Welcome To Fort Sanders Regional Medical Center Clinical Orientation

1. Welcome To Fort Sanders Regional Medical Center Clinical Orientation

2. Our Purpose Our Vision Our Values We serve the community by improving the quality of life through better health. Through its people Covenant Health will be recognized as the premier health services system in Tennessee. • Working together in service to God, our values are: • Integrity • Quality • Service • Caring • Developing People • Using Resources Wisely

3. Human Resources Department Laurel Plaza, Suite 106 Knoxville, Tennessee 37916 (865) 541-1247 HR Director Gina Kinkaid 541-2817 Sr. Generalist Susan Thompson 541-1891 Generalist Jason Shubert 541-1947 Coordinator Missy McCarter 541-1888 Coordinator Tonya McDonald 541-2572 We want your employment and/or clinical rotation here to be satisfactory for both you and your manager. We are here to help you with any concerns or problems.

4. PATIENT CARE PHILOSOPHY • Every patient who enters a Covenant Health facility is to be treated with courtesy, compassion, respect, and dignity. As an employee or student, you have accepted the high and special challenge of providing advanced technological care while maintaining a personal and close awareness of the individual human needs of our patients. In any activity conducted by, for, or in the organization affecting care and treatment of patients, there will be no separation, discrimination or other distinction on the basis of race, color, disability, or national origin. All cultural diversity is acknowledged and incorporated into the patient plan of care. • In working with the sick and injured, it is important to remember that you are dealing with persons in exceptional circumstances. You will discover that many patients have fears and resentments that may manifest themselves as irritability, lack of cooperation and apprehension. Courtesy, kindness, and above all, sincere understanding are important steps in overcoming these problems. Always remember that what is routine for you may be a great emergency in the mind of the patient and his/her family. Your thoughtful consideration will often be remembered long after the medical services performed have been forgotten. • When a patient requests to Opt Out of the Hospital Directory they are considered to become NO INFORMATION status. The patient and/or the patient’s personal representative will be advised by the registrar that as a No Information patient, all telephone calls, visitors, florists, etc., will be informed there is no listing for the patient. Only the room # and the MD’s name will appear on the front of the chart • STAFF RIGHTS NOT TO PARTICIPATE IN CERTAIN ASPECTS OF CARE • Requests by a staff member not to participate in any aspect of patient care where there is perceived conflict with the staff member’s cultural values or religious beliefs will be addressed in the following manner: • The Ethics Committee is available to employees as a forum and source of ideas for resolution of ethical conflict. • Employees may transfer to a position in another department, if available. • If the ethical conflict occurs when the employee is on duty, and the patient’s need for care or treatment is imminent, the staff on duty should decide who will care for the patient. If no decision can be reached, the staff member in charge should refer the issue to the manager, Director, Administrative Supervisor, or Administrator On-call to render a decision to ensure that the patient receives appropriate care.

11. CARE OF EQUIPMENT AND SUPPLIES Medical equipment is one of the most important resources we use in treating patients. It is vital that you be alert to any malfunction or disrepair of any equipment and that you report it to your Supervisor or Manager immediately. Do not attempt to use any equipment for which you have not been properly trained. Always ask for assistance with unfamiliar equipment. Supplies are expensive, and you should try to prevent waste and spoilage. If you should find that you could not satisfactorily complete your duties because of inadequate supplies, you should report the shortage immediately to your Supervisor or Manager. As part of the organization’s involvement in and commitment to the national cost containment program, we ask your help in treating all equipment and supplies with extreme care. Losses in these areas mean increased costs for the organization, which result in increased costs for our patients.

13. Approved By:

17. HIPAA 101 Privacy Rules

29. Comment Boxes are provided for all employees, visitors or patients to provide feedback on our organization and the services we provide. The comment boxes may also be used to submit “Star of the Month” cards. Lost and Found All property found in the hospital including, but not limited to, personal articles, property or other valuables that are found on the premises must be turned over to the Security Department. Star of the Month

30. INFECTION PREVENTION

31. INFECTION PREVENTION HAND HYGIENE, WITH SOAP AND WATER OR ALCOHOL HAND SANITIZER, IS THE SINGLE MOST EFFECTIVE WAY TO PREVENT THE SPREAD OF INFECTION. IT IS OUR DUTY TO PROTECT OUR PATIENTS!!! FSRMC has Infection Control policies and an Exposure Control Plan to prevent the transmission of bloodborne pathogens such as HIV, HBV, HCV, and other potentially infectious agents to its staff by: • Reducing reasonably anticipated exposure to blood and other potentially infectious materials, • Establishing engineering and work practice controls, • Providing appropriate employee training and follow-up, and monitoring of work practices. • The following pages will cover: • Categories of isolation • Hepatitis B and C • HIV • MRSA • C. difficile (C. diff) • VRE • TB • Needlestick/Body Fluid Exposure Policy

32. ISOLATION IMPLEMENTATION

33. WHAT YOU SHOULD KNOW ABOUT HEPATITIS B • WHAT IS HEPATITIS B? • A virus that causes inflammation of the liver—one of your body’s most vital organs • It is found in blood and other body fluids • HOW IS IT SPREAD? (Mainly through blood) • Infected needles and sharps • Shared personal care items (razors and toothbrushes) • Unprotected sex • Membranous exposure (eyes, nose, mouth) • Bites and wounds • Perinatal transmission • HEPATITIS B CAN RESULT IN: • No symptoms • Mild illness • Acute (severe) illness • Chronic infection • Liver damage, such as cirrhosis • Liver cancer • Death due to liver failure • WHAT ARE THE SYMPTOMS? (May appear 1-9 months later) • Can be asymptomatic • Flu-like (vomiting, nausea, diarrhea, sore muscles and joints, mild fever, headaches) • Fatigue • Stomach pain • Loss of appetite/weight • Jaundice • Dark urine • HOW DO WE TEST FOR HEPATITIS B? • Physical exam to check if liver is swollen • Blood test for liver function • Blood test for virus and antibodies • HOW DO WE TREAT HEPATITIS B? • No treatment • PREVENTION - Vaccine is very effective • Health care workers: use standard precaution, get vaccinated, exposure management • HBV + individuals: protected sex, don’t donate blood or organs, don’t share personal care items • Hepatitis B vaccine is offered to eligible FSR employees at the time of employment

34. WHAT YOU SHOULD KNOW ABOUT HEPATITIS C • WHAT IS IT? • A virus that can cause serious liver disease • Found in blood; possibly other body fluids • HOW IS IT SPREAD? (Mainly through infected blood) • Infected needles (IV drug, body piercing, and tattoo needles) • Shared personal care items (razors and toothbrushes) • Unprotected sex (less common) • Blood transfusion (before 1992 only) • HOW DOES IT AFFECT YOUR HEALTH? It damages your liver • Approximately 85% develop chronic liver disease 20-30 years after initial infection • Cirrhosis (30-40%) • Cancer (2-4%) • Liver failure • Problems withyour immune system • WHAT ARE THE SYMPTOMS? (Usually the acute infection is without symptoms) • Flu-like (fatigue, nausea, vomiting, diarrhea, sore muscles and joints, mild fever, headaches) • Loss of appetite • Weight loss • Right upper abdomen tenderness • Jaundice • Abdominal swelling • Itching • Dark urine • HOW DO WE TEST FOR HEPATITITS C? • Physical exam to check if your liver is swollen • Blood test for liver function • Blood test for virus and antibodies • HOW DO WE TREAT HEPATITIS C? • Avoid alcohol and non-prescription medications containing acetaminophen • Eat a well-balanced diet • Get adequate rest • Exercise • Take medication asprescribed by your doctor • PREVENTION STEPS (No vaccine or medication can prevent Hepatitis C) • Health care workers: • Use standard precaution practices if there is risk of exposure • Follow hospital policy for exposure management • If you are Hepatitis C positive: • Use condoms during sex • Don’t donate blood products, body tissue, organs • Don’t share needles, razors, toothbrushes, manicure tools, or other personal items.

35. HIV WHAT IS IT? A virus that enters the bloodstream, invades and overwhelms the immune system Causes AIDS (acquired immunodeficiency syndrome) HOW IS IT SPREAD? Infected needles and sharps Shared personal care items Unprotected sex Membranous exposure (eyes, nose, mouth) Broken skin exposure Perinatal transmission HOW DOES IT AFFECT YOUR HEALTH? (Stages of the disease) Early on - may not have symptoms for years Later - swollen glands, minor diseases and infections Very late - inability to fight off life-threatening diseases WHAT ARE THE SYMPTOMS? Weakness Fever Sore throat Nausea Diarrhea White coating on tongue Weight loss Swollen lymph glands HOW DO WE TEST FOR HIV? Antibody test Western Blot HOW DO WE TREAT HIV? (No vaccine or cure) Anti-retroviral drugs PREVENTION Health care workers: Use standard precautions, exposure management. HIV + individuals: Protected sex, don’t donate blood or organs, don’t share personal care items

36. Methicillin-resistant Staphylococcusaureus (MRSA) • What is Staphylococcusaureus? • Staphylococcus aureus is a bacterium frequently found on the skin and groin and in the nose and GI system. It can cause infection at many sites in the body. Methicillin is a drug frequently used to treat S. aureus. If S. aureus becomes resistant to methicillin, it is called methicillin-resistant Staphylococcus aureus (MRSA). MRSA strains are frequently resistant to other antibiotics also, so MRSA can be serious or even life-threatening to your patient. • How Does Infection Occur? • MRSA is usually transmitted from patient to patient by the hands of health care workers. Also, patients may already have it on their bodies. They may become infected with their own bacteria, so MRSA already on the patient’s skin could cause a wound infection, for example. • How Do You Prevent Transmission of MRSA? • Infections caused by MRSA require extra precautions in addition to Standard Precautions. Practicing good patient care and maintaining required aseptic and sterile technique is important. Reasons for extra precautions include the potentially serious outcomes of infection, the ease by which MRSA contaminates the environment, and its ability to live for many days on the environment, objects, and fabrics. Patients with MRSA are placed in Contact Isolation. • How Do You Implement Contact Isolation? • Post the contact isolation sign on the patient’s door or door frame. • Ensure cabinet is adequately stocked with gloves, gowns, and thermometer. • Dedicate equipment for that patient’s use only. If equipment must be used on another patient, clean and disinfect with an appropriate cleaner/disinfectant. • Place the isolation label on the front of the chart. • Handwashing must be performed before and especially after leaving the room. Either 10-15 seconds of lathering with soap and water or alcohol hand sanitizer is okay. Be sure to clean under and around the fingernails and jewelry if worn. • Gloves and gowns mustbe worn in order to enter the room. • Alert other departments if the patient is to be transferred for diagnostic testing (i.e., surgery and radiology) or if transferred to a different unit. • Encourage and educate others to appropriately follow isolation precautions. • Used linen should be bagged in the patient’s room. • Place disposable stethoscope in patient room. • Family and Patient Fact Sheet for MRSA are available by calling Infection Prevention at 541-1259 or House Supervisor at 541-4948.

37. Clostridium difficile (C. difficile) Fact Sheet What is C. difficile? A spore-forming bacterium that produces toxins. It is a common cause of antibiotic-associated diarrhea (AAD). What causes C. difficile? Antibiotics can cause diarrhea, but it is more severe if caused by C. difficile. C. difficile-associated diarrheacan be mild and self-limited, but it can result in pseudomembranous colitis (PMC), a more severe form. How is C. difficile transmitted? It is most often transmitted via the hands of health care personnel or unclean patient care equipment. Infection results from ingestion of C. difficile spores. Commodes, baby baths, and electronic thermometer handles are among the environmental sources known to transmit C. difficile. What prevention and control measures can be taken? Post the enteric version of the contact isolation sign on the patient’s door or door frame. Ensure cabinet is adequately stocked with gloves, gowns, and thermometer. Place disposable stethoscope in patient’s room. Alcohol hand sanitizers will not kill C. difficile spores; therefore washing with soap and water is important to physically remove the spores. Wear gowns and gloves to enter the room. Dedicate equipment for that patient’s use only. Adequate disinfection of medical devices is important (especially items likely to be contaminated with feces, such as thermometers). Wheelchairs, intravenous poles, and stretchers should be cleaned by vigorously wiping surfaces with an approved disinfectant/cleaner. The environment of the room may be highly contaminated with C. difficile spores. Thoroughly clean and disinfect the room, especially: toilets, reusable bedpans, furniture, floors (in the bathrooms, patients’ rooms, and soiled utility room), sinks, bedrails, and telephones. Mops and water are changed for each isolation room. Special cleaning attention should be given to areas around the toilet. Walls should be spot cleaned for all visibly soiled areas. Used linen should be bagged in the patient’s room. Minimize antibiotic use in patients. How is C. difficile infection treated? Discontinue antibiotics if possible, or use agents less likely to cause C. difficile-associated diarrhea. Antibiotics effective against C. difficile may be indicated in more severe cases.

38. Vancomycin-Resistant Enterococcus (VRE) • What is Enterococcus? • Enterococcus is a bacterium normally found in the gastrointestinal tract and female genital tract. It can cause infection of the urinary tract, abscesses and wounds, decubitus ulcers, diabetic foot ulcers, bloodstream infections, and endocarditis. If Enterococcus is resistant to the antibiotic vancomycin, it is referred to as VRE (vancomycin-resistant Enterococcus). VRE is often resistant to many of the other drugs used to treat enterococcal infection. Infections caused by VRE can be life-threatening. • How Does VRE Infection Occur? • Infection often results from bacteria leaving the patient’s GI tract or GU tract, entering a site elsewhere on the body and causing an infection (i.e., wounds or a urinary catheter). • VRE can also be transmitted to a patient by the contaminated hands of HCW’s (with or without gloves), contaminated patient care equipment or a contaminated environment. • How Do You Prevent Transmission of VRE? • Infections caused by VRE require extra precautions in addition to Standard Precautions. Practicing good patient care and maintaining required aseptic and sterile technique is important. Reasons for extra precautions include the potentially serious outcomes of infection, the ease by which VRE contaminates the environment, and its ability to live for many days on the environment, objects, and fabrics. Patients with VRE are placed in Contact Isolation. • How Do You Implement Contact Isolation? • Post the contact isolation sign on the patient’s door or door frame. • Ensure cabinet is adequately stocked with gloves, gowns, and thermometer. • Place disposable stethoscope in patient room. • Dedicate equipment for that patient’s use only. If equipment must be used on another patient, clean and disinfect with an appropriate cleaner/disinfectant. • Place the isolation label on the front of the chart. • Handwashing must be performed before and especially after leaving the room. Either 10-15 seconds of lathering with soap and water or alcohol hand sanitizer is okay. Be sure to clean under and around the fingernails and jewelry if worn. • Gown and gloves must be worn in order to enter the room. • Alert other departments if the patient is to be transferred for diagnostic testing (i.e., surgery and radiology) or if transferred to a different unit. • Encourage and educate others to appropriately follow isolation precautions. • Used linen should be bagged in the patient’s room. • Family and Patient Fact Sheet for VRE • If the patient or family requests information about VRE, contact Infection Control at 541-1259 or the House Supervisor at 541-4948.

39. WHAT YOU SHOULD KNOW ABOUT TUBERCULOSIS (TB) WHAT IS IT? An infection that occurs mostly in the lungs, although other body sites (such as the larynx and bones) can also be infected. HOW IS IT SPREAD? The germs are spread in the air when an infected person coughs or sneezes. WHAT ARE THE RISK FACTORS FOR TB? • HIV infection/AIDS • IV drug abusers • Foreign-born • Elderly • Homeless • Institutionalized persons (eg, in nursing homes, prisons) • Heavy smokers • Alcoholics WHAT ARE THE SIGNS/SYMPTOMS? (May vary from person to person) • Fevers, cough, weight loss, and night sweats • May have a positive TB skin test • May have an abnormal chest x-ray • Symptoms may depend on the body part that is infected HOW DO WE TEST FOR TB? TB skin test, which is “read” within 48-72 hours after placement Chest X-Ray Sputum specimen for smear and culture HOW DO WE TREAT TB? • Airborne isolation. • A respirator, not a paper mask, must be worn by HCWs entering the patient’s room. The room door must be kept shut and the pressure monitor turned on. • Anti-tuberculosis drugs

40. NEEDLESTICK/BODY FLUID EXPOSURE POLICY Policy Statement All work-related percutaneous (needlestick, laceration, bite) or permucosal (ocular, mucous membrane) exposure to blood or body fluids must be reported to Employee Health. CDC guidelines will be followed for assessment and treatment. Objective To prevent transmission of hepatitis B (HBV), hepatitis C (HCV), and HIV to health care workers. Procedure • All exposure sites will be washed with soap and water. Eyes and mucous membranes exposures will be flooded with water. • Incidents (including needlesticks, eye/nose/mouth exposure, and intact skin exposure if amount of body substance or if duration of exposure is considered to be significant) must be reported immediately to the employee's supervisor or the house supervisor and an incident report completed. The employee will then go to Employee Health with the report. If the injury occurs during a time in which Employee Health is closed, the employee will contact the House Supervisor for evaluation and follow-up by Employee Health. • A tetanusbooster is given per protocol, if indicated. • Subsequent management of the employee depends on the serological status of the source patient and the vaccination and/or serological status of the employee. Infection Control Safety Measures: • Personal Protective Equipment includes gowns, gloves, masks, eye protection, and face shields. The procedure to be performed dictates the type(s) of equipment needed. Disposable gloves must be changed between patients, when visibly soiled, or when their ability to function as a barrier has been compromised. • Standard Precautions: An approach to infection control that regards all bodily secretions, excretions, drainage and warm moist body areas as having a microbial population such that transmission to others could occur. • Universal Precautions: An approach to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infections for HIV, HBV, HCV, and other blood borne pathogens. • Clean-up of blood spills or other potentially infectious materials includes: using gloves, remove the visible material, then clean the area with detergent followed by an EPA-approved hospital disinfectant. • Contaminated needles are to be placed in an appropriate receptacle such as a sharps container. When full, the container is closed off and placed in the appropriate location for disposal. Contaminated needles are not to be recapped unless there is no safe alternative. A one-handed scoop technique must be used by the employee. (see EOHS, Blood/Body Fluid Exposures Policy and FSRMC Exposure Control Plan – Policy # EC.SF.006)

42. Age Specific

43. Age Specific Care When caring for patients it is important to take into consideration their age and developmental stage. There are 5 stages of life. #1 Infancy (newborn to 1 year) During this stage, patient safety is important. Make sure side rails are up on cribs, small objects cannot be swallowed, limit visitors and increase security. Approach infants in a calm, caring manner. #2 Pediatrics (1 year to 12 years of age) For patients during this developmental stage, provide a safe environment and use age appropriate equipment such as potty chairs. Involve the child in their care and allow them to make choices when appropriate. Use praise, reward and positive attitude. #3 Adolescence (12years to 18 years of age) It is important to involve patients of this age in their care, speak directly to them, and allow time for questions. Allow for their privacy during personal hygiene and give them choices to ensure self confidence. Also, it is important to provide the patient and parents with information regarding health care issues related to their age (sex, contraception, substance abuse, nutrition, etc.) #4 Adulthood (19 years to 64 years of age) It is important to involve these patients in their care, treatment, diagnosis, and procedures. Family support and visitors are necessary to their improvement. Allow them to verbalize fears, anxiety, and concerns related to their care. #5 Geriatrics (65 years and older) It is crucial to maintain a safe environment for these patients (side rails up, fall prevention, mobility needs, and communication.) Prior to performing any treatments of procedures, explain fully to the patient and allow time for questions. Provide for sensory losses such as visual impairment and hearing loss. Involve family in patients care and decision making.

44. SAFETY & EMERGENCY MANAGEMENT

45. SAFETY DEPARTMENT • Fort Sanders Regional Medical Center Safety Department phone number is 541-1213. • The Safety Department is here for YOU! We want you to work safely and feel safe at work • so that you may go home to your families. The Safety Department is located on the 3rd floor • of Laurel Plaza. • To Report a Safety Issue: • Notify your Supervisor Immediately! • Or, notify the Safety Department (if immediate assistance is needed call the PBX Operators to contact Safety Representative) • Safety Manual (Red Book) • Contains polices regarding: Spills, Decorations, Hazard Communication & Respiratory Protection Program • Smoke Compartment diagrams • Know where this book is located in your Department! • Emergency Operations Manual (Yellow Book) • Contains Emergency Operating Procedures (Notifications/Responsibilities) • Contains Hazard Vulnerability Analysis (Know what are top threats are and know your responsibilities are during a Code Yellow) • Know where this book is located in your Department! • Material Safety Data Sheet (MSDS) Manual (Orange or Labeled Book) • Your Right to Know what chemicals you work around. • A MSDS will give you information on how to clean up a spill, what Personal Protective Equipment to wear and how to dispose of the waste. • Know where this book is located in your Department! • Danger Out Of Order Tags • Use on any piece of equipment that is broken, damaged or malfunctioning. • Fill out the Form Completely and Attach to the equipment. • This includes but not limited to patient – non-patient equipment, furniture, computers etc…… • Activation of any Emergency • Dial “66” this is the Emergency Line to the Operators • Security Department is 541-1309 or in house #11309 • Fire Emergency • Activate the nearest pull station • Remember RACE and PASS • Close ALL Doors in the hospital and clear all items from corridors • Know where the next smoke compartment is if evacuation is necessary (located in Safety Manual) • Respond to the affected area if available with yourself, wheelchair or fire extinguisher R - Rescue A - Activate C - Contain E - Extinguish P – Pull the Pin A – Aim at the base of the fire S – Squeeze handle S – Sweep from side to side

46. Safe Haven Law Hospitals and clinics are designated under TN state Law where a new mom desperate to hide an unwanted baby can bring her newborn instead of abandoning the infant in an unsafe place where it may die. As a Safe Haven, all employees are required to perform any act necessary to protect the physical health and/or safety of the child. Surrendered Newborn If a baby is surrendered anywhere on the hospital property, ANY hospital employee will accept the newborn infant presented to them assuring the mother that this is a Safe Haven. Students and Instructors: Promptly contact the unit manager or shift leader for assistance.

47. Falls Safety Program Identify those at “high risk” for falls using the Heinrich II assessment tool. Utilize the Falls Safety Bundle including: • Yellow arm band • Yellow star on door frame • Continuous bathroom observation • Scheduling toileting • Bed Alarm • Gait Belt with ambulation • Helmet and mat if patient is on an anticoagulant