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Student Orientation Packet
2017 - 2018
This presentation will provide you with a
foundation of knowledge as you begin
your patient care here at Carroll Hospital!
Today…
• Carroll Hospital Center is part of the LifeBridge team!
• Carroll Hospital has more that 400 physicians on its staff representing
over 35 medical specialties.
• We have over 1,800 employees and are the second largest employer
in Carroll County.
• Annually we serve more that 300,000 individuals with direct medical
care, outreach and community programs, diagnostic and outpatient
services and health screenings.
Mission:
Our communities expect and deserve excellent medical treatment, compassionate care and expert guidance in maintaining their health and well-being. At Carroll Hospital, we offer an uncompromising commitment to the highest quality health care experience for people in all stages of life. We are the heart of health care in our communities.
Vision:
Founded by and for our communities, Carroll Hospital will help people maintain the highest attainable level of good health throughout their lives. We strive to be the best place to work, practice medicine and receive care. Our commitment is to be the hospital of choice.
Carroll Hospital Pillars of Excellence
Service
People
Quality
Financial
Growth
Community
AIDETWe expect all of our staff/students/ and volunteers to utilize
the AIDET concept.
AIDET is an acronym that indicates
“The Keys to Effective Patient and Customer Communication”
A: Acknowledge
I: Introduce
D: Duration
E:Explanation
T: Thank you
A- Acknowledge
• Acknowledge the patient by name
• Make eye contact, smile
• Acknowledge everyone in the room (patient and
families)
I: Introduce
• Yourself
• Your skill set
• Your professional certification
• Experience
(To the Staff; to the Manager; and to the patient if you are involved in patient care)
D:Duration
• Give an accurate time expectation for tests
and physician arrival
• Identify/communicate next steps
• When this is not possible, give a time in
which you will update patient on progress
E:Explanation
• Explain step by step what will happen
• Answer questions
• Leave a way to contact you; a nurse call button
or phone number
• Use language a patient can understand
T: Thank You!
• Thank the patient
• You may thank them for choosing
your hospital, and for their
communication and cooperation
• Thank the family for their assistance
and being there to support the
patient
Purpose of AIDET?
• Decreases patient
anxiety
• Builds trust
• Increases compliance
• Reduces complaints
We Impact Our Patients
First Touch……..
Last Touch……..
Heart to Heart…….
HCAHPS
Our Culture of Always
HCAHPS measure…
The perception of frequency versus degree of satisfaction
Patients rate:
- Always
- Usually
- Sometimes
- Never
Our Goals:
- Implement an action plan to increase consistency
and improve performance
- To maximize Medicare reimbursement under Value
Based Purchasing by raising our scores to 70
Some thoughts…
“If the other guy’s getting better, then you’d better be
getting better faster than the other guy’s getting
better….or you’re getting worse.”
Tom Peters
The Circle of Innovation
Survey Questions
• Nurse Communication
• Doctor Communication
• Responsiveness of Hospital Staff
• Pain Management
• Communication about Medications
• Discharge Information
• Noise at Night
• Room/Bathroom Cleanliness
Hardwiring Best Practices…
“The hardwiring of best practices and standardization of
leadership will create consistency.”
“Consistency will then improve performance across the board.”
Quint Studer
If a patient complains of pain to you, inform the patients nurse so that she
can get something to make the patient more comfortable.
Pain Management
Documentation Reminders
The next slide will review
important information that
you need to share with the
Staff Nurse caring for the
Patient you are assigned.
Documentation Reminders
• Are restraints in use? What kind and what is the patients’ response?
• Is the patient in pain? What is their score? Reassess score and obtain vital signs within 1 hour after giving pain medication.
• Fall Potential? What devices are we using to keep the patient safe?
• Is the Bed Alarm in use? If not, should it be? (If you need help to set the bed alarm please ask the Nurse assigned to your patient.
• Please obey all traffic signs!
• Register vehicles
• Lock your vehicle and secure your belongings
• Don’t leave valuables in plain sight
• Pay attention to your surroundings
• Park in appropriate areas
Safety on Campus
Use Emergency Call Boxes for
emergencies and accidents!
Smoking
You are acknowledging receipt of this information and
your understanding of the consequences associated
with any violations.
Accountability
• Identify smoking history on patient assessment
• In a non-judgmental approach, assure the patient
that you understand their addiction
• Ensure the patient/visitor understands our smoke
free commitment and state law
As Healthcare professionals we must set the standard
to make our Community healthier!
Appropriate and Professional Attire
and Appearance
You are acknowledging receipt of this information
and your understanding of the consequences associated with any violations.
What to Wear: What not to Wear:Uniforms and /or scrubs in designated
departments
Facial and tongue piercings
Attire that complies with safety and health
regulations
Jeans on days other than Fridays
Attire that is in good taste Artificial nails in clinical and food areas
Attire that is appropriate for professional
contact with the public
Low-cut and sheer clothing
Clothing with holes
Flip-flops
Sweatshirts and sweatpants
According to Policy
If you are in the hospital for a business-related reason such as:
• Staff meeting
• Education including CPR
• Spirit Speak Out
• Other activity for which you are getting paid
Your are expected to dress in accordance with the policy including
your Carroll Hospital badge!
Infection Control
Standard Precautions and
Transmission-Based Precaution
guidelines and signage still
present challenge throughout
the organization.
Everyone must abide by
the standard identified on
the Infection Control
signs.
Transmission-Based Precautions require:
• Patients to be placed in a private room
• Appropriate precautions sign on the door frame
• PPE (gowns, gloves, masks) in caddy on the door or
on the cart
Airborne Precautions
Droplet Precautions
Contact Precautions
Airborne PrecautionsFor Measles/Chickenpox For Tuberculosis (TB)
Persons entering the room
MUST be immune to measles or
Chickenpox
For suspected or known TB patient,
People entering the room must wear an
N-95 or PAPR.
Contact Precautions
For patients with MRSA, VRE, and
other highly antibiotic-resistant
organisms, RSV, Scabies, etc.
Contact Precautions: Enhanced Contact
For patients with Clostridium difficile
(C.Diff.), wash hands thoroughly with
soap and water only
Droplet Precautions
For patients with influenza,
bacterial meningitis, pertussis, or
RSV, a surgical tie mask preferably
with face shield is recommended
NOTE: Patients with RSV also need to be placed in Contact Precautions
Reducing Healthcare Associated Infections
Associates must wash hands or apply a waterless hand antiseptic:
• Before having direct contact with a patient
• Before putting on sterile gloves to insert catheters or
other invasive devices
• After any contact with a patient, including intact skin
(taking a pulse, BP, or lifting a patient, etc.)
Associates MUST wash hands or apply
a waterless hand antiseptic:
• After contact with body fluids or
excretions, mucous membranes,
non-intact skin, and wound
dressings, even if hands are not
visibly soiled
• When moving from a
contaminated-body site to a clean-
body site during patient care
Associates MUST wash hands or apply
a waterless hand antiseptic:
• After contact with inanimate objects in the immediate vicinity
of the patient
• After using a computer keyboard and/or mouse and before
patient contact
• After removing gloves
Hand Hygiene Guidelines Staff must
wash hands with soap and water:
• When hands are visibly soiled
• After using a restroom
• After caring for a patient with C.
difficile
Corporate Compliance
Corporate Compliance
All Jump Drives (USB, Thumb drives, Flash drives, Memory
sticks, etc) must be cleared through IS (Information Systems)
before used by Associates, Physicians, Students or Outside
speakers
You MUST minimize or sign off a computer when there is the
potential for others to see information
Everyone has the responsibility to protect PHI (Patient Health
Information). This can be verbal, electronic or written. Be
aware of how you dispose of any paper with PHI on it! Never
use this as scrap paper
Do NOT access any information, especially a patient’s chart,
unless you have a work-related reason to be there
Patient Safety and the Joint
Commission
Your Role:
You are an Advocate for Patient Safety!
The Institute of Safe Medication(IOM) reports there are
44, 000 – 98,000 deaths/year from medical errors! This
equals the number of deaths from one 747 airplane
crashing everyday for 1 year. Medical errors are the 6th
leading cause of death.
Joint Commission
In 2002, Joint Commission established National Patient Safety Goals
(NPSG) to help educate Healthcare personnel on Medical Errors.
The Joint Commission developed Standards of Practice that must be
consistently met. Each Patient Safety Goal comes from a Nationally
Reported Sentinel Event. A Sentinel Event is when a Patient is
severely harmed or dies.
Keys to Prevention
By improving all these processes, we can greatly reduce medical
errors. We need to concentrate on the top three!
Let’s review Patient Safety Goals
1. Identify patients correctly
2. Improve staff communication
3. Use medicines safely
4. Uses alarms safely
5. Prevent infection
6. Identify patient safety risks
7. Prevent mistakes in surgery
1. Identify Patients Correctly
Patient identifiers are used when providing care or treatments
such as specimen collection, giving medications, and
tests/procedures
Use at least 2 ways to identify patients
2. Improve Staff communication
Critical Results must be communicated among caregivers.
Critical Results are those that if left untreated, can be life
threatening or place the patient at serious risk. Critical Results
need to be reported to the doctor within 60 minutes after
identification
When writing any orders, charting in the medical record or
using any preprinted form, “Do not use Abbreviations, “
acronyms, symbols and dose designations are not to be used
2. Improve Staff Communication
Handoff Communication is an interactive opportunity to ask and answer
questions. This conveys up-to-date information regarding the patient’s,
care, and treatment. Management of any unanticipated changes can be
discussed. Remember, Handoffs identify the potential risk for errors! A
“Ticket to Ride” is used to communicate essential information when a
patient is transported from department to department.
3. Use Medicines Safely
Labeling medications, medication containers and solutions is
essential. Medications and solutions are labeled even if only
one is being used. Labeling occurs when the medication is
taken from the original package to another container.
Take extra care with patients who take medications to thin
their blood.
Record and pass along correct information about a patient’s
medicines. Find out what medicines the patient is taking.
Compare that list to those being given to the patient. Make
sure the patient knows which medicines to take when they are
at home. Remind the patient to bring a current list of their
medicines when they go to the doctor.
4. Use Alarms Safely
Make improvement to ensure that alarms on medical
equipment are heard and responded to on time.
Check to make sure that the bed alarms are set and audible
to ensure that the patient doesn’t experience a fall.
5. Prevent Infections
Our Hand Hygiene Guideline requires that Associates,
Volunteers and students wash their hands with soap and
water when visibly soiled or contaminated, especially with
blood and/or body fluids. This also applies after using a
restroom or before preparing food or drinks.
Associates must wash hands or apply a waterless hand
antiseptic after contact with body fluids even if hands are not
visibly soiled, after contact with inanimate objects in the
immediate vicinity of the patient, after using a computer
keyboard and /or mouse before patient contact and after
removing gloves.
5. Prevent Infections
Patients and families should be
educated pre-op about preventing
surgical site infections.
6. Identify Patient Safety Risks
Across the country, suicide is the 2nd leading inpatient sentinel
event!
Patients are screened for suicide risk. If you notice a change in a
patient’s behavior, please report this to their nurse or Charge
person. It is better to be on the safe side.
7. Prevent Mistakes in Surgery
Make sure the correct surgery is done on the correct patient
and at the correct place on the patient’s body.
Mark the correct place on the patient’s body where the
surgery is to be done.
Pause before the surgery to make sure that a mistake is not
being made.
A “Time Out” must occur prior to any procedure.
Additional goals at Carroll Hospital
Encourage patients to report safety concerns.
On admission, patients, and families are
made aware how to report safety concerns.
For example, calling for the COT team.
Encourage patients and families to ask for
assistance when their condition gets worse.
Don’t hesitate to ask for assistance if you see
a patient getting worse.
After years of working on
safety, the airline industry
has become very safe. Our
goal is to make Carroll
Hospital extremely safe too!
Reporting Safety Issues
You are instrumental to keep our
hospital safe.
Whenever you see an unsafe
condition, report it to your
Supervisor, call the Safety Hotline at
6909, or record it under “Incident
Reporting” on the intranet.
Don’t wait for someone to get hurt.
Universal Protocol
Universal Protocol focuses on safety for all surgical and
non-surgical invasive procedures. It prevents wrong
patient surgery.
Environment of Care
Environment of Care (EOC)
• Emergency codes provide a system to manage
unexpected situations that may occur on our campus
• Everyone should know how to report an emergency
• Know your responsibilities as a student during all of
the emergency response codes reviewed in this
program
• Identify each code and what it represents
The State of
Maryland adopted
the following codes
to be used
universally
throughout
Maryland hospitals.
Code
BRTTo activate ALL CODES
call
Extension 4444
Let’s review the codes we use at
Carroll Hospital
Code Green:
Used for Behavioral Emergency
What you need to know:
• Make the staff aware that the patient is starting
to “escalate”
• Position yourself in the room close to the door
so that you have a way out if need be
• Don’t corner yourself in the room
• Call a Code Green for any situation involving a
patient with aggressive behavior
Code Grey
Elopement
What you need to know:
An elopement occurs when a patient attempts to
leave/flee the unit assigned and/or the hospital
A Code Gray or elopement is not when a patient
leaves against medical advice
All staff must observe corridors, look out windows and check general areas
for the eloped patient.
Code Orange
Hazardous Chemical Spill
What you need to know:
Any time an associate works with a chemical, it’s their job to know and understand the hazards of risks to using that chemical.
Information about Hazardous materials can be found on Material Safety Data Sheets (MSDS) online link found at the top of the Intranet page.
Code Blue: Adult/Child/Infant
Cardiopulmonary Resuscitation Emergency:
This code is activated when anyone is
discovered in respiratory and/or cardiac arrest
Code Pink
A Code Pink alert is activated in the
event of an attempted or actual
infant or child abduction.
What you need to know:
Cover the building exit nearest to your location in
accordance with the Code Pink Plan
Environmental Services and Maintenance
Associates will patrol the building perimeter
during a Code Pink Alarm
Be on Alert for:
Anyone acting suspicious
Any person or Associate carrying an infant or small child
Any person or Associate carrying a large bag, box, coat or
anything which could conceal an infant/child
OBRRT: OB Rapid Response Team
This team will respond to any woman
presenting with an obstetrical or
newborn emergency.
What you need to know:
• The OBRRT can be initiated by any staff member
by dialing 4444
• Ask the operator to page an OBRRT
• Caller will need to give the patient location
• All OBRRT members carry pagers
• A group page is sent out to the team
• An overhead page will be announced
Code Gold Bomb Threat
Bomb Threat
What you need to know:
All Associates will assess their own area for any
suspicious objects!
If a suspicious object is located, DO NOT move the object!
Do not touch the object or anything attached to it
Code O2
Oxygen Emergency Procedure
What you need to know:
Telecommunications will page the:
Nursing Shift Coordinator
Cardiopulmonary Director
Respiratory Therapist
Maintenance personnel
Those on duty will report to Telecommunications
Code Purple
Firearm/Weapon Present
What you need to know:
If you observe or receive a report of an individual(s) displaying a fire arm or other lethal weapon in a threatening manner, contact the following, if possible:
x4444 Maryland State Police – 911
Notify patients and visitors of the situation and direct them to an area of refuge.
Area of refuge:
Any area that will keep you out of harm’s way,
such as:
Locked room
Locked office
Closet
Exit the building
Code Silver
Active Assailant
What you need to know:
Quickly determine the most reasonable way to
protect your own life. Patients and visitors will
follow the lead of employees and managers.
Know your environment.
Commit to your actions.
Area of refuge:
Any area that will keep you out of harm’s way,
such as:
Locked room
Locked office
Closet
Exit the building
RUN—HIDE--FIGHT
• Run - attempt to escape and evacuate the premises.
• Hide - locate place to hide out of shooter’s view.
• Fight – last resort, disrupt or incapacitate shooter
Code Red
Fire Response Plan
Code Red
• This code is activated in the event of a fire, smoke,
odor of smoke, suspected fire, etc.
• If you report the fire by telephone (ex.4444), you MUST
also activate the nearest Fire Alarm Pull Station.
What you need to know:
Ensure that all exit doors, especially those to
stairways, are not propped open.
All stairwell doors must remain closed and latched
to prevent smoke and fire from entering escape
routes.
DO NOT use elevators during a fire
emergency!
To help you remember the steps to take in the
event of a fire, use the acronym RACE
R: Rescue
A: Alarm
C: Confine
E: Extinguish
COT
Critical Outreach Team
What you need to know:
Inpatient requires urgent attention
Initiated by nurse or other clinical staff
Reasons for call: Acute clinical change or nurse
considers patient at risk
Code Emergency Response
What you need to know:
Staff, Visitor, or Outpatient in need
Code Emergency Response is to ensure that all individuals
requiring emergency care, who are located on the hospital
campus, receive care in a well-coordinated manner.
Emergency Management Plan
When you aren’t
sure what to do,
here is a
resource for
you!
This concludes your Orientation CBT!
Make sure you print and sign all the necessary paperwork and
submit them to The Learning Center.
Education keeps us all informed and ready for various surveyors that come
throughout the year. Thank you for contributing to our success!