mandatory education self study - avera health education_v2.pdf · has the three prong grounding...

© 2008 by Avera Education & Staffing Solutions

1000 West 4th Street, Suite 9 Yankton, SD 57078

(605) 668-8475 Fax: (605) 668-8483

E-mail: [email protected] www.averasolutions.org

Mandatory Education Self Study


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GOAL: This mandatory self-study will review the training topics required on an annual basis. TARGET AUDIENCE: All Staff OBJECTIVES: Upon completion of this self-study, the participants will have reviewed the following topics:

• Fire Prevention and Response

• Emergency Procedures & Preparedness

• Infection Control and Prevention

• Accident Prevention and Safety Procedures

• Proper Use of Restraints

• Patient and Resident Rights

• Confidentiality of Patient or Resident

Information

• Incidents and Diseases Subject to Mandatory Reporting Procedures

• Care of Patients or Residents with

Unique Needs

• Dining Assistance, Nutritional Risks, and Hydration Needs of Patients or Residents

INSTRUCTIONS: All Avera Education & Staffing Solutions employees are required to complete a minimum of yearly education covering topics mandated by the governing bodies overseeing the healthcare facilities we serve. Topics covered are indexed at the beginning of this education packet. Carefully review all the information provided in this document. When finished with your review of the materials, please complete the post-test. There is a separate answer sheet following the post-test. You may wish to print the post-test and answer sheet prior to reviewing the material. The post-test includes an answer sheet. You may send us the answer sheet only, or you may answer the questions directly on the post-test, and mail that. The completed post-test or answer sheet must be returned to the AESS offices for you to receive credit for completing your yearly mandatory education requirements. If at anytime you experience any difficulties opening this document, or have any questions about the information being presented, please call our offices.


INDEX OF TOPICS

PAGE # SECTION 1 Fire Safety 4 Causes of Fire 4

Responsibilities of a Health Care Facility 4 RACE 5

PASS 5 Oxygen Safety 6 SECTION 2 Emergency Preparedness 7 Disasters 7 Weather 8 Responsibilities of a Health Care Facility 11 Winter Weather 11 Bomb Threats 13 SECTION 3 Infection Control 15 Chain of Infection 15 Transmission 16 Protection 16 Handwashing 17 Bloodborne Exposure 18 Mandatory Reporting 19 What to Report 22 SECTION 4 Accident Prevention and Safety Procedures 24 Body Mechanics 24 Ergonomics 25 Material Safety Data Sheets (MSDS) 25 Hazard Communication 27 Lockout/Tagout 28 Workplace Violence 28 SECTION 5 Resident Rights 32 Patient and Resident Rights 32 Confidentiality 33 Employee Confidentiality 33 Privacy 36 Restraints 37 Abuse and Neglect 38 SECTION 6 Clients with Unique Needs 41 Hearing Impaired 41 Visually Impaired 42 Stroke Victim 43 Age Specific Needs 44 SECTION 7 Dietary Needs of Residents 48 Nutrition and Hydration 48 Assisting a Client 49 Recognizing and Reporting 49 Consequences 50 Interventions 50 SECTION 8 Corporate Compliance 51 POST TEST 53 ANSWER SHEET 55


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FIRE SAFETY

CAUSES OF FIRE • Smoking and matches • Defects in heating system • Improper rubbish disposal • Misuse of electricity • Spontaneous ignition

Fire is a possibility anywhere at anytime in a healthcare facility, and providers always need to be on the lookout for possible causes of fire; being ready to intervene immediately to prevent a fire from starting. Listed above are some of the common causes of fire in the workplace. The most common cause of fire is from smoking and matches. However, these types of fires should be decreasing because of the ruling that all healthcare facilities are smoke free. That means that residents, patients, visitors, and staff all need to utilize the designated smoking location outside of the building. But, just because the smoke free policy is in place, does not mean that a resident or a patient will not try and smoke in the bathroom! The maintenance department is responsible for the heating system, but anytime a problem or a hot smell is noted, report it immediately so maintenance can investigate before a fire breaks out. Follow facility protocols when throwing certain items away such as aerosol cans and batteries. These items can be an explosion risk especially if the facility uses an incinerator. In addition, always be on the lookout for frayed cords or exposed wires in electrical cords and discontinue use of the equipment until repaired. Never use a piece of equipment if it shocks or sparks when plugging in or turning it on. Mark it with a lockout tagout indicator and have it repaired. Finally, extension cords should not be used or run across floors or under carpeting. If an extension cord is needed for a short period of time make sure the cord is in good repair and has the three prong grounding connector. Housekeeping should ensure that their cleaning chemicals are stored appropriately in a well ventilated room. A spontaneous ignition could start if the fumes are allowed to mix. In summary, fire safety is the responsibility of everyone. RESPONSIBILITIES OF A HEALTHCARE FACILITY

• Know the floor plan of your facility • Know the exit routes • Know the location of fire alarms and fire extinguishers • Know how to report a fire • Know your facility’s plan and your role The healthcare facility will have their fire plan in place and it is the responsibility of each

employee to be familiar with the plan and know how to respond and report in the event of a fire. Whenever a healthcare provider is in a new facility, one needs to check the location of all of the exit routes, be aware of where the fire pull stations and fire extinguishers are located. It is easy to “think” one can locate these items, but remember locating them may need to be done in a dark, smoke filled hallway with only memory and familiarity of the facility to guide the employee. Many healthcare facilities will have a sticker on the phones to tell one where to call in the event of a fire; however, do not rely on this! Review the policy and know if the facility utilizes a


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FIRE SAFETY specific phone number to the operator, or a specific code phrase such as “Code Red” or “Code Orange” followed by an announcement of a location. Finally, always review the fire plan of the facility. In general, most will follow the RACE plan; know each department’s role in this plan. Routinely look for situations that could cause harm to a resident or hamper the notification or evacuation process. For example, if a resident or a patient is sitting in the direct line of a fire door, move that resident to one side or the other. Fire doors close quickly and with great force which could seriously injure someone in its path. Keep in mind the fire doors can shut with a power surge or loss of electricity, not just with the activation of the fire pull station. Second, do not park equipment or food carts, wheelchairs, housekeeping carts, etc. directly under a fire pull box or fire extinguisher. These obstacles will only slow one down in sounding the alarm or grabbing the extinguisher. Third, equipment should not be stored in the hallway if at all possible. The more clutter in the hallway, the increased risk of blocked exit routes in the event an evacuation is necessary. Always think and be prepared for a fire. They can happen at a moment’s notice anywhere, anytime of the day! RACE

R = Rescue anyone in danger A = Activate the alarm C = Confine or contain the fire E = Extinguish or evacuate

PASS

P = Pull the safety pin A = Aim at the base of the fire S = Squeeze the trigger handle S = Sweep from side to side

If the decision has been made to fight the fire, remember the acronym PASS to help utilize the extinguisher. Most extinguishers will be the ABC or “all-purpose” extinguishers that are compatible with any type of fire; normal combustibles like paper and fabric, grease or oil fires, electrical fires or chemical fires. The all-purpose fire extinguisher contains foam to help suffocate the oxygen from the fire. Consider the fact that most extinguishers will last only 3-20 seconds depending on the size of the extinguisher. If the extinguisher empties and the fire is still burning, drop the extinguisher and get to safety! Remember things can be replaced, but people cannot!


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FIRE SAFETY OXYGEN SAFETY

• No smoking or open flames • Adequate space around concentrators • Appropriate procedure when “cracking” portable tank • Aware of what could start a fire when oxygen is in use (electricity sparks, static) • Keep portable tanks upright and secure in vehicles

Oxygen is part of what healthcare facilities are all about! It is worked with on a daily basis; therefore knowledge of oxygen safety is crucial. Remember that oxygen itself is not flammable; the danger is when the oxygen is accompanied by a heat source and a fuel source to complete the fire triangle recipe. The oxygen will help to feed the fire and sustain its duration while it finds more fuel to burn and increase in size. Therefore, eliminating the oxygen source is the best way to stop a fire. If possible, one should shut the oxygen off, shut windows and doors to cut down on the air flow to minimize or eliminate the fire. While working with oxygen tanks and oxygen concentrators, always think of safety. If one is not sure how to “crack” a tank or refill a tank, read the procedure and ask for help. When tanks are incorrectly “cracked” a tank could become a projectile missile and cause injury if it should be dropped or knocked over. The oxygen concentrators should be monitored closely to ensure that there is at least one foot of clearance all around the perimeter of the machine to provide the best circulation of the room air, which is absorbed and concentrated then delivered to the patient or resident. One should be observant of any bed linens, curtains, walls or furniture that is pushed up next to the concentrator. Finally, follow the facility protocol regarding shutting off the concentrators when not in use. Some facilities ask that the machines remain on at all times because once turned off, the concentrators need 10-15 minutes to reach therapeutic levels and a resident could become very short of breath and anxious during this time.


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EMERGENCY PREPAREDNESS

• Disasters • Severe spring/summer weather • Winter weather • Fire safety • Bomb threat • Bioterrorism

Healthcare facilities need to be prepared for any type of a disaster including natural

disasters, man-made disasters, fire, or threats of terrorism. The following section will discuss the above types of disasters and how a healthcare facility should prepare for such a disaster. Whenever a situation or a question should arise while you are working in a facility, refer to the policy manual or the Emergency Preparedness Manual. DISASTER

A disaster is a natural or man-made event that significantly disrupts the environment of care, such as damage to the facility and grounds due to severe weather or fires. Also, events that disrupt care due to loss of utilities, civil disturbances, floods, accidents or emergencies in the facility or community.

Many workers in healthcare facilities will refer to a bad or a busy day as a “disaster”. However, the definition of a disaster in accordance with Emergency Preparedness refers to an event that prevents the normal routine of care from being carried out. There are two types of disasters, an external disaster and an internal disaster. Both will be defined in the next pages. EXTERNAL DISASTER

• An event which requires expansion of facilities to receive and care for a higher than normal number of victims. Results from a disaster that causes little or no damage to the facility or staff.

• Plane crash • Food poisoning • Industrial accident

If you are working in a long-term care facility, chances are that an external disaster will not hold that much of an impact. However, you would still want to refer to the facility policy to determine your role in the event of an external disaster. If you are working in a hospital, you could see the biggest impact of an external disaster because you will need to put the Emergency Plan into action. Depending on the severity of the external disaster the facility could receive a large number of casualties and injuries at one time. It may be necessary to call in extra staff and even the need to triage the injuries.


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While it is not expected for temporary staff to know the Emergency Preparedness Plan for each facility, please locate the facility’s policy manual or Emergency Preparedness manual for review and referral. INTERNAL DISASTER

• An event which causes or threatens to cause damage and injury to the medical facility, staff, patients and residents.

• Fire • Tornado • Flooding • Bomb Threat/Explosion

The internal disaster could affect any type of facility by destroying all or part of the physical structure of the building. A hospital will have the biggest challenge if an internal disaster occurs as it will likely be receiving victims of the disaster for medical treatment. The patients in the hospital and/or the residents in a long-term care facility may need to be evacuated to another healthcare facility. Refer to the facility’s emergency preparedness policy for an outline of the disaster plan. WEATHER RELATED TERMS

• Weather Watch: Conditions are favorable for severe weather. Used to increase public awareness about where severe weather is most likely to occur (time of preparedness).

• Weather Warning: Issued when severe weather has been reported by weather spotters or radar. Indicates imminent danger to life and/or property to those in the path of the storm (time of action).

The above terms should not be anything new; however, some individuals mix the two phrases up. These phrases refer to spring and summer severe weather only. The National Weather Service will issue a severe weather watch (tornado or thunderstorm) when the atmosphere has the right ingredients for producing a storm. For example, the day may be a hot, humid day with lots of sunshine and strong winds; ideal conditions for strong storms to develop. The weather watch is the time of preparedness when the person in charge should review the policy and give assignments to personnel according to the policy. During this time, curtains should be closed, windows shut, pillows and blankets gathered for all clients, visitors and staff. Chairs for ambulatory clients should be placed in the hallway outside the room and special provisions should be made for those with special needs. For example, portable oxygen tanks should be ready for those needing oxygen as well as ensuring all pumps and lifesaving equipment are plugged into the emergency generator outlets, in most facilities the red outlets.


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EMERGENCY PREPAREDNESS A weather warning is issued by the National Weather Service when a severe storm has been noted. The warning is the time of action, when all clients, visitors and staff are moved to the safe area according to the policy. This safe area is usually on the lowest level and behind fire doors and away from outside doors and windows. After the first group of clients has been evacuated, make sure a staff member stays with them while the others are being evacuated, to ensure all people are accounted for. THUNDERSTORMS • A severe thunderstorm is associated with wind speeds of 58 miles per hour or more, hail ¾

inch in diameter or larger and heavy rain, lightening and tornadoes. • When the wind speeds are expected over 75 miles per hour, the NWS requests the siren

activation in the community (Hurricane Strength Winds). It is very important to remember that lightning is one of the most dangerous aspects of storms. Lightning kills more people each year than tornadoes do! As healthcare workers we need to be careful with performing certain tasks inside the facility while an electrical storm is going on outside. Some tasks that should be avoided are:

• Bathing a client • Talking on the telephone • Working on the computer • Handling anything electrical

Just for your information, some of the activities people have been doing when struck and killed by lightening include:

• Boating • Swimming • Golfing • Bike riding • Standing under a tree • Riding on a lawnmower • Talking on the telephone • Loading a truck • Playing soccer • Fishing in a boat • Mountain climbing

THUNDERSTORM HAZARDS • Lightening • Flash flooding • Strong winds

• Hail • Tornadoes


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Typically a thunderstorm is 15 miles in diameter and lasts an average of 30 minutes. As noted above there are several other dangerous events that can accompany a thunderstorm, which all require planning and caution as well. As mentioned previously, lightening is very dangerous. Let’s talk about the intensity lightening has:

• FYI: To estimate the distance in miles between you and the lightening flash, count the seconds between the lightening and the thunder and divide by 5.

• FYI: A single lightening flash could light a 100 watt bulb for up to 3 months • FYI: The air near a lightening strike is heated to 50,000 degrees F (hotter than the

surface of the sun) Nearly 1800 thunderstorms occur at the same time around the world = 16 million per year. TORNADO • A violently rotating column of air extending from a thunderstorm to the ground; destructive

in nature with wind speeds up to 250 mph or more. • Damage paths can be in excess of one mile wide and 50 miles long. The tornado is another dangerous product of a severe thunderstorm. Usually, the tornado is most likely to occur east of the Rocky Mountains during the spring and summer months but can occur anytime of the year. The number of tornados nationwide average 800 per year, with an average of 80 deaths and 1500 injuries per year. When the weather conditions are just right a tornado is more likely to form. A tornado will form from a thunderstorm that develops along a dryline which separates warm, moist air to the east from hot, dry air to the west. The storm is likely to occur as the dryline moves east during the afternoon hours. Therefore, most of the tornadoes are more likely to occur between 3pm and 9pm. It is very important that the healthcare worker on the evening shift be familiar with the severe weather action plan of the facility. STAY INFORMED • Listen to the radio • Watch television weather bulletins • Understand the difference between a “Watch” and a “Warning” The best way to respond to threatening weather is to stay informed! By staying in touch with the above informational systems you can keep your clients, staff and any visitors safe. Therefore, the person responsible for putting the emergency plan into action needs to be informed, regardless of the source of information. In some communities, the area healthcare facilities are notified by local law enforcement and utilize a weather radio.


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EMERGENCY PREPAREDNESS HEALTHCARE FACILITY RESPONSIBILITY • Develop a severe weather action plan and have frequent drills • Have a designated shelter or safe place • Responsible person needs to stay informed • Plan provisions for special needs clients • Move clients quickly and safely • Responsible person for utility sources-off

The responsibilities of the healthcare facility will be located in the policy manual and/or the emergency preparedness manual. It is the responsibility of each employee to review the policy and become familiar with the roles of each person and/or department in the event of an emergency. The importance lies in knowing the policy before the severe weather or emergency is occurring. WINTER STORM WATCH • Severe winter conditions such as heavy snow or ice may affect your area but its occurrence,

location and timing are still uncertain • Provides 12-36 hour notice for the possibility of severe weather • Provides enough time for those who need to set plans in motion to do so Healthcare facilities cannot close for severe winter weather like schools and shopping malls. Therefore, facilities also need to have a winter weather plan in place in their disaster manual as well. Each individual working for a facility needs to be accountable for their safety and make sure their car is winter ready. He/she should have warm clothes and blankets in the event that one finds themselves stranded. Unlike a summer weather watch a winter storm watch may inform the public of the imminent weather several days in advance. The watch informs people that an area somewhere is going to get snow in a significant amount, but the National Weather Service has not narrowed the targeted area. The goal of the winter storm watch is to allow people to plan ahead and make provisions to accommodate the weather. All healthcare facilities need to be prepared in the event of a severe winter storm because it could impact the operations of the hospital or long-term care facility. For example, staffing may be a problem if the new shift of workers cannot make it to work. The clients being cared for need people to be there so the on duty staff may need to stay for another half or full shift. Also, the storm could be severe enough that utilities are affected and phone lines or electricity are cut off resulting in working with generator power. Cell phones may be the only operable phone system. Finally, if the storm is a several day storm, which are known to occur in the Midwest, deliveries of food and supplies might not happen. Therefore, one should be familiar with the winter weather policy just as he or she is familiar with the spring and summer time policy.


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EMERGENCY PREPAREDNESS WINTER STORM WARNING • Issued when 4 or more inches of snow or sleet is expected in the next 12 hours OR 6 or more

inches in 24 hours OR ¼ inch or more of ice is expected. Once the National Weather Service has narrowed the path of the winter storm, then the storm is upgraded to a warning for the area. The warning is issued to inform the community that snow will be falling with some significant accumulations. The same plan needs to be considered for a warning as was taken for the watch. BLIZZARD WARNING • Snow and strong winds will combine to produce a blinding snow (zero visibility), deep drifts

and life-threatening wind chills. The worst type of winter weather is the blizzard. Although most of us would rather be home in our sweats watching the weather from inside our house, that is not always possible for a healthcare worker. The clients are still in need of care and staff needs to be at work to deliver that care. Therefore, keep in mind all of the special provisions already discussed and plan ahead for the nasty winter weather. WINTER WEATHER • Advisories: winter weather conditions are expected to cause significant inconveniences that

may be hazardous (if caution used, should not be life threatening). • Wind Chill: One of the most dangerous conditions of winter. Wind chills that accompany winter weather are very dangerous! As winds increase, heat is carried away from the body at an accelerated rate, decreasing the body temperature. Always be prepared for life threatening winter conditions that could put one’s health and/or life at risk. The wind chills and weather advisories are posted to inform the public that conditions are potentially dangerous and that advance planning is needed. Always be prepared for life-threatening weather conditions in the winter, and in the event one becomes stranded, remember to stay with your car. WINTER WEATHER • Best Advice: BE PREPARED!


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EMERGENCY PREPAREDNESS It is very important that one is accountable for his/her own safety while driving the commute to work..

• FYI: 70% of fatalities related to winter weather occur in cars • FYI: 25% of fatalities of all winter related fatalities are the people caught off

guard What can you do to prevent yourself from becoming a fatality statistic?

• Winterize your car • Care Package in the car: Blankets, sleeping bag, non-perishable high energy food,

a bright colored fabric to attach to the antennae • Candles and matches in a coffee can • Flashlight • Extra dry clothes - including hat, gloves, scarf, boots • Cell phone • Staying with the car if stranded

BOMB THREAT • Be Calm. Be Courteous. Listen. Do not interrupt the caller! • Notify your local police department and supervisor as soon as the caller hangs up. The threat of terrorism has been targeting the larger cities and the financial and government buildings in those cities, but one should not exclude rural America from a potential terrorist act. A healthcare facility could be an easy target for a bomb threat just as schools in communities receive bomb threats. In the event a threat is called into a healthcare facility, never refer the call to a supervisor. The caller will probably hang up in the interim and the only information to go on will be the threat of the bomb. Whoever answers the phone is responsible for handling the phone call. While one is taking the call, alert another staff member that there is a bomb threat on the phone and the second person can alert administration and the local law enforcement. Listen to the caller while tuning into any background noise or characteristics that might help identify the caller or the location of the caller. Never hang up on the caller first! Let them hang up first to allow you the most time possible to acquire information. BOMB THREAT • When is the bomb going to explode? • Where is the bomb right now? • What does the bomb look like? • What kind of bomb is it? • What will cause the bomb to explode? • Did you place the bomb?


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EMERGENCY PREPAREDNESS • Why? • What is your address? • What is your name? Remember to try and write some of the information down. It is very important to gather:

• Exact wording of the threat • Sex of the caller • Age (if possible) • Length of call • Number at which call is received • Date/time • Caller’s voice • Background noises • Threatening language (well spoken, foul, taped etc)

Remember to report the call immediately. Maybe your co-workers will get the idea from

your questions and remarks that they can go ahead and report to the supervisor and the police. Most telephone bomb threats are hoaxes which are made in an effort to disrupt normal business. However, no bomb threat should be dismissed as a hoax without notifying the proper authorities. Healthcare facilities are required to have a bomb threat policy in their institution. Refer to the policy at the same time a review of the weather policies is taking place.


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INFECTION CONTROL

TYPES OF INFECTION CONTROL • Cross Infection • Re-infection • Environmental Control

• Isolation • Disinfection • Sterilization • Clean • Dirty

The practice of infection control is extremely important in healthcare. Protection of the clients that are being cared for in hospital and long-term care settings, as well as protection of the healthcare worker and anyone else entering a healthcare facility, is necessary. The practice of infection control is to help prevent infections through cross infection, re-infection and with environmental control. If an organism is transmitted by cross-infection, a person-to-person transmission via hands of a healthcare worker or through use of the same equipment has occurred. The process of re-infection occurs when an individual becomes ill with the same illness that he/she was recently being treated for. Possibly, the reinfection results from incomplete prescription usage. The person was probably feeling better so did not finish the prescribed antibiotic, resulting in incomplete organism kill and re-infecting the individual. This practice results in antibiotic resistant organisms and super bugs! Finally, infection control is practiced through environmental control. While cleaning and utilizing isolation, disinfection, and sterilization procedures, prevention of organism transmission is also occurring. Always practice by the simple equation that: CLEAN + CLEAN = CLEAN CLEAN + DIRTY = DIRTY The three second rule does not apply in healthcare! CHAIN OF INFECTION • A germ such as a virus, bacteria, fungus (infectious agent) • A person or object where the germ can live (reservoir) • A way for the germ to get out (portal of exit) • A way for the germ to travel (mode of transmission) • A way for the germ to get into the person (portal of entry) • A person whose resistance to germs is low (susceptible host) To prevent infections, healthcare workers must understand how infections are spread. There are 6 links in what is called the “chain of infection”. All 6 of the links must be present for an infection to occur.

IF ANY LINK IN THE CHAIN IS BROKEN, AN INFECTION WILL NOT OCCUR!


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INFECTION CONTROL ORGANISM TRANSMISSION There are five means by which an organism can be spread from one person to another: • Direct contact – touching, rubbing, or bathing the patient/resident; secretions, urine or feces

from the patient/resident • Indirect contact – touching objects, dishes, bed linen, clothing, instruments, belongings • Droplet spread within three feet – sneezing, coughing, talking • Vehicle – contaminated food, water, drugs or blood • Airborne – dust particles and moisture in the air INFECTION PROTECTION • Precautions

• Universal Precautions – all blood and body fluids are considered infectious • Transmission-based Precautions

o Contact o Droplet o Airborne

There are several different types of precautions that a healthcare worker needs to follow to ensure effective infection control. The first precaution used is Universal Precautions which is the concept that all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens. Standard Precautions represent a system of barrier precautions to be used by all personnel for contact with blood, all body fluids, secretions, excretions, non-intact skin, and mucous membranes of all clients regardless of the diagnosis. These precautions are the “standard of care.” This system includes the concepts of universal precautions and body substance isolation. The transmission-based precautions that healthcare workers need to be aware of are contact, droplet and airborne. First, contact precautions should be used when there is a potential of coming in contact with known infectious body fluids. The healthcare worker needs to use appropriate PPE (personal protective equipment) such as gloves and gowns while caring for the client. Handwashing with an antimicrobial soap after removal of gloves and other PPE must be performed. The droplet and airborne precautions are put into place for the client with an infectious respiratory disease. The healthcare worker must wear a mask when working within 3 feet of the individual and use a N95 respirator mask, at all times, when working with an individual with known or suspected tuberculosis. Also, the infected person needs to be placed in a private room and any transport outside the room requires a mask on the infected person. A reminder that the transmission-based precautions are to be used in addition to the standard precautions.


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INFECTION CONTROL THE MOST IMPORTANT PRACTICE IS HANDWASHING Regardless of all precautions that are followed in healthcare facilities, the best and most effective method of infection control is handwashing. HANDRUBS • More effective when decontamination not needed • Proper use = 25-30 seconds • Hand rubs reduce bacteria better then antimicrobial soaps • Gentler on hands HANDWASHING • Employees who handle food, must wash hands • Use plain soap • Wet hands with warm water (not hot) • Friction for a minimum of 20 seconds • Clean paper towel to shut off the water There are two methods for handwashing in healthcare facilities, the original method with soap and water as well as the new method with alcohol hand gels. The question is when to use which kind of hand hygiene. The CDC is recommending that soap and water with at least 15-20 seconds of friction be utilized after glove removal and anytime the hands become visibly soiled. While washing the hands, pay close attention to the area between the fingers, the area around the fingernail, wash up the wrist 1-1 ½ inches and remember to move jewelry and wash around and behind the rings. Dry hands with a paper towel and throw towel away, then turn water off with a clean, dry paper towel. The alcohol hand gels are to be used only when decontamination of hands is not needed or when hands are not visibly soiled. However, to use the hand gels correctly, 3ml or ½ tsp. of gel must be placed in the palm of the hand. Rub hands together for at least 25-30 seconds, until hands are dry to ensure that the organism kill is effective on the hands. If the gel only lasts 10-15 seconds, the hand hygiene was ineffective and complete organism kill was not accomplished. Hands should be washed according to facility policy after a specific number of hand gel uses. A reminder that soap and water removes dirt while killing germs, whereas, a hand gel only kills germs! As noted above, the CDC is recommending plain soap for handwashing instead of antimicrobial soap. It is believed that the antimicrobial soaps are killing off the normal flora (good bacteria) on hands resulting in more illnesses and less defense against invading organisms.


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INFECTION CONTROL BLOODBORNE EXPOSURE • Follow up action plan

• Individual’s action • Immediate first aid/treatment • Report to supervisor right away

• Supervisor’s immediate responsibility • Exposed individual needs to go to nearest ER • Contact SD Dept. of Health 1-800-592-1861

• Healthcare provider’s action • Determine if a post-exposure prophylaxis (PEP) is required • PEP Hotline 1-800-448-4911

All healthcare facilities must develop and follow an exposure control plan according to

OSHA bloodborne pathogen standard 29 CFR 1910.1030. A bloodborne pathogen refers to pathogenic microorganisms that are present in human blood and can cause disease in humans. A bloodborne exposure refers to a healthcare worker coming in contact with infected or potentially infected bodily fluids via an eye, mouth or mucous membrane splash, or exposure through nonintact skin or needle stick injury. The primary diseases of concern are those of Hepatitis B (HBV), Hepatitis C (HCV) and Human Immunodeficiency Virus (HIV). Each individual employee is responsible for following the facility’s bloodborne exposure plan. All employees must utilize personal protective equipment (PPE) that is necessary to ensure adequate protection while still providing quality care. The minimal requirements of any exposure control plan include but are not limited to following universal and standard precautions as well as any body substance precautions that are needed for a particular situation. If an employee should discover that needed PPE is not available or is not suitable for the individual (ex: latex allergy or sensitivity), the facility is responsible for providing the necessary equipment. Other specifics of an exposure control plan would include: proper laundry handling and washing, correct biohazard waste management, housekeeping procedures, handling of sharps equipment, sterile processing procedures, laboratory management, and not eating, drinking, applying cosmetics or handling contact lenses in an area that is potentially infected (ex: nurses station, medication rooms, soiled utility rooms, etc.). All employees are responsible for following each facility’s exposure control plan. Remember: utilizing PPE is not a choice, while on the job it is a requirement. In the event that an exposure does occur while on the job, refer to the facility’s exposure plan and report the incident to the facility supervisor as well as the Staff Coordinator of Avera Education & Staffing Solutions. Follow the treatment plan below:

1. Wash needle stick and skin exposure with soap and water (do not use bleach). 2. Splashes to the nose, mouth or skin should be flushed with water. 3. Splashes to the eyes should be irrigated with clean water, sterile saline or sterile irrigants. 4. Report immediately to supervisor; do not delay. If PEP treatment for HIV exposure needs

to be started, it needs to be started within 1-2 hours after the exposure.


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INFECTION CONTROL 5. When the source of the bloodborne exposure is known the individual may need to be

tested for a baseline result on HIV and Hepatitis. Permission needs to be obtained from the client and assurance that you are just taking precautionary means because of an employee exposure. The cost of the lab tests, etc. should not be charged to the client.

EXPOSURE CONTROL PLAN • Universal/standard precautions • Use of PPE • Procedures to ensure sanitation/cleanliness • Exposure evaluation and follow up • Hazardous material labels • Confidential medical records • Training in exposure plan • Appropriate handling of sharps • Eating and drinking in appropriate areas only The chance of being directly exposed to bloodborne pathogens is very small, but this chance can be ZERO if the exposure control plan is carefully followed. A summary of how one can protect themselves is listed above. All employees can help to break the infection cycle by remembering to use common sense and to think before acting! MANDATORY REPORTING • South Dakota Department of Health

• Category I (report immediately) • Category II (report within 3 days)

Telephone Fax Mail Courier

According to the Centers for Disease Control, certain illnesses need to be reported to the State Department of Health. Each individual state has developed its own list and reporting requirements, therefore both South Dakota and Nebraska has been included. As a summary to the required reportable diseases, many diseases that are reportable are those that can cause an epidemic, are preventable by a vaccine, could be a threat to a large number of people, or are agents of bioterrorism. In any event, one cannot possibly remember all of the diseases that are listed; therefore, a poster of each state’s listing as been included. The information can also be accessed on the Department of Health website as well as by calling the Department of Health.


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INFECTION CONTROL

The South Dakota reportable list is divided into two categories. The first is report immediately. The diseases listed in Category I are to be reported as soon as symptoms appear or a suspicion of a disease is present; it is not necessary to wait for lab results to confirm diagnosis. The Category II diseases must be reported within 3 days of the disease recognition or strong suspicion of a disease. In many situations, the laboratory personnel report the disease findings to the State Department of Health.


21

INFECTION CONTROL

South Dakota Department of Health Office of Disease Prevention

Reportable Diseases in South Dakota (Effective December 2007)

The South Dakota Department of Health is authorized by SDCL 34-22-12 and ARSD 44:20 to collect and process mandatory

reports of communicable diseases by physicians, hospitals, laboratories, and institutions. Instructions for reporting. (Download

poster version of South Dakota reportable diseases list; use ADOBE)

Category 1:

Report immediately on suspicion

of disease

Category II:

Report within three days

Anthrax (Bacillus anthracis)*

Botulism ((Clostridium botulinum)

Cholera (Vibrio cholerae)

Diphtheria (Corynebacterium

diphtheriae)

Enterohemorrhagic E. coli (EHEC) shiga-

toxin producing (Escherichia coli), includes E.

coli O157:H7*

Influenza, novel strains

Measles (paramyxovirus)

Meningococcal disease, invasive

(Neisseria meningitidis)*

Plague (Yersinia pestis)*

Poliomyelitis (picornavirus)

Rabies, human and animal

(rhabdovirus)

Ricin toxin

Rubella and congenital rubella

syndrome (togavirus)

SARS (Severe Acute Respiratory Syndrome,

coronavirus)

Smallpox (Variola)

Tularemia (Francisella tularensis)*

Typhoid (Salmonella typhi)*

Viral Hemmorrhagic Fevers

Acquired immunodeficiency syndrome

(AIDS)

Arboviral encephalitis, meningitis and

infection (West Nile, St. Louis, Eastern and

Western equine, California serotype,

Japanese, Powassan)

Brucellosis (Brucella spp.)*

Campylobacteriosis (Campylobacter spp.)

Chancroid (Haemophilus ducreyi)

Chicken pox/Varicella (herpesvirus)

Chlamydia infections (Chlamydia

trachomatis)

Cryptosporidiosis (Cryptosporidum

parvum)

Cyclosporiasis (Cyclospora cayetanesis)

Dengue fever (flavivirus)

Drug resistant organisms

• Methicillin-resistant

Staphylococcus aureus (MRSA),

invasive

• Vancomycin-resistant and

intermediate Staphylococcus

aureus (VRSA and VISA)*

• Drug resistant Streptococcus

Influenza

• hospitalizations and

deaths,

• lab-confirmed cases

(culture, DFA, PCR),

• weekly aggregate report of

total rapid

antigen positive (A and B)

and total tested

Legionellosis (Legionella spp.)

Leprosy/Hansen's disease

(Mycobacterium leprae)

Listeriosis (Listeria

monocytogenes)*

Lyme disease (Borrelia burgdorferi)

Malaria (Plasmodium spp.)

Melioidodosis (Burholderia

pseudomallei)

Mumps (Paramyxovirus)

Nipah virus (Paramyxovirus)

Pertussis (Bordetella

pertussis)Psittacosis

(Chlamydophila psittaci)


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(Filoviruses, arenaviruses)

Outbreaks

• Acute upper respiratory illness

• Diarrheal disease

• Foodborne

• Illnesses in child care settings

• Nosocomial

• Rash illness

• Waterborne

Syndromes suggestive of bioterrorism and

other public health threats unexplained

illnesses or deaths in humans or animals

pneumoniae (DRSP), invasive

Ehrlichiosis (Ehrlichia spp.)

Epsilon toxin of Clostridium perfringens

Giardiasis (Giardia lamblia / intestinalis)

Glanders (Burkholderia mallei)*

Gonorrhea (Neisseria gonorrhoeae)

Haemophilus influenzae type b disease,

invasive*

Hantavirus pulmonary syndrome

(hantavirus)

Hemolytic uremic syndrome

Hepatitis, acute viral A, B, C, D, and E

Hepatitis, chronic viral B and C

Hepatitis B infection, perinatal

Herpes simplex virus infection, neonatal or

genital

Human immunodeficiency virus infection

(HIV)

Q fever (Coxiella burnetii)

Rocky Mountain spotted fever

(Rickettsia rickettsii)

Salmonellosis (Salmonella spp.)*

Shigellosis (Shigella spp.)*

Staphylococcus enterotoxin B

Streptococcal Group A, invasive

Streptococcal Group B, invasive

Streptococcus pneumoniae,

invasive, (<5 ears of age)

Syphilis (Treponema pallidum)

Tetanus (Clostridium tetani)

Toxic shock syndrome

Transmissible spongiform

encephalopathies

Trichinosis (Trichinella sprialis)

Tuberculosis (Mycobacterium

tuberculosis and Mycobacterium

bovis) active disease and latent

infection (positive skin test)

Typhus fever (Rickettsia prowazekii)

Vaccine Adverse Events

Yellow fever (flavivirus)

*Send isolate to South Dakota Public Health Laboratory

WHEN TO REPORT

Category I diseases are reportable immediately by telephone on recognition or strong suspicion of disease.

Category II diseases are reportable immediately by telephone, mail, or fax within 3 days of recognition or strong suspicion of

disease.

WHATTO REPORT

Disease reports must include as much of the following as is known:

• Disease or condition diagnosed or suspected


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• Case’s name, age, date of birth, sex, race, address, and occupation

• Date of disease onset

• Pertinent laboratory results and date of specimen collection

• Attending physician's name, address and phone number

• Name and phone number of person making the report

HOW TO REPORT

Secure website: www.state.sd.us/doh/diseasereport

Telephone: 1-800-592-1804 confidential answering-recording device, or 1-800-592-1861 or 605-773-3737 for a

disease surveillance person during normal business hours; after hours to report Category I diseases, call 605-280-

4810

Fax: 605-773-5509

Mail or courier, address to: Infectious Disease Surveillance, Office of Disease Prevention, Department of Health, 615

East 4th Street, Pierre, SD 57501; marked "Confidential Disease Report"

CANCER (SDCL 1-43-14) Report to SD Cancer Registry; call 800-738-2301; Reportable cancers list found at

http://doh.sd.gov/SDCR/PDF?ReportableList.pdf.

Fetal Alcohol Syndrome (SDCL 34-24-27) Report to Office of Data, Statistics and Vital Records, 600 E. Capitol Ave, Pierre 57501

(605) 773-5683. Report forms: Diagnosed case of FAS; Suspected case of FAS (use ADOBE for both).

These bacterial isolates should be sent to the South Dakota Public Health Laboratory (call 605-773-3368) * Select Agent

*Bacillus anthracis

*Brucella spp.

*Burkholderia spp.

E. coli, shigatoxin

producing

*Francisella tularensis

Haemophilus influenzae B

Listeria monocytogenes

Neisseria meningitidis

Salmonella spp.

Shigella spp.

Vancomycin

intermediate/

resistant S. aureus

*Yersinia pestis


24

ACCIDENT PREVENTION AND SAFETY PROCEDURES

BODY MECHANICS • Special ways of standing and moving one’s body with a purpose of maximizing your

strength, minimizing fatigue, and most important, avoiding back strain –Center of gravity –Base of support

One’s back takes part in almost every move made and is at work 24 hours a day supporting the entire body and most of the weight. Because of the stress a back endures on a daily basis, back injuries are the most commonly suffered on the job injuries. Back injuries are painful, expensive, life changing, and sometimes debilitating, so one needs to think before he/she performs a lift. There are three most common types of injuries to the back, and they are:

• Strain: overused or overstretched muscles • Sprain: when sudden movements tear ligaments • Herniated disc: due to strain or age, a disk can leak fluid and lose its cushioning ability

thus increasing pressure on nerves and joints Most back injuries come from a combination of problems, including:

• Improper lifting, carrying, or moving techniques • Weak back and abdominal muscles • Excess weight around the abdomen • Poor physical conditioning and flexibility • Poor sitting and standing posture

RULES FOR BODY MECHANICS • Use many muscles and/or muscle groups • Use good posture - body aligned, back straight and weight evenly balanced • Ensure a broad base of support • Let arms support object, legs do the work (not the back) • Work with the direction of body (avoid twisting) • Correct use of a back support Before completing a lift, remember the rules of proper body mechanics and put them to work throughout the entire lifting process to minimize or, hopefully, prevent the risk of a back injury. Review the list of rules for body mechanics and remember to apply them with every lift, transfer or carry that is done. The correct use of a back support is an issue that needs to be addressed. If one uses the black elastic back supports while on the job, it is important to use the support only when engaging in a lift or transfer. If the belt is worn all day even while standing, walking or sitting, the back muscles become weak secondarily to the support, causing an increased risk in back injuries off the job, when the back support is not in use.


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ACCIDENT PREVENTION AND SAFETY PROCEDURES ERGONOMICS • What is it?

–Work station is “body” friendly –Computer monitor is at eye level –Chair has lumbar support –Keyboard is easily accessible –Feet flat on the floor –Walk once every hour

Ergonomics is the process of dealing with the disciplines that involve the interaction between the worker and the total working environment. Its goal is to have the work environment adapt to the worker rather than the worker to the environment -- (OSHA). In summary always put the safety of the back as a top priority while on the job, and at home. After all, people only get one back in a lifetime and it needs some careful monitoring. MSDS • Material Safety Data Sheet

• Written or printed material concerning a hazardous chemical that presents information required by OSHA’s hazard communication standard

MSDS provide more detailed information on a particular chemical. Although there is no one MSDS format, you will find specific information about each chemical, such as:

• Ingredients • Hazard identification • First aid measures • Firefighting measures • Accidental release measures • Safe handling and storage • Exposure controls and personal protection • Physical and chemical properties • Stability and reactivity

The new 16-section MSDS format developed by the American National Standards Institute

(ANSI) includes: • Toxicological information • Ecological information • Disposal considerations • Transport information • Regulatory information

Please review the sample MSDS form that follows.


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Reminder: Anytime there is an exposure to a chemical while on the job, refer to the MSDS and the poison control center for guidance. If emergency treatment is needed, take a copy of the MSDS to the emergency room.


27

ACCIDENT PREVENTION AND SAFETY PROCEDURES HAZARD COMMUNICATION

The Occupational Safety and Health Administration (OSHA) has issued a rule called the Hazard Communication Standard that mandates all employers will maintain a safe working place. All workers have the RIGHT TO KNOW what hazards one may encounter while on the job. The Hazard Communication Standard was developed to inform employees of potential hazards, such as chemicals, that one might face while on the job. The communication standard starts with the manufacturers that need to determine what (if any) physical and health hazards of each product they produce. The hazards are communicated to the consumer via container labels and Material Safety Data Sheets. The employer must develop a written hazard communication program that is communicated to all employees. The plan must include:

• Informing employees about the Hazard Communication Standard • Explain how it is being put into effect in the workplace • Provide information and training on hazardous chemicals; including assistance with

recognizing, understanding and using labels, use of the MSDS and practice of safe procedures when working with hazardous substances

LABELS Every container of hazardous chemical is labeled by the manufacturer. The actual format will differ from company to company, but the labels must contain similar types of information. That makes it easy to find out at a glance about the chemical’s possible hazards, and the basic steps one can take to protect him or herself against any risks. The information on labels can be shown using words, colors, numbers, pictures, symbols, or any combination of these. The most common labeling systems use color-coded bars or diamonds to indicate the type of hazard. Colored areas on bars and diamonds indicate the kind of hazard. Samples of these types of labels are found on this page.


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ACCIDENT PREVENTION AND SAFETY PROCEDURES LOCKOUT/TAGOUT Procedures

• Disconnect equipment • Turn off • Lock out • Tag • Test

When a machine requires maintenance or repair, energy must be turned off and locked

and tagged with a label to protect workers from accidental machine start up or unexpected energy release. Lockout and tagout procedures are used to warn employees and ensure that the electrical power is properly disconnected. Only qualified, authorized employees can disconnect the source of power and lock out and tag it.

Locks and tags are used for everyone’s protection against electrical dangers. For one’s own safety, NEVER REMOVE OR IGNORE A LOCK OR TAG! WORKPLACE VIOLENCE

Two Definitions: An armed, disgruntled employee or client who shoots selectively or indiscriminately at

employees, supervisors and managers (Media) Any act against an employee that creates a hostile work environment and negatively

affects the employee, either physically or psychologically (Workplace Violence Research Institute)

Physical or verbal assaults Threats Coercion Intimidation Harassment (all forms)

Review the workplace violence definition and imagine the picture the media has painted of people randomly gunned down by some enraged employee. Although the berserk, disgruntled worker accounts for a small percentage of occupational deaths, a much more common cause of death is robbery, accounting for approximately 1,000 deaths per year. In healthcare facilities in the rural Midwest, one may not worry about workplace violence. However, violence may and can happen when it is least expected! Thus, every facility is expected to have a procedure for handling workplace violence. Statistics: Every workday, an estimated 16,400 threats are made, 723 workers are attacked, and 43,800 are harassed. (May 1995 WVRI)


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WORKPLACE VIOLENCE • Workplace violence can affect many healthcare and social service organizations Facilities that can be affected include:

• Hospital emergency and medical facilities • Psychiatric facilities • Community mental health clinics • Drug abuse treatment clinics • Visiting nurse/home healthcare • Community care facilities • Long-term care facilities • Prisons

Review the situations listed below to determine the type of workers most at risk for workplace violence. You are at risk if you work:

• In a facility which encounters highly emotional and turbulent situations • As a supervisor with the authority to make employment decisions • Late at night or in the early morning hours • In home health care or social work • With criminals or aggressive patients • In law enforcement or security • In an emergency healthcare setting • Around handguns or weapons • In remote locations • With mentally ill patients • Alone or in small groups • In a hospital/clinic • Around drugs • In poorly lit areas • In high crime areas

HEALTHCARE FACILITY VULNERABILITY • Factors that target healthcare facilities:

• Have drugs that are sought after • Mentally ill patients are released without follow up • Insufficient staff • Client/family anger if long wait for treatment • Increase use of weapons in society • Hospitals used for mentally disturbed violent criminals • Lack of staff training on recognizing violent behavior • Public can wander unescorted in some facilities


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Healthcare facilities and workers are mentioned several times in the list on the previous page, and it is important for the employer to take all measures possible to protect healthcare workers while on the job. Some of the measures an employer may implement to ensure safety are:

• Creating a workplace violence prevention policy statement and procedures and making sure all employees are aware of them

• Installing alarm systems, metal detectors, and other security systems • Enclosing high-risk locations and installing deep service counters or bullet and

shatterproof glass • Installing 24-hour closed circuit video surveillance • Provide bright lighting indoors and out • Placing curved mirrors at hallway intersections or concealed areas • Controlling access to employee work areas • Provide adequate staffing

Workplace violence training programs are also important in identifying and preventing incidences of potential violence, like anger. What could cause an individual to get angry enough to become violent?

• Waiting for extended periods of time • Disoriented as a result of psychiatric conditions, drugs, alcohol, or stress • Restrained or isolated • Faced with highly emotional situations

The employee can use some of the following tips to help face a violent situation. Always:

• Take threats seriously • Follow employer procedures • Remain calm and courteous • Be assertive - find a way to solve the problem or ease the tension • Show respect for other people • Empathize with a violent individual • Know when to get help • Report violent or threatening situations

Never: • Get angry, argue, or raise your voice • Respond to a threat with a threat • Do anything to increase a person’s anger

VIOLENCE PREVENTION A successful prevention plan includes all of the following: • Management support and commitment • Employee involvement • Written workplace violence program • Post-incident response

• Employee surveys • Control and prevention of violence • Training • Record keeping


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ACCIDENT PREVENTION AND SAFETY PROCEDURES A successful workplace violence prevention program involves cooperation between management and front-line employees who work together to write a program and implement that program. A successful implementation involves all employees by ensuring their knowledge and understanding of the written plans’ overall goals and objectives - that a zero tolerance policy will be implemented for all types of violence. All employees must be aware that help is available after an episode of violence and that no repercussions will result for reporting the situation. The employee will be entitled to immediate treatment of physical injuries as well as any long-term treatment required for psychological injuries to the victim or any witnesses. All prevention programs must be accompanied by training. Earlier a list of training procedures was mentioned. These should be carried out through an employee training session to educate all on the written prevention plan. Perhaps, after the program has been in place for several months, an employee survey or evaluation may be used by the planning committee to identify the aspects of the plan that are working and those that are not. These surveys could also help employees to identify problem situations in their own working area that could produce violence. Finally, all incidents of violence must be reported and kept in a record keeping system that logs each incident and documents the type of injury sustained. The log that is used is mandatory from OSHA and it is through this record keeping system that OSHA will use to survey any problem areas or situations when they come to a facility. In summary, all employees must be involved in maintaining a safe working environment by being involved with reporting potential problems, completing surveys, offering feedback and assisting with the record keeping system.


32

RESIDENT RIGHTS

RESIDENT/PATIENT RIGHTS • Every client in the healthcare industry has rights. As a healthcare provider we need to be

aware of these rights and respect them in all areas of care. • LTC • Acute Care • Assisted Livings • Clinics/Dr.’s office

On admission to a LTC facility or to a hospital, the care staff needs to inform the resident or the patient and his/her family of their rights. The information must be presented at the time of admission. In LTC facilities it is the Social Service Worker or designee that informs the new client of his/her rights. If that designated person is on vacation or out of the facility for any reason, someone else needs to fulfill the requirements. In many instances it is the charge nurse that makes sure this is completed. The rights must be informed both in an oral and a written fashion. The resident needs to verify in writing that he/she received the information. The facility needs to be responsible to inform the resident both in writing and verbally of any changes or updates to the Resident Rights. It is the responsibility as the direct care provider to make sure the client’s rights are not being violated. A list of the resident rights has been included for review. The hospitalized client generally is informed of his/her rights in a different way. In some settings, the rights are posted on the wall in the hallway or the patient’s room. Other facilities may have a flyer or a brochure that is left with the patient at the time of admission for the individual to review at their own leisure. Regardless of how one is informed of their rights, as the healthcare provider, we must respect the rights and be an advocate for those rights whenever a situation arises. A patient or a resident can ask questions anytime he/she desires about their rights and an answer needs to be provided to them. RESIDENT/PATIENT RIGHTS

The healthcare facility must protect and promote the rights of each resident/patient, including

the following:

1. The right to civil and religious liberties 2. The right to file complaints without fear 3. The right to be informed of his/her rights and the rules of the facility upon admission 4. The right to inspect their chart or medical record 5. The right to be informed of his/her medical condition and treatment and to take part in

planning the care 6. The right to refuse medication and/or treatment 7. The right to information from agencies of inspection 8. The right to be informed of responsibility for charges and services


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RESIDENT RIGHTS 9. The right to manage his/her own financial affairs 10. The right to receive adequate and appropriate healthcare 11. The right to be free from unnecessary physical and/or chemical restraints 12. The right to be free from verbal, mental, sexual or physical abuse 13. The right to personal privacy and confidentiality of information 14. The right to be treated courteously, fairly and with dignity 15. The right to send and promptly receive mail that is unopened 16. The right to have private communication with any person of choice 17. The right to receive visitors at reasonable hours 18. The right to immediate access to family and friends 19. The right to chose a personal physician 20. The right to have access to private use of a telephone 21. The right to participate in social, religious and group activities of choice 22. The right to retain and use personal possessions and clothing as space permits 23. The right to equal medical practices regardless of source of payment 24. The right to privacy during visits with spouse and to share a room when a married couple

resides in the same facility CONFIDENTIALITY • The nondisclosure of private information regarding residents and patients; not revealing

private information to others. One right that all individuals seeking treatment in the healthcare industry have the right to is confidentiality. Now more then ever it is important to be careful with private information to ensure breaching of any protected information is not occurring. All healthcare workers must make a conscious effort to keep all private information private. This includes: identity of the client, medical diagnosis, financial situation as well as any other information the client or his/her family may share. The individual being cared for in a long-term care facility, hospital, clinic or any aspect of healthcare needs to be assured that the healthcare employee can be trusted with his/her confidential information. Whenever in doubt of releasing information to someone else other then the client, ask a supervisor or simply do not reveal the information. However, there are exceptions to the rule when private information needs to be shared with others on a professional basis only. For example: medical emergencies, abuse and neglect, reportable illnesses, or on direction from the facility’s legal representative. EMPLOYEE CONFIDENTIALITY Employees of Avera Education & Staffing Solutions must agree to hold all individually identifiable patient health information (“Protected Health Information”) that may be shared, transferred, transmitted, or otherwise obtained by their employment with the Agency, strictly confidential, and provide all reasonable privacy and security protections to prevent the unauthorized disclosure of such information, including, but not limited to the protections


34

RESIDENT RIGHTS

afforded by applicable Federal, State and Local laws and/or regulations regarding the security and confidentiality of patient health care information including, but not limited to, any regulations, standards or rules promulgated pursuant to the authority of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Specifically, employees agree to: (1) to maintain safeguards as necessary to ensure that the Protected Health Information is not used or disclosed except as required by my position with the Agency; (2) to ensure that any subcontractors or agents to whom Protected Health Information is provided from the Agency will agree to the same restrictions and conditions that apply to them; (3) to return or destroy all Protected Health Information received that may be in their possession from their employment with the Agency in the event their employment ends and not to retain any such Protected Health Information in any form upon such employment ending; (4) abide by any applicable Agency policies regarding Protected Health Information and HIPAA; and (5) report to the Agency any use or disclosure of Protected Health Information which is not provided for in this Agreement, by HIPAA, by other applicable confidentiality laws, or by express consent of the Agency’s clients. METHODS OF BREACHING CONFIDENTIALITY • Print or electronic client-related information that is left exposed where visitors or

unauthorized personal can see it • Discussions of client information in a public place or with inappropriate, unauthorized

individuals.

One method of breaching confidentiality is by print or electronic source. This information could be breached through the clients chart or via information on the computer screen or fax machine. Remember to ask yourself “Who is able to read this?”

• Turn computer screens inward • Keep printed materials hidden • Post schedules on inside walls • Keep client forms, charts, and records face down on desks or closed and put away • Monitor the duplication and transmission of records on fax machines,

photocopiers, and printers • When sending a confidential fax, call first to notify the recipient • Never leave a photocopier unattended when copying confidential materials • Always put medical, financial records in the confidential bin or shred the

document, never discard in the regular trash Every time you communicate medical information when the client is not present, ask yourself, “To whom am I speaking?”

• Ask in advance if you can confirm appointments and leave messages • Confirm appointments in a generic way; leave the date and time only • Never leave details in a message • Never give details to a third party


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RESIDENT RIGHTS METHODS OF BREACHING CONFIDENTIALITY • Unauthorized people hearing client sensitive information • Records that are accessed for the wrong reasons or by inappropriate individuals When speaking of clients ask yourself, “Who else can hear what I am saying?”

• Page clients only if you have their permission • Don’t announce names or specific information • Speak softly so that others do not accidentally overhear confidential information • Find a private place to discuss client information

Please remember that the dining room, the hallway, the nurses’ station, the elevator or any other public access way is no place to discuss the client’s private information. If you need to have a discussion regarding a client with another co-worker or make a sensitive phone call concerning the client, utilize the report room and/or a private phone. Whenever you access a client’s medical record, ask yourself “How am I using these records?”

• Always use information from medical records only for the treatment of clients • Do not reveal your computer password to anyone, and do not post your password

near your computer • When you do not recognize staff members who request records, ask them for

identification • Never leave file rooms unlocked or unattended • Never leave computer files open, they may provide access to the master index or

client database

Anytime client information needs to be passed from one person to another, always ensure the most confidential exchange of material is occurring and the exchange is occurring with someone else who needs to know the information to care for the client. CONSEQUENCES OF BREACHING • HIPAA • Disciplinary Action • Legal Implications • Distrust by Co-workers/Clients • Loss of job and/or license There are several consequences to discuss should one breach confidentiality. The first is HIPAA (Health Insurance Portability and Accountability Act of 1996) which is the first ever federal privacy standard to protect patients’ medical records and other health information provided to health plans, doctors, hospitals and other health care providers. This law went into effect on April 14, 2003. The law that was developed by the Department of Health and Human Services (HHS) allows patients access to their medical records and more control over how their personal health information is used and disclosed. The rulings represent a uniform, federal floor


36

RESIDENT RIGHTS

of privacy protections for consumers across the country. Individual state laws providing additional protections to consumers are not affected by this ruling.

The new privacy regulations ensure privacy for patients by limiting the ways health

plans, pharmacies, hospitals and other covered entities can use patients’ personal medical information. The protection applies to all identifiable health information regardless if it is on paper, on computers or communicated orally. Key provisions of these new standards include: www.hhs.gov/news/facts/privacy Patient Protections:

• Access to medical records • Notice of privacy practices • Limits on use of personal medical information • Prohibition on marketing • Stronger state laws • Confidential communications • Complaints

Health Plans and Providers: • All of the above listings • Written privacy procedures • Employee training and privacy officer • Public responsibilities • Equivalent requirements for government

Outreach and Enforcement: • Guidance and technical assistance materials • Conferences and seminars • Information Line at (866) 627-7748 • Complaint investigations • Civil and criminal penalties against an individual and/or a facility that ranges from $100-

$250,000, 1-10 years in jail and loss of licenses, depending on severity of the violation PRIVACY • Invasion of Privacy occurs when personal information is exposed publicly, violating an

individual’s right to privacy. • Inalienable human right under the constitution. We all have the right to Privacy. All clients in healthcare facilities have the right to privacy. It is very simple to protect and respect this right of the individual. Deliver healthcare while keeping some of the privacy tips listed below:

• knock before entering room • pull privacy curtains and window shades • shut doors when doing private cares • do not read mail or cards unless given permission • do not listen in on phone conversations


37

RESIDENT RIGHTS

Anytime a patient or a resident wishes to have a private conversation with someone of their choice, even their doctor, that wish must be granted and any other healthcare personnel must leave the room. Privacy is an inalienable human right and all people have the right to privacy under the US Constitution. RESTRAINTS • Physical, chemical or mechanical devices used to restrict the movement of a patient or

resident or the movement or normal function of a portion of the patient’s or resident’s body, excluding devices used for specific medical and surgical treatment.

Anytime a physical or chemical restraint is used on a resident, his/her right to be free from unnecessary physical or chemical restraints is being infringed upon. According to regulations, the use of restraints must be based on a comprehensive assessment of the patient’s or resident’s physical and cognitive abilities. Also, interventions and effectiveness of less restrictive alternatives must be completed and documented prior to implementation of any type of restraint. Once the decision is made to use a restraint, the restraint is selected based on the least restraining for the client and is ordered for a medical symptom or emergent safety need to prevent harm to the resident, patient, or others. An example is a wrist restraint that is ordered on the right wrist to prevent the client from pulling the feeding tube out. It was ordered for one hand only because this particular client had a stroke and has a paralysis in his left arm and hand. Restraints require a physician order including specific time frames and necessity of the restraint. The continued use of the restraint may be given only after a review of the client’s condition by the physician and the interdisciplinary care team. The restraint must be included on the care plan, and once the issue requiring the use of the restraint is resolved; all measures to re-introduce the restraint must start over at the beginning. Restraints must be checked every 30 minutes by nursing personnel and the client must be given the opportunity for motion and exercise for not less then 10 minutes. The intervals must be frequent enough to meet the needs of the client, but at least every 2 hours. Restraints cannot be used to limit mobility, for convenience of staff, for punishment or as a substitute for supervision. Restraints cannot hinder the evacuation of the client during a fire or cause injury to the resident or patient. Examples of restraints:

• Wrist restraints • Vest restraints • Side rails • Wheelchair brakes • Recliners • Geri chairs • Sedating medications • Waist restraints


38

RESIDENT RIGHTS

Statistics have documented that use of physical restraints has contributed to more resident deaths than they have promoted safety!

ABUSE • The willful infliction of injury, unreasonable confinement, intimidation or punishment with

resulting physical harm, pain or mental anguish

Abuse and neglect is a very real situation in healthcare facilities, especially in long-term care. It is not a pleasant topic to discuss or think about, but it is happening and all healthcare providers need to be educated on how to identify and how to report abuse of the elder client. Statistics show that the frequency of elder abuse is slightly lower than that of child abuse, but not as publicly voiced. Therefore, it is a federal requirement that any abuse and/or neglect that takes place in a healthcare facility needs to be reported to the appropriate agencies. Each nursing facility shall report to the SD Health Department within 24 hours, and any other licensed facility shall report to the Health Department within 48 hours of the event, any death resulting from other than natural causes originating on facility property such as accidents, abuse, negligence, or suicide, any missing patient or resident, any allegation of abuse or neglect of any patient or resident by any person, or any injury of unknown origin. Each facility shall report the results of the investigation within 5 working days. TYPES OF ABUSE • Verbal Abuse • Physical Abuse • Sexual Abuse • Mental Abuse • Neglect

• Passive • Active

• Exploitation Verbal Abuse: any use of oral, written, or gestured language that includes disparaging and derogatory terms to a resident or his/her family, or within their hearing distance, to describe residents regardless of their age, ability to comprehend, or disability. To reduce the risk of verbal abuse, always be aware of what tone and words are being used when speaking with a resident or the family and be conscious of the non-verbal message that may be sent by the hands, arms, facial expressions, and posture. Verbal abuse has occurred without the abuser being aware of doing anything wrong. Physical Abuse: willful infliction of injury; including hitting, slapping, pinching, and kicking. It also includes controlling behavior through corporal punishment (punishing because of an undesirable behavior).


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RESIDENT RIGHTS Sexual Abuse: includes but is not limited to, sexual harassment, sexual coercion, or sexual assault. Mental Abuse: includes, but is not limited to, humiliation, harassment, threats of punishment or deprivation. An example may include embarrassing a resident in front of others when he/she had an incontinent episode. Neglect: Failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness. Neglect can occur in either a passive form, not being consciously

aware that harm will occur to the individual, or an active form, consciously knowing that the action being taken against the individual will cause harm. Exploitation: Misappropriation of resident’s property through deliberate misplacement or wrongful, temporary or permanent use of a resident’s belongings or money without the resident’s consent. A simple example includes but not limited to, taking candy from a resident’s candy dish without his/her permission. ABUSE AND NEGLECT • Legally obligated as a healthcare facility to report episodes of abuse and/or neglectful

situations • Family • Staff • Resident

Injuries occur to residents during routine cares and activities of daily living. The significant point about these injuries is how they are categorized as “Injuries with known origin” vs. injuries subject to abuse suspicion as “Injuries of unknown origin.” The importance of reporting an injury of known origin cannot be stressed enough; these must be reported to the charge nurse promptly with an explanation of cause to allow assessment, intervention and documentation. If the injury has a known origin and the proper steps have been followed, there will be no further action and no suspicion of abuse. The “injuries of unknown origin” are the injuries that will prompt an investigation and cast a suspicion of abuse. When an injury of any nature is discovered on the resident or a suspicious behavior is noted from the resident, questions will be asked. These questions will be geared toward finding a cause for the injury or the behavior. If unsuccessful in finding a cause, the injury is required to be reported to the State Department of Health as an “Injury of unknown origin”, and the report could prompt an investigation by state officials. In the unfortunate incident that a healthcare employee witnesses abuse or neglect acts against a resident, that employee is required by law to report the situation to the charge nurse and/or administration. The report needs to be made if a fellow employee, a family member, a visitor or a resident abuses a resident. The report is going to be a very difficult thing; however, one will be acting on behalf of the resident and protecting him/her from further harm. In addition to watching for any signs of abuse and/or neglect, the healthcare provider must follow the care plan at all times. For example, if the care plan indicates a transfer of two assist


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RESIDENT RIGHTS with a mechanical lift, that is the way a transfer must be completed. If the care plan was not followed and an injury occurred to the resident, the healthcare provider could be guilty of neglect because he/she was not following the care plan (negligence), as well as abuse because an injury resulted from a negligent act.


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CARE OF INDIVIDUALS WITH UNIQUE NEEDS

CLIENT WITH UNIQUE NEEDS

• Hearing impaired • Visually impaired • Language barrier • Cultural preferences

The American with Disabilities Act (ADA) has prompted all business, including

healthcare to adapt their facilities to the needs of disabled people. Individuals with special needs may require an interpreter to help translate the medical procedure, diagnosis, test results, or simply to explain what to expect from the healthcare facility in general. Regardless of the individual’s special need, the healthcare providers must accommodate the needs and help the individual. For example, a visually impaired person is entering the facility with a Seeing Eye Dog, is the dog let into the healthcare facility, or would an issue of infection control be brought up? According to the ADA, that dog needs to be allowed into the hospital, clinic, or LTC facility without question.

Please review the following pages to help with communication and interaction with an individual with a disability and/or a unique special need.

Awareness of Cultural Diversity in the healthcare setting is a major goal. Due to the variety of individuals being cared for in healthcare and the fact that each person has rights, individuals with special cultural preferences must have accommodations made to meet their needs. The cultural preferences may include special dietary requirements, religious ceremonies, needs for herbal therapies, extended family involvement and many more. Regardless of their culture, their needs must be met as best as the facility can accommodate.

GUIDELINES FOR COMMUNICATING WITH THE HEARING IMPAIRED

1. Use normal tone and rhythm of speech. If you normally speak rapidly, you may need to slow down somewhat.

2. Do not over exaggerate your mouth movements. Exaggeration distorts the formation of sounds and words. Speak naturally.

3. Be sure to get the person’s attention before speaking. 4. It is important that your lips be visible. Even a good lip reader can only lip read 25% of

what is said. 5. Standing in front of a window will make lip-reading impossible. If necessary, lower the

shade behind so that the person being spoken to is not looking directly into the direct sunlight.

6. Stand 3 to 6 feet away, but never more than 10 feet. 7. Do not turn your head away, laugh while you talk, or move your head constantly. Do not

talk with anything in your mouth. 8. Be natural in your gestures, but be sure they are not distracting. Keep your hand away

from your face and let your face be expressive.


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9. It is not always helpful to talk louder to persons with hearing impairment or difficulty. Ask the person you are talking to if it is helpful to him or her.

10. If you are not understood the first time, re-word, trying to use words that are more easily seen on the lips. (More than 50% of the sound we make is not visible on the lips.)

11. During movies, TV programs, etc., the hearing impaired person may find it helpful to sit near the sound source.

12. Be aware of outside environmental noises (airplanes, lawn mowers, tree trimmers, etc.) The hearing impaired person will have difficulty hearing you, even with a hearing aid.

13. Indoor environmental noises (visitors in the hall, trays being delivered, the “normal” buzz of the dining room) will make hearing very difficult, even with a hearing aide.

14. Hearing impaired people will not always tell you when they don’t understand. They may be embarrassed or they may not be aware they have missed anything. Encourage them to ask for clarification.

15. Know which ear the person has least difficulty with and always speak to that side. 16. Announcements over a public address system may have to be repeated for the hearing

impaired person. For example the announcement states, “We will not have bingo today,” and the “not” is missed. The whole message is misunderstood.

17. Hard of hearing persons have difficulty monitoring the loudness of their voices. The hard of hearing person does not know if he or she is talking too loudly or if he or she needs to speak louder because the environment is noisy. Do not let him or her know if you observe that the loudness of his or her voice is inappropriate.

18. Let the person know that his or her problem may be normal because of aging and that he or she can help himself or herself by helping others to be better speakers.

19. A hearing aide acts like a miniature loudspeaker, which presents amplified sound to the ear.

a. Unlike eyeglasses which for the most part correct a person’s vision to normal, a hearing aide does not “correct” the hearing loss. It cannot make words any clearer than the capability of the ear. If the ability of the ear to transmit sound clearly is damaged then speech amplified by a hearing aid will not sound clear. This situation is especially true for older persons who have damage to their inner ear. Also, a hearing aid does not reproduce all sounds in a natural, clear way, nor does it “tune out” extraneous or unwanted sounds.

b. If you notice that a hearing aide is squealing, alert one of the staff members. GUIDLEINES FOR WORKING WITH THE BLIND OLDER PERSON

1. Always introduce yourself. Let the blind person know who he or she is talking to so he or she doesn’t have to try to figure out who you are while trying to listen.

2. When you leave a blind person, tell him or her that you are going. 3. Do not worry about using words such as “look” and “see” when you are talking to

someone who is blind. 4. Speak directly to the blind person. If he or she is with a friend, do not use his or her

companion as an interpreter.


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5. Unless he or she is hard of hearing, there is no need to speak more loudly to the blind person than you would do to others.

6. Do not pet a guide dog or otherwise distract him form his job. 7. Use the same common sense and sensitivity toward the elderly person that you would

with anyone else. 8. Certain things have to be explained. For example, a nurse who is about to give an

injection should tell the blind person so that he or she is aware of what will happen to them.

9. When teaching a blind person, explain the procedure fully and, wherever you can, let the sense of touch replace the sense of light.

10. Allow the blind person the time he or she needs to learn a new skill. If the skill is complicated, break it down into steps and teach one step at a time.

11. Remember that the person who is older may not have a good memory. 12. Refer to the numbering on a clock when telling a blind person where things are placed in

front of him or her. This is especially useful for placement of food at mealtime. For example, certain foods are always placed at 6 o’clock and milk is always above the plate at 10 o’clock.

GUIDELINES FOR COMMUNICATING WITH A STROKE VICTIM

1. Talk to them in a normal volume, one person at a time. 2. Use short sentences; don’t change the subject abruptly. 3. Let the resident struggle to get the word out. Try not to supply the word until it is

absolutely necessary. Do not correct mistakes. 4. Assure the resident that you want them to try talking. 5. Phrase your questions so that the aphasic person can respond with a yes or no, or with a

movement of the head. 6. Start a sentence and let the resident finish. 7. Allow time to finish conversation. 8. Writing the word is sometimes helpful – bring a large pad. 9. If the stroke resident cannot write, use pictures of common things to which he or she can

point to. 10. Give the resident choices. This facilitates independence and helps to supply the missing

vocabulary (Do you want candy? Do you want fruit?). 11. Explore the possibility of signing (this may come automatically). 12. Instead of correcting errors, restate what you think the person is trying to say. 13. Remember that the wrong words come out sometimes; “no” may not mean “no”. 14. Ignore profanity. 15. Be honest and realistic, but always giving hope, encouragement, and touch.


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CARE OF INDIVIDUALS WITH UNIQUE NEEDS AGE SPECIFIC NEEDS Your patient has no hair on his head. He does not speak. Your nursing care for him will include feeding him and changing his diaper.

Do you have a mental picture of this patient? Do you imagine a normal newborn? A brain-injured teen-ager post neurosurgery? A middle-aged man who has received surgical and chemotherapy treatments? An elderly man who has had a cerebrovascular accident?

The description might fit any of those patients. However, you care for each one quite

differently because each age group has unique characteristics and needs: physical, including motor/sensory attributes; psychosocial and developmental tasks; cognitive and intellectual functioning, and major fears and stressors. The following tables provide information related to each age group describing what you would typically expect to find when caring for individuals that fall into each category. Special intervention suggestions for each group are also provided. Remember that a fifty year old who has had a stroke may fall into the “child” category better than the “adult” category in respect to motor/sensory adaptation, cognitive, psychosocial, and special intervention areas.


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DIETARY NEEDS OF RESIDENTS

Nutrition and Hydration • Good nutrition and hydration is essential to the health and well being of elderly clients • Malnourished clients are more likely to become ill and have difficulty recovering from

sickness because their bodies do not have the proper nutrients

The elderly residing in long-term care facilities are being monitored for weight loss, malnutrition and dehydration, as a result of the federal government implementing assistance to reverse this growing concern. Malnutrition and dehydration concerns are not only local, but also national, resulting in the federal government’s involvement. Elderly clients continue to require a well balanced diet with adequate hydration. However, some clients are not getting the adequate nutrition for one reason or another. The key points to remember are that all residents have the right to eat what they desire, to eat at different times than other residents and to choose not to eat if they wish. It is the responsibility of the care staff to respect these wishes and make the necessary accommodations, while providing the documentation to support the interventions. For example, a resident does not cooperate with being fed at meal time, he/she clamps his/her mouth shut and turns his/her head. In similar situations, residents are not being encouraged to eat or offered other choices and staff is just giving up and not feeding the resident, assuming he/she is not hungry or is refusing the meal. No longer is this an option! He/she will require encouragement, choices, supplements or other options to receive proper nutrition and hydration. All of these tried interventions will need to be documented in the event that the resident will still not eat. Through complete documentation, the fear of neglect will not be a concern. If weight loss, malnutrition and/or dehydration are discovered without documentation, a federal deficiency of neglect can be held against the facility. The interventions are in the chart and on the care plan indicating the resident’s continued refusal to eat. Residents cannot be forced to eat!

Causes for Reduced Intake • Loss of appetite • Difficulty chewing and swallowing • Mouth pain • Decreased sense of taste • Drug interaction • Disease state • Mental factors

• Dementia • Depression

There are several reasons why an elderly person may have reduced nutritional intake,

including loss of appetite. Elderly people require balanced nutrition, not increased caloric intake. Residents are not as active and do not produce an appetite like someone younger. If a resident states they are full or not hungry, respect them and do not force them to clean their plate. A


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DIETARY NEEDS OF RESIDENTS

resident that exhibits problems with chewing or swallowing may be having trouble with the food type and/or texture. Possibly he/she will need a soft or pureed diet or thickened liquids or their food cut up smaller. Mouth pain can be an indicator of several potential problems like sores, tooth pain, poor fitting dentures, or maybe even a sore throat. Ask questions and be observant of the resident’s oral health. The elderly experience a decreased taste sensation because of the aging process and/or secondarily to long-term medication use. Regardless of the cause, the elderly will require increased seasonings to taste the food and enjoy mealtime. It is estimated that an elderly person requires 7 times the amount of salt and 3 times the amount of sugar to taste their food. Possibly this explains why elderly like to eat dessert first! Also, the elderly who are fighting a variety of illnesses requiring multiple medications may experience loss of appetite or a metallic taste in their mouth resulting in poor eating habits. Finally, the cognitively impaired resident may not be aware that he/she needs to eat or he/she may require food that is easy to eat while “on the run”, especially if the resident wanders. If residents are demonstrating poor eating habits and are having trouble eating, assess the needs of the resident and ask questions, the problem could be very simple to fix. ASSISTING A CLIENT

• Follow the care plan • Provide seasonings • Assist with opening containers • Offer additional food and beverage after the client eats most of their meal • Offer a substitute of similar nutritional value if the client does not like or eat the meal

served

The above suggestions are easily applied to a resident’s care plan to help mealtime and eating become more appealing and enjoyable. When providing seasonings, remember to double check the care plan to determine if it is something he/she can have. Opening the containers and cutting meat is a small task, but a big help to those residents with impaired respiratory symptoms who become fatigued easily at mealtime. Helping with food preparation helps him/her to save the energy required to eat! When a client eats well, offer rewards of his/her choice. Finally, provide a resident with other choices if he/she does not like what is being served. Allow the resident to make the choice and provide some control in his/her life.

RECOGNIZING AND REPORTING • Be alert to changes in a client’s food and fluid intake • Identification of change is the first step in preventing malnourishment, weight loss and

dehydration • Open communication and teamwork is a vital component to prevention of problems

Anytime a concern is noted about a resident’s intake or dietary habits, report the concern to the charge nurse. The concern should be documented and an investigation started. The earlier


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DIETARY NEEDS OF RESIDENTS the symptoms are identified, the sooner treatment can begin, and hopefully, the lesser degree of consequences.

CONSEQUENCES • Malnourishment • Dehydration (confusion, agitation) • Weight loss • Skin breakdown (bruises, skin tears) • Increased risk of infection • Weakness relating to immobility and falls • Constipation • Urine retention Poor dietary intake impacts the body as a whole, not just the weight. The consequences will affect the entire system and the resident will become much more difficult to care for. His/her quality of life will decrease as well as any independence he/she may have had. INTERVENTIONS • Ongoing assessments by dietician • Monitoring of weight • Recording intake and output • Taking the time to assist client with eating

• Feeding assistants • Allow choices by client • Keep food appealing to client

Several of the interventions have been mentioned already, but the newest intervention is that of feeding assistants. As of October 2003, facilities using anyone to help feed other than a CNA or a licensed nurse must be a trained feeding assistant. These individuals are responsible to assist at mealtime, with snacks or passing fresh water. The feeding assistant can take time with the resident who eats slowly or who requires verbal cueing to eat. The feeding assistant does not have to be concerned about the other tasks that need to be done. If a feeding assistant is having success with a resident and getting him/her to eat, leave them alone. The intake is important and there will be plenty of other residents in need of care.


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CORPORATE COMPLIANCE

Avera Education & Staffing Solutions agrees to use good faith efforts to abide by the corporate compliance program of Avera Sacred Heart Hospital and of the facilities in which Avera Education & Staffing Solutions’ staff provides services. The purpose of a Corporate Compliance Program is to assure that Avera Education & Staffing Solutions maintains its commitment to high ethical standards and that it is willing to comply with all applicable laws and regulations that pertain to the work environment.

Every employee, regardless of job title, plays an important role in maintaining a strong approach to ethical standards and commitment to doing the right thing in any given situation. Each facility has its own program of corporate compliance and temporary employees, when informed of such policies, are expected to comply. Employee’s Role • To be aware of all procedures of the compliance program, including the mandatory duty of

all employees to report actual or possible violations of laws and regulations; • To understand and adhere to the policies of the Compliance Program, especially those which

relate to the employee’s functions within Avera Education & Staffing Solutions; and • To report any actual or potential violations of laws and regulations to Avera Education &

Staffing Solutions. • To accurately record time and mileage on timecards so that agency billing is accurate

and fulfills the corporate compliance standards.

All individuals affiliated with Avera Education & Staffing Solutions are required to report any policy, procedure or activity which they believe may not be in compliance with laws and regulations or Avera Education & Staffing Solutions’ policies. The only effective way to insure that potential violations of laws or regulations can be corrected is to be sure they are reported. Reporting Information Reports can be submitted to: • Your supervisor or the Director at Avera Education & Staffing Solutions • Your supervisor at the facility in which you are placed and where you witnessed a potential

violation • The Facility Compliance Officer • Any Compliance Committee member

Good faith reporting is an essential component of Avera Education & Staffing Solutions’ Compliance Program. Therefore, Avera Education & Staffing Solutions will insure that no one will be punished for reporting evidence of violations or suspected violations of other employees.

Any individual who makes a report under the policy regarding a possible violation may request information from the Compliance Office regarding the follow-up and investigation of the report. The response will be as thorough as possible without violating the confidentiality of other employees.


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CORPORATE COMPLIANCE

Avera Education & Staffing Solutions is very serious about its commitment to organizational ethics and compliance. Failure to follow the standards of the Compliance Program (including the responsibility to report violations) is a violation of Avera Education & Staffing Solutions policy and may be grounds for disciplinary action, including termination of employment when warranted.

As part of the agency’s compliance efforts, random audits of agency billing and staff timecards will be conducted. Fraudulent billing violates federal law and could subject the agency and the appropriate employee to possible fines and/or jail time. Any employee knowingly submitting fraudulent billing to Avera Education & Staffing Solutions will be responsible for reimbursing any overpayments. The employee will also be terminated from employment with Avera Education & Staffing Solutions.


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MANDATORY EDUCATION SELF STUDY POST TEST 1) Fire safety in a healthcare facility is the

responsibility of all staff. a) true b) false

2) A common cause of fire is spontaneous ignition.

a) true b) false

3) Oxygen is a flammable gas.

a) true b) false

4) A weather watch is a time of preparedness;

during watch time prepare for a weather warning by giving your residents baths. a) true b) false

5) The goal of the winter storm watch is to allow

people to plan accordingly and make provisions to accommodate the weather. a) true b) false

6) The Occupational Safety and Health

Administration (OSHA) has issued a rule that all employers will maintain a safe working place and all workers have the right to know what hazards one may encounter while on the job. a) true b) false

7) A hazardous chemical contains a label with a red

diamond with a number 4 inside the red diamond; this tells us there is no fire hazard. a) true b) false

8) Back injuries are the most common work related

injuries. a) true b) false

9) Remembering the rules of proper body

mechanics will help the worker gain the strength needed to complete a lift by maximizing strength while minimizing injury. a) true b) false

10) Ergonomics is the process of dealing with the disciplines that involve the interaction between the worker and the total working environment. a) true b) false

11) To ensure patient and resident safety, one tactic

to consider using is to communicate with the team members as little as possible to allow more time for direct care. a) true b) false

12) One is at risk for encountering workplace

violence if he/she works in an emergency healthcare setting. a) true b) false

13) A successful workplace violence program

includes cooperation between management and front line employees. a) true b) false

14) A client that has just been admitted to a long-

term care facility needs to be informed of his/her rights whenever it is convenient for the staff. a) true b) false

15) PHI about a client must be kept confidential.

a) true b) false

16) The use of a restraint must be based on an

assessment of the client’s physical and cognitive abilities. a) True b) false

17) Statistics have documented that use of physical restraints has contributed to more resident deaths than they have promoted safety. a) true b) false

18) Injuries of known origin will be reported to the

State Department of Health. a) true b) false


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19) If abuse and/or neglect are suspected you should do nothing as the actions do not physically harm the client. a) true b) false

20) A hearing aid corrects the hearing loss of an

individual with impairment. a) true b) false

21) An alphabet is a common tool used to help a

blind individual picture where items are in front of him/her. a) true b) false

22) During communication with a client who has

suffered a stroke, always supply a word for him/her when difficulties saying or finding a word are noted. a) true b) false

23) A surgical mask should be utilized when caring

for an individual with suspected or confirmed tuberculosis. a) true b) false

24) While performing handwashing, the friction

process with soap and water should be a minimum of 5 seconds. a) true b) false

25) When using the alcohol based hand gels, it is

important to only utilize them when decontamination of the hands is not necessary. a) true b) false

26) The minimal requirements for protection from a bloodborne exposure include universal and standard precautions. a) true b) false

27) Individual state departments of health along with

the CDC require that certain illnesses be reported, these illnesses could be summed up as those that can cause an epidemic, are preventable by a vaccine, could threaten the health of a large number of people or are agents of bioterrorism. a) true b) false

28) One is taking a chance at breaching

confidentiality when completing a mandatory reporting procedure. a) true b) false

29) Poor nutrition and hydration of the elderly client

can affect every functioning aspect of the body. a) true b) false

30) All clients need the same interventions

regardless of their age. a) true b) false

31) Failure to follow the standards of the Compliance Program may be grounds for disciplinary action. a) true b) false

32) AESS employees should always refer to the

policy and procedure manuals of the facilities that they are working at. a) true b) false

I the undersigned, an employee of Avera Education & Staffing Solutions (the “Agency”), do hereby agree to hold all individually identifiable patient health information (“Protected Health Information”) that may be shared, transferred, transmitted, or otherwise obtained by me pursuant to my employment with the Agency, strictly confidential, and provide all reasonable privacy and security protections to prevent the unauthorized disclosure of such information, including, but not limited to the protections afforded by applicable Federal, State and Local laws and/or regulations regarding the security and confidentiality of patient health care information including, but not limited to, any regulations, standards or rules promulgated pursuant to the authority of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

I have reviewed Avera Education & Staffing Solutions’ corporate compliance policy and understand my responsibility in adhering to the policy. I also understand that violation of Avera Education & Staffing Solutions’ corporate compliance policy may be grounds for disciplinary action, including termination of employment.

_______________________________________________________

Employee Signature


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MANDATORY EDUCATION SELF STUDY ANSWER SHEET Name (please print) _________________________________

Date ____________________________

1. a. true b. false 2. a. true b. false 3. a. true b. false 4. a. true b. false 5. a. true b. false 6. a. true b. false 7. a. true b. false 8. a. true b. false 9. a. true b. false 10. a. true b. false 11. a. true b. false

12. a. true b. false 13. a. true b. false 14. a. true b. false 15. a. true b. false 16. a. true b. false 17. a. true b. false 18. a. true b. false 19. a. true b. false 20. a. true b. false 21. a. true b. false 22. a. true b. false

23. a. true b. false 24. a. true b. false 25. a. true b. false 26. a. true b. false 27. a. true b. false 28. a. true b. false 29. a. true b. false 30. a. true b. false 31. a. true b. false 32. a. true b. false

I the undersigned, an employee of Avera Education & Staffing Solutions (the “Agency”), do hereby agree to hold all individually identifiable patient health information (“Protected Health Information”) that may be shared, transferred, transmitted, or otherwise obtained by me pursuant to my employment with the Agency, strictly confidential, and provide all reasonable privacy and security protections to prevent the unauthorized disclosure of such information, including, but not limited to the protections afforded by applicable Federal, State and Local laws and/or regulations regarding the security and confidentiality of patient health care information including, but not limited to, any regulations, standards or rules promulgated pursuant to the authority of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

I have reviewed Avera Education & Staffing Solutions’ corporate compliance policy and understand my responsibility in adhering to the policy. I also understand that violation of Avera Education & Staffing Solutions’ corporate compliance policy may be grounds for disciplinary action, including termination of employment.

_______________________________________________________

Employee Signature

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