Welcome!
Nash Health Care
Student Orientation Handbook
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Instructions for Completion of
The Nash Health Care
Student Orientation
1. Please read the information provided in the on-line link to Nash Student
Orientation.
2. Please print and sign the Nash Health Care Student Orientation
Acknowledgement Form.
3. Turn in the signed form to your clinical instructor. These forms are kept on
file.
4. The contents of this orientation are for your reference and will be updated
on an as needed basis.
5. For further information please contact:
Van Holt, MSN, RN
Director of Education
252-962-8764
[email protected]
Lee Bailey, BSN, RN
Nurse Liaison
252-962-8440
[email protected]
Thank you for choosing Nash Health Care
for your student clinical experience.
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Student Orientation
Organization Structure
Nash Health Care is a non-profit hospital authority comprised of five licensed
hospitals totaling 403 beds: Nash General Hospital, Nash Day Hospital, the
Bryant T. Aldridge Rehabilitation Center, Community Hospital and Coastal Plain
Hospital. It serves Nash, Edgecombe, Halifax, Wilson and Johnston counties, but
draws patients from beyond these areas as well.
There are 7 (seven) Nash County Commissioners.
Each County Commissioner appoints 2 (two) people to the Nash Health Care
Board of Commissioners.
The 14 (fourteen) member Board provides oversight and guidance to the
hospital.
Each Board member serves a three-year term and may serve a total of three
terms.
Nash Health Care Systems is comprised of 4 corporations
Larry Chewning-President
1) Nash Medical Development Authority
Leases offices behind Nash General Hospital (NGH) to physicians or other
health professionals who are not = employees of Nash Health Care.
2) Nash MSO
Includes Nash Neurosurgery, Orthopedic Associates of Nash, and the Middlesex
Clinic.
3) Nash Community Health Services, Inc.
Responsible for the former Community Hospital at the Community Medical
Plaza in Rocky Mount. The Community Medical Plaza is leased, with 70 percent
of the facility leased to Life Care—a long-term acute care hospital that focuses
on the care of patients who require an extended length of stay.
4) Nash Hospitals, Inc.
Nash Hospitals, Inc.
353 Licensed Beds
Brad Weisner, Executive VP, COO
Nash General Hospital (NGH)
Opened in 1971, NGH was the first all-private room hospital in N.C. with 280
licensed acute care beds. The hospital includes the Claude Mayo Surgery
Pavilion, which opened in September, 2004. Future expansion plans include
anew Emergency Care Center, a separate Pediatric Emergency Care Center, a
new Women’s Center and a new Nash Heart Center
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Nash Day Hospital (NDH)
Opened in 1984, this was the first free-standing day hospital in N.C. , and it
offers outpatient rehabilitation, diagnostic and surgical care. It is also the
home of Nash Cancer Treatment Center.
Coastal Plain Hospital (CPH)
A 50-bed licensed inpatient and counseling and substance abuse treatment
facility, CPH became a part of Nash Health Care in 1994.
Bryant T. Aldridge Rehabilitation Center (BTAR)
Opened in November,1999, this all-private room center is licensed for 23
inpatient rehabilitation beds.
Accreditation
Nash Health Care is accredited by many agencies: The Joint Commission (TJC),
CARF, DHSR (State), CMS (Federal), the Health Department and OSHA. Various
other agencies survey the Laboratory, Nash Cancer Treatment Center, and other
specialty areas. Most agencies may arrive unannounced and at any time.
Progressive Institution
Rehabilitation Services
Inpatient and outpatient services
Education
TIGR, AHEC Digital Library (on-line journals and textbooks), On-line education
materials, NetLearning, Webcasts, and a variety of educational in-services
Patient Education
TIGR, On-line patient education materials, many references & resources
Community Outreach
Education for schools and community support groups
Computerization
Electronic medical record with multiple patient safety enhancements
Pastoral Care/Ethics
In-house chaplains, chapel located on the 1st floor of hospital
Policies
Professional Image /Dress Code/Identification
Clothing must be neat, clean and professional. All employees are expected to
project a positive, professional image as a representative of the hospital. Wear
your hospital identification badge above the waist with the front of the badge
visible at all times.
Do NOT wear leggings, sweats, mid-drifts, tank tops or jeans.
Hairstyles, clothing, and jewelry must be business-like and professional.
No visible body piercing is allowed except for ear piercing. No tongue
piercing, eyebrow or nose piercing.
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No see-through clothing. Dresses must be no more than 2-3 inches above the
knee.
For the safety of patients and staff/students in patient care areas, do not wear
the following: long, dangling or hoop ear rings or any other clothing or item
that may present a danger to a patient or caregiver.
No acrylic nails or other synthetic material nails. Nails must be clean, neat
and trimmed.
No cologne or perfume products in patient care areas.
Parking
Students may park in the gravel lot to the left as you drive onto campus.
Location of Food and Snacks
Cafeteria:
Located on Ground Floor
Monday-Friday
Breakfast 0615-1015
Lunch
1100-1400
Dinner
1630-1815
Night Shift 2400-0300
Weekend and Holidays
Breakfast 0615-0930
Lunch
1100-1115
Dinner
1630-1815
Night Shift 2400-0300
Montague’s Deli: 1st floor lobby area
Weekdays 1015-2030
Weekends 1100-2000
Gift Shop: 1st floor lobby area
Weekdays 0900-1900
Weekends
Saturday 1000-1700
Sunday 1100-1700
Vending Machines
Cafeteria entrance
Emergency Care Center – Lobby Area
Nash Day Hospital – Rehab Services Area
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Life Safety Issues for Occasional and Temporary Employees,
Contract Staff, Students and Others Involved in Temporary Work
at Nash Hospitals Inc.
Mission Statement
To provide superior quality health care services and to help improve the
health of the community in a caring, efficient and financially sound
manner.
It is the intent of Nash Health Care to inform each of its temporary employees or
contracted staff of basic Life Safety Issues related to patient care and outcomes.
Persons employed in a temporary capacity with Nash Health Care must be
familiar with the following life safety policies and procedures. The following
policies apply to all personnel unless otherwise stated :
FIRE
In the event of a fire, the operator will announce ―CODE RED.‖ To report a fire,
either pull the nearest fire alarm and wait for assistance, or call (962) 8123 and
announce ―code red‖ and describe your location. Do not hang up until instructed
to do so. If anyone is in immediate danger, assist with moving him or her to a
safe place. Remain at your work area unless instructed to leave and refrain from
using the elevators until the ―all clear‖ announcement is given.
Use fire
extinguishers only if you are familiar with their operation. If you must use an
extinguisher to protect others or yourself, remember ―PASS‖ and ―RACE.‖
P-Pull the pin
A-Aim the nozzle at the base of the fire
S-Squeeze the handle
S-Sweep the spray across the base
R-Rescue any persons in immediate danger safely or exit and report to
your assembly area
A-Activate the fire alarm box or call 8123
C-Contain the fire (close doors)
E-Extinguish the fire if it can be done. Be sure not to impede personnel
responding to the fire emergency.
CODE BLACK-BOMB THREAT
Call (962) 8123. If the threat is by telephone, get as much information as
possible from the caller, and do not hang up.
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Call (962) 8123. Follow your manager’s instructions and act to protect patients
and others. This code requires evacuation.
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HAZARDOUS MATERIAL EXPOSURE OR CHEMICAL SPILLS
Call (962) 8123 to report any exposure to hazardous materials or chemical spills
and see the Material Safety Data Sheet (MSDS). Immediately place someone
around exposed area to make sure no one enters exposed area. Each department
maintains a file of Hazardous Chemicals. Some units keep this information in a
notebook while others use the computer to access the MSDS information. The
Material Safety Data Sheet (MSDS) for each hazardous chemical includes physical
and health hazards, protective measures, labeling and may also include
monitoring devices if applicable. See the department head for access to
hazardous chemical information.
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Call (962)-8123 in the event we have an emergency situation that requires
patient decontamination, and extra staff is needed to handle the process.
Phase 1-Minimal casualty, adequate staff
Phase 2-Mass casualty, interruption of normal operations
RADIATION SAFETY AND YOU
Nash Health Care follows ALARA (As Low as Reasonably Achievable) Guidelines.
Only necessary staff should be in the room during X-ray examinations. If the
radiographer feels injury may result to the patient without human intervention,
other employees may be chosen to assist with the exam. The assisting personnel
shall follow radiation safety practice and NOT BE (1) PREGNANT, (2) UNDER
THE AGE OF 18 YEARS, OR (3) ROUTINELY HOLDING PATIENTS FOR XRAY EXAMS.
The Key to Radiation Safety is TIME, DISTANCE, and SHIELDING
1. Limit time in a radiation area
2. Stay out of the direct beam of the X-ray
3. Wear lead shielding if you are required to be in the room during x-ray
exposure
The Radiation Safety Officer can address any questions regarding Radiation
Safety at 962-8083.
MRI SAFETY
Do not proceed into the MRI area without hospital personnel accompanying you
due to the serious nature of metal objects flying into the MRI machine and room.
We do not wish for you to accidentally cause injury to yourself or others.
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Call (962)-8123.
Phase 1-Adequate Staff on duty
Phase 2-Staff Callback Necessary
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A ―CODE BLUE‖ announcement means that a patient is in distress and needs
immediate attention. Please do not interfere with or impede employees
responding to this announcement. Refrain from using the elevators at this time.
In the event you find a patient in distress and in need of immediate attention call
(962)-8123 and announce ―code blue‖ and give your name and location.
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A ―CODE PINK‖ announcement means that there is a suspected abduction of an
infant. Watch and report any unusual or suspicious behavior to your supervisor
or call (962) 8123 and state your name and location.
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A ―CODE AMBER‖ announcement means there is a suspected abduction of a
child. Watch and report any unusual or suspicious behavior to your supervisor.
Call (962) 8123 and state your name and location.
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A ―CODE SILVER‖ announcement means that there is a suspected abduction of
a person older that 16 (sixteen) years old. Watch and report any suspicious
behavior to your supervisor or call (962) 8123 and state your name and
location.
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Call (962) 8123 to report any utility failures; identify yourself and your location.
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Call (962) 8123 to report a fire and the location. Use RACE and PASS if
needed.
CODE 1-Combative Patient
Call (962) 8123 to have a CODE 1 (one) announced over the intercom system.
This means a patient is combative and may be endangering the safety of himself,
other patients, or staff. Staff trained in CPI (Nonviolent Crisis Intervention)
should respond. The Code One Team responds in attempt to de-escalate a
behavioral situation.
CODE 4-Active Shooter/Hostage
In a situation involving a perpetrator with a weapon with or without a
hostage(s), call 8234 to notify the switchboard to alert Security and the House
Supervisor to activate a Code 4. Please refer to the Code 4 Annex Plan.
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CODE 99-Rapid Response Team
Call (962) 8123 to have the Rapid Response Team paged. This team is called
when a patient’s condition is deteriorating and intervention is necessary to
support the patient and prevent the situation from progressing to a Code Blue.
CONDITION H-Condition Help
When necessary, (962) 8123 is called by a patient or family member when he
or she feels additional help is needed for a patient whose condition is
deteriorating.
POISON CONTROL
1-888-222-1222
INFECTION CONTROL
One of the most difficult problems in a hospital is preventing the spread of
infectious agents. The most effective means of controlling this spread is by hand
washing. Always wash your hands after using the bathroom, before and after
eating, and after removing gloves.
If your job involves patient contact, wash
your hands before and after contact with the patient. Hospital-provided hand
sanitizer is located in patient rooms. DO NOT USE HAND SANITIZER IF HANDS
ARE VISIBLY DIRTY OR IF THE PATIENT HAS DIARRHEA.
Occasionally you will see signs posted outside a patient’s room describing special
infection control procedures: Droplet, Airborne Infection and/or Contact. Before
entering any of these rooms, contact the nurse on the floor to receive
instructions about proper attire and instruction on entering and leaving these
rooms.
Dispose of sharp objects in the sharps containers located in the area in which you
are working. Dispose of ―regulated‖ waste in the red bio-hazard bags located
within your work area. Regulated waste is defined as any waste/trash items that
will release more than 20 ccs of blood or body fluids when compressed or
squeezed OR will release cakes of dried blood or body fluids and any body parts.
If you have any questions, ask the operator to page the Infection Prevention
Nurse.
NO artificial nails of ANY type may be worn in patient care areas.
DO NOT use lotions from home while at work. Soap used at Nash Health
Care has an antimicrobial agent which actively fights against bacteria and fungi.
Its killing activity can be reduced by the over-the-counter lotions which contain
petroleum and glycerin. Also, lotions from home may affect the integrity of latex
gloves.
Please use the hospital-provided lotion. REMEMBER—proper hand
hygiene is the #1 method to prevent the spread of infection. Proper
hand hygiene protects our patient as well as ourselves!
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All patients shall be treated as potentially infected with a bloodborne disease and
Standard Precautions (previously called Universal Precautions) shall be followed.
In the event you are exposed to blood/body fluids, report immediately to your
supervisor or nursing supervisor for follow-up. In the event your clothes become
soiled with blood/body fluids, remain in the area if possible and report to your
supervisor or nursing supervisor.
Be sure to wear your PPE (personal protective equipment) if you anticipate
exposure to blood or body fluids.
ELECTRICAL SAFETY
Do not use any equipment with frayed cords or broken ground. Make sure hands
and area are dry when working with patients attached to monitors and IVs.
Report damages to your supervisor and they will notify maintenance or Biomed.
Make sure all medical equipment has a hospital identification number and check
to make sure the preventive maintenance label is current.
ETHICAL ISSUES
Anyone concerned about an ethical situation may request an ethical evaluation.
All concerns should be directed to the on call ethics consultant by calling the
Hospital Operator (0).
PATIENT RIGHTS AND RESPONSIBILITIES
The basic rights of human beings for independence of expression, decision and
action, and concern for personal dignity and human relationships are always of
great importance. During sickness, however, the presence or absence of these
rights becomes a vital deciding factor in survival and recovery. Thus, it becomes
a primary responsibility for Nash Health Care to preserve these patient rights. In
addition, Nash has the right to expect the behavior of patients and their relatives
and friends to be reasonable and responsible. For a detailed list of Patients Rights
and Responsibilities see the on-line policy manual on the Intranet.
SMOKING POLICY
Nash Hospitals, Inc. is Smoke-Free. Smoking is prohibited throughout Nash
Health Care -which includes all buildings and the grounds.
CONFIDENTIALITY
Patient information is very personal and private and must always be kept strictly
confidential. Although Nash Health Care owns the medical record created and
maintained by its division hospitals, patients have rights, including the right to
expect that their records be kept confidential. Please refer to the on-line policy
manual on the intranet for a complete confidentiality policy.
CORPORATE COMPLIANCE AND HIPAA
Simply stated, ―Corporate Compliance‖ means that everyone in the
business/hospital will obey all laws, regulations, policies and procedures, and
conduct themselves in an ethical manner.
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Everyone is held to this standard, whether they deal with treatments, billing,
confidentiality, or any type of patient care. On a departmental level, Corporate
Compliance means you are to properly complete job assignments and obey rules
and regulations. Clear and accurate recording of what is done for the patient is
vital to provide an accurate medical record and to provide a basis for proper
coding and billing of those services.
HIPAA stands for the Health Insurance Portability and Accountability Act that
was passed in 1996. It covers the following areas:
It provides for ―portability‖ of health care coverage so that individuals can
transfer from one health plan to another without exclusions and limitations from
pre-existing conditions. It prohibits discrimination related to health plan eligibility
and premiums. It establishes increased surveillance and penalties related to fraud
and abuse, and it includes administrative simplification provisions that establish
standards for electronic transmission of certain health information.
It also provides guidelines to maintaining privacy and security of PHI, ―Protected
Health Information,‖ by prescribing how such information is to be shared,
transferred, and stored. This is designed to protect the confidentiality of PHI
relating to the internal handling of that information and any transfer of that
information whether it is verbal, written, or electronic in any format.
The administration of Compliance and HIPAA programs at Nash Health Care is
through the Compliance and Privacy Officer.
It is Nash Health Care’s expectation that each of our employees should be able to
communicate their concerns freely to the Corporate Compliance officer. In
addition, to further encourage reporting, NHCS has set up a toll-free voice
mailbox @ 877-733-5102 to which employees can report issues anonymously.
The number for the Corporate Compliance officer is 962-3342.
OCCURRENCE REPORTING
Any person involved in or witnessing an unusual occurrence will notify his or her
immediate supervisor to initiate an occurrence report. An occurrence is any
happening or event which is not consistent with the routine operation of the
hospital or the routine care of a particular patient. This includes, but is not
limited to, accidents or a situation which may result in bodily injury to a patient.
ACCIDENT REPORTING
Contractual persons and visitors who are injured while at Nash Health Care may
need to report to the Emergency Care Center for treatment.
Allied
Health/Nursing Students need to report to Occupational Health for injuries, if
needed. Any employee or student who witnesses visitor falls and/or damage to
property should report the incident to security.
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COMPLAINTS AND GRIEVANCES
At times, patients may express concerns about the care they or a family member
receive or about other issues while at Nash Health Care. It is our responsibility
to address these concerns in a timely manner. What is the difference between a
grievance and a complaint?
COMPLAINT
A complaint is any issue or concern, relatively minor in nature, which is
expressed verbally and which can be immediately resolved by staff present.
GRIEVANCE
A grievance is an issue or concern, expressed formally or informally, that cannot
be resolved immediately by staff present, or issues and concerns which do not fit
the definition of a complaint.
Nash Health Care strives to handle complaints and grievances promptly to ensure
patient satisfaction and quality healthcare for our patients.
PROCESS IMPROVEMENT
Nash Hospitals Inc. Process Improvement Program uses FOCUS-PDSA.
F-Find a process to improve
O-Organize an effort to work on improvement
C-Clarify current knowledge of the process
U-Understand process variation and capability
S- Select a strategy for continued improvement
P-Plan an activity aimed at improvement
D-Do. Carry it out
S-Study the results. What did we learn? What can we predict?
A-Act. Adopt or abandon the change or run through the cycle again.
All of our policies may be found on line on the Nash Intranet under Policies and
Procedures
These instructions do not cover all possible life safety issues. If you
have any questions regarding safety, contact the manager of the
department in which you are working or your clinical instructor.
Instituted 5/25/99
Revised 12/2007, 02/2008(VLH), 01/2009 (VLH), 10/2010 (KSP), 06/2011(LBB), 06/2012 (LBB)
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The Pursuit of Excellence (POE)
Nash Health Care’s Mission Statement:
To provide superior quality health care services and to help improve the
health of the community in a caring, efficient, and financially sound
manner.
The goal of The Pursuit of Excellence, Nash Health Care’s customer service
program, is to teach staff the necessary techniques and strategies to provide our
customers with superior quality care – the type of care that goes beyond the
customer’s expectations. At Nash Health Care, we strive to make our customers
feel welcome, cared for, and valued. POE teaches staff the communication skills
and strategies designed to ensure our customers have positive experiences at
Nash Health Care from ―the front door to the back door.‖
To help achieve superior quality care, Nash Health Care has ten Standards of
Performance all employees are expected to know and follow. The standards are:
Call lights
Appearance
Privacy
Etiquette
Communication
Customer Service
Ownership
Appearance
Safety
Teamwork
Remember the acronym CAPE C COAST
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―DO NOT USE‖ Abbreviations
Do Not Use
Potential Problem
Use Instead
Official ―Do Not Use‖ List:
U (unit)
Mistaken for ―0‖ (zero), the number
―unit‖
―4‖ (four) or ―cc‖
IU (International Unit)
Mistaken for IV (intravenous) or the ―International
number 10 (ten)
Unit‖
Mistaken for each other. Period
Q.D., QD, q.d., qd (daily)
after the Q mistaken for ―I‖ and
Q.O.D., QOD, q.o.d, qod
the ―O‖ mistaken for ―I‖ (q.i.d. is
(every other day)
four times a day dosing)
―daily‖
‖every other day‖
Trailing zero (X.0 mg)
Lack of leading zero (.X
mg)
Decimal point is missed
X mg
0.X mg
MS
Can mean morphine sulfate or
magnesium sulfate
―morphine
sulfate‖
MSO4 and MgSO4
Confused for one another
―magnesium
sulfate‖
For possible future inclusion in the official list:
> (greater than)
< (less than)
Misinterpreted as the number ―7‖
(seven) or the letter ―L‖.
Confused for one another
―greater than‖
‖less than‖
Abbreviations for drug
names
Misinterpreted due to similar
abbreviations for multiple drugs
Write drug names
in full
Apothecary units
Unfamiliar to many practitioners.
Confused with metric units
metric units
@
Mistaken for the number ―2‖ (two)
―at‖
cc
Mistaken for U (units) when poorly
written
―mL‖ or
―milliliters‖
µg
Mistaken for mg (milligrams)
resulting in one-thousandfold
overdose
―mcg‖ or
―micrograms
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The Journey to Magnet
1. Purpose

To demonstrate a management philosophy

To demonstrate adherence to high standards of care

To award hospitals for cultural and ethnic diversity
2. Why is Magnet important to our department?
Positive impact on mortality and patient satisfaction.
Increases staff morale
Creates a positive ―halo‖ effect beyond the nursing services
department that permeates the entire health care team.
Creates a ―Magnet Culture‖ reflecting core values such as
empowerment, pride, mentoring, nurturing, respect, integrity and
teamwork.
Fosters respect and caring for patients and staff by actively
bringing out the best in people.
Improves patient quality outcomes
Highlights the positive/very good care we give
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3. Phases of Application
Phase One: Application
A two-page document commits applicants to submitting their
documents at the time of application or within 1 year.
Phase Two: Evaluation of document
Phase Three: Site visit
Phase Four: Completion
The commission votes on awarding Magnet Status. This can
take up to eight weeks to complete. Magnet status is awarded
for four years.
4. Shared Decision-Making/Shared Governance
Gives staff nurses control over their practice and can extend their
influence into administrative areas previously controlled only by
managers.
Shared governance underlying principles of partnership, equity,
accountability, and ownership are embodied in all of sources of
evidence.
5. Sources of Evidence
Transformational Leadership
Quality of Nursing Leadership
Management Style
Structural Empowerment
o Organizational structure
o Personnel policies and programs
o Community and the health care organization
o Image of nursing
o Professional development
Exemplary Professional Practice
o Professional Models of Care
o Consultation and resources
o Autonomy
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o ―Nurses as Teachers‖
o Interdisciplinary relationships
o New knowledge, innovation, and improvement
o Quality improvement
Empirical quality results
o Quality of care
o Consultation and resources
6. Evidence-Based Nursing:
o The process by which nurses make clinical decisions using the best
available research evidence, their clinical expertise and patient preferences.
Three areas of research competence are: interpreting and using research,
evaluating practice, and conducting research. These three competencies are
important to evidence-based nursing.
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Nash General Hospital Directory
6th Floor
5th Floor
Storage
Cardiopulmonary Support Unit
(CPSU)
th
4 Floor
North-Surgery
South – Surgery
East – Joint Center/Bariatrics
West – Oncology
rd
3 Floor
North – Medicine
South – Medicine
East – CCU and Dialysis Unit
West – Pediatrics
nd
2 Floor
North – Gynecology
South – Newborn & Special Care Nursery
East – Labor & Delivery
West – Postpartum/OB
st
1 Floor
Nursing Administration
Business and Hospital Administration
Educational Services
Health and Information Management
Patient and Family Services
Admitting
Credit and Collections
Volunteer Services
Gift Shop/Snack Bar
Pastoral Care
Quality Support
Public Relations
Medical Library
Ground Floor Emergency Care Center
Dietary Office
Kitchen
Housekeeping
Morgue
Pharmacy
Employee Pharmacy
Special Medicine
Rehab Services
Radiology
Information Services
Central Sterile Supply Self-Serve
Laboratory
Maintenance
Nash Heart Center
Cafeteria
Critical Care Unit
Entrance to Nash Day Hospital
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EMERGENCY MANAGEMENT CODES
Call 8123 For All Codes
Code Red – Fire
Code Blue – Cardiac / Respiratory Arrest
Code Pink – Possible Infant Abduction
Code Amber - Possible Child Abduction
Code Silver- Missing Adult
Code Yellow – Disaster Requiring Evacuation
Code Green – External Disaster/Influx of Patients
Phase 1: Adequate Staff on duty
Phase 2: Staff Callback Necessary
Code Orange – Hazmat / Chemical or Biological
Phase 1: Minimal Casualty Response-Adequate Staff
Phase 2: Mass Casualty Response-Interruption of Normal Operations
Code Black – Bomb Threat
Code Gray – Utility Failure
Code 1 – Combative Patient
Code 4 – Active Shooter/Hostage
Code 99 – Rapid Response Team
Chemical Spill - Call 8123
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TUBE SYSTEM TIPS
1. The Pneumatic Tube System is used to transport supplies,
records, specimens, medications, and other small items.
2. There are approximately 12 tube stations.
3. The following are items approved for transport in the tube
system:
Tubes of blood
Blood gases
Sealed urine specimens
Pap smears
Culture specimens (sputum, culturettes, etc.)
Containers < 150cc
Medical records
Pharmacy supplies (excluding controlled substances)
Paper (excluding money/checks)
4. The following items are NOT approved for transport in the tube
system:
A. Lab specimens
Physician collected specimens: spinal fluid, thoracentesis
fluid, pleural fluid, umbilical cord segments
Stool specimens
24 hour urine
Specimens preserved in alcohol or formalin
Items implicated in a possible transfusion reaction: blood
bag, IV solution, blood administration set
B.
Pharmacy supplies
Controlled substances (medications)
Chemotherapy drugs
Prescriptions
Protein-based drugs (albumin, gamma globulin, Factor
VIII)
C.
Other
Contaminated supplies
Sharps
Food items or drinks (soda)
Patient valuables
Non-leak tight containers
Money/checks
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5. According to Universal Precautions and OSHA Bloodborne
Pathogen regulations, all blood and body fluids must be handled
as potentially infectious. Items must be contained and
transported in a manner that prevents breakage, leakage and
contamination of the system.
6. To prevent spillage or breakage
Tighten all container lids
Use the foam-lined carriers when appropriate
Use biohazard zip lock bags to contain specimens
Double-bag when appropriate
7. If you receive a contaminated carrier, handle with care using
Universal Precautions. Notify maintenance IMMEDIATELY @ 8088
8. Refer to Policy #PC 210.73 - Pneumatic Tube System for further
details and operating guidelines.
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PREVENT PATIENT FALLS
Physical therapy consult
Review medication profile
Environmental stimulation decreased
Visualization of patient by staff
Encourage family/friends to stay with patient
Non-skid footwear provided
Toilet/offer drink every 2 hours while awake
Family/patient teaching
Assess pain/adequate lighting
Leisurely/diversional activities provided
Leave bed alarm on
Star on door/yellow armband on patient
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Falls Prevention Program
PC 210.50
Purpose
To identify patients at risk for falls
To promote patient safety in the hospital setting
To provide guidelines for the staff in the prevention of and/or the
response to falls
Patient Safety – Back to the Basics
Lock bed wheels, wheelchairs, and stretchers
Ensure the bed is in low position
Be sure the two top side rails up
Ensure the call light is within the patient’s reach
Place frequently used items within the patient’s reach
Clear the room of clutter
Risk Factors for Falls
Prior history of falling
Dependence with ambulating: bed rest, Nurse assistance, and use
of ambulatory aids such as crutches, cane, walkers
Absence of normal gait
Decreased level of consciousness, mental status, or cognitive state
Presence of severe pain
Receiving medications that may cause orthostatic hypotension,
dizziness, or sensory deficits
Receiving medications that may increase the need to urinate or
defecate
Receiving medications that may impair judgment or awareness of
surroundings and decision-making skills
History of bowel and bladder surgery or incontinence
Age-specific concerns
Assessment
RN completes a FALL RISK assessment during the initial inpatient
nursing assessment for admissions
Reassessment
Must be conducted at least daily by the nurse
Must be updated upon a change in the patient’s condition
Must be updated upon transfer from one unit to another
Must be conducted upon a patient sustaining a fall
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Fall Prevention Packets
Fall Prevention packets are available on each unit
The fall prevention packet consists of:
1. A falling star
2. Non-skid slippers
3. Falls prevention educational printout
4. Yellow armband
The High-Risk Patient
Place a yellow armband on the patient
Place a FALLING STAR on the patient’s door
Initiate patient/family teaching and give a falls prevention pamphlet
to patient and family
Instruct patient to call for assistance with transfers and ambulation
Offer toileting and drink every 2 hours while awake
Optimize use of eye glasses and hearing aids
Use non-skid footwear
Ask for physical therapy consult
Other considerations
Move patient to a room that allows maximum visualization by staff
Decrease environmental stimulation
Encourage family/friends to stay with patient
Use bedside commode
Initiate bed alarms
Drugs that May Increase the Risk for Falls
Narcotics: Fentanyl (Duragesic®)
Antihypertensives: Terazosin (Hytrin®), Doxazosin (Cardura®)
Antibiotics: Nitrofurantion (Macrodantin®, Macrobid®)
Muscle Relaxants: Cyclobenzoprine (Flexeril®)
Anticholinergics: Hyoscyamine (Cystospaz®, Levsin®, etc)
Document the fall in the medical record
When a Patient Falls
Notify the emergency contact listed on admission
Notify the MD
Complete an SEM form
SEM Live Site is located on the Nash Intranet
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Safety Syringes in Use at Nash Health Care Systems
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Safety Syringes in Use at Nash Health Care Systems
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Workplace Violence Program
HR 402
Purpose
To maintain an environment that is as safe as possible for patients,
visitors, employees and physicians.
Policy Statements
It is the policy of Nash Hospitals, Inc. to maintain a safe and secure
environment free from intimidation, threats of violence and acts of
violence for all persons while working, visiting or receiving care at our
facilities or facilities leased by Nash Hospitals Inc.
Warning Signs of Increased Anger/Hostility
There is no exact method to predict when a person will become
violent. One or more of these warning signs may be displayed before a
person becomes violent, but they do not necessarily indicate that an
individual will become violent. These signs should trigger concern:
Verbal, nonverbal, or written threats
Intimidation (explicit or subtle)
Fascination with weaponry and/or acts of violence, –carrying a
concealed weapon
Expression of a plan to hurt self and/or others
Feelings of persecution and expressing distrust, especially with
management
Fear reaction to employee among coworkers/clients
Expressing extreme desperation over family, financial or personal
problems
Frequent interpersonal conflicts
Unable to take criticism of job performance
Displays of unwarranted anger
Displays sense of moral righteousness – believing the organization
is not following its rules
Violence toward inanimate objects
Sabotaging projects, computer programs or equipment
Holding a grudge against a specific person; verbalizing a hope that
something will happen to him/her
Those who witness these warning signs are strongly encouraged to
inform their supervisors. Managers and supervisors are encouraged to
consult with Human Resources to attempt to prevent a difficult
situation from escalating into violence.
Workplace violence may also occur when an individual becomes
romantically obsessed with someone who does not reciprocate the
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romantic feelings. The obsession is irrational and the subject does not
respond to the victim’s attempts to set limits or to end the
attachment. Obsessed individuals have sometimes been known to be a
threat to the safety of the individual with whom they are obsessed. If
you believe that you are being stalked or that someone has an
obsessive attachment to you, you should notify Security.
Classification of Violence in the Workplace
To help distinguish the sources of workplace violence, we use these
four categories:
Type I (Criminal Intent) Committed by a perpetrator who has no
relationship to the workplace
Type II (Patient) the perpetrator is a patient at the workplace who
becomes violent towards a worker or another patient
Type III (Worker to worker) the perpetrator is an employee or past
employee of the workplace
Type IV (Personal relationship) the perpetrator usually has a
relationship with an employee (example: domestic violence)
You should be aware of these examples of workplace violence, which
includes, but is not limited to:
a. Verbal abuse and threatening behavior (also known as
psychological abuse)
Shouting
Condescending language
Swearing
Bullying or any other behavior meant to intimidate, belittle or
demean another
Mobbing, by a group of individuals towards one or more members
of NHI
Making racial slurs or comments
Obscene or threatening phone calls at work or home
Any behavior meant to offend, humiliate or embarrass
Veiled threats or open threats
Gestures with the hands or other parts of the body that indicate
harm
Stalking
Display or use of any kind weapon, including a gun, baseball bat,
knife, surgical instrument or any other object that could be
interpreted as being dangerous
Leering or staring
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b. Physical abuse and threatening behavior
Slapping
Shoving and pushing
Pinching
Hair pulling
Punching
Hitting
Throwing an object at a person
Kicking
Scratching
Tugging at clothes
Biting
Shooting and stabbing
Suicide/ attempted suicide
Mobbing
c. Damage to employees’ personal property or to NHI property
Throwing of any object
Deliberately kicking or punching fixtures and fittings, walls
Banging or throwing equipment or furniture
Interfering with NHI vehicles or causing damage to employee
vehicles at work
Type 1: Criminal Intent Crisis Response
Any emergency, perceived emergency, or suspected criminal
conduct (for example, a restraining order violation) should be
immediately reported to Security.
Code 4: In a situation involving a perpetrator with a weapon,
with or without a hostage(s), call 8123 to notify the switchboard
to alert Security and the House Supervisor to activate a Code 4.
Please refer to the Code 4 Annex Plan.
Code Black: In a situation where there is the threat of a bomb,
call 8123 to notify switchboard to alert Security and the House
Supervisor to activate a Code Black. In the Emergency Care
Center front waiting area, activate the panic button. For further
information regarding Code Black please refer to the Code Black
Annex Plan.
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Type 2: Patient Violence
Code 1: In a situation where a patient’s behavior is escalating or
has become violent towards a staff member, visitor, or another
patient, call 8123 to notify the switchboard to activate a Code 1.
Please refer to the Code 1 Policy.
Please refer to HR Policy 402 for additional information regarding the
Workplace Violence Program.
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Cultural Diversity
As clinicians, we need to ―check our own pulse‖ and become aware of
personal attitudes, beliefs, biases, and behaviors that may influence
(consciously or unconsciously) our care of patients, as well as our
interactions with professional colleagues and staff, from diverse racial,
ethnic, and sociocultural backgrounds.
It should be understood that there is no ―one‖ way to treat any racial
and ethnic group, given the great sociocultural diversity of our
country.
Please keep in mind that while culture is an essential mediator in
health status, culture is not the only factor that shapes us. Other
factors including environment, economics, genetics, previous and
current health status, and psychosocial factors, exert considerable
influence on our well-being.
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Cultural competence
Cultural competence begins with an honest desire to treat every
individual with respect. It requires an honest assessment of our
positive and negative assumptions and biases about others. While an
organization can help its health care professionals gain cultural
competence through formal training, most people require consistent
practice over time to gain cultural competence.
Barriers to Equitable Care
It is important for nurses to be aware of personal factors that have an
impact (consciously or unconsciously) on patient care.
Becoming aware of individual attitudes, beliefs, biases, and behaviors
that may influence patient care is a vital component of cultural
competency. This awareness can help nurses improve access to care,
improve quality of care and, ultimately, improve health outcomes for
their patients.
Among the more prominent barriers to equitable care are language
and access. Language barriers have been found to decrease the
quality of care and lead to serious complications and adverse clinical
outcomes (Grantmakers in Health, 2003).
Did You Know?
More than half of New York City’s Haitian, Russian, and Hispanic firstgeneration immigrants said that language barriers led to reduced
quality care for their children In a 2006 report from the Foundation for
Child Development, participants stated that limited English language
proficiency led to discourteous treatment, partial disclosure of
symptoms, and partial comprehension of medical information and
instructions.
Asthmatic patients who do not speak the same language as their
physicians were less likely to keep scheduled office appointments and
more likely to miss follow-up appointments and use the emergency
room instead. Data also suggests that when a physician is unable to
communicate effectively and take an accurate patient history, serious
side effects may occur.
A survey of health care providers in Miami, Los Angeles, New York
City, and Houston revealed that language difficulties were a major
barrier to immigrants’ health care. Language difficulties also posed a
serious threat to medical care since clinicians could not obtain
information to make good diagnoses. Other difficulties can arise
because a patient may not understand his/her prescribed treatment.
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Culture shapes our language, behaviors, values, and institutions.
Understanding culture can help us interact with other groups and help
us avoid prejudice, stereotypes, and biases. To be culturally
competent means to understand how your patients present themselves
based on their culture. Being culturally competent also means
managing your own cultural beliefs and those of your patients. Cultural
competence can help ensure the delivery of effective, understandable,
and respectful care for all patients.
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Americans with Disabilities Act (ADA)
A Focus on Those Who Are Deaf or Hard of Hearing
Under the Americans with Disabilities Act (ADA), hospitals MUST
provide effective means of communication for patients, family
members, and hospital visitors who are deaf or hard of hearing.
The ADA applies to all hospital programs and services,
such as:
Emergency room care
Surgical services
Clinics
Cafeteria and gift shop services
Wherever patients, their family members, companions, or members
of the public are interacting with hospital staff, the hospital must
provide effective communication.
Communication
People who are deaf or hard of hearing use a variety of ways to
communicate, including:
Sign language interpreters
Assistive listening devices
Written messages
Many can speak even though they cannot hear
Important
The method of communication and the services or aids the hospital
must provide will vary depending upon the abilities of the person
who is deaf or hard of hearing and on the complexity and nature of
the communications that are required. Effective communication is
particularly critical in health care settings where miscommunication
may lead to misdiagnosis and improper or delayed medical
treatment.
Clear Communication
There are situations that necessitate clear communication, such as:
Obtaining a patient’s medical history & initial assessment
Obtaining informed consent and/or permission for treatment
Diagnosing an illness or injury
Explaining a planned medical approach
Determining whether or not the patient is conscious and
mentally alert during treatment or following surgery.
During acute or emergency episodes as condition allows
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Explaining prescribed medications, including how and when they
should be taken
During patient and/or family teaching
During discharge planning
During discharge of the patient
Assistance Available at Nash Health Care
Martti, a web-based program, is available 24 hours a day, 7 days a
week, to access sign -language interpreters. The units are housed
in the following locations: House Supervisor’s office, Emergency
Care Center, 2nd Floor, 3rd Floor, 4th Floor, 5th Floor, Labor &
Delivery, BTAR, Coastal Plain Hospital, Nash General Hospital
Pre/Post OR and Nash Day Hospital Pre/Post OR. Each Martti unit
has a folder with ―Important Tips for Use‖ and a laminated copy of
―Step-By-Step Instructions.‖
Other Assistance Available
If you need communication assistance (sign language or nonEnglish language), Martti should be your first resource. However, if
Martti is unavailable, additional communication assistance devices
are available and are described in the Communication Assistance
Policy, PC 210.11.
Raising Awareness
The deaf culture has no prohibition against staring because it is
necessary for effective communication. In the hearing culture,
staring is often considered rude. Some people assume deaf people
have less than average intelligence because their speech sounds
different. This is an inaccurate assumption!
The majority of deaf people do not read lips well. Only about 40%
of what is said can be read on the lips, and it is a difficult skill to
learn. Most deaf people do not wish to be called ―hearing
impaired.‖ ‖Impaired‖ implies something is broken. Deaf people
prefer to be called deaf or hard of hearing.
Most deaf people have trouble with the written language because
sign language—not English—is their first language. As a result,
most deaf people have a fourth-grade reading level. Remember
that any concept or idea can be expressed in sign language.
Important Points
ADA mandates provisions for effective communication with those
who are deaf or hard of hearing. People who are deaf or hard of
hearing use a variety of ways to communicate. To ensure clear
communication with those who are deaf or hard of hearing,
remember that Martti provides 24/7 access to sign language
interpreters.
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Resources
Nash Policy PC 210.11
Disability Rights North Carolina www.disabilityrights.org
Americans with Disabilities Act of 1990 www.ada.gov
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Nash Health Care Student Orientation Acknowledgement Form
Please complete the following items before entering
the clinical area
Check off the topics below as you complete them:
__________General Information
__________Life Safety Information
__________Influenza and Influenza Vaccine Myths & Reality
__________2012 National Patient Safety Goals
__________2012 Quality and Patient Safety Indicator Priorities
__________HIPAA Guidelines
__________Pursuit of Excellence
__________‖Do Not Use‖ Abbreviations
__________Journey To Magnet
__________Tube System Tips
__________Falls Prevention Program
__________Donning and Removing Personal Protective Equipment
__________Safety Syringes
__________Workplace Violence Program
__________Cultural Diversity
__________Americans With Disabilities Act
Sign and turn in the acknowledgement form to your agency/school
clinical instructor or site coordinator. Thank you for your time and
attention.
___________________________
___________________
Signature
Date of Completion
__________________________________________________
Agency/School
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