization, and take

action to prevent errors. Use caution when preparing medications to assure you follow the five rights of medication administration: Right Drug, Right Dose, Right Patient, Right Route, Right Time

Label all medications, medication containers (e.g. syringes, medicine cups, basins), or other solutions on and off the sterile field in perioperative and other procedural settings.

Maintain and communication accurate patient medication information: WestCare has established a process for medication reconciliation throughout the continuum of care. Your preceptor can assist you in understanding this procedure.

Goal: Use alarms safely

Westcare has made improvements to ensure that alarms on medical equipment are heard and responded to on time.

Goal: Reduce the risk of health care-associated infections

Elements of this safety goal include following national established standards for hand hygiene, use of proven guidelines to prevent infections that are difficult to treat, use of proven guidelines to prevent infections caused by central lines, and use of proven guidelines to prevent infection after surgery, and prevention of catheter-associated urinary tract infections.

ALWAYS wash hands before and after patient care. Follow established procedures for isolation patients.

Goal: Identify patient safety risks

Patients are screened on admission for suicide risk. Ensure you provide a safe care environment for the patient at all times.

Goal: Prevent mistakes in surgery

WestCare’s timeout procedure verifies the correct procedure, for the correct patient, at the correct site. All individuals involved in the procedure participate in the time out.

Some procedures require marking of the surgical site. All procedures require a “surgical pause” immediately prior to the start of the procedure to

confirm right patient, right procedure, and right side/site.

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EMERGENCY CODES

Definition Code

Code initiated by dialing: 4444

Cardiac Arrest / Medical Emergency – Any patient found in a dying state, defined as having shallow, gasping or absent respirations and/or a weak, thread or absent pulse, will receive emergency care unless there is a written DO NOT Resuscitate order by the patient’s physician. Initiate CPR. Dial 4444

CODE BLUE

Rapid Response – to bring additional personnel to assess a patient whose condition has deteriorated and who may be in need of additional specialized care: RAPID RESPONSE

Fire – In the event of a fire, all care providers should remain calm and do not yell “fire”

Remember R-A-C-E

R – Rescueo Remove all patients and visitors from immediate danger

A – Alarm/Alerto Pull nearest fire alarmo Call the Operator to report location and extent of fire

C – Contain/ Confineo Contain fire by closing patient room doors

E – Extinguisho Use fire extinguisher to attempt to extinguish the fire – Remember

P.A.S.S. – Pull, Aim, Squeeze, Sweep

CODE RED

Infant Abduction: Staff stationed to keep watch at all exits to department, stairwells, and elevators CODE PINK

Work Place Violence CODE GRAY

Bomb Warning/ threat: Do not panic! Remain calm! Prolong the conversation as long as possible. If possible, get the immediate attention of a co-worker to let them know that you are receiving a Bomb Threat. Turn off/do not use wireless communication devices; do not change positions of doors/windows.

CODE YELLOW

In the event of a major disaster in the community or internally, the Emergency Department Physician, in consultation with the Chief of Staff (if available), and the administrator on call has the authority to declare a disaster, implement the Emergency Management Response Plan, and in conjunction with the President/Administrator on Call and Chief of Staff, has the authority to terminate the Emergency Management Response Plan. “Return to your area and await instructions”

CODE DIASTER

Inclusive of radiation leaks or individual contamination; Review hazardous decontamination plan CODE ORANGE

When large numbers of patient with multiple traumatic injuries arrive in the ED CODE TRIAGE

National weather service advisories CODE GREEN

Evacuation of the building is required CODE SILVER

Utility failure CODE BLACK

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Security and Safety Review

There are four main Goals of facility security, as follows:

(1) Personal Protection Escorts are available from Security for employees, visitors and patients. Please call and

notify the hospital operator (0) of your needs Keep wallets, purses along with other valuables locked securely Report any physical assaults or threats to Security immediately

(2) Property Protection The following incidents should be reported to Security immediately:

Any thefts of property, either personal or facility Any acts of vandalism of personal or facility property Anything that you feel could be a safety issue

(3) Facility Protection Students are required to display student school ID badges above the waist at all times with

photo visible (4) Parking and Traffic Control

Where are students and faculty allowed to park? Harris Regional Hospital: parking lot closest to the EMS building to the left side of the

hospital Swain campus: parking lot across the street from the hospital Other facilities: ask your preceptor for specific parking instructions

Failure to park in designated parking areas may result in cars being towed from premises.

INFORMATION SECURITY

WestCare information security is achieved thorough the implementation of policies, processes, procedures, software and hardware designed to secure WestCare data. These measures are monitored and reviewed and improved when necessary to ensure specific security is in place and the business objectives of WestCare are met. These information security practices and procedures are concerned with maintaining confidentiality, integrity, and availability of data and assist in protecting from theft, misuse, and unauthorized use.

Knowing who to report a computer-related information security incident to is an important aspect of information security. During a computer-related security incident, you are required to notify your faculty and preceptor immediately of the incident.

COMPUTER ACCESS

You may be provided with computer access as part of your clinical experience at WestCare Health System. Such access may be limited and will be restricted to essential information to do your job ad support your clinical learning experience. Keep in mind that these computers are strictly monitored for inappropriate use and are the property of WestCare. You will be held accountable to the WestCare privacy and confidentiality statement you will sign and for the information provided in this orientation

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manual regarding privacy, confidentiality and information security. Do not share passwords or access inappropriate sites via computer. Failure to follow policy pertaining to computer use will result in discharge from the clinical experience.

PASSWORD

You will be provided with a password to access information and data. This is an important security feature in protecting confidential information and data. Your password is to be kept secure for your use and only your use. No sharing No exceptions. Passwords serve as your identity to the computer. If you suspect your password has been compromised, change it immediately and inform your faculty or preceptor.

LOG OFF THE COMPUTER STATION

In order to protect patient privacy and confidentiality care providers should log off each computer session when finished or when leaving the computer unattended.

UTILITIES INTERRUPTION

In the event of a utility interruption (i.e. power or telecommunications failure), the facility has a generator system that will be employed to provide essential power to the facility. Should overhead lighting fail, flashlights will be provided to the staff. Telecommunication failures are communicated via e-mail and emergency communication procedures are implemented. Administrative staff will be informed and necessary actions taken. Your faculty or preceptor can provide further information regarding your role during utilities interruption.

RADIATION SAFETY

You can reduce your radiation exposure risk by time, distance, and shielding. Key radiation safety tips include:

Any decrease in the amount of time spent helping with a procedure will decrease your radiation exposure

By increasing the distance from the source of radiation (the x-ray tube, the fluoroscopy beam, or an injected nuclear medicine patient) you also decrease your radiation exposure. By merely stepping back one step during a portable exam you can reduce your exposure by more than half and then reduce any radiation exposure side effects. Six feet of distance from the source of radiation is preferable when possible.

By either placing a shield between yourself and the source of radiation, or by properly wearing a lead apron if you are assisting with an exam, you reduce your risk of exposure. During the exam you may be asked to step behind a leaded barrier. If you are female you will be asked if there is any possibility of your being pregnant. If so, you will likely be asked to wait outside the exam room until the procedure is complete. If it is absolutely necessary for you to assist with the exam and you are pregnant, there is no reason to be alarmed if you are wearing the proper shielding. Use protective wear for both you and the patient whenever working in an exposed area.

Lead aprons, worn correctly, will protect you. Remember: aprons that don’t wrap around don’t cover your back – ensure that your back is turned away from the radiation beam.

Lead gloves should be worn when holding a patient or limb during a radiographic procedure. Thyroid collars should be worn for persons needing to remain at the head or foot of the

fluoroscopy table.

Everyone is exposed daily to various kinds of radiation which includes heat, light, ultraviolent, microwave, and ionizing radiation. Ionizing radiation such as x-rays, radiation therapy, and gamma rays used in nuclear medicine are potential sources of radiation exposure in healthcare settings. Sources of

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background radiation include terrestrial (from soil and rocks); cosmic (from outer space); and normal human radioactivity found in the body. We are exposed to approximately 125 mR per year from natural radiation which amounts to approximately 2% of the maximum permissible yearly dose. Radiation exposure from medical diagnostic procedures contributes 4-11% of a person’s yearly dose.

If radiation exposure occurs during a diagnostic procedure, notify the appropriate people that an exposure has occurred. If the exposure is related to a spill, for example urine, prevent the spread of contamination by covering the spill with absorbent paper. Limit the movement of people in the room and don’t allow others to enter if it is not necessary. Notify your faculty or preceptor for further direction.

HAZARDOUS MATERIALS – MATERIAL SAFETY DATA SHEETS (MSDS)

Material Safety Data Sheets are available for every chemical found in individual work areas. MSDS sheets provide faculty, staff, and students with all information regarding handling chemical exposure in accordance with OSHA guidelines. Contact your preceptor for the location of the MSDS sheets in your area. Make yourself aware of potential hazards, routes of exposure, and treatment in your area. Should you encounter a chemical spill – don’t panic. Chemical spill kits are located in each facility.

LOST AND FOUND

Personal property found on the Health System premises should be promptly turned in to Security. Should you lose an item, notify Security. If the item has been turned in, you may claim it after proper identification.

CORPORATE IMAGE

First impressions are considered lasting impressions. WestCare Health System’s goal is to present a professional image to the public at all times, both in person and/or on the telephone, and through all means of communication and interaction. Whether interacting with internal or external customers, students/staff convey the reputation of WestCare Health System; therefore, maintaining a professional, business-like appearance and behaving in a mature, professional manner is very important to our overall success.

All members of the team are expected to exhibit a positive attitude, along with a willingness and eagerness to assist others, recognizing needs before requests are made. Work environments are expected to be neat and clean. Organized workspaces convey that we take pride in our facility and that we are efficient and in control of responsibilities. Infection control, safety, and sanitary conditions must be maintained and are expected of all students and staff.

Because of diversity of duties and activities performed within WestCare Health System, dress requirements and uniforms may differ among various departments. Consequently, each department may have its own set of guidelines. Faculty and students are expected to follow their college or university policy regarding attire and appearance in the clinical environment as well as adhere to WestCare policies. Failure to meet established standards may result in discharge from the clinical rotation.

ORGANIZATIONAL GUIDELINES

Identification Badges Picture ID badges are worn by all faculty and students. If an ID badge is not provided by the college or university, faculty and students must obtained a WestCare ID badge from Security. The badges must be worn above the waist while on duty. Patients have the right to know who is caring for them and the credentials of the care provider.

Grooming

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All faculty and students are required to maintain standards of dress and grooming that are consistent with good hygiene and professional appearance.

Tattoos Visible tattoos are to be covered where possible. Body art of extreme or exotic nature is not permitted to be visible while at work and must be covered.

Hair Faculty and students are required to style or restrain their hair so that is does not interfere with the safe performance of their job. Hair must be neat and clean with little or no ornaments. Sideburns, mustaches and beards must be kept neat and trimmed. Hair color must also reflect a traditional color (as opposed to green, purple, etc.).

Artificial nails WestCare prohibits artificial nails in patient care settings or in the performance of direct patient care. If artificial nails are worn in permitted areas, the nails cannot extend longer than ¼” beyond fingertip. Nail polish, if permitted, must be intact without chips or cracks.

Dress and Uniforms Clothing must be appropriate for the job and area where the work is performed. Clothing must be clean, and in good repair. Uniforms and dress/skirts must be at a professional length.

Shoes When working in patient care areas, shoes are soft soled with covered toes, clean, and in good repair. Foot wear maybe adapted to specific areas worked.

Jewelry/Make-Up/Fragrances Visible pierced accessories other than earrings (unless for religious/cultural purposes) are inappropriate. Jewelry should not be worn where/when it may pose as a sanitation/safety hazard. Make-up must be conservative and professional. Faculty/students are not to wear strong fragrances while in the work environment.

Attendance Students not reporting as assigned will be reported to their faculty.

Cell Phones Students should not bring cell phones into the work environment.

Tablet UseStudents should only use tablets for medical reference purposes and should not be used in the hallways, nurses’ station, or in view of patients or visitors. Tablets should be used infrequently in the clinical setting.

ELECTRICAL SAFETY

WestCare Health System seeks to provide a safe environment for patients and personnel through properly chosen and maintained electrical equipment, proper grounding of equipment, and alert, concerned and knowledgeable staff and guests.

Be alert for the following signs of electrical danger:

Plug doesn’t fit properly in the outlet Feels unusually warm to touch Smells as if burning Makes noise or pop when turned off Has power cord longer than 10 feet Gives inconsistent readings Knob or switch is loose or worn Tingles when you touch it

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Third or grounding pin on the plug is missing Cord is frayed (most frequently occurs where the cord comes out of the equipment)

If any of these are found notify your faculty or preceptor immediately. Do not use defective equipment. Do not attempt to repair the equipment yourself. Make sure that long cords are rolled up or otherwise secured where possible and don’t ever roll beds or equipment over power cords. Lastly, never pull out a plug by pulling the cord. Instead, grasp the plug and pull firmly. Anyone who witnesses, discovers, or becomes aware of information that a piece of equipment has, may cause, or contributes to the injury, illness, or death of a patient or care provider has responsibility to report the incident. This responsibility applies to medical devices used in patient care or diagnosis. Report such incidents to your faculty or preceptor and complete an occurrence report.

Leakage current (low levels of current on the surface of equipment or cords) can occur with defective equipment and can cause micro-shock to the patient. Patients at high risk for micro-shock include those with indwelling cardiac catheters, pacemakers, and chest tubes or drains. To reduce the possibility of injuring a patient from micro-shock, never touch a patient and an electrical device or cord at the same time.

Remember the following:

All electrical medical equipment brought into the hospital must be checked by Biomedical Engineering PRIOR to use to ensure it meets electrical safety criteria

The use of patient owned electrical devices, except those powered by batteries, must be inspected by Engineering Department and labeled

For hospital and/or staff owned electrical devices, contact the Engineering Department for safety criteria or inspection

Extension cords are a frequent cause of electrical faults, improper grounding, and accidents involving falls and fires. The use of extension cords can cause hazards and increase the probability of sparks, and/or electrical shock. In addition, use of extension cords may cause excessive voltage drop resulting in low efficiency, equipment malfunction or damage, and subsequent patient safety problems. For these reasons, the use of electrical extension cords is restricted. If an extension cord is required, contact the Engineering Department.

Remember: Malfunctioning equipment must be removed from service immediately.

POLICIES AND PROCEDURES

Each facility has a set of specific policies and procedures with which you should make yourself familiar based on your clinical assignment. Adherence to these policies and procedures can impact delivery of patient care, ethics, legalities, and regulatory standards. These policies and procedures may include some or all of the following topics and are not meant to be exclusionary:

Pain management Restraints Fall prevention Adverse drug reactions Assessment and reporting of abuse and neglect Handling of hazardous medications and chemicals Nursing procedures Risk management and occurrence/incident reporting Workplace violence Personal conduct policies

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Faculty and students are responsible for knowledge of how to access the information on facility specific policies and procedures. Ask any facility staff for clarification of policy or procedure or the location of site or unit-specific policies and procedures.

Medical Waste Disposal

Pharmaceutical Waste - RCRA Classification Table

FLAMMABLE/TOXIC PHARMACEUTICALSDISCARD WASTE IN BLACK BIN

ALPROSTADIL SOLUTION DECAVAC PHENASEPTICAMMONIA SOLUTION INHALANT DEHYDRATED ALCOHOL PHENOL EZ SWABSARGATROBAN DIPHTHERIA/TETANUS TOXOIDS ADS SANDOSTATIN LAR DEPOT KITBETAMETHASONE DIPROPIONATE AUG CREA

FASLODEX SSD

BLEPHAMIDE S.O.P. GRAMICIDIN/NEOMYCIN/POLYMYXIN SUPRANECLEOCIN PHOSPHATE SOLUTION HUMULIN R and HUMALOG TETANUS TOXOID ADSORBEDCLINDAMYCIN SOLUTION LANOXIN THERA-M ENHANCEDCOLY-MYCIN S LANTUS SOLOSTAR TOPOSARCYANIDE ANTIDOTE MITOMYCIN TRACE METALSCYCLOPHOSPHAMIDE NOVOLIN N TRIFLURIDINECYTOXAN PACLITAXEL

P-LISTED WASTE & PACKAGINGPHYSOSTIGMINE SALICYLATE NICODERM CQ COUMADIN*ALL P-LISTED WASTE AND ITS PACKAGING MUST BE CAPTURED IN A PLASTIC BAG, SEALED AND THEN DISCARDED IN THE BLACK BIN. NICODERM CQ PATCHES THAT HAVE BEEN WORN BY THE PATIENT DO NOT NEED TO BE CAPTURED. IF A TABLET OR A PATCH HAS BEEN OPENED BUT NOT USED, PLACE IT IN ALONG WITH THE PACKAGING/CONTAINER IN A PLASTIC BAG, SEAL IT AND DISCARD IN BLACK BIN. REPORT WASTE OF PHYSOSTIGMINE TO PHARMACY FOR SPECIAL TRACKING OF WASTE.

AEROSOLS (SEND TO PHARMACY)Return pressurized aerosols to the pharmacy for further segregation.DERMOPLAST SPRAY HURRICAINE SPRAY ETHYL CHLORIDE

OXIDIZERS (SEND TO PHARMACY)Return unused/expired silver nitrate to pharmacy for further segregation. Used silver nitrate sticks can be discarded in the red bag.

SILVER NITRATE

CORROSIVE ACIDS (SEND TO PHARMACY)Return corrosive acids to pharmacy for further segregation. MULTITRACE-4 CONCENTRATE

MIXED INFECTIOUS HAZARDOUS WASTEIf any of your RCRA hazardous medications is mixed with blood or bodily fluids (blood drawback in IV tubing, infectious needles, etc), these are to be set aside in the black container and marked with additional “BIOHAZARDOUS” labels. Notify Heritage Environmental and we will prepare for shipment.

CONTROLLED SUBSTANCESCONTINUE WITH DOUBLE WITNESS WASTING PROCEDURES PER DEA REGULATION.

DIAZEPAM SOLUTION

BIOHAZARDOUS/INFECTIOUS (REGULATED MEDICAL WASTE)DISCARD WASTE IN RED BAG OR SHARPS CONTAINER

ABRAXANE DIGIFAB PRIVIGENALBUMIN EPOGEN PROCRITARANESP HYPERRAB S/D PROFILNINE SDBAYHEP B IMOGAM RABIES-HT PULMOZYMEBAYRAB M-M-R II RECOTHROM

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BAYTET NABI-HB RHOGAM ULTRA-FILTERED PLUS

BOTOX OCTAGAMTHANK YOU FOR CHOOSING WESTCARE FOR YOUR CLINICAL EXPERIENCE WE WELCOME THE

OPPORTUNITY TO SUPPORT YOUR CLINICAL TRAINING AND WISH YOU WELL IN YOUR FUTURE HEALTHCARE CAREER

APPENDIX A: PRIVACY AND CONFIDENTIALITY STATEMENT

WestCare Health System considers protecting patient private and confidential information the highest priority. In the course of your educational activities at WestCare Health System including: Harris Regional Hospital, Swain County Hospital, WestCare HomeCare, WestCare Hospice, and the MedWest Physicians Network you may have access to confidential information about patients or other individuals involved in a patient’s care. You have the responsibility to maintain the privacy and confidentiality of all patient information you are aware of during your clinical rotations.

I understand my responsibilities for safeguarding Protected Health Information (PHI). I understand I must maintain the privacy and confidentiality of all verbal, written, and electronic information. I understand patient information is protected by law. Furthermore, I understand that violations of confidentiality and privacy could result in discharge from my clinical/faculty rotation with WestCare and/or penalties provided by law.

I agree to the following:

To view only the information necessary to fulfill my educational requirements To share only necessary information with those who officially need to know To handle all records, written or electronic, in a manner to prevent unauthorized use or disclosure

of patient information To not photocopy or remove any patient information from any WestCare Health System facility To not audio or videotape any patient encounter without written permission from WestCare and

the patient To not photograph any patient or portion of a patient without written permission from WestCare

and the patient Any passwords that have been assigned to me are intended for my sole use. I will not share

them and will not attempt to learn or share others’ passwords. If I discover someone has knowledge of my password, I will immediately notify my clinical supervisor. If I willfully allow my password to be known by another, I understand I will be held accountable.

I have read and agree to comply with the terms of this statement. Failure to comply with these terms may result in the termination of my student privileges within the WestCare Health System.

Faculty/Student Name ______________________________________________ (Print)

Faculty/Student Name ______________________________________________ (Signature)

College/University _________________________________________________

Program of Study __________________________________________________

Date: _______________________

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APPENDIX B: COMPLIANCE AGREEMENT

By my signature below I indicate I have reviewed the Corporate Compliance information and the Code of Conduct information contained in the Academic Affiliate Clinical Orientation Manual. I agree to perform in accordance with the WestCare Health System Corporate Compliance policies and the Code of Conduct. I am aware that failure to comply, including reporting of known violations, can result in discharge from the clinical experience and termination of my student/faculty privileges within a WestCare Health System facility.

Faculty/Student Name ______________________________________________ (Print)

Faculty/Student Name ______________________________________________ (Signature)

College/University _________________________________________________

Program of Study __________________________________________________

Date: _______________________

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APPENDIX C: ACADEMIC AFFILIATE CLINICAL ORIENTATION POST-TEST

Instructions: Select the best answer and indicate your choice by circling the letter by your response.

Where is the appropriate location to wear your photo identification badge? a. Above your waist with the photo visible b. On the front seat of your car at your waist c. Wearing your photo identification badge is not required

When lifting and carrying you should: a. Bend at the waist b. Lift the item to assess how heavy it is c. Tuck your gluteus muscles d. Hold the load close to your body

When handling sharps you should: a. Always recap a needle b. Aim the sharp towards you c. Dispose of all sharps in a proper container immediately d. Always break the sharp into smaller pieces to fit in the container

In the event of a fire, the first action faculty or students would take after discovering the danger is: a. Remove all patients, staff and visitors that are in immediate harmb. Report the fire c. Await evacuation orders

When reporting a fire, you should: a. Report your concern after you investigate the source b. Pull the alarm and call the operator c. Alert everyone using the over head speaker system d. Call the fire department

What does the acronym R.A.C.E .stand for? a. Report, Alarm/Alert, Control/Confine, Exit b. Rescue, Alarm/Alert, Contain/Confine, Extinguish c. Run, Apprehend, Correct/Confine, Exit d. Rapid, Alarm/Alert, Control/Confine, Extinguish

Which of the following is not a sign of potential danger? a. Improperly fitting plug b. Unusual warmth to touch c. Loose knob or switch d. Secured power cord

The use of a patient’s own electrical device is not a safety concern. a. True b. False

The use of an extension cord is a safety risk. a. True b. False

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The duration of exposure (time) to radiation reduces your risk. a. True b. False

Placing a shield between you and the radiation source decreases your exposure. a. True b. False

The minimum recommended distance between an individual and the radiation source is 6 feet.a. Trueb. False

Frequent and thorough hand washing is the best way to prevent transmission of infectious organisms.

a. Trueb. False

It is not necessary to wash your hands after you remove your gloves.a. Trueb. False

If I sneeze and cover my mouth and nose with my hand, I don’t have to wash my hands as no germs have been spread.

a. Trueb. False

It is appropriate to use alcohol-based cleansers (hand sanitizers) for the following:a. Patient in contact isolationb. To remove blood from handsc. When no visible soiling of the hands is present and no isolation has been ordered d. It is never permissible to use alcohol-based sanitizers

MSDS stands for:a. Multi Service Detail Stampb. Material Safety Data Sheetsc. Many Staff Details Sheetd. May Substitute Drugs Safely

MSDS: a. Are available for reference in the event of a chemical spillb. Describe how to clean chemical spillsc. Are available in 4 languages at WestCared. a and b only

Patient, personal and financial information are considered:a. Confidential information and should be shared only with authorized individualsb. Public information and can be shared on FaceBookc. Confidential information but can be shared with anyone requesting it

At WestCare, it is not permissible to discuss patient information:a. In the cafeteria during lunchb. In the elevatorc. With your colleagues in the parking lotd. All of the above

If you discover someone is using your confidential computer password your first action would be: 27


a. Ignore it, no one will find outb. Report it to my instructor and preceptorc. Confront the person using it and tell them to stopd. Call the Administration office

To resolve an ethical situation, you would:a. Deal with it yourselfb. Discuss the situation with your peers to come to a resolutionc. Call the patient advocated. Discuss with your instructor and/or preceptor

The primary goal of the implementation of the Joint Commission National Patient Safety Goals is: a. To improve patient safety in health care settingsb. To increase the burden on health care providersc. To improve patient outcomesd. Both a and c

The two patient identifiers used to identify all patients prior to treatment and procedures are:a. Name and room numberb. Room number and diagnosisc. Name and date of birthd. All of the above

Appendix D: ACADEMIC AFFILIATE CLINICAL ORIENTATION MANUAL EVALUATION FORM

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WestCare Clinical Learning wants to ensure that students and faculty receive appropriate orientation to our environment. Please take a moment and complete the following evaluation to provide us with feedback on your experience with the online orientation manual. All response data will be confidential

Please place an “X” in the column corresponding with your selected response:

Item Strongly Agree

Agree

Neither

agree or

Disagre

e Strongly D

isagre

The online clinical orientation manual was convenient and easy to useThe content of the online orientation manual was easy to understandI prefer online orientation

I prefer an in-person orientation

I was able to have my questions answered

The online clinical orientation manual enhanced my knowledge of the clinical environment and WestCare Health System

I recommend the following:

Other comments:

APPENDIX E: INFORMATION SYSTEM STUDENT/FACULTY ACCESS FORM (Complete this form ONLY if you document in the Medical Record)

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Please complete the following information and submit to faculty:First Name:

Middle Name:

Last Name:

Date of Birth:

SSN:

Current WestCare Employee?

College/ University

Program of Study:

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academic affiliate clinical orientation...

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