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UPMC SHADYSIDE HELP VOLUNTEER MANUAL 2013

Volunteer Manual

UPMC Shadyside HospitalHospital Elder Life Program (HELP)

February 2014


© Copyright, 2000. Sharon K. Inouye, M.D., M.P.H.; with revisions by UPMC Shadyside HELP site VERSION: APRIL 2013) *Not to be shared or reproduced without permission.

Table of Contents

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1. What is the Hospital Elder Life Program (HELP)?1.1. History of HELP1.2. History of HELP at UPMC Shadyside Hospital

2. What is Delirium?2.1 Risk factors for Delirium2.2 The Confusion Assessment Method (CAM)2.3 Delirium is not Dementia

3. HELP Patient Criteria3.1 Patients age 70 and older3.2 HELP Database & Diet Orders3.3 Patients who volunteers will NEVER see

4. What is the role of the HELP volunteer?4.1. Meals4.2. Communication and Comfort (CC)4.3. Recreation and Relaxation (R&R)4.4. On every visit to a patient room4.5. Orientation 4.6. Items for patients use

5. Mealtime responsibilities5.1 Aspiration Risk5.2 Dysphagia5.3 NPO5.4 Thickened Liquids5.5 Diet Type and descriptions

6. Recreation & Relaxation 6.1 Prioritizing patients 6.2 Menu Completion 6.3 IPAD use

7. Communication & Comfort

8. Rhythm of the Shift & Directions on the Diet Orders 8.1 Active Range of Motion (AROM)8.2 Out of Bed (OOB)8.3 Fluid Protocol8.4 Tray Set-up8.5 Menu HELP

8.6 Offer AHD8.7 Complete Survey at Discharge

9. Volunteer Interaction with Hospital Unit staff9.1The Role of the Patient’s RN (Registered Nurse)9.2The Role of the Patient’s NA (Nursing Assistant) or PCT (Patient Care Technician)

9.3The Role of the HUC (Hospital Unit Coordinator 9.4The Role of Housekeeping

9.5The Role of Pantry and Kitchen Staff

10. Infection Control & Hand Hygiene 10.1 Hand Hygiene10.2 Contact Precautions

11. Patient Safety11.1 Dress code and safety11.2 Wander Risk11.3 Fall Risk11.4 Stop Sign11.5 Hospital Conditions

12. How to handle specific situations:12.1 Patient is sleeping 12.2 Patient’s door is closed12.3 Patient’s meal is incorrect12.4 Patient would like the services of a Chaplain12.5 Picture of a Lily on the patient’s door12.6 Patient has a cognition risk factor and delirium risk factor and seems confused12.7 Patient is blind 12.8 Patient does not speak English

13. Communication Skills required of all volunteers

14. Expectations for all HELP Volunteers14.1 Patient Confidentiality14.2 HELP Expectations (posted in our offices)

14.3 Hospital and Program Guidelines

15. Shift InstructionsFirst Homework for you to prepare and submit

1. History of HELP at Yale

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The Hospital Elder Life Program (HELP) was created by Professor Sharon K. Inouye, M.D., M.P.H., at Yale University School of Medicine. HELP was designed to prevent cognitive and functional decline in patients during hospitalization, by preventing hospital acquired delirium. Yale-New Haven Hospital served as the initial clinical trial test site for the HELP model and the program continued there from 1994 until 2001. Patient interventions were designed to target those risk factors that were known to lead to delirium in the hospitalized elderly. Specifically these risk factors are hearing impairment, vision impairment, immobility, withdraw from drug or alcohol usage, dehydration, and impaired cognition. At Yale-New Haven sleep deprivation was also included as a risk factor. Volunteers and researchers at Yale-New Haven selected a limited number of patients each day and studied the impact on those patients of reminiscing, massage therapy, active exercise, encouragement of fluids, discussion of current events and similar interventions. The HELP model at Yale-New Haven resulted in beneficial outcomes for the patient and cost-effectiveness for the hospital, including a significant reduction in:

the development of delirium the total number of patient days with delirium the use and cost of hospital services by patients.

Since 2001, the Yale University team has focused on dissemination of the HELP model to other hospitals nationally and internationally. As of 2013 there are approximately 200 facilities world-wide that employ the HELP model to prevent delirium. There is a free educational website regarding HELP which you can access for further information (http://hospitalelderlifeprogram.org/) 1.2 History of HELP at UPMC Shadyside Dr. Fred H. Rubin, MD brought the HELP Program to UPMC Shadyside Hospital in 2001 as a quality improvement program rather than a research program. The HELP Model was modified to allow all patients age seventy and older on select hospital units to participate in the program. Changes were made to the interventions performed by trained volunteers so that massage therapy was no longer offered. The risk factors that are targeted at Shadyside do not include sleep deprivation but do include:

Hearing impairment – Assisted hearing devices are offered to the patient; Vision impairment – magnifiers are offered to the patient or glasses encouraged to be worn; Mobility - Active Range of Motion exercises and encouragement to get out of bed for select patients; Withdraw from drug or alcohol usage- no active involvement by volunteers for this risk factor; Dehydration- fluids are encouraged for select patients; Impaired cognition- patients are oriented to the day, the time, and the place.

Under Dr. Rubin’s leadership, as both a Geriatrician and Chief of Internal Medicine, the HELP Program at Shadyside Hospital has grown from 3 volunteers seeing patients on one unit of the hospital to nearly 90 volunteers per year seeing over 7000 patients annually on 8 different hospital units. The delirium rate among HELP patients is consistently lower than it would be without this vital program. The overall quality of the HELP program has improved and expanded as well. UPMC Shadyside Hospital became a HELP Center of Excellence in 2010, and as a result, we host visitors from around the world to see our HELP program in action. Dr. Rubin is instrumental in organizing and hosting an annual conference,

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typically in Pittsburgh, as an educational conference for all hospitals with HELP programs. We have published articles about the HELP program at UPMC Shadyside in the Journal of the American Geriatrics Society (JAGS).

The Mission of HELP at UPMC Shadyside is To improve our processes of care for elderly inpatients, such that the risk of delirium is minimized. To recognize, manage and document delirium. To support and provide educational opportunities for nursing staff. To include Families and community volunteers in the care of the hospitalized elderly.

HELP is somewhat of a surveillance program, where trained volunteers are on the lookout for delirium, while visiting patients to improve the quality of the patient’s hospital stay.

2. What is Delirium?Delirium is a specific kind of confusion that develops over hours or days. It is a sudden change in a person's mental status. It is always marked by a sudden onset and always marked by the person being unable to pay attention. Because it has a fluctuating course, a person may seem fine at lunch time and confused after dinner. The person will exhibit disorganized thoughts and speech and often exhibit an altered level of consciousness.

A person with delirium may develop auditory, visual or tactile hallucinations, but this does not mean that delirium only occurs in the person's imagination. To the contrary, delirium is real and causes biological changes to the brain. Those changes are typically reversible if the delirium is quickly and properly treated. Some of the most common causes of delirium include urinary tract infections, fluid imbalances, kidney or liver failure, side effects of medications or their interaction, head injury, pain itself, or a high fever. Delirium may also develop after major surgery.

Preventing delirium is easier and less costly than it is to treat delirium after it occurs. As a society, we should all care about preventing delirium because of its substantial financial and human costs. Delirium leads to an increased risk of death, an increase in health care costs due to complications from delirium, an increased length of hospital stay, and an increase in the number of patients who are discharged from the hospital to a skilled care facility rather than back to their own home. Our staff can direct you to further information about delirium if you wish.

Delirium may express itself as:Hyperactive- the patient is confused and restless or agitated;Hypoactive- the patient is confused and lethargic or asleep;Mixed- the patient exhibits behavior which is characteristic of both hyperactive and hypoactive.

For your purposes as a volunteer, be aware that delirium expresses itself on a continuum from the very sleepy patient to the very agitated patient. As you can imagine, the patient who is agitated will receive attention, but it might be easier for hospital staff to ignore the sleeping patient. HELP volunteers must pay particular attention to the sleeping patient, as you will see throughout your training.

Each patient with delirium is different but these are some common behaviors that you may observe in a patient with delirium:

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New or increased uncertainty about the day of the week or the date or how long they have been in the hospital; Disinterest in activities which would typically be of interest (example: not interested in reading the sport section

of the newspaper when they always do at home, or not interested in watching their favorite TV show); Confusion only at certain times of the day, or that fluctuates throughout the day (example: the patient only

seems confused when it is getting dark outside); Seeing or hearing things which are not there (example: the patient thinks that bugs are crawling on the bed or

hears someone speaking to them who is not present); Restless behavior (example: patient is pacing back and forth or simply cannot get comfortable in the bed despite

your best efforts to adjust their blankets); Sleepy or drowsy behavior (example: the patient dozes off to sleep when you stop talking, or the patient falls

asleep when you turn your back to update their orientation board); Emotional reactions which seem inappropriate for the circumstances (example: the patient cries because they

don’t like their meal or laughs uncontrollably when you introduce yourself); A change in thinking that is not normal for the patient (example: expressing concern about being poisoned or

thinking that they should call the police about a crime show they are watching on TV); Mood changes that seem beyond the patient’s control (example: temper tantrums or fearfulness over an

unlikely event).

Delirium can happen to a person of any age, but the HELP program focuses on hospitalized patients who are age seventy (70) and older, because delirium is most common in this age group. If the patient arrives at the hospital with a delirium it is referred to as PREVALENT DELIRIUM and we know that our prevention program will not help a patient who already has a delirium. The HELP program is actively trying to prevent INCIDENT DELIRIUM, which is a delirium that develops during hospitalization. In either instance, our staff works to minimize the impact of the delirium if or when it does develop.

Delirium does not develop randomly. There are precipitating factors that put a patient at risk for developing delirium and six of those risk factors are closely monitored in our program at Shadyside.

2.1 Risk FactorsThere are six risk factors that put the hospitalized elderly at risk for developing delirium. These risk factors are:

1. Cognition impairment (such as memory loss, diminished speed of processing information, dementia)2. Dehydration3. Drug and/or Alcohol withdrawal4. Vision Impairment5. Hearing Impairment6. Mobility impairment

New patients age 70 and older, on hospital units serviced by HELP, are individually assessed by HELP staff for each of these risk factors. The patient is assessed through a review of their electronic medical records, in addition to a meeting with the patient individually in their hospital room. As a volunteer, you will be seeing some patients who our staff has already assessed and some patients who are not assessed. You may be the first person from the HELP program to meet the patient and your observations and feedback will be of great importance. For instance, during your visit with a patient, you may discover that the patient cannot hear unless you yell; that they wear glasses but cannot see without

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them and they are at home; or they repeat the same story three times during your ten minute visit with them. Information such as this will be important to record in the patient’s chart in our HELP database and this is something you will learn during your training.

Volunteers address these six risk factors in the following way:1) Cognition- orient the patient to person place and time by using the patient’s name, mentioning that they are at

Shadyside Hospital and updating the patient’s white board with the date; offer the patient a newspaper (Monday through Friday), a current magazine or puzzles to use such as crosswords or word searches.

2) Dehydration – the patient is assessed for this risk factor when they are admitted to the hospital. Your paperwork will continue to show the dehydration risk factor throughout the patient’s stay, even if the patient is no longer dehydrated. If the patient has fluids on their meal tray or in a water pitcher, volunteers make sure patients can access their fluids.

3) Withdraw from Drugs or Alcohol or both – there are no volunteer tasks that specifically address this risk factor.4) Vision deficits – offer a magnifier, offer to clean the patient’s glasses or bring their glasses closer to them, assist

with completing the patient’s menu if they cannot see it, write on the orientation board with large writing, using a black marker for a contrast, or letting the RN know if the patient’s glasses are elsewhere and need to be brought to them at the hospital.

5) Hearing deficits – offer the patient an Assisted Hearing Device (AHD); encourage the use of the AHD if the patient already has one, speak clearly and precisely facing the patient so the patient may read your lips.

6) Mobility issues- make arrangements for the patient to be moved to the chair whenever your paper work shows that they may be out of bed (OOB); and when a volunteer completes their separate training in Active Range of Motion (AROM), engage some patients in upper and lower body exercises, when this is appropriate for the patient as indicated on their diet orders by the AROM notation.

Keep in mind that the more risk factors a patient has, the LESS LIKELY it is that delirium can be prevented. Because of this, volunteers are expected to give more attention to the patients with the fewest number of risk factors. 1 st priority patients have 1 or 2 risk factors; 2 nd priority patients have 3 to 5 risk factors.

2.2 Confusion Assessment Method (CAM)Clinicians on our staff assess delirium using the Confusion Assessment Method , © CAM. This is a diagnostic tool developed by Dr. Sharon Inouye, who also established the first HELP Program. It is not a volunteers’ job to diagnose delirium, but it is still important for you to understand how it IS diagnosed. The observations you make about our patients and the feedback you provide can be vital information in this process of identifying NEW confusion.

A diagnosis of delirium by the CAM requires the presence of features 1 AND 2 below, and EITHER 3 or 4:

1. Acute onset with a fluctuating course AND 2. Inattention;

PLUS3. Disorganized thinking OR4. An altered level of consciousness.

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To clarify: Acute simply means quick or fast, rather than gradual. A fluctuating course means the patient is better sometimes than others. Inattention may mean that the patient is sleepy or the patient is distracted by an imaginary presence. Disorganized thinking may mean that the patient doesn’t finish their thought; their reply makes no sense in

relation to what was asked; their conversation sounds like gibberish, or similar examples. An altered level of consciousness means that the patient’s responsiveness to the stimulus in their environment

is different than their normal. You may not have enough information about a patient to know what their normal behavior is, but you can always describe their behavior as it relates to their ability to be aroused.

2.3 Delirium is not Dementia. The HELP program is about preventing Delirium.

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Identifying Delirium VS DementiaClinical Features Delirium Dementia

Onset Acute InsidiousCourse Fluctuating with lucid Intervals;

worse at nightProgresses slowly

Duration Hours to weeks Months to yearsSleep-Wake Cycle Always disrupted Sleep fragmentedLevel of Consciousness Disturbed. Person less clearly

aware of environment with fluctuation in attention

Usually normal until later in the course of the illness

Behavior Activity often abnormal:Decreased-somnolentIncreased-agitation, hyper vigilant

Normal to slow; may become inappropriate

Speech May be hesitant, slow or rapid or incoherent

Difficulty in finding words

Mood Fluctuating, labile, from fearful or irritable to normal or depressed

Often flat, depressed

Thought Processes Disorganized, may be incoherent

Impoverished

Thought Content Delusions common, often transient

Delusions may occur

Perceptions Illusions, hallucinations, most often visual

Hallucinations may occur

Judgment Impaired, often to varying degree

Increasing impaired over the course of the illness

Orientation Usually disoriented especially for time. A known place may seem unfamiliar.

Fairly well maintained, but becomes impaired in the later stages of the illness

Attention Fluctuates. Person easily distracted, unable to concentrate on selected tasks

Usually unaffected until later in the illness

Memory Immediate and recent memory impaired

Recent memory and new learning especially impaired

ADAPTED From the Bates Guide to Physical Examination and History and Physical; 7th edition, 1999

3. HELP Patient Criteria

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3.1 Patients age 70 and older – All patients who are age 70 and older are considered to be a patient within the HELP program, if they are assigned to a room on a unit serviced by the HELP Program. Currently the HELP program operates on 8 units of the hospital and our HELP staff is present Monday through Friday to see patients. Our staff reviews the electronic History and Physical (H&P) of all patients 70 and older on our 8 HELP units. From that initial set of patients, our staff excludes those patients with severe dementia, combative behavior and patients who are in a coma or medically too ill to be seen by volunteers. Some of the remaining patients are personally assessed by a HELP staff member and subsequently either ENROLLED in the HELP program or determined to be quality improvement (QI) patients only and receive less of the volunteers’ time. It is possible that a patient may never be assessed by our staff, if the patient has transferred to a HELP unit from a hospital unit that did not have HELP. Simply know that all of the patients assigned to you during your shift are a part of our program, which at its core is a quality improvement program. Each patient’s needs are different, but they will all benefit from your attention and compassion. You will always know which hospital unit (or units) you are working on and which patients are your patients to see. Sometimes the volunteer is the first person from the HELP program to see the patient, and your feedback and observations about the patient will be critical to the next volunteer and our HELP staff.

3.2 HELP Database & Diet Orders – You will have access to the HELP Database and receive training on using it. The patients you will see and the information we have about their risk factors for delirium are organized in a report called Diet Orders. You will print out a copy of the Diet Orders at the start of each shift and carry it with you when you see patients. Knowing what diet the patient is on, and what they may or may not have to eat or drink, is a critical piece of information for you to know. Because this information may change throughout the day, our Database updates at these times: 7AM, 10AM, 11AM, 1PM, 4PM, and 6PM. In addition to these scheduled updates, the Database updates in real time, with any information entered by a volunteer or our HELP staff.

As part of your training you will see a detailed PowerPoint about the information contained on the Diet Orders. Briefly, the Diet Orders contain information such as the patient’s name, room and bed number, and their known risk factors for delirium. If our staff has personally assessed the patient, the staff will determine what priority you should give that patient for R&R’s (1st or 2nd priority). If our staff sees a patient and determines that we are not likely to prevent delirium with the patient, the patient is designated as a Quality Improvement patient (QI). If our staff has not seen the patient you will know that as well, because the patient will be labeled, Not Assessed on the Diet Orders. This is important for you to know, because you may be the first individual to interact with the patient, and your insights about the patient will be valuable regarding the patient’s ability to hear you, to see, to fend for themselves at meal time, and their frame of mind.

Only 1st and 2nd priority patients are officially enrolled in the HELP program for purposes of preventing delirium. As a result, there are services provided to these patients that are not provided to any other patients on your Diet Orders. These services include Active Range of Motion (AROM), Encouraging Fluids, and assessment of the patient for being moved out of bed (OOB).

3.3. Patients volunteers will NEVER see- If you arrive at a patient’s room and you see any of the following signs on the door, DO NOT go in to see the patient:

NEUTROPENIC PRECAUTION ~ this patient has a compromised immune system so visitors are limitedAIRBORNE PRECAUTION ~this patient has a virus that is airborne and it would be unsafe for volunteers to visit

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PHOTO OF A LILY ON THE PATIENT’S DOOR ~this patient is deceased but still in the room

If a patient is listed on your Diet Orders, and you discover one of these signs at their door, please cross the patient off your list, create an alert in the Database in the patient’s chart, and let your Volunteer Coordinator know so that the patient can be excluded from the Diet Orders for the next volunteer. Do not visit with the patient.

4. What is the role of the HELP volunteer? There are three distinct ways in which volunteers engage with patients and we refer to them as Meals, Communication and Comfort and Recreation & Relaxation. Which order you do things in depends upon the shift you work and what time meals come out on that shift. Following is a brief description, with further development of each topic throughout this manual.

4.1 Meals- enter the patient’s room soon after the Hostess/Host has delivered their meal and offer to open containers, unwrap plastic ware, and see it that the patient is in a good position to eat. This is often referred to as tray set up.This visit usually takes no more than 4-5 minutes because you are trying to see all of your assigned patients in a timely fashion while the patient’s meal is still fresh.

4.2 Communication and Comfort or simply: CC – assess the patient’s room as you enter and offer to make improvements such as adjusting their blinds or lighting, moving their phone or call bell closer to them, discarding old newspapers, and offering to get the patient items which they might need such as a comb or toothbrush, or fresh water in their pitcher. This visit usually takes no more than five minutes

4.3 Recreation & Relaxation or simply : R&R- There are two kinds of R&R’s: active and passive. An active R&R is a visit with the patient for conversation or other cognitive stimulation such as a game of cards, checkers, word search competition, reminiscing about the past using Reminisce Cards, or sharing interesting technology on the IPAD or engaging in Active Range of Motion (AROM) exercises. An active R&R usually takes 10-20 minutes but should not exceed 30 minutes. Active R&R’s are reserved for patients with the fewest risk factors, and for patients who need help completing their menu. A passive R&R occurs when you leave a magazine or a paper puzzle with the patient, with the hope that they will engage with the item for 10 minutes or more.

When you leave a patient’s room you will make a written note about your interaction with the patient so you can provide feedback about your interactions and interventions. This feedback is entered into the HELP Database, the electronic record that you will be trained to use.

4.4 Things to do every time you enter a patient’s room – Every time you enter a patient’s room you will Use hand-sanitizer as you enter the room and as you leave the room. This is provided in a container at the

doorway of each patient room. You will always introduce yourself as a HELP volunteer, because there are a wide variety of volunteers with

whom the patient interacts, each with a different set of services that they can provide. Offer the patient a HELP Brochure if they don’t have one.

4.5 Orientation -Keeping the patient oriented

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Orientation is a clinical term that refers to a person’s own awareness of their physical environment with regard to time, place, and their identity. This is often referred to as person, place and time. Keeping HELP patients oriented is a critical part of your responsibilities. Whenever you enter a patient’s room you should:

Use the patient’s name Use the words: Shadyside Hospital Update the patient’s white orientation board with the day, month, date and year and say that information

aloud. Make sure you also write the name of the patient’s nurse and nursing assistant on the white board. Use your own name and identify yourself as a Hospital Elder Life Volunteer at Shadyside Hospital Use the terminology breakfast, lunch or dinner rather than the word ‘meal’ if you are visiting at meals. Offer the patient a brochure if they do not have one and use it as an opportunity to identify yourself as a HELP

volunteer. If newspapers are available and the patient would like one, use the paper as an opportunity to say the date. Incorporate conversation about the season or the weather and tie it back to the month or season. You should orient the patient to their environment by making sure that their call bell is within easy reach and

that they know how to use it.

Even if it feels repetitive to you, you MUST orient a patient on every visit if that patient has a Cognition Risk Factor or if the patient already has a Delirium. You will know this information from the Help Database and Diet Orders. When you provide feedback in the HELP database about your patient interactions, you will indicate if you oriented the patient. You have oriented the patient when you used their name, said the day and date, and made it clear to the patient that they are at Shadyside Hospital. Remember: Person, Place and Time.

4.6 Items for Patient’s use- Each HELP office is stocked with supplies that you can offer to the patient. Some of these supplies will be theirs to keep and some items are just on loan during their stay. It is always best to emphasize that everything a volunteer offers is free of charge.

Examples of items that the patient can keep include: combs, Kleenex, razors and shaving cream, mouth swab, soap, mouthwash, cream, lip moisturizer and a discharge bag for their belongings. If the HELP office happens to be out of these items, let your Volunteer Coordinator know, or simply ask the patient’s Nursing Assistant for them.

Patients keep the free newspaper, Bible, rosary beads, word search, crossword puzzle, Sudoku puzzle, HELP Brochure and magnifier that the HELP program offers.

Each HELP office is also stocked with books, magazines and playing cards that we typically loan to patients, unless the patient insists on keeping them. If any patient is in a contact precaution room, the volunteer would make it clear that we cannot take these items back out of the patient’s room. The patient can keep them or throw them away when they are discharged.

An example of items that a volunteer can loan, to any patient who needs it, is an Assisted Hearing Device (AHD). Volunteers will be trained on offering the AHD to any patient who has a difficult time hearing. If a patient accepts the AHD, the volunteer writes the word, Amplifier, on the patient’s white board, so other visitors to the room know to encourage its use by the patient.

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5. Mealtime responsibilities - The volunteer does not deliver the meals but is expected to be in the patient’s room, offering assistance, shortly after the patient’s meal is delivered by the pantry Hostess/Host. The volunteer’s role is to encourage the patient to eat and to make sure there are no obstacles to the patient’s ability to eat.

The pantry is where the meal delivery carts are located. NOTE: Meals for the West Units come out of the larger pantry on the Main Units.

Each cart is for a specific unit and has a sheet indicating when meals are scheduled to be delivered. The countdown timer will indicate the actual time that the meals will be ready (sometimes earlier or later than the time indicated on the sheet).

Water, ice, coffee, tea, ginger ale, milk, Jell-O, and applesauce are located in the large refrigerator. These are extras and can be given to patients if their diet permits and can also be given to patient's guests.

Extra Eating utensils, straws, crackers (low-sodium and regular), and other items are located in drawers and cupboards in the pantry.

If your Diet Orders show that you have a patient in a low bed, try to get to that room before meals come out to make sure that the tray table will lower down to the patient’s level or ask the NA to raise the bed.

If your Diet Orders show that you have an Out of Bed (OOB) patient, you should encourage the patient to eat the meal in a chair rather than in bed. Try, if possible, to get to that room before meals come out to see if the patient is already in a chair. Contact the NA to move the patient.

If your Diet Orders indicate Tray Set UP for one of your patients, this indicates that this patient will need your immediate assistance before they can begin to eat. Pay attention to these patients as quickly as you can. See these patients first if you have fallen behind during meals. (It is also possible that the patient’s diet order has been changed, and during your shift, the patient may not be receiving a meal, and no tray set up would be necessary. The patients Diet is controlling.)

Try to stay one or two rooms behind the meal cart. If for some reason you are running behind during meal delivery, you can see which room is currently receiving their meal from the Hostess/Host, start there, and stay caught up with the meal delivery.

Offer to refill water pitchers if appropriate for the patient, given their diet. (Note: Water pitchers and the Styrofoam liner in the pitcher cannot be removed from Contact Precaution rooms. Instead get a new Styrofoam liner (found in a HELP Office or Pantry) and fill it with ice/water from the pantry and insert it into the patient's pitcher. You can also simply refill the water pitcher in the patient’s room if the patient does not want ice.)

Ask the patient if you can open containers, unwrap the utensils, cut up food and reposition it, etc. Remind patients that the packaged hand sanitizer on their tray is for use before the meal, to clean their fingers,

and should not be used on their face. Contact the NA if the patient needs a boost in bed, if the patient seems too lethargic to eat safely on their own,

or if the patient needs to be fed and you are not feeding certified. Any volunteer may put food on the utensil and hand the utensil to the patient to feed themselves.

5.1 Aspiration Risk – a patient may be at risk for choking and there may be a sign in their room explaining actions to take and avoid on their behalf. Look for this sign in the patient’s room.

5.2 Dysphagia - is the medical term for the symptom of difficulty in swallowing. If the patient’s diet indicates Dysphagia, then the patient’s food should be cut in very small pieces and the patient should be encouraged to swallow what’s in their mouth before eating more food.

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5.3 NPO – a patient may not be permitted any food or drink by mouth. At meal time the volunteer can simply check to make sure that the patient did not receive any food. You should still stop into the patient’s room at meal time to see if the patient needs anything such as a newspaper, magazine or puzzle.

5.4 Thickened Liquids - If the patient’s diet indicates thickened liquids, ALL liquids must be thickened. Packets of Thickener are located in the pantry. Ask the patient’s Nursing Assistant (NA) for help with this if you have never done this for a patient in your training. The patient will not and should not have a water pitcher.

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5.5 Diet Type and Description It is critical that no food or drink be given to a patient until a volunteer has reviewed the patient’s most recent diet order and determined that the food or drink is permitted. Listed below are the most common special diets that you will see as a patient’s diet. If you know that you are going to assist a patient in completing their menu, verify what diet they are on and refresh your memory as to what that diet allows. (This list will be in the HELP office in the office copy of this manual.)

General/Regular Diet - All foods are permitted on a general/regular diet. *NPO - NPO stands for “nothing by mouth” and is frequently ordered before or after a test, procedure, or surgery. If a patient is NPO, they will not be receiving a tray or food items. If the patient mistakenly receives a tray, politely remove it from reach and verify with the patient’s RN whether the patient is now permitted to eat and drink.*Clear Liquid Diet - frequently used before or after a test, procedure, or surgery. Patients with nausea or vomiting may also be on this diet. Foods allowed on a clear liquid diet include clear tea or coffee, cranberry, apple, or grape juice, carbonated beverages, popsicles, Italian ice, plain gelatin, and fat free bouillon or broth.*Full Liquid Diet - may be given between clear liquids and solid foods. In addition to the clear liquid foods, you are also allowed fruit and vegetable juices, milk, milkshakes, pudding, custard, ice cream, cream of wheat, cream of rice, and cream soups*Soft/Low Residue Diet - typically used as a temporary diet as a person adjusts to solid or regular foods. A soft/low residue diet contains foods that are easy to digest and have only moderate amounts of fiber. Foods encouraged include canned or cooked fruits without the skin or seeds, dairy, well-cooked vegetables, well-cooked and tender meats, and breads and cereals made from refined flour.*Pureed/Mechanical Soft/Dysphagia Diets - used to help with chewing and/or swallowing. These diets contain soft foods that are chopped, ground, or pureed. Nuts, seeds, and stringy foods such as celery and onion, and foods with a tough skin such as dried beans, peas, or corn should be avoided. If the patient is having swallowing problems, their liquids may also need to be thickened and this would be indicated on their diet orders. There are packets of thickeners in every pantry and you should ask the patient’s Nursing Assistant to show you how to prepare thickened liquids. Low Sodium Diet - (low salt) may help lower blood pressure and help prevent water retention. Foods encouraged on a sodium controlled diet include fresh or frozen fruits and vegetables, breads, cereals, plain pasta or rice, low sodium soup, low fat or fat free milk and yogurt, and fresh meat and poultry. A seasoning packet is available for patient meals in place of salt.Heart Healthy Diet - may help lower cholesterol levels and the risk of heart disease. Foods recommended include fresh or frozen fruits and vegetables, breads, cereals, pasta, or rice, low sodium soup, skim, ½ percent, or 1% milk, 2% milk or low fat or fat free yogurt, and lean cuts of meat, poultry, or fish.Consistent Carbohydrate Diet - used to help keep blood sugars at the right level. Meals should be well balanced, include a variety of foods from each food group and have consistent carbohydrates. Use artificial sweetener in place of sugar and choose diet desserts. If a patient is diabetic, they should also receive a bedtime snack every evening. Volunteers who work the 4-8pm shift should check with the patient’s nurse if the patient needs their snack.*Renal Diet - used when the kidneys no longer function properly. A renal diet is low in the minerals potassium and sodium. A renal diet may also limit the amount of protein, fluid, or phosphorus you are allowed to consume. A renal diet is individualized based on the patient’s special needs that their doctor determines.

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*Neutropenic Diet – a low bacteria diet for those who have a weakened immune system. If you notice that the patient has been put on a Neutropenic Diet, do not see the patient, make an alert in their chart to that effect, and let your Volunteer Coordinator know so the patients name can be removed from the Diet Orders

*These diet orders are not controlled by the patient, and they do not have free choice in what meal they receive.

6. Recreation & Relaxation – or R&R is either ACTIVE OR PASSIVE. An Active R&R is a patient visit of 10-20 minutes in length and it is offered to select patients. A Passive R&R can be offered to any patient on your Diet Orders, as it consists of dropping off a magazine, or paper puzzle for the patient to use on their own time.

6.1 Prioritizing patients for an ACTIVE R&R – A volunteer will not have time to complete an ACTIVE R&R with every patient listed on their Diet Orders. Consequently, an R&R should first be attempted with those patients who are already assessed as First Priority (1st) patients. These patients have only 1 or 2 risk factors for delirium and are the patients with whom we are most likely to prevent delirium. After 1st priority patients, volunteers will see 2nd priority patients for an R&R, and these are patients who have 3, 4 or 5 risk factors for delirium. If there is still time, then see patients who are not assessed but who have few risk factors for delirium. Keep in mind that many times a patient will need help completing their Menu for the next day, and these patients should be assisted, even if the patient is a Quality Improvement (QI) patient. Other than Menu HELP, a QI patient is not a patient who would receive an R&R, unless there were no other HELP patients available for the volunteer to see. Do NOT sit on a patient’s bed during an R&R.

6.2 Menu Completion – It will take at least 10 minutes with the patient to help fill out their menu for the coming day. The time spent with the patient should be coded as an R&R. A patient, who is NPO on one day, may not be NPO on the coming day, and may still need to complete a menu for the following day’s meals. It is not the volunteer’s responsibility to tell the patient that they may not have a particular food. You simply need to encourage the patient to choose items appropriate to their diet, such as heart healthy choices on a heart healthy diet. The dietitians in the kitchen will correct the patient’s choices if they are inappropriate.

Note the patient's diet from the diet orders before beginning the menu. Be aware that there are several menus: Special Services (ecru/off-white), Kosher (green), Gluten-Free (yellow) and the regular menu booklet (white). Each one will have a different color menu sheet to fill out (color noted in parenthesis).

Extra menus are located in the pantry at the dietician's desk and in the HELP Office. Remember that every item, no matter how small, must be indicated on the menu. Milk is not automatically

delivered with cereal, milk and sugar with coffee/tea, or condiments with a sandwich. When counting carbohydrates for a patient on a carbohydrate diet, the number of carbohydrates in each item is

printed in the menu booklet. If no number is provided then it is considered a free exchange. Patients should be encouraged to make choices that are appropriate to their diet, such as heart healthy items

for patients on a cardiac diet. However, you do not have to be the food police if the patient makes bad choices. Dietary will send the correct diet.

Make sure to read back what you are ordering for the patient to verify their order, preferably after completing each meal order.

Once you have completed the menu, you can leave it in the patient’s room, clip in to the patient’s room number outside their doorway, or place it on the desk in the Pantry.

To help speed the process along you may want to begin by asking the patient, what they usually like to eat for breakfast, and if lunch or dinner is usually their big meal of the day.

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6.3 iPad use- Each HELP office should have an iPad that a volunteer can use in their own creative way with a patient for an Active R&R. iPads are not intended to be left with the patient because they would be too expensive to replace if they were lost. iPads are typically available for your use with patients from 8am to 5pm, Monday through Friday, when HELP staff is present. At other times, the iPads are recharging.iPads are to be used for the patient’s benefit only, and not to be accessed for the volunteer’s own personal use.

7. Communication & Comfort or CC- A CC can be done alone, or as part of any other visit with a patient. Communication and Comfort (CC) simply means that you suggest to the patient those things that you notice that you might do for them to improve their comfort. This begins by surveying the patient’s room as you enter it and offering to do things that the patient may not be able to do. This might include:

Adjusting the blinds or the lighting in the room Throwing away old newspapers Bringing the patients Assisted Hearing Device (AHD) closer to them and suggesting they use it Cleaning the patient’s glasses Getting the patient an additional blanket or adjusting the room thermostat if they are cold or hot Replacing an empty box of tissues Refilling their water pitcher, if they have one Getting the patient whatever toiletry items they need that are stocked in each HELP office Moving the call bell or telephone closer to where the patient is seated

If you notice spills or trash in the room, you can arrange with the unit housekeeper to visit the room to clean it.If you notice items that are broken in the room, such as the clock, you can contact the Hospital Unit Coordinator (HUC) to have it fixed. Section 9 contains further information about which staff you would contact to follow up on a patient’s needs or request.

8. Specific Directions on the Diet Orders & the Rhythm of the Shift – Each shift is different and the rhythm of your shift depends upon when meals come out during your shift. Certain services only happen during certain shifts. This will become very clear during your training.

Breakfast Shift (8am to noon) Meals come out soon after the volunteer arrives, blinds are opened for patients, bread is toasted,

newspapers are offered, patients are oriented to the new day, R&R’s after meals, no AROM is offeredLunch Shift (Noon to 4pm)

Meals come out soon after the volunteer arrives, AROM is offered after 2pm, Menus are completed, R&R’s occur after the meal

Dinner Shift (4 to 8pm) R&R’s and AROM occur first, meals come out an hour or more into the shift, most newspapers have

been distributed, volunteers offer to close patient’s blinds, promote relaxation channel for patients who express sleep issues.

Some protocols, or volunteer interventions with patients, are only offered to patients on days when our HELP staff is present, Monday through Friday, on non-holidays. A trained RN on the HELP staff must first determine if

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it is appropriate, each day, for the patient to engage in the activity. These activities will only appear on your Diet Orders for selected 1st and 2nd priority patients, and only Monday through Friday:

o Active Range of Motion (AROM)-targeted Upper Body and Lower Body exercises with the patient. No exercises are done with patients prior to 2pm.

o Out of Bed (OOB) - the patient is encouraged to move from the bed to the chair. The volunteer involves the Nursing Assistant (NA) to move the patient, once the patient agrees.

o Fluid Protocol – the patient is encouraged to drink fluids every time the volunteer visits the patient.

Again, do NOT offer any of the above activities unless the Diet Orders direct you to do so. You will receive further training on each of these protocols.

Some interventions can be offered by the volunteer to any patient on the Diet Orders. For instance:

o Tray Set-up-these words identify a patient who needs immediate assistance when their meal is delivered. They may be paralyzed on their dominant side, have a broken arm or severely arthritic hands. If you identify a patient who needs tray set up you can make this notation in the patient’s chart in the HELP Database. If your Diet Orders already indicate that a patient needs ‘tray set up’, try to see that patient soon after their meal is delivered.

o Menu HELP- these words indicate that a patient is unable to fill out their own menu form and require your assistance. Volunteers receive training on completing a menu. Menus are typically completed with patients between the hours of 11am and 4pm. (It is possible that the patient’s diet will change during their stay and they may no longer be ordering food from the menu.)

o Offer AHD- these words are a direction to the volunteer to offer an Assisted Hearing Device (AHD) to a patient who is hard of hearing. Volunteers will have access to AHDs and learn how to use them with a patient and how to update the Database if the patient accepts or refuses the AHD. Volunteers may freely offer an AHD to any HELP patient who will benefit from it.

o Complete Survey at Discharge- these words automatically appear on your Diet Orders when a patient has had sufficient contact with the HELP program and the patient may have an opinion about our services. There are survey forms in each HELP office that the volunteer can give to the patient to complete, or you can help the patient fill out the form. If these words appear on your diet order, it does not mean the patient is being discharged that day. You will learn how to tell if a patient is being discharged from information on each hospital unit’s patient board.

9. Volunteer Interaction with Hospital Unit Staff –Staff roles are well defined in a hospital setting so that everyone is clear of their responsibilities. As much as possible, please try to involve the appropriate staff member and you will achieve a better result for the patient, and in your interaction with the hospital staff.

9.1 The Role of the Patient’s RN (Registered Nurse)Each patient is assigned a specific nurse (RN) who is in charge of that patient’s care on the Unit. It is your responsibility to ask that patient’s RN if you have questions about the patient’s diet and to inform the RN if you suspect NEW confusion. If the patient tells you vital information, which you believe the patient’s RN may need to know, then it is your responsibility to be in contact with the RN by phone or in person. The conversation might go like this, “ I’m (your name), the HELP volunteer and I was just with Mr. X in Room Number, Bed Number. You may already be aware of this but I wanted to mention that he told me that…

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He thinks he will die during the night. He wishes he could just commit suicide. He is distressed because his family has not been to visit and he wanted to know if a call could be made to them. He believes someone stole his wallet and would like to report it. He is confused about his upcoming tests tomorrow and would like to speak with you about them.”

If you are visiting with a patient when an RN (or a Physician) enters the room, please ask if they need privacy with the patient, and inform them that you can leave the room and return later.

If a patient asks you to get their Nurse it is OK to ask the patient if YOU might be able to assist them before contacting the Nurse. Often the patient will tell you what they want and you can involve the correct staff member, which may not be the RN.

Highlighted below is a very general list of the specific duties of an RN, versus an NA or PCT, so you will know which staff person to involve for specific issues. During your training, you will learn where to find the name and phone number of each patient’s nurse and nursing assistant during the shift you are working.

Ask or Involve the Nurse (RN) Ask or Involve the Nursing Assistant (NA) or Patient Care Technician (PCT)

Patient wants to switch to nasal (prong) oxygen instead of using an oxygen mask, in order to eat

Patient wants to drink or refill to their water pitcher, but their intake and output (I&O) are being recorded

Patient’s meal is significantly different from the diet order

Patient is not eating and says they don’t want to eat now, but maybe later

Patient cannot eat because their dentures are at home

Patient needs help getting to the bathroom or off the urinal or commode

Patient is nauseated or vomiting and needs assistance

Patient wants an item such as a toothbrush or razor and the HELP office is out of them

Unsure if you should wake up patient for a meal or a visit

Patient needs to be repositioned in bed or moved from the bed to a chair

Dangerous situation involving the patient, such as hot liquids spilled.

Patient asks you to bring a water pitcher to their room because there is not one in there.

Used needles are laying in the patient’s room Patient’s bedding needs to be changed because it is soiled

Patient wants medication -Patient wants to be washedPatient’s machines are beeping -Gowns or gloves need to be restocked on the

door of a contact precaution roomPatient is bleeding -Patient’s drink needs to be thickened and

you have not yet seen how to do thisPatient is having difficulty or pain with -Patient seems too lethargic to eat on their

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swallowing own and you are not certified to feedPatient has a question about their discharge -Any other potential patient problem or emergency

-

Emergency Situations: choking, breathing problems, fall, or painIf there is no nursing staff in the room, immediately call out to an NA/PCT or RN, press the call

bell at the bedside and/or, if possible use the patient’s phone to call the RN on the phone.

9.2 The role of the patient’s NA (Nursing Assistant) or PCT (Patient Care Technician)The chart above identifies some key times when a Volunteer might involve the NA or PCT. If a patient needs to be fed at meal time, and you are not feeding certified, you should contact the patient’s NA or PCT.

9.3 The Role of the HUC (Hospital Unit Coordinator)A Hospital Unit Coordinator (HUC) is assigned to every nursing station on each unit of the hospital. The HUC is often sitting at a computer in the nursing station.

You should involve the HUC for any of the following: The thermostat in the patient’s room is broken or will not adjust to the desired room temperature. The TV, remote, or telephone are not working properly. The clock in the patient’s room has stopped. Maintenance issue that needs to be addressed on the patient’s behalf, such as a leaking toilet. If you are unclear from the unit board whether a patient was discharged already, ask the HUC.

10. Infection Control & Hand Hygiene The following facts about germs and infections, from the UPMC infonet, will provide a perspective on the significant impact each volunteer has in keeping our patients, and each other, healthy:

Nearly 80% of all germs that cause sickness are spread by our hands. A single germ can multiply to become more than 8 million germs in just one day. Germs can stay alive on your hands for up to three hours. There are between 2 million and 10 million bacteria between your fingertips and your elbow. You are likely to find more germs on a computer keyboard or elevator button than on a toilet seat. Clostridium Difficile (C.Diff) spores are not killed by alcohol or soap and water, but vigorous scrubbing dislodges

the spores from the surface of your hands so they can be safely washed away. MRSA and VRE (Methicillin-resistant Staph aureus and vancomycin- resistant Enterococcus) have been shown to

survive on surfaces from days to months.

10.1 HAND HYGIENEHand hygiene is the single most important strategy to reduce the risk of transmitting organisms from one person to another or from one site to another on the same patient. Cleaning hands promptly and thoroughly between patient contacts is an important strategy for preventing healthcare associated and occupational infections. Effective hand hygiene removes transient microorganisms, dirt and organic material from the hands and decreases the risk of cross contamination to patients, patient care equipment and the environment.

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In most cases, either a waterless antiseptic product, such as Purell, or actual hand washing with soap and water may be used for hand hygiene. Volunteers use Purell from the dispenser in the patient’s room every time the volunteer enters and leaves the room. After 5 uses of Purell hands must be washed.

Hand hygiene is performed utilizing the World Health Organization’s (WHO) five moments of hand hygiene. The five moments are: 1. Before touching a patient 2. Before clean/aseptic procedure 3. After body fluid exposure risk 4. After touching a patient 5. After touching patient surroundings

In certain circumstances, using Purell is NOT ENOUGH and Hand washing with soap and water must be performed: When hands are visibly dirty. When hands are visibly soiled with blood or body fluids. After using a restroom. After caring for patients with suspected or confirmed Clostridium difficile or Norovirus.

Hand washing procedure: Use warm, running water; moisten hands well. Dispensers are set to deliver the recommended amount of liquid soap or foam from the dispenser. Lather well and rub hands together for a minimum of (15) seconds. Remember that friction removes the surface

organisms, which then wash away in the lather. Clean under and around fingernails. Rinse hands well, holding downward. All soap or foam should be removed to avoid skin irritation. Dry hands with paper towel and use the paper towel to turn off the faucets. Use appropriate hand lotion as needed. Moisturizers alleviate dry or chapped skin. UPMC provides a

moisturizing product that is compatible with the hand care products and gloves that are used.

All staff and volunteers are expected to perform proper hand hygiene, appropriate to the situation, as described above. Ongoing monitoring by trained observers occurs daily throughout the hospital and we expect HELP volunteers to be in compliance with these important procedures. DO NOT SIT ON ANY PATIENT’S BED; JUST PULL UP A CHAIR TO TALK.

10.2 Contact PrecautionsSome patients will have a sign at the entrance to their room indicating special precautions that must be followed when seeing that patient. ALL staff and volunteers must follow these procedures for patients with a Contact Precaution and in doing so, keep themselves and other patients safe from the spread of germs. Typically these are patients who have a “superbug” or diarrhea, or are suspected of having a germ that is easily transmitted. The signs will be various colors and have specific information indicating what precaution you must follow. Typically this will involve wearing a disposable yellow gown and disposable gloves, which you will put on before entering the patients room and take off and discard before you leave the room. In some instances you may also need to wear a disposable mask. HELP Volunteers do not see patients with a Contact Precaution sign that reads, “Airborne Precaution”.

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During your training, you will learn more about the variety of Contact Precaution signs that you will see. You will also learn how to indicate in the HELP Database if a patient is a Contact Precaution patient. There may be gown and gloves stocked on the door of the patient’s room, even if the patient is not a Contact

Precaution. You will learn what you may take into a Contact Precaution room and what you may not bring out of the room. When you are in a Contact Precaution room, you will leave your Diet Orders in your jacket pocket, under the

protective disposable yellow gown. Volunteers will verbally orient patients in a Contact Precaution room because there may not be a black marker

to write with on the patient’s orientation board.

11. PATIENT SAFETY- One of the Core Values at UPMC Shadyside Hospital is Quality and Safety. We believe in providing exceptional care in a safe environment. As a volunteer, you have an important role in patient safety and here are some of those ways:

11.1 Dress code and safety Recent research has shown that artificial nails and long natural nails harbor bacteria that can spread infection.

As a result, artificial nails are prohibited for all staff and volunteers who have contact with a patient or their environment. No HELP volunteer may have acrylic nails, overlays, tips, bonding, extensions, tapes, inlays or wraps.

All personnel and HELP volunteers must keep their nails neat, clean, manicured and short and should not extend more than 1/4 inch in length past the tip of the finger.

Nail polish is permitted if it is in good repair and does not have embedded enhancements. Shoes must be close-toed shoes, for your own protection. Excessive cologne or perfume is not appropriate. Facial and oral jewelry is not permitted. Wearing rings and other jewelry during direct patient contact is strongly discouraged. Dangling earrings or hoops

larger than one inch are not permitted.

11.2 Wander RiskPatients at risk for wandering away are dressed in a green hospital gown so all staff and volunteers are alert to these patients. Volunteers should engage the patient, steer them back to their room and solicit the assistance from any staff on the unit to keep the patient from wandering off. Volunteers must never bring these patients a different color hospital gown. If a HELP patient has a green gown, please be certain that you checkmark ‘wander risk’ in the database. NEVER uncheck this unless you have spoken with the patient’s RN and know with certainty that the patient is no longer or never was a wander risk. All staff in the hospital are looking out for patients in green gowns who are at risk for wandering; this is not just the responsibility of volunteers.

11.3 Fall RiskPatients who are at risk for falling wear a yellow wrist band and are typically assigned to a low bed. The bed adjusts low to the floor and may have alarms that activate when the patient leaves the bed. Soft mats are placed around the bed to cushion any fall. Volunteers may need to see that the bed is raised up to the height of the bed tray at meal time.

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Volunteers are not permitted to move patients from the bed to a chair, or assist a patient by holding their arm when walking. Contact the patient’s Nursing Assistant or Patient Care Technician if the patient needs this kind of assistance. However, a volunteer’s involvement with a patient can help prevent falls.Here is a list of tips to keep patients, staff, and visitors safe from falls:

Be mindful of the environment. o Keep floors free from spills. o Keep pathways clear. o Ensure that lights are operational.

Share information with the patient. o Orient the patient to their call bell. o Assist the patient by moving their personal items within reach, including a walker or cane if used at

home. o Advise the patient to wear nonslip footwear when walking, which are available free of charge.

Make sure that the phone is in reach of the patient and that the phone cord is not in the way Pick up trash in the room, wearing gloves Call housekeeping or let the HUC (Hospital Unit Coordinator) know if there is a spill in the patient’s room. Cover

the spill with paper towel and bring that to the attention of the patient Make sure that the call bell is adjacent to the patient Bring the patient their glasses if they need them to see Make sure that there are no wires dangling in a patient’s room that they could become entangled in, such as on

an I.V. pole Make sure that blankets and sheets are completely on the bed and not about to fall off.

11.4 Stop SignPatients who are at risk for wandering may have a mesh banner that reads, “STOP”, hung with Velcro in their doorway. This sign is intended to keep the patient in their room. It is not intended to keep volunteers out of the room. These patients might not have on a lime green gown, because they may not be officially designated as a Wander Risk.

11.5 Hospital ConditionsThe hospital uses code words to alert staff to certain patient or hospital circumstances called 'Conditions.' These conditions are listed on the back of the volunteer badge, for easy reference, and they are:Condition A - Respiratory or Cardiac Arrest AlertCondition C - Medical Crisis AlertCondition F - Fire or similar building emergency, announced over the loud speaker. No need to evacuate unless the Condition F is on the unit where you are working. In that event, leave the unit.Condition H – This code provides patients and families an avenue to call for immediate help when they feel they are not receiving adequate medical attention.Condition M - Summons the Crisis Intervention TeamCondition L - Lost Patient Alert, announced over the loud speaker and all staff and volunteers are on the lookout for the lost patient, who will be described in detail.Bronze Alert - Weapon AlertCode Blue - Internal or External Disaster

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Volunteers should let HELP staff know if a Condition A, C, H, or M is announced for a HELP patient, and also write it as an alert in the patient’s chart in the HELP Database. Volunteers should stay out of the way when one of these Conditions is called because a team of trained staff speed to the patient's room. Volunteers should also make sure NOT to phone the RN assigned to that patient while the Condition is active.

12. Specific situations a volunteer may encounter

12.1 The sleeping patientA patient may be sleeping because they are tired but it may also be a sign of hypoactive delirium. It is in a patient's best interest to sleep at night and be awake during the day. Volunteers need to remember that it is not rude to awaken a patient and that you should not allow a patient to remain asleep during your entire four hour shift unless the RN said you should let the patient sleep. Here are some tips for arousing a patient from sleep:

As you enter the room and are using hand sanitizer, clear your throat or cough to see if the patient stirs. As you walk closer to the patient, make some noise with your shoes and call to the patient using their name. The

patient may be resting but not sleeping. If it is meal time and the patient does not stir, ask the RN if you should awaken the patient to eat. Nourishment

is important. If you have been to visit the patient's room and they are always sleeping, bring this to the attention of the RN

during your shift. This conversation might be, "I've been to visit Mr. X in Room 503 Bed 1 on three occasions in the last two hours and he is always sleeping. Should I awaken him?"

12.2 The Patient's door is closedDon't be stopped by a closed door unless there is a Lily on the door (see 11.5). A patient may simply want to keep noise out of the room. Volunteers should knock on the door and open it or simply push the door open slightly to determine if you should enter. You should not enter, but return later, if the patient is with staff, the curtain is pulled and the patient is dressing, the patient is on the bedside commode, or the patient is praying.Volunteers should make sure that the patient receives attention later in the shift.

12.3 The Patient's meal is incorrectIf the patient receives the wrong meal tray, politely remove the meal tray from the patient's reach and let the patient know that you will go get the Hostess/Host who delivered the meal. The more likely scenario is that the patient receives a meal they didn't choose for themselves, one they don't recall choosing, or a meal that is missing something they ordered. In all instances, the Hostess/Host who delivered the meal tray is your best first contact to resolve any discrepancies. If the Hostess/Host is not available, the number for Dietary is on the back of your ID badge and you can phone them from the patient's room or any phone on the unit. OF COURSE, you will know the patient's diet from the paperwork you are carrying with you and if you have any question about which diet a patient is on, you MUST involve that patient's RN.

12.4 The patient wants a service provided by Pastoral Care (Chaplains) When you are with a patient who expresses anxiety about dying, sadness in having no one to talk to about important life issues or simply a need to connect spiritually, please suggest the services of Pastoral Care Department. Patients may not even know that Pastoral Care services are available in the hospital. Volunteers may need to say, "If you care to speak with a Priest or Rabbi or lay minister here at Shadyside, I'd be happy to make those arrangements." Jewish, Protestant

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and Catholic Chaplains are available and their phone numbers are posted in each HELP office. Other services such as communion are also available. You cannot promise what time or day a Chaplain will see the patient, but you can let the patient know that you made the call.

13. Communication Skills Required of Volunteers- All HELP volunteers must speak clear English at a volume that can be heard by the patient. Volunteers must provide appropriate feedback to the patient’s staff on the unit, being succinct and thorough in the process. Volunteers also update the HELP Database with accurate information regarding their interactions and interventions with patients.

14.1 Patient Confidentiality- All volunteers receive instruction on Patient Confidentiality, in a Handbook and test prepared by UPMC Shadyside Hospital. In addition to that training, it is important to know that

No printed patient information can leave the hospital with you, and must be inserted in a shred box at the end of your shift.

Volunteers are not at liberty to discuss patient’s by name, even in a journal or paper prepared for credits received as part of the HELP experience

Volunteers are completely responsible for the safety and security of the Diet Orders used during the shift, which cannot be left out where they might be read by passersby.

14.2 HELP Expectations of Volunteers

HELP Policies and Procedures

These expectations are essential to our ability to operate the HELP Program smoothly each day. Despite the fact that you are working as a volunteer, abiding by these policies is not voluntary.

Calling OffThe HELP Call-Off Line will be your only way to call off for your shift. The number is on the back of your ID badge.

You should also consider putting the number (412-623-4357) into your cell phone, in the event you don’t have your ID badge with you if you need to call-off.

We will not accept email call-offs. The only way the entire HELP Department knows that a volunteer is calling off due to illness or an unexpected emergency is through the call to the HELP line. You should use this number even if you are calling off for a shift that is several days away.

No-Call No-ShowIf you fail to call the HELP Call-Off Line and do not come in for your scheduled shift, this will be considered a No-

Call, No-Show. One occurrence will result in a counseling session with a HELP Staff member. If there is a second occurrence, your service as a HELP volunteer will come to an end.

No Cell PhonesNo cell phones are permitted in a volunteer’s pocket during their shift, either in the HELP office or on the

hospital unit(s) where you work. Please keep your phone with your belongings, locked in the designated cabinets in the HELP office. If you do need to check your phone, in case of any emergencies, please be brief and return your phone to the locked cabinet.

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Proper Internet UsageThe internet should only be accessed for your unit’s diet orders. It is not acceptable to use the internet to access

your email account, websites, Google, etc. If you are looking up information for a patient, that is an acceptable use of the HELP office computer.

Volunteer MealIf you want to grab something to eat during your shift, please keep it to 15 minutes, and feel free to eat in the

HELP office. When you leave the unit to take this break you should write the time of your departure on the HELP office calendar and when you return you should write the time of your return. It saves our staff time if we are not looking for you on the hospital unit, if you are off the unit.

Books and Personal BelongingsYour personal belongings should be locked in one of the cabinets provided in each HELP office. You may not

study during your HELP shift.

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14.3 Hospital and Program Guidelines

Hospital Elder Life Program (HELP) Volunteer Program Guidelines1. Communication: Communication is important to a successful and rewarding volunteer experience. Keep your supervisor informed on your ongoing experiences with the program, especially if you feel uncertain or uncomfortable about your role or if you need more to do during your shift.

2. Teamwork: The HELP staff and unit staff are here to support you as well as our patients. Do not hesitate to ask the appropriate staff member on the unit if you have questions.

3. Appropriate Attire : Volunteer attire is dressy-casual (guidelines below), and your appearance should be professional. You are required to wear your photo ID badge and red volunteer jacket during your shift.

DO WEAR NEVER WEARUPMC ID badge (worn on your jacket above the waist) No jeans, sweatpants, yoga pants, or leggingsRed volunteer jacket No shorts, miniskirts, or revealing clothingCasual slacks such as khakis No open-toed shoes (Open-backed shoes are discouraged)Knee length (or longer) skirts No heels higher than two inchesT-shirts, polo shirts, or dress shirts without writing No hats unless for religious or medical reasonsShoes: clean, comfortable, and close-toed No unnatural hair color (blue, purple, green)Socks or stockings are required No acrylic nails

No facial or oral jewelryNo large or excessive jewelry

4. Signing In/Out: Please sign in at three places every shift as follows: 1. S ign in (and out) at the Posner Information Desk using the touchscreen, 2. Sign in on the paper calendar schedule hanging in the HELP office, and 3. Sign in on the dry erase board on your unit(s).

a. Recording false volunteer hours is grounds for termination (more than a 5-minute difference is false).b. Any break or trip off your unit should be noted on the paper calendar in the HELP Office.

5. Attendance: HELP Volunteers are required to volunteer for a minimum of 125 volunteer hours . Punctual and regular attendance is required as follows:

a. Punctuality: Please plan to be on the unit ready to begin at your designated shift time. If you are going to be more than 10 minutes late, please call the HELP Call-Off Line (412-623-HELP). We will not accept email call-offs.b. Vacations: Please notify your supervisor of vacation plans and school breaks as soon as you know them.

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c. Absences: Please give your supervisor two weeks notification for an absence . If you are calling off for a shift that is several days away, please call the HELP Call-Off Line (412-623-HELP).

Absence Record : An absence record will be kept in your permanent file and used by HELP staff in writing recommendation letters or personal references.

Emergency Absence : Please provide at least two hours advance notice if you need to call off due to an emergency absence such as a serious illness or accident.

No Call, No Show : If you fail to call the HELP Call-Off Line and do not come in for your scheduled shift, this will be considered a No-Call, No-Show. One occurrence will result in a counseling session with one of the HELP Staff. If there is a second occurrence, your service as a HELP volunteer may end.

College Exams and Finals : Plan ahead! Calling off the day before or day of an exam or project is NOT an excused absence. Inform your supervisor one week ahead of time if you cannot volunteer on a particular day due to a school commitment. Please do not put a burden on other HELP volunteers or patients because of poor planning on your part.

d. Shift Make Up: If you have an unplanned absence, please plan to make up your missed shift within one week.

6. Termination: Volunteers are expected to abide by these guidelines and refer to them as needed. Violations of these guidelines are cause for termination at the discretion and judgment of HELP staff including:

a. Overstepping the boundaries of the volunteer roleb. Using poor judgment in clinical situations (interfering with patient care and/or safety)c. Inappropriate behavior or misconductd. Disregarding volunteer policiese. Non-work related computer usage (see item #10)f. Two emergency absences may result in termination of your volunteer position even if it is for school credit.

7. Gratitude and Gifts: Please discourage gift giving by patients or visitors. Acknowledge their kindness, and inform them that gifts are not expected but that the thought is appreciated.

8. Contact with Patients:a. Outside of the hospital: Contact with patients after their hospital discharge is NOT permitted. This assures confidentiality and safety to everyone involved.b. While in the hospital: Avoid getting too personal about yourself, your peers or other hospital staff. Also, avoid talking negatively about any of your peers or hospital staff.

9. No Cell Phones: No cell phones are permitted in a volunteer’s pocket during their shifts. Please keep your phone locked with your belongings in the office. If you do need to check your phone, please do so briefly in the HELP Office, and return your phone to your locked drawer afterwards.

10. Work Related Computer Access: The use of UPMC computers is for work purposes only. It is prohibited to complete personal emails or to log on school or other personal websites. The information contained within any computer system is also confidential and proprietary information of UPMC only, and subject to all HIPAA rules. Unauthorized access to or use of any computer system is strictly prohibited and grounds for immediate termination from the HELP program without credit, without a favorable reference and with appropriate feedback to any institution or individual who

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referred you to the HELP program. Any violation of UPMC policies pertaining to systems access or confidentiality may also result in criminal and civil penalties.

11. Resignation after 125 Hours: When you know that your volunteer work with HELP is ending, please notify your supervisor at least one -month in advance of your last HELP shift . Volunteers should plan to complete an exit questionnaire prior to the last HELP shift. You are required to return you ID badge and red volunteer jacket at the completion of your final shift.

12. A Reference from HELP: The recommendation that you receive from HELP is based on your performance as a volunteer in the HELP program. A written recommendation can be requested from your supervisor after 100 HELP volunteer hours are completed and with at least a five week notice. The reliability of your attendance and punctuality will be factors in the recommendation that you receive. A reference may be withheld if the above courtesies are not observed.

13. Meal Tickets & Parking Vouchers: Meal tickets and parking vouchers are offered to volunteers who are NOT receiving school credit for volunteering. If you are receiving course credit for your HELP experience, you are not eligible for a meal ticket or parking voucher per UPMC policy.With your initial paperwork you will receive a copy of this to sign, as additional emphasis regarding the importance of these guidelines.

SHIFT INSTRUCTIONS

The rhythm of your shift, and how it all comes together, depends upon which shift you are working: breakfast, lunch or dinner. Meals come out right away on the breakfast and lunch shift, so that’s where you will begin. On the dinner shift, there is at least a full hour before meals come out, so on the dinner shift you will begin with R&R’s or with Active Range of Motion (AROM), once you are trained for AROM. These instructions are posted in each HELP office.

PRIOR TO SEEING PATIENTS1. Write your signature next to your name on the daily printed calendar posted in the HELP Office, and note any

changes to your shift location. Please discard calendar pages from prior days. Log on to the computer in the HELP office using your assigned user name and password.

2. Choose MY APPS (from the tool bar on top or the file at the bottom left), log on again, and select Internet Explorer. From the drop down menu, go to Elder Life address (http://elderlife.upmc.com).

3. From the Menu, choose “Diet Orders.” Print the Diet Orders for your assigned unit(s). NOTE: Select the printer for the office where you are working, which is posted on the printer. We recommend printing in landscape format with 0.25 margins.

4. Check the top left corner of the Diet Orders’ front page to confirm that you have the most recent list. Diet Orders update on the computer at approximately 7:00am, 10:00am, 11:00am, 1:00pm, 4:00pm, and 6:00pm. Check back periodically to see if there is new information on your patients or new admissions.

5. Use your copy of the Diet Orders to make any pertinent notes from the patient’s chart in the Database. 6. Please be certain you read all “Alerts” for your patients, and write down those Alerts that are relevant.7. When you are finished viewing and printing documents from the computer, please LOG OFF so the computer is

available for the next person.

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http://elderlife.upmc.com/


AT THE NURSES’ STATION ON THE FLOORPlease sign in at the Nurses’ Station on the “HELP Volunteer” dry erase board. Include your first name, the date, and the hours of your shift.

8. On your Diet Orders, write the name and phone number of the RN and NA/PCT for each of your patients. Phone numbers are for your use only with the exception of 3-Pavillion (3PAV). On 3PAV, you should write the RN and NA/PCT’s phone numbers on the patient’s orientation board.

9. On your Diet Orders, note any patient with a discharge order. These patients may need a plastic bag to collect their belongings. Surveys should be given to patients if it is indicated on their Diet Order.

10. Please note any rooms that are under “Contact Precautions,” and check the Contact Precaution box on the patient’s chart in the database if it has not been done already.

MEAL-TIME GAME PLAN11. Approximate times for meal delivery are posted in the HELP offices. Newspapers (weekday service only) can be

given to patients before or during meals. Patients with the “OOB” (out of bed) notation on their Diet Order should be encouraged to move to their chair (with the NA or PCT’s assistance) to eat their meal.

12. Introduce yourself as a HELP Volunteer to the host or the food service worker, and let them know that you will be available to complete menus or assist with meals for certain patients 70 and older.

13. The words “tray set up” identify patients who need immediate help during meals. Please see these patients first. Encourage fluids or offer fluids with patients who have that notation on their Diet Order.

14. Highlight special Diet Order information, such as NPO, Fluid Restrictions, Low Sodium, Thickened Liquids or Supplements (e.g. Enlive, Ensure/Ensure pudding, Shake-em-up, Magic cups, thickened liquids, Glucerna, Carnation Instant).

15. Compare the name on the white slip of paper on the tray to your Diet Orders to be certain they match.16. Please consult the RN for patients who have an Intake & Output order (I&O), are on thickened liquids, or have a

Dysphagia/Aspiration precaution BEFORE refilling the patient’s water pitcher. Do not refill the water pitcher for NPO patients.

17. The water pitcher of a Contact Precaution patient may not be removed from their room, but you may bring in a new container of water if their Diet Order permits it.

ORGANIZING YOUR R&RS18. Patients are prioritized for R&Rs based on the fewest risk factors as follows: 1) 1st Priority Patients: patients with

one or two risk factors. 2) 2nd Priority Patients, 3) Not Assessed patients: prioritize, based on the number of risk factors, from lowest to highest. 3) Quality Improvement (QI) patients. If you are the second or third shift volunteer, check the database to see which patients have not yet had an R&R that day and prioritize accordingly.

19. During an R&R, you can talk, offer patients magazines, books, word puzzles, or use a game or memory cards with patients. Each office has an iPad to use with patients during an R&R. If you use these items with the patient for ten minutes or longer, record this as an active R&R. If the patient accepts an item to use on their own, record this as a passive R&R. NOTE: Some books are marked if they should not be left in the patient’s room.

20. Contact precaution patients can receive disposable magazines, magnifiers, Assisted Hearing Devices (AHDs) and paper puzzles. Cross out the sticker on the magazine that says the magazine should be returned. We cannot reuse magazines from contact precaution rooms. Please do not take cards or games into the room to play. Since we cannot reuse books from a contact precaution patient’s room, please make sure you know what type of book the patient likes before taking one to their room.

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21. If trained on AROM: Volunteers who work Monday through Friday may do Active Range of Motion (AROM) with any patient who has the “AROM” notation on their Diet Order under the Mobility column. Range of Motion Exercise booklets are available in each HELP Office and HELP staff can train you in this activity. If a patient becomes short of breath (SOB) or complains of pain during any visit, STOP, and alert the RN immediately.

CODING YOUR PATIENT INTERACTIONS IN THE ELDER LIFE DATABASE22. When you have completed your time with patients, please log on to the HELP office computer and update each

patient’s chart in the Diet Orders.23. Please update the Chart with relevant information, such as Brochure Given, Survey Completed, Magnifier

Refused, etc.24. If you have information to enter as an ALERT, please begin by typing the date of the alert. End the alert with

your initials.25. Accurately account for the interactions you had with each patient, such as CC Alone, R&R or a Meal.26. For every patient on your unit(s), indicate if you completed a passive or active R&R, whether the R&R included

AROM, or if no R&R was attempted. 27. HELP staff may exclude some patients who should not be seen by volunteers. As a result, patients’ names may

disappear from the Diet Orders.28. The computer system will automatically discharge patients. You do not need to create an Alert that a patient is

discharged. Charts for Discharge Patients are in a separate file at the top of the Diet Orders.29. When you have coded your interactions for a patient, be sure to click “UPDATE” on that patient’s chart, so your

coding is saved and properly recorded. When you are finished, please LOG OFF the computer. Do not share your screen time with any other person, unless a volunteer is shadowing you during training.

30. Please place all paperwork with confidential patient information in a shred bin at the Nurses’ Station. Also, please remove your name from the HELP Volunteer dry erase board, so the staff are aware that you are leaving. Revised Aug 2013 (J Drive: VC-Forms/Forms-Mass Copy)

Through this manual and the hands-on training to follow, we are providing you with the information you need to perform your HELP volunteer role at your very best. The important ingredients that you bring to the patients are your compassion, empathy and positive outlook. The HELP Department staff looks forward to your contribution to our program and the patients whom we all serve. WELCOME!

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FIRST HOMEWORK ASSIGNMENTDUE IN ADVANCE OF OR ON THE FIRST DAY OF TRAINING

Please create a quiz on the information found in this manual. The quiz questions can have any format or combinations of formats, such as True/False, Multiple Choice, Fill in the Blank, etc.

You should create 40 questions and provide the answers to your questions. Please try to create questions from every section of this manual.

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Documents

· Web vieware hearing impairment, vision impairment, immobility, withdraw from drug or alcohol usage, dehydration, and impaired cognition. At …