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Clinical Student Orientation
Environment of Care
This section prepares you to safely respond to an emergency situation at work as well as at home. This section will help you learn how to respond to unexpected events and emergencies, as your actions could have an impact on patients, parents and coworkers. Following these procedures may ensure safety for you, our patients and their families.
Code Red = Fire
Code Red means there is a fire somewhere at the hospital.
RACE is a national acronym used to help you remember what you must do in case of a fire.
If there is a fire, remember the term “RACE”:
R - Rescue: Your first priority is to remove patients from immediate danger.
A – Alarm: Pull the nearest red fire alarm box.
C – Contain: Close all doors.
E – Evacuate/Extinguish: Know the location of all fire exits should evacuation become necessary.
Evacuate horizontally following your unit’s evacuation plan. Do not use elevators, use only stairs. Remember to CLOSE ALL DOORS.
Use the proper fire extinguisher to extinguish or control a fire, only if trained to do so. ORMC’s safety plan outlines specific personnel that will respond should a code red be called.
Code Blue = Adult Cardiopulmonary Arrest
Code Blue means cardiac arrest or respiratory arrest.
If a patient, visitor or employee has cardiac or respiratory arrest, call for help by dialing 3999 on any in-house phone. Most patient rooms have a “Code Blue” button. It is preferable to use this if available. Give the number of the patient’s room or area where the victim is located. The switchboard operator will page “Code Blue” on the Overhouse page. Begin CPR if you are certified to do so.
Code Pink = Infant/Child Cardiopulmonary Arrest
Follow the same procedure above.
Code Black = Tornado sighted in the area
Code Adam = Infant/Child abduction
Code Triage = an event that significantly disrupts the environment of care and/or the care and treatment of patients
Electrical safety is very important for preventing fires and shock.
Personal Safety Tips
You can help us make the hospital a safer place by taking steps to protect yourself.
Security officers are to be contacted through the hospital switchboard at extension 3505.
Hazardous materials are chemical products that can harm yours eyes, lungs or skin. Be sure to protect yourself when handling chemical products. Use Personal Protective Equipment including gloves, mask, gown, and protective eyewear.
Waste Disposal: There are several types of hospital waste. Each type of waste has its own type of waste container.
Biohazard Waste is any type of waste that is contaminated by blood or other body fluids contaminated with blood. All items contaminated with more than a small amount of blood, drainage, or infectious secretions are discarded in red bags for incineration. These containers have the Biohazard symbol. Note: always wear Personal Protective Equipment (PPE) when handling Biohazardous Waste.
Sharps are substances that can poke or cut your skin, such as needles, broken ampules and/or lancets. Sharps are disposed of into a hard, plastic Sharps Box. Sharps may be contaminated; therefore, you must always wear PPE when handling sharps.
ORMC students/volunteers need to follow a basic level of caution during their work activities. They include:
Universal or Standard Precautions are a set of standardized precautions to be used for all patients, regardless of illness or medical condition for the prevention of blood-borne pathogens.
Hand washing is required before and after patient contact as it is the single most important action in preventing the transmission of disease.
Personal Protective Equipment (PPE) is worn to protect against blood/body fluid exposures. Staff should know location of PPE in each patient care area and be familiar with them when barriers are indicated and used as required.
*Gloves for hand protection
*Gowns to protect clothing
*Protective eyewear to reduce risk of splashes, use goggles or masks with shield
*Masks to reduce risk of respiratory exposure
Avoid touching face or eyes during patient care activities. Many respiratory viruses are readily transmitted through the mucus membranes of the eyes, nose, and mouth.
Avoid eating, drinking, or applying lipstick or lip balm in patient care areas. Enteric viruses such as Rotavirus may survive for up to 5 days on environmental surfaces.
Staff should know the location of eye wash stations in patient care areas and use to immediately cleanse eye if contamination with blood, body fluid or hazardous chemicals should occur.
Injuries with contaminated sharps present a significant risk to healthcare workers. Blood borne pathogens, which have been documented to be transmitted by percutaneous exposure, include: Hepatitis B, Hepatitis C, and Human Immune-deficiency Virus (HIV). Hepatitis B is best prevented by administration of Hepatitis B vaccine. Post exposure prophylaxis for HIV requires administration of anti-retroviral medications. There is currently no prophylaxis for Hepatitis C.
Handling Sharps Safely
*Never recap used needles by hand. If needles must be recapped, use on handed scoop method or recapping device (activate protective covering).
*Do not bend or break needles.
*Keep used sharps separate from other items such as gauze and alcohol wipes.
*Always point a used sharp away from your body.
*If assisting with a procedure always be aware of where the sharp is being placed.
*Never clean up broken glass by hand.
*Do not overfill a sharps container. If it appears to be over 2/3 full, notify Environmental Services at 3100.
*Do not open, reach into, empty, or clean a sharps container.
*When using sharps remember to activate protective covering.
Reporting a Blood/Body Fluid Exposure
If you are injured by a contaminated sharp, the incident must be reported immediately.
Patient Safety Goals
Improve the accuracy of patient identification
ORMC requires the use of two identifiers whenever administering medications or blood products, taking blood samples and other specimens for clinical testing, or providing any other treatment or procedures. These two identifiers are specifically the Name and Birth date. All patients must have an ID bracelet.
Improve the effectiveness of communication among caregivers
ORMC has a standardized list of abbreviations and also a list of “Do Not Use Abbreviations” posted on each clinical unit. Reporting of critical results of tests and diagnostic procedures in a timely manner is defined in policy ADM-PC-060. Specific times are defined for Radiology, Cardiopulmonary, and Laboratory results.
Improve the safety of using medications
All medications, medication containers (ex. Syringes, medicine cups, basin), or other solutions on and off the sterile field must be labeled with the name of the medication, amount, dilution, date, and initials. ORMC has a standardized Heparin drip and protocol.
Reduce the risk of healthcare-associated infections
ORMC complies with CDC hand hygiene guidelines and implements evidence-based practices to prevent health care associated infections due to multiple drug-resistant organisms. Nasal swabs are done for certain populations and isolation procedures. There is a central line check sheet for guidelines to prevent central line-associated bloodstream infections. There are surgical guidelines for antibiotic administration and discontinuation.
Accurately and completely reconcile medications across the continuum of care
ORMC has a written process for reconciling medications on admission, at discharge, and throughout the hospital stay.
Identifies safety risks inherent in its patient population
ORMC identifies patients at risk for suicide using a suicide screen. The policy is HW-PC-210 on the Intranet. Nurses screen all patients for the risk of falls and institute the fall protocol if indicated.
Universal Protocol for preventing wrong site, wrong procedure, wrong person surgery
*ORMC conducts a pre-procedure verification of the correct person, procedure, and site regardless of being elective or emergent.
*Site marking is done for all procedures involving incision or percutaneous puncture or insertion. The site is marked initially before the patient is moved to the location of the procedure and takes place with the patient involved, awake and aware. The physician will mark the site with a permanent marker.
*A time-out is conducted immediately prior to starting the procedure. The time-out addresses the following: correct patient identity, confirmation that the correct side and site are marked, an accurate procedure form, agreement on the procedure to be done, correct patient position, relevant images and results are properly labeled and appropriately displayed, the need to administer the antibiotics, and safety precautions based on patient history or medication use.
ORMC’s primary patient education systems are Krames and Micromedex. Both of these web-based software programs allow the hospital staff to access and print out patient information about illnesses or medications. The health sheets are available in English and Spanish, with many available in more languages than this. The content is written on a 6th through 8th grade reading level and is updated on a regular basis by the respective editorial boards. They are located on the hospital’s Intranet under “User Applications”. Any of our staff will be happy to assist you with accessing these.
At ORMC, the patient’s self-report of pain is the single most valuable indicator of pain. The patient and their caregiver can expect that pain will be evaluated using an appropriate pain scale. The pain scales include: 0-10 pain scale, FLACC pain scale, or the Wong-Baker Faces pain scale. Patients will be taught that the goal of pain management is prevention (when possible) and that early intervention in the course of pain management is important. Patient care providers will respond to the patient’s report of pain as quickly as possible. Nursing will assess the effectiveness of interventions within 1 hour or as appropriate according to the patient’s condition and/or the intervention utilized. The outcome goal for pain management is to bring the pain to a level acceptable to the patient. A pain assessment is performed and documented upon admission, after any known pain producing event, and with each new patient report of pain, and at every 2 hour rounds.
A restraint is any involuntary method of restricting an individual’s freedom of movement or normal access to his/her body. Restraints may be physical or chemical and may only be applied after all other measures have failed (moving closer to nurse’s station, family or sitter at bedside, distraction, etc). A physician’s order must be obtained and reordered every 24 hours as needed. During the time the patient is in the restraint, the patient is assessed every 2 hours for the following elements to ensure that the patient’s safety and health are maintained:
Patient’s physical needs (circulation checks, elimination, hydration, nutrition and hygiene) are met at least every two hours while the patient is awake. During these checks, the nurse should release the restraint and perform range of motion to the limb. Only staff that has been deemed competent to apply restraints may do so.
Age-specific competencies are tools for learning more about how to best meet each patient’s unique needs as you care for him or her. By demonstrating your understanding of age-related differences, you can ensure that our facility meets Joint Commission standards.
There are many ways to learn about each patient’s specific needs. Depending on the patient and your job, it may be appropriate to:
Each patient is unique.
Always keep in mind that:
Avoid stereotyping a patient – consider all the factors that may affect his or her care needs.
Infants and Toddlers (birth to age 3)
Young children (ages 4 to 6)
Older children (ages 7 to 12)
Adolescents (ages 13 to 20)
Young adults (ages 21 to 39)
Middle adults (ages 40 to 64)
Adults (ages 65 to 79)
Adults (ages 80 to older)