HOSPITAL ORIENTATION 2010

June 22, 2010Center for Health and Healing

Dr. Donald Girard, Associate Dean of GME & CME

Dr. Andrea Cedfeldt, Assistant Dean for GME

Dr.Tana Grady-Weliky, Associate Dean of Undergraduate Medical Education

ACGME Core Competencies

Patient AdvocateSusan Yoder, RN, BSN

Director, Department of Patient RelationsAdministrator on Duty & Decedent Affairs

Manager

Patient Advocacy• Complaint Management• Mediation & Conflict Resolution• Accessing & Navigating Systems

Palliative Care Consult ServiceSpiritual Support – Chaplaincy ServicesMedical Ethics ConsultationCrisis Intervention & Debriefing for Staff

Department of Patient Relations

Administrator on Duty & Decedent Affairs

Administrator on Duty• Front Line Hospital Administration • “House Supervisor” (on steroids)• Patient Placement/Access Management• Bereavement & Requesting Organ/Tissue Donation• Conflict Resolution/Crisis Intervention • Resource to the Healthcare Team (policies, etc.)Decedent Affairs• Track documentation & location of deceased patient• Work with providers, staff, ME, Funeral Directors & Loved

Ones for a smooth, compassionate process

Contacts:

Patient Relations for an Advocate X4-7959Administrator on Duty (AOD) pager 12241 24X7Decedent Affairs Coordinator pager 12813

(covered by AOD after hours)Hospital Chaplain – Campus Operator

Susan Yoder pager 11405

Welcome to OHSU!

E*Value SystemChristine Flores

Evaluations and Time Keeping

Sleep Deprivation in Residency

Dr. Holger LinkSleep deprivation in residency

Epworth Scale

The Scope of the Problem

“… I always had a prior theory that when you look up all the old sixties research how do you brainwash someone? You sleep deprive them. That’s number, two, and three. Sleep deprive them. You feed them bad food and you repeat things over and over again. It’s like that kind of covers residency.”

© American Academy of Sleep Medicine

© American Academy of Sleep Medicine

American Academy of Sleep Medicine

Epworth Sleepiness Scale

Sleepiness in residents is equivalent to that found in patients with serious sleep disorders. Mustafa and Strohl, unpublished data. Papp, 2002

0

5

10

15

20

Mean 5.90 2.20 11.70 14.70 17.50

Normal InsomniaSleep Apnea

Residents Narcolepsy

Consequences of Insufficient Sleep

• Increased medical errors• Impaired judgment• Impaired learning• Impaired physical health• Impaired mood and energy• Drowsy driving

Adapting to Sleep Loss

• Sleep need is genetically determined

• You can’t “adapt” to getting less sleep than you need

• Performance may improve somewhat with effort

• You can not achieve optimal performance!

Recovering from Sleep Loss

• Recovery from on-call sleep loss generally takes at least 2 nights of extended sleep

• Most sleep debts can be paid off in 3-4 days!

Source: www.drowsydriving.org

Driving Home Post Call

Signs of Drowsy Driving

Trouble focusing on the road

Difficulty keeping your eyes open

Nodding

Yawning repeatedly

Drifting from your lane, missing signs or exits

Not remembering driving the last few miles

Closing your eyes at stoplights

Drowsy Driving:

What Doesn’t Work

Turning up the radio

Opening the car window

Chewing gum

Blowing cold air (water) on your face

Slapping (pinching) yourself hard

Promising yourself a reward for staying awake

4 second lapse = drowsy crash

Drive Smart and Safe

Do not drive drowsy!

Take a 10-20 minute nap and/or drink a cup of coffee before going home post-call

Stop driving if you notice the warning signs of sleepiness

Pull off the road at a safe place, take a short nap

Get ride home, take taxi, or use public transportation

Napping

Benefit: Temporarily improves alertness

Types: Preventative (pre-call)

Operational (on the job)

Length:

Short naps: no longer than 20 minutes to avoid grogginess Long naps: 2 hours (range 30 to 180 minutes). Be aware of sleep-inertia.

Caffeine

Strategic consumption is key

Effects within 15 – 30 minutes; half-life 3 to 7 hours

Use for temporary relief of sleepiness

Cons:

Disrupts subsequent sleep (more arousals)

Tolerance may develop

Diuretic effects

Library ServicesAndrew Hamilton

Overview of the Library

Library is here

OHSU Library

• You need one• Where you can get

one– Library circulation

desk– Online at

www.ohsu.edu/xd/education/library/services/forms/barcode.cfm

Barcode

The Library Home Pagewww.ohsu.edu/xd/education/library/

Online Catalog

Get access from off-campus

Get help

Databases

Electronic articles and journals are linked from within databases.

Databases may include their own links to full text, as well as the “Find It@OHSU Library” link.

3 different ways to get to the article

Manage your citations

What if we don’t have it?

Summit Catalog

• Includes 36 college and university libraries in Oregon and Washington

• You can request books, videos, CDs through Summit and they will be sent to the OHSU Library for you to pick up or will be sent directly to distance students

• Generally it takes less that 72 hours to get the book• 95,000 titles at OHSU; 9.2 million titles in Summit• IT’S FREE• More information at

www.ohsu.edu/library/orbiscascade.shtml

Ways to get help:•Ask a Librarian links•Chat•Email•Phone

Infection Prevention & Control Summer, 2010

Department of Infection Prevention & Control: Objectives

• How to contact our program• Review resources that will be helpful when

caring for patients• Review the OHSU isolation categories• Organism – specific guidelines• Employee Health topics

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Department of Infection Prevention & Control

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VA Medical Center Rita Tjoelker- 5-7143 Sherri Atherton-5-7144

Tom Ward, MD– Infectious Diseases

Phone: 494-6694 M-F 7:30AM - 5:00PM– Contact AOD after hours

• Physician Epidemiologists– John Townes, MD Adult Infectious Diseases– Judy Guzman-Cottrill, DO Pediatric Infectious Diseases– Lynne Strasfeld, MD Transplant Infectious Diseases

• Infection Control Program Manager– Marjorie Underwood RN, CIC

• Infection Control Specialists– Linda Young RN, MSN, CIC– Molly Hale MPH, CIC– Emily Ackiss MPH, CIC– Gail Carberry RN, MSN

The IC Isolation Grid as a Resource

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Isolatable Infections & Conditions

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De-isolation Grid

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EPIC VRE Alert Screen

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Back to Basics:Hand Hygiene

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Cleaning your hands isthe most important thing you can do to prevent transmission of infection

Hand Hygiene

Interrupts the chain of disease transmission

• Antibacterial Soap & Water – Hand friction for 15 seconds

• Hand Sanitizer needs to dry

• Ensure all surfaces of hands, in between fingers & nail beds are cleaned

WHO: “5 Moments of Hand Hygiene”

Hands Visibly Dirty? Wash Your Hands with Soap and Water

Turn on faucet Wet your hands with warm

water Apply soap Scrub your hands for at

least 15 seconds Pay attention to fingernails

and areas around jewelry (rings and watches)

Dry hands completely with a paper towel

Use a paper towel to turn off faucet

Hands Not Visibly Dirty? Use alcohol-based waterless product

Apply enough to cover all surfaces of the hands, rub until dry, about 15 seconds.

Resident Hand Hygiene Compliance

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How do Residents Compare With Others?

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Standard Precautions: Protect Yourself!

• 100% compliance with hand hygiene• Gloves if touching non-intact skin or rash,

any body fluid or mucous membrane• Gown if you may get it on you• Mask/face protection if you may get

sprayed or splashed in the face

…Think about it before it happens!

Remember - if it is wet and it is not yours- use a barrier!

Standard PrecautionsDetails you might not know…

• During aerosol generating procedures (bronchs, suctioning, intubation, nasal wash, NP cx, etc.) use face shield or mask & goggles

• If pulmonary TB or other diseases requiring airborne isolation is suspected, wear a fit-tested N95 masks or PAPR

• Wear masks for spinal procedures (myelograms, LPs, spinal or epidural anesthesia)

Respiratory Hygiene & Cough Etiquette

• YOU and your patients should follow these rules!

• Wash hands after coughing and using tissue

• Wear mask/eye protection if close to coughing patient (if contagious disease is suspected, patient should be in private room)

• Provide patients with tissues, instruct them to cover their coughs, have hand sanitizer available

Isolation Precautions (In addition to Standard Precautions)

1. Contact Precautions2. Modified Contact Precautions3. Droplet Precautions4. Airborne Precautions

Isolation categories may be used in combination, if needed – Example: Chickenpox (airborne + contact)

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Contact PrecautionsExamples

– Diarrhea - if incontinent, diapered, or contaminating the room

– Norovirus until 72 hours after lastdiarrhea episode

– Multi-drug resistant organisms (MDRO)– Draining wounds or body substances not contained– Nasty rashes that may be contagious

• Scabies, secondary syphilis

MRSA and VRE & Other Multi-drug Resistant Organisms (MDRO)

• For colonized and actively infected pts• Contact Precautions

– You must wear gloves and gowns every time you go into the patient room

– Even if you are not touching patient or environment!

• Patient’s room & equipment contaminated• Hand Hygiene after gloves come off

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“De-isolation” for MDRO

• Usually occurs in the ambulatory setting, because patient must be clinically well

• Rule of 3’s:– 3 months since last positive result (cx or PCR)– Must be off abx for 3 weeks– Obtain 3 screening tests 1 week apart

• Contact Infection Control Dept for additional guidance or for EPIC alert screen removal

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Modified Contact Precautions

• Same as Contact Precautions with the exception that traditional handwashing with antimicrobial soap and water must be used

• NO hand sanitizer• Use for patients with positive, symptomatic C.

difficile diarrhea or high clinical index of suspicion • Isolate until Rx complete and 72 hr symptom free• Rooms cleaned with bleach to kill C. diff spore

Droplet Precautions

• Used for pts known or suspected to be colonized or infected with microorganisms transmitted by large-particle respiratory droplets

• Conditions that may require Droplet Precautions– Any symptomatic respiratory viral illness, even if

pathogen unknown– Haemophilus influenza type b (Hib)– Meningococcal disease– Mumps– Pertussis (Whooping Cough)

Contact + Droplet Precautions

• When one set of precautions is not enough!• Conditions that may require Contact and

Droplet Precautions– Respiratory Syncytial Virus (RSV)– Adenovirus pneumonia– Parainfluenza– Influenza A &B– All pediatric bronchiolitis (even if culture negative)– All immunocompromised hosts with respiratory

viral infection

How do YOU take off YOUR gloves, mask and gown?

Airborne Precautions

• Small droplet nuclei stay suspended in the air for prolonged periods of time

• Room Requirements: – Private room– Negative pressure airflow with ante-room– Doors always closed except for entry/exit

• Personal Protective Equipment:– Fit-tested N-95 Mask or PAPR

• Diseases requiring airborne precautions: – Pulmonary or laryngeal tuberculosis– Measles– Chicken Pox (Varicella) or disseminated zoster

N95 Respirator or PAPR

• A Fit Test is now required if you wear an N95 TB mask (orange duckbill)– Fit-check each time mask is put

on

• If you cannot or have not been fit tested for N95 mask:– Use a Powered Air Purifying Respirator

(PAPR) to enter a room with a patient who has active pulmonary TB

– Disinfect the PAPR on the inside of the hood and then on the outside in between use.

Tuberculosis

• Airborne Precautions in negative airflow room– Rule out pulmonary TB (work up in progress)– Confirmed pulmonary TB– Laryngeal TB

• Patients need to be restricted to their rooms other than medically necessary procedures (no smoking!)

• OR cases- Should be the last case of day, unless emergent

• Discontinue Isolation– 3 negative AFB-smear sputum samples– ADEQUATE SPUTUM SAMPLES

Reportable Infections (Case Reporting to the Health Department)

• If disease confirmed by a lab test, OHSU lab automatically reports cases to the health department

• Clinicians required to report to county of patient’s residence for clinically suspected cases or culture-negative cases– Toxic shock syndrome, hemolytic uremic syndrome

• Call Infection Control Program for assistance

Spotlight on Infection Prevention:Central Line-Associated Bloodstream Infections(CLABSI)

• Evidence-based guidelines must be followed (CLABSI Bundle) every time

Hand hygiene Maximum sterile barrier precautions Chlorhexidine skin antisepsis Choosing best anatomical site for insertion Use of an Insertion Checklist Remove line ASAP

• Mandatory CLABSI Educational Module (Big Brain) for all house staff

• Rates are publicly reported in Oregon

Sani Cloth® Plus

• Use on computers: keyboard, mouse and screen

• Patient care equipment: wheelchair, gurney, BP cuff, stethoscope, etc.

• Use 2 wipes(1) Clean off debris, gross contaminants

(2) Disinfection• Allow 5 minutes to dry (“contact time”)

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Avoiding Exposure to Bloodborne Pathogens

• Minimize or eliminate splash, spray, splatter, and droplet/aerosol generation

• Do not bend or recap sharps or needles• Contain specimens during transport• Proper use/laundering of scrubs, etc• No food/drink near blood or other

potentially infectious material– No food/drink in patient care areas!!!

Protect Yourself!

Use Standard Precautions every time you care for a patient

or handle blood & other specimens

Safety goggles are available through

Logistics

What to do if you have a blood or body fluid exposure

1. Wash the area well with soap and water

2. Flush eyes well with water if splashed

3. Immediately report accident to your supervisor

4. Call Employee Health for low risk exposure advice Monday-Friday

5. Report to the Emergency Department for high risk exposures or those occurring after hours, or on weekends

6. Bring patient name, medical record number, and any known HIV risk factors

• Complete confidential and free baseline & follow up lab testing and counseling

2009 OHSU Bloodborne Pathogen Exposures

• 368 exposures in 2009– 150 hollow needles– 133 solid sharps– 78 splashes– 7 Bites & Scratches

• Source Patient– 2% HIV +– 16% HCV+– 0.3% HBV+

• No Conversions

Employee Health Program

• Main phone number is 4-5271• TST is required on hire and ANNUALLY• Exposure follow up

– Bloodborne pathogens– Communicable diseases

• Immunization history and vaccines– Annual Influenza vaccine– Tdap

INFECTION PREVENTION & CONTROLWe are here to assist you!

• Call us when you have questions or need clarification

• Call if a patient needs an MDRO alert screen placed

• We like to be involved earlier rather than later…

Phone: 4-6694Email: infcont@ohsu.edu

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Interpreter ServicesSamia Saad

Resources and Legal Requirements

If you talk to a man in a language he understands, that

goes to his head. If you talk to him in his

language, that goes to his heart.

-Nelson Mandela

OHSUMedical Interpreter Services

Mission Statement

 

“Our goal as Medical Interpreters is to provide communication support for the healthcare professional and the patient. Our

support gives strength the interpersonal relationship between the hospital staff and the patient, and therefore enhances the

quality of patient care. We are committed to service excellence by our dedication to all parties who need our

services.”

 

 

 

OHSU Medical Interpreter Services

• MIS Department was established 30 years ago. It is located on OHSU campus.

• Interpreter Services Department serves all OHSU patients in all OHSU departments.

• MIS department serves all languages in person, via telephone, and video.

• Interpreter operation at OHSU is 24 hours a day, 7 days a week.

Why does OHSU Provide Medical Interpreters?

• Communication is the very heart of health care. It is a process that leads to the development of trust between a patient and a provider.

• Growing diversification of the U.S. population brings a necessity to provide equal access to health care for people who have limited English Proficiency (LEP) or the deaf and hearing impaired.

• It is the policy of OHSU to provide equal access and equal participation in health care activities for persons who are deaf or hearing impaired, and for persons with Limited English proficiency as governed by Title VI of the Civil Rights Act of 1964.

• All recipients of federal funds must comply with these requirements at no cost to the patient or to the healthcare professional. The function of a medical interpreter in this process is to facilitate the implementation of this policy.

Top 20 Languages used July 2009- Feb 2010

76%

10%

4%

3%

1%1%

1%

1%

1%

1%

1%

0%0%

0%

0%0%

0%0%

0%0%

Spanish Russian Vietnamese Cantonese Sign Language Mandarin Somalia

Arabic Korean Farsi Burmese Cambodian Bosnian Nepalese

Japanese Romanian Ukrainian Mien Laotian Kirundi

Who are the OHSU professional health care interpreters?

• OHSU Medical Interpreters are native speakers and linguist professionals. They have been certified by the OHSU Translation & Interpreter Dept as Medical interpreters after successfully passing a written and oral examination for medical interpreters developed and administered by the OHSU Translation & Interpreter Services Department.

• They are fluent and proficient in English and the target language• They possess vast knowledge of medical terminology • Medical Interpreters are professionally trained to interpret in consecutive

mode of interpretation and are able to do sight translations • They comply with The National Standards of Practices and The Code of

Ethics for Interpreters in Health Care, established in this industry

Scope of Service:

• Medical Interpreter Services is able to provide the following specific services:

• Telephone interpretation (about 80% of the total volume)

• Face-to-Face interpretation

• Videoconferencing (VIP) At CHH

• Limited translation services are available for discharge instructions, letters to patients, directions to the medical facilities and instructions on taking medications. Any complex or lengthy materials will be referred to the contract translation agency

• A selection of translated documents is available on the OHSU Translation Web Site at http://ozone.ohsu.edu/healthsystem/PED

OHSU MEDICAL INTERPRETER SERVICES

OHSU MEDICAL INTERPRETER SERVICES

Business hours are:

Monday through Friday

7:30am to 5:30pm

 

INTERPRETING SERVICES ARE AVAILABLE AT ALL TIMES, EVERY DAY 24 HOURS A DAY.

Our main telephone number is

 503-494-2800 option 1

 

For scheduling

For interpreting and translation questions

For language competency exams

For any question pertaining to interpreting services

 Direct telephone numbers to specific languages for phone interpreting:

Spanish is 503-494-8900

Russian is 503-494-8922

Vietnamese 503-494-8989

Chinese 503-494-4914

DURING BUSINESS HOURS WE COUNT ON:

1 Chinese interpreter

3 Russian interpreters

1 Vietnamese interpreter

11 Spanish interpreters

 

4 language agencies

AFTERHOURS:

Call OHSU Operators at 503-494-8311

 They can connect you to any language interpreter for phone interpreting and assist you in getting a face to face interpreter if the need arises.

 There is a Spanish interpreter at OHSU Monday to Friday until 11:30pm. On Saturdays, Sundays and Holidays, there is Spanish interpreter on campus from 8am to 6pm.

FOR FACE TO FACE INTERPRETING

 

Call the dispatcher at 503-494-2800 option 1

For clinic appointments:

Language indicator in Epic has to be present in RED. This automatically schedules a phone interpreter for all appointments.

We have to rely on phone interpreting because DEMAND FOR OUR SERVICES IS MUCH GREATER THAN INTERPRETER THE AVAILABILITY

While phone interpreting may seem less than ideal, our experience has shown that many encounters can successfully and effectively done with a phone interpreter.

Given our limitation of resources, we have to be very judicious about scheduling face to face interpreters, hence you will probably be asked why you need an interpreter in person versus by telephone

There are encounters are much more effectively done with a face to face interpreter

If in doubt, please call us

How to schedule interpreters?

Bilingual Assessment Tests for all OHSU employees

• MIS Department provides free bilingual assessment tests for all OHSU employees for all languages.

 • The exam consists of a written part, and an oral part. Passing score should be at 80% or more for

both exams in order for employee to be certified by MIS.

 • The exams were developed by MIS Department to enable employees to use their language skills with

patients or customers at OHSU.

 • Bilingual exams available:

1. Professional Interpreters Exam (Employees who would work as Medical interpreters)

2. Language Proficiency for Medical Staff- Doctors, Nurses or any staff members who use medical terminology in their scope of work

3. Language Proficiency Exam for Non- Medical Staff- Registration people, case workers, schedulers etc. 

Call Samia Saad, or Monica Serrano at 4-2800 to schedule time for the exam.

Testing are done between 8:30am and 3pm Monday-Friday.

Questions?

سؤال أيВопросы?

¿PREGUNTAS?

Safety/Environment of CareNina Wolf

Ben RichardsEnvironment of Care

The Joint Commission

Environment of Care

Standards in OHSU Hospitals and Clinics

Environment of CareCommittee

503/494-7795

Why?

Goal: “Provide a safe, functional, supportive, and effective environment for patients, staff, and visitors.”

Test:

What do you expect if YOU are a patient?

Patients are being taught to look for, and empowered to ask about safety issues.

General Safety

• Ergonomics – Adjustable furniture (including CIMs) and

assessment help• Incident Reports• Patient Lifting

– Page the Lift Team… ask your nurses• Tobacco Free Campus• Waste Handling

– Trash, Medical (Red Bags), Pathological, etc.

Hazardous Materials Safety

• Know what you are working with• Labels–Manufacturer containers–Secondary containers

• Material Safety Data Sheet (MSDS)• Spill Response Team

Personal Protective Equipment (PPE)

N95 – requires medical certification and fit test (annual event)

Use: whenever there is a potential or actual exposure risk

Limitations: soak through, single use, etc.

Types: mask, gloves, face mask, gown, lab coats (sometimes), eye protection, etc.

Fire Response

• RACE:– Rescue anyone in danger– Activate the Alarm– Confine the fire (close doors and windows)– Evacuate – if ordered

• Moving around– Avoid the elevators - Some are safe, but reserve them

for people who can’t use the stairs– You CAN go through fire doors…

just make sure they close after you– Move to another compartment

if instructed (marked by flame decal)• Listen for instructions from area leadership

Medical Equipment

• Train before use and document your training• Clinical Technology Services checks all equipment

prior to use around patients– Inspection and

Periodic Maintenance• Lasers, X-ray, Fluoroscopy, others

– Training? Tests? Badges? • Department specific requirements

• Cell phones and other devices– Settings can be changed when used close to

medical equipment• Malfunction? Clinical intervention & report!

Preventative Maintenance

Done _________ By ____________

Due __________ CE# ___________

Utility Problems

• What do you do?• Clinical intervention • Refer to Emergency Resource Book! to

call the right people

Emergency power: red plugs Critical equipment only

4-8054

Public Safety

• Photo Identification – always!• Security Sensitive Areas - ED, Pharmacy, Pediatric

areas, L&D, Mother Baby, inpatient psych, etc.

• Emergency? – 4-4444• “Dr. Strong”• Forensic Patients – orientation handout to

officers, safety considerations• Code Pink – your role• Clinical Violence Alert Symbol

Emergency Preparednessand Response

• Emergency Resource Books and Manuals• Prioritize your personal safety• Assess your area for safety hazards,

injuries, damage, utilities • Report to area supervisor• Defer to staff expertise• Incident Command System

– NOT normal operations

• Incident Information Hotline 503 494-9021

• Printed: ERBs, badge backers, yellow phone stickers, etc.

• OHSU Faculty, Staff & Students• Great O-Zone sites• Environmental Health & Radiation

Safety (4-7795)• Public Safety (4-7744)• : (4-4444)

Injury, Fire, Chemical Spill

Resources

15 Minute Break