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MSU Nursing Students MDG Orientation. Welcome. We are excited to have students at the 5 Medical Group (5 MDG) and would like to extend a warm welcome to you. The following slides are a compressed MDG orientation. Please read through them carefully and if you have questions, don’t

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welcome
Welcome

We are excited to have students at the

5 Medical Group (5 MDG) and would

like to extend a warm welcome to you.

The following slides are a compressed

MDG orientation. Please read through them

carefully and if you have questions, don’t

hesitate to ask a staff member when you

arrive at the MDG.

informing patients of student status
Informing Patients of Student Status

It is required that all students working at a

medical facility ALWAYS inform patients that

they are students PRIOR to asking the patient

any questions, conducting any type of assessment,

or providing any type of treatment. Most patients

are happy to have students help them out and will

gladly accept you as a member of their care team.

So, let the patient know at the beginning of the

encounter that you are a student.

definitions
Definitions
  • Chaperone – A person, especially an older or married woman, who accompanies a young unmarried woman in public; an older person who attends and supervises a social gathering for young people. {Webster’s II New Riverside University Dictionary}
  • Medical Chaperone – A third party, usually the same gender as the patient, who maintains a presence during an exam or treatment
    • Promotes patient/provider comfort and safety
    • Guards against professional impropriety and/or unethical treatment
who can chaperone
Who Can Chaperone?
  • All patient care staff members, including administrative personnel, can serve as chaperones.
  • The chaperone should, in most cases, be the same gender as the patient.
    • If a same-gender chaperone is not available, the patient may consent to an opposite-gender chaperone. Document consent thoroughly.
  • If required chaperone is not available during duty hours, contact the flight commander.
when is a chaperone needed
When Is a Chaperone Needed?
  • Any time a minor is examined or treated (parent/legal guardian is acceptable)
    • A parent/legal guardian must be present except during emergencies or life-threatening situations, or if the visit concerns sexually transmitted diseases.
  • Any time a provider exposes, examines or treats the genitalia or rectum of a patient of the opposite sex
  • Any time a male provider exposes, examines or treats a female’s breasts
  • Upon patient or provider request
duties of chaperone
Duties of Chaperone
  • Ensure patient privacy
  • Be present at all times during exam or treatment
  • Identify and report suspected misconduct
    • Suspected misconduct (and any other concerns regarding chaperones) will be reported to the flight commander.
    • If warranted, the flight commander will report the suspected misconduct to the Chief, Medical Staff (SGH), and to the squadron commander.
suspected misconduct
Suspected Misconduct?
  • The nature/purpose of the exam or treatment and extent/purpose of disrobing not fully explained to the patient prior to the procedure
    • Explain what the patient can expect and feel during exam or treatment; avoid surprising patient
  • Patient not provided privacy during undressing and dressing
    • At a minimum, draw privacy curtain; shut door if possible
  • The extent of required disrobing inconsistent with exam or treatment
    • A patient need not disrobe (usually) for a foot exam
suspected misconduct cont
Suspected Misconduct? (cont.)
  • Exam inconsistent with patient’s complaint or purpose of visit
    • Every woman does not need a breast exam every visit
  • Provider’s comments unprofessional
    • Comments should not be obscene or demeaning
    • Off-colored jokes or comments about patient’s anatomy inappropriate
    • Excessive flattery about patient’s body/body parts inappropriate
patient misconduct
Patient Misconduct?
  • Chaperones protect provider as well as patient
  • Provider responsible for managing inappropriate patient behavior
    • Serious consideration should be given to documentation of patient behavior
  • Recommend documenting name of chaperone when present
    • Concerns may arise long after issue (and name of witnessing chaperone) forgotten
infection control
Infection Control:
  • It establishes prevention, control and reduction interventions for NOSOCOMIAL, community acquired and clinic acquired infections.
  • Infection control practices minimize the risk and spread of infection throughout the hospital

Goals of infection control within 5 MDG

bloodborne pathogens
HEPATITIS

&

HIV

Health care facilities are concerned about the occupational (work related) exposure of their employees to diseases transmitted through contact with blood or body fluids. The two blood borne diseases that hospital employees are most at risk for developing are :

BLOODBORNE PATHOGENS







proper technique
Proper Technique
  • Wet hands to reduce irritation from the soap
  • Keep hands lower than elbows to keep contaminants from running onto clothing
  • Use antiseptic soap
  • Wash vigorously for 10 seconds
  • Rinse under running water to remove contaminants
  • Use paper towels to dry hands
  • Use towels to turn off water to prevent cross contamination and so you don’t re-contaminate hands on dirty faucet handles
slide18
TRANSMISSION BASED ISOLATION

- AIRBORNE

- DROPLET

- CONTACT

Types of isolation used in 5 MDG (two-tiered)

Standard Precautions: apply to blood, body fluids, secretions and excretions,

nonintact skin and mucous membranes. Standard precautions are used for each

and every patient.

Transmission-based precautions: used for patients with known or suspected

infections by epidemiologically important pathogens spread by airborne, droplet

transmission or by contact with dry skin or contaminated surfaces..

MDGI 44-15 attachment 4 lists specific precaution and discusses type and

duration of precautions needed for selected infections and conditions.

ALL personnel are responsible to comply with the requirements of isolation

or precautions.

slide19
PPE

Just do it !!!

. . .

PPE = Personal Protective Equipment.

Also known as: PPA = Personal Protective Attire

what ppe to wear
WHAT “PPE” TO WEAR?

WEAR GLOVES -any time contact with blood or other body fluids may occur. For example:

  • when touching any mucous membranes or broken skin
  • when handling items or surfaces soiled with blood or other body fluids
  • when drawing blood

Change gloves if they’re torn, and after contact with each patient. Do NOT reuse disposable gloves.

Washing hands with gloves on is not an acceptable practice.

Gloves are cheap compared to the cost of treating an infection!

more protection
MORE PROTECTION!!

USE MASKS AND EYE PROTECTION - or protective face shields if there’s any chance that blood or other body fluids may splash into your mouth, nose or eyes.

WEAR A GOWN - or apron if splashing of blood or other body fluids is likely.

AND REMEMBER TO WASH YOUR HANDS AND OTHER SKIN SURFACES IMMEDIATELY AFTER:

  • direct contact with blood or other body fluids
  • removing gloves, gown or other protective clothing
  • handling potentially contaminated items
  • all patient interactions

PPE is only effective if it is used appropriately. It is not a total

prophylactic. Hand washing is still necessary

slide22
USE SHARPS CONTAINERS FOR DISPOSAL
  • REPORT INCIDENTS
  • DON’T SCRUB INSTRUMENTS AT USER LEVEL
  • DON’T RECAP

Basics of sharps/needle safety

needlestick protocol
Needlestick Protocol

Needlestick protocol to be followed in the 5 MDG

  • Wash area immediately
  • Report to Public Health; if after hours report to after hours clinic
  • Supervisor completes incident report
    • AF Form 765
  • Prophylactic medication if patient is infected with HIV/Hepatitis
  • Follow-up care
take care when using sharps not chances
Take CARE when using sharpsNOT CHANCES!!

Take care when using sharps, NOT CHANCES! Pay attention to

what you are doing when handling sharps. Do not jeopardize

coworkers or your own safety.

red bag waste
RED BAG WASTE

Red bag is for potentially infectious,

contaminated material ONLY.

Must be saturated with body fluids

before qualifying for disposal

in red bag. Non-saturated

dressings, band aids, outer

wrappers go in regular

trash.

VERY EXPENSIVE to dispose of!

slide26
Either complete the Nosocomial Infection Report Form ACC 323 or inform the ICO of a known infection and ICO will fill out the form.
  • If you fill out the form, turn into Infection Control Officer
    • within 24 hours of suspicion

Whenever a suspected nosocomial infection is

discovered, fill out a report form.

slide27
Infection Control Officer

Leisa Johnson, PRP Clinic

723-5199

background
BACKGROUND

Safety-related incidents are those that directly pose a health threat to staff and patients, can directly impact the mission, and that are generally considered preventable. The most common safety-related incidents in the 5th Medical Group are medication errors, needlestick/sharps injuries, falls (both patient and staff), and exposures to blood-borne pathogens and chemicals.

prevention
PREVENTION
  • DoD requires analysis of processes that place patients and staff at-risk
  • Failure Mode and Effects Analysis (FMEA) is one the tools the MDG uses to proactively reduce and prevent injuries and incidents.
  • MDG Safety Committee tracks and trends incidents that occur.
reporting
REPORTING
  • Use AF Form765, Medical Facility Incident Report
    • FormFlow version on LAN
  • Turn in to Quality Services within 24 hours
  • Seek medical care for injuries
  • Report exposures to Public Health
slide32
Incidents are unexpected occurrences such as:

sharps injuries

medication errors

patient falls

exposures to blood-born pathogens

equipment failures during patient care episodes

incident evaluations
INCIDENT EVALUATIONS
  • Reviewed by supervisor, flight/squadron leadership, and Risk Management
  • Non-attributional except in cases of gross neglect or intentional misconduct
  • Presumed to be a system error unless proven otherwise – errors and accidents cannot be completely eliminated and thus are treated as a workplace process that can be improved
5 th medical group34

5th Medical Group

MANAGEMENT OF VIOLENT PERSONS

governing directive the 5 th mdg is a restraint free facility
Governing Directive(The 5th MDG is a restraint free facility!)
  • 5 MDGI 44-121, Management of Violent Persons
    • This instruction establishes the policy for managing persons with specific behavioral health needs/issues (e.g., psychotic and/or violent behavior).
    • Nonviolent, restraint-free intervention is emphasized and safety of all personnel is primary concern.
staff education the 5 th mdg is a restraint free facility
Staff Education (The 5th MDG is a restraint free facility!)

5 MDGI 44-121, Management of Violent Persons, mandates orientation and annual training on use of nonviolent intervention

It discusses expected outcomes (goals) of nonviolent intervention and steps for implementing nonviolent intervention

definitions37
Definitions
  • Restraints fall into three categories:

Protective Devices – devices used to protect patient, or posturally support or assist to obtain/maintain normative bodily functions; such as bedrails, halter restraints, orthopedic devices, braces, etc.; not considered restraints

Medical Immobilization – mechanisms employed during procedures, without which patient could suffer harm; such as body restraint during surgery or soft restraints to prevent dislodgement of intravenous lines; associated with normal behavior; not considered restraints

Restraint – use of physical or mechanical devices used to involuntarily hinder movement of all or portion of person’s body to control physical activities, thereby protecting person or others from injury; key is the intent for its use; is person’s behavior itself that determines the need

definitions cont
Definitions (cont.)
  • Dr. Strong – a code for requesting an immediate show of force to subdue a potentially hostile or violent person or to defuse a potentially dangerous situation
    • THE USE OF FORCE BY 5 MDG WILL BE AVOIDED IF AT ALL POSSIBLE
  • Code Black – a code used during a general state of duress at a location within the confines or surrounding grounds of 5 MDG; announced location is to be avoided by all personnel because of presence of possibly dangerous person
responsibilities
Responsibilities
  • Manage person using nonviolent interventions
  • Consult Life Skills Support Center regarding persons suspected of being violent or psychotic
  • Contact Ambulance Services when behavior suspicious of becoming violent
  • May assist in transfer of person in need of care to appropriate (e.g., psychiatric) facility
  • Document all care on progress notes in medical record
  • Physicians may administer medications to address targets behavioral symptoms based on clinical judgement and the person’s
  • Ambulance Services will announce Code Black/Dr. Strong and location via overhead paging system and Will contact Security Forces for assistance managing violent persons who cannot be managed effectively using nonviolent means
procedures interventions
Procedures/Interventions

Egress immediate area ASAP; behind locked doors

if possible

  • DO NOT ATTEMPT TO APPREHEND OR SUBDUE
  • If you cannot egress area safely, lock all personnel into a room, avoiding doors and windows
  • Primary Care Staff will clear the atrium of personnel and lock them in clinic area

Notify Ambulance Services or activate automated

alarm when safe to do so

Ambulance Services will announce twice, “Code

Black/Dr. Strong in (location).”

procedures interventions cont
Procedures/Interventions (cont.)
  • Drop cage windows immediately
  • Lock hallway doors once personnel evacuated from main hallways
  • Lock all interior doors once all personnel safely inside
  • Ambulance Services will contact Security Forces and inform them of situation and location of aggressor(s) if possible. If it is not safe to do so, they will activate the duress alarm.
procedures interventions cont42
Procedures/Interventions (cont.)
  • Remain in secure locations until given “All clear!”
    • Ambulance Services will announce “All clear!” overhead when assured the situation safe.
    • Ambulance Services will authenticate “All clear!” in following manner: “This is Ambulance Services control. Code Black/Dr. Strong is terminated at this time (by Security Forces).”
    • Will announce authentication twice
  • In event of casualties, Ambulance Services will activate Medical Group Control Center (MGCC) and implement Disaster Casualty Control Plan (DCCP).
procedures interventions cont43
Procedures/Interventions (cont.)

Facility Management will survey premises and

determine any structural damage that might

jeopardize safety and if necessary, will activate

alternate facility plan

Ambulance Services will document events in the

shift log

If the MCC was activated, documentation will be

consistent with MDG’s DCCP.

expected outcomes
Expected Outcomes
  • The person will regain control of his/her behavior.
  • The person will not harm patients, community members or staff.
  • The dignity of all will be maintained.
slide46
ITEMS EVERYONE SHOULD KNOW

1. Know the location of the nearest alarm pull station.

2. Know the location of the nearest fire extinguisher.

3. Know by heart the number for the Ambulance service. (5627)

4. Know by heart the number of Facility Management. ( 5260)

5. Know who your safety monitor for your section is.

6. Know who your area fire marshal is.

7. Know the fire escape plan for your area.

8. Select an area that everyone meets to have a head count.

9. Always use the outside stairs to evacuate the building.

10. Your 5th Medical Group Primary safety officer is Ms. Carrie Mullin

fire safety47
Fire Safety

The 5th Medical Group is on a fire zone

system. When a fire alarm is activated, the

system generates two series of rings. The

first series indicates on which floor the fire

alarm has been activated. This is followed

by a brief pause, followed by a series of

rings that indicates where on the floor the

alarm has been pulled.

slide48
Fire Safety

Know what fire zone you are in at all times.

Reason: If you are in a zone that has a fire in it, you only need to go to the next fire zone to have more time to escape. Unless Fire Dept evacuates whole building

How do I know what fire zone I am in????

You need only to look at the fire alarm bells it is printed on each one also it is on each pull station.

where are alarm stations and pull station located
Where are alarm stations and pull station located?
  • All alarm stations are located near the ceiling in hallways.
  • All pull stations are located in hallways near doorways at about shoulder height.
  • Both have printed on them the floor and zone that you are in. Such as (1-4, or 2-1 or 3-2).
fire extinguishers
Fire Extinguishers

If the fire is small and you feel you

have the ability to extinguish it using an

extinguisher, remember the acronym

PASS.

P - Pull pin: you will need to pull hard on the pin to break the seal

A - Aim: at the base of the fire, ensure you do not stand too close or the force of the extinguisher may spread the fire

S - Squeeze: the trigger

S - Sweep: side to side at the base of the fire

Fire extinguishers in the facility are of the "ABC" variety. These extinguishers can be used on ALL types of fires.

fire safety51
Fire Safety

If at any time you doubt whether you have the ability to put out the fire using an extinguisher, leave, ensure the fire alarm is activated and the Fire Department is notified. Life safety takes precedence over anything. It is everyone's responsibility to know the locations of fire alarm pull stations and fire extinguishers in their work ar

Evacuate upper floors via the four corner stairways, leave the atrium stairs for upcoming traffic--NEVER USE THE ELEVATORS DURING A FIRE.

In case of fire at the 5 MDG you would call 9-911.

fire safety52
Fire Safety

Listen for the location of the fire through

the overhead. If you are located adjacent

to the fire area, close all doors to rooms

and wait for further instructions. If the fire

is in your area begin RACE procedures.

R- REACT by shouting FIRE & RESCUE

A - ACTIVATE the fire warning/ alarm system-KNOW location of nearest alarm pull box

C - CLOSE all doors in affected fire zone

E - EVACUATE ALL PERSONNEL

questions
Questions?
  • Contact Carrie Mullin at 723-5260
initial screening
Initial Screening
  • Recent (within past year) TB skin test
  • Hepatitis B Vaccination
    • Required for all Active Duty
    • Offered to Civilian employees
  • HIV
    • Required for personnel potentially exposed to blood/body fluids
  • Evidence of immunity to chickenpox, rubella, and rubeola (measles)
annual screening
Annual Screening
  • TB skin test
    • Required for everyone
  • HIV
    • Required for personnel potentially exposed to blood/body fluids
sick employees
Sick employees
  • Must see PCM to determine duty restrictions needed to prevent transmission to patients and coworkers
  • PCMs should complete Quarters Authorization form and provide a copy to Public Health
  • Public Health reports numbers to Infection Control Committee
  • Should see PCM upon return to work if still sick
bloodborne pathogens exposure
Bloodborne Pathogens Exposure
  • If you get exposed do the following:
    • Fill out an incident report
    • Get the name of the patient you were exposed to if at all possible
    • Go to Public Health with the incident report and patient if possible
  • Public Health will order lab work (HIV/Hepatitis Panel) on you and the patient and have you seen by your PCM.
bloodborne pathogens exposure follow up labs
Bloodborne Pathogens Exposure Follow-up Labs
  • 3 Months and 6 Months
    • HIV
    • Hepatitis Panel
tb exposure control
TB Exposure Control
  • Active TB risk for Minot is low
  • No isolation facilities available here
  • Suspected or confirmed cases should be referred downtown
  • If you suspect an active case:
    • Mask the patient and yourself
    • Isolate as much as possible
    • Contact Infection Control & Public Health
5 th medical group health insurance portability and accountability act hipaa training

5TH MEDICAL GROUP HEALTH INSURANCE PORTABILITY and ACCOUNTABILITY ACT (HIPAA) TRAINING

WHAT ARE THE HIPAA RULES?

HOW DOES HIPAA APPLY TO ME?

HELP ME UNDERSTAND HIPAA.

table of contents
TABLE OF CONTENTS
  • Why HIPAA
  • Notice of Privacy Practices (NOPP)
  • Authorizations
  • Patient Rights
  • Penalties
  • Contacts
why hipaa
Why HIPAA?

1996 – In Tampa, a public health worker sent to two newspapers a computer disk containing the names of 4,000 people who tested positive of HIV.

2000 – Darryl Strawberry’s medical records from a visit to a New York hospital were reviewed 365 times. An audit determined less than 3% of those reviewing his records had even a remote connection to his care.

2000 –An Atlanta truck driver lost his job in early 1998 after his employer learned from his insurance company that he had sought treatment for a drinking problems. (USA Today, 23 Mar 2000)

2001 - Elli Lilly accidentally sent e-mail to Prozac users on an informational list server revealing identities of numerous other Prozac users.

cast of characters
Cast of Characters
  • Amn Notsofarfrumpukin – Our Military Patient
  • Mrs Imsik – Our Civilian Patient
  • Ms Lookemup – Our Records Technician
  • Mr Doody – Our Front Desk Clerk
  • Mr Shhh – Our Privacy Officer (HPO)

(HIPPA PRIVACY OFFICER)

protected health information
Protected Health Information

What is Protected Health Information?

Basically, any information pertaining to an individual’s treatment

It is a subset of individually identifiable health information

(click)

Including payment for the provision of health care

slide66
Amn Notsofarfrumpukin reports to your clinic and you notice that the Notice of Privacy Practices (NOPP) has not been signed.
  • Per DOD 6025.18 and MDGI 41-10, clinics are required to check the medical records for signature.
    • Ask if he has received the NOPP
      • If not, give him one and have him sign the sticker.
      • If he has, and has not signed the sticker, have him sign and give him another NOPP if he wants one.
    • Refusal to sign will not impede medical care.
    • Front desk clerk will initial the NOPP on appropriate line if the patient refuses to sign.
slide67
Amn Notsofarfrumpukin’s 1st Sgt calls and wants to know if he made his appointment and the nature of the appointment.
  • Under the Military Command Authority (MCA) rule, Commanders, 1st Sergeants and those designated in writing by the Commander may receive Protected Health Information (PHI).
    • We must verify position
    • Give only minimum information necessary
amn notsofarfrumpukin s supervisor calls for information on the appointment
Amn Notsofarfrumpukin’s supervisor calls for information on the appointment.
  • Since the supervisor is not the 1st Sgt or Commander, he is not entitled to the information.
    • You can tell him that if the Amn is available, you will have him return the call or
    • Ask him to have the 1st Sgt call.
disclosure reports
DISCLOSURE REPORTS
  • When Personal Health Information (PHI) is accessed, used or disclosed without patient authorizations (except for those purposes that are exempted) a signed and completed PHI Disclosure Report must be completed and forwarded to the HIPAA Privacy Office for filing.
lets s look at some other examples
Lets’s look at some other examples

Yes, under HIPAA, if there is an ongoing investigation we can release Information

I received a phone call from the base legal office for records on an Amn, can I give it to them?

However, we will need the request in writing and only minimum information should be given, and the legal office should be specific about what they are looking for.

authorizations
Authorizations

Will I have to do a disclosure report?

Yes, disclosures that do not have written authority to release, require a disclosure report.

authorizations72
Authorizations

We have a patient that came from another state. We need her records to continue her care. Does she need to request them?

However, if the patient is available, it is always a good idea to get a signature.

No, under Treatment, Payment, and Healthcare Operations (TPO)

we can request the records without authorization.

there are other occasions where authorizations are not required
There are other occasions where authorizations are not required.
  • To Public Health Authorities
  • To Military Command Authority (i.e., Commanders and First Sergeants)
  • Judicial and Administrative Proceedings
  • Required by law
  • Victims of abuse, neglect or domestic violence
  • Health oversight committee
  • Law enforcement
  • Identification and location purposes
  • Reporting crime in emergencies
  • Corners, Medical Examiners and Funeral Directors
  • Research involving minimal risk
  • Avert serious threat to health and safety
  • Worker’s Compensation

Remember a disclosure report isrequired

lets take a look at patient rights under hipaa
Lets take a look at Patient Rights under HIPAA.

I would like a copy of my medical records

Under DOD 6025-18R and MDGIS 41-10 and 41-12, patients have a right to inspect or have copies of their medical records.

patient rights medical records
Patient Rights – Medical Records
  • We must comply with the request within 30 days.
  • A one time extension of 30 days may be granted.
  • A one-time copy will be prepared without cost to the patient. Other copies can be provided at a fee determined by the Business Operations Flight.
  • There are circumstances where access is denied. If you have any questions contact the Privacy Office at ext 5134 or 5206.
patient rights continued
Patient Rights -continued
  • To file a grievance or complaint about any aspect of their PHI or the MTF’s practices and policies.
  • They have a right to designate a personal representative with authority to act on their behalf
  • Un-emancipated minors, under ND law, may only consent to treatment for drug and alcohol abuse, treatment for sexually transmitted diseases and medical emergencies.
patient rights continued77
Patient Rights - Continued

I have a problem with a notation in my records and I would like it amended.

Under HIPAA a patient has the right to request an amendment or correction. The physician needs to review the records. The request may be denied if:

patient rights reasons for denial
Patient Rights-Reasons for denial
  • The information was not created by the 5th Medical Group.
  • The information is not part of the record set (medical records)
  • The information is accurate.

The Privacy Officer will be consulted prior to any denial to the Patient.

other patient rights include
Other Patient Rights Include:
  • The right to full disclosure of release of disclosures, except for those that have been authorized.
  • Request restrictions of the uses of PHI, but the MTF is not necessarily required to follow the request (i.e. would there be a mechanism in place to monitor the restriction).
penalties
Penalties

What if I mess up and release PHI to the wrong individual?

Notify the Privacy Officer immediately

Document it on an AF Form 765, Medical Facility Incident Report and forward to the Risk Manager within 24 hours

Persons making intentional unauthorized disclosures will be referred to their unit commander for appropriate administrative or disciplinary action.

slide81
What are the Medical OIs concerning HIPAA?

MDGI 41-12 – Patient’s Rights Under HIPAA.

MDGI 41-10 – Implementation of Privacy Practices

MDGI 41-11 – Accounting of Disclosures of PHI

Located on the “U” drive; Shared folder; HIPAA Compliance folder

points of contact
Points of contact
  • If you have any questions please contact:
  • Lorenda Poissant-Salling (Privacy Officer)
    • ext 5206

OR

  • Kim Lemley (Privacy Assistant)
    • ext 5134
responsibilities83
Responsibilities
  • Remember, everyone who works with or comes in contact with protected health information (PHI) or any medical information is responsible to maintain the confidentiality of that information.
patient rights
Patient Rights

Access

Treatment

Respect

access
ACCESS

Patients have the right to receive care within a reasonable period of time

What is considered reasonable depends on the type of care required

access86
ACCESS
  • The access to care standards at the 5th Medical Group are as follows:
  • Acute/Urgent appointments within 24 hours
  • Routine Care within 7 days
  • Wellness appointments within 30 days
treatment
TREATMENT

Patients have the right to receive the

appropriate care required to achieve or

maintain the highest possible quality of life.

That may include not only physical care

but…..

psychosocial

spiritual

cultural

end of life

slide88
Patients have the right to be involved in any decision that involves their care including:

Advance Directives

Conflict Resolution

advanced directives
ADVANCED DIRECTIVES

Advance Directives are written or verbal Statements made by the patient indicating his or her treatment wishes in the event

the patient becomes incapacitated.

Patients must be given the opportunity to make these provisions

slide90
Advanced Directives may include living wills,,durable powers of attorney, or similar documents or documentation conveying the patient’s preferences.
advance directives
Advance Directives
  • Patients may obtain advance directives from their attorneys
  • For Active Duty members this service is provided for free at the base legal office
  • If you do have an advance directive, please ensure that a copy of it gets placed in your outpatient medical record
patient advocacy program
PATIENT ADVOCACY PROGRAM

A patient has a right to voice

complaints about his or her

care and to have those

complaints reviewed, and when

Possible, resolved.

patient advocacy program93
PATIENT ADVOCACY PROGRAM
  • 5th MDGI 41-18 - Patient Relations Program outlines the mechanism for investigation and resolution of patient complaints/concerns
  • Each section involved in patient care has an appointed Patient Advocate, as does the Medical Group
  • The goal is to resolve the issue at the lowest level, whenever possible
patient advocate
Patient Advocate
  • The 5th Medical Group’s primary Patient Advocate is Mrs. Jean Cadell (723-5109)
  • The 5th Medical Group’s alternate Patient Advocate is Mrs. Lorenda Poissant-Salling (723-5206)
respect
RESPECT

Patients have the right to be treated with respect in all

interactions. Respect involves numerous issues

including:

Confidentiality/Privacy

-only those needing specific information in order to

provide care are allowed access to patient information

-sharing patient information is restricted to staff involved in the patient’s care and is limited to information essential to that care

Spatial-Patients have the right to physical privacy during

interviews, procedures, etc.

Security-Patients have the right to a safe, secure

environment, for themselves and their property.

Communication-Patients have the right to be treated as

valued individuals in all interactions.

ethics
ETHICS

MDGI 37-1 outlines the facility’s Ethics policy and provides the mechanism for obtaining assistance in making ethical decisions involving patient care

The EthicsCommittee meets on an as needed basis to discuss ethical issues. Members are available to assist in the decision making process.

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Questions?

Contact Mrs. Lorenda Poissant-Salling at 723-5206 or Mrs. Jean Cadell at 723-5109

definition
DEFINITION

CODE BLUE: Code name for cardiopulmonary arrest or any situation in which a cardiopulmonary arrest is imminent.

bls and acls
BLS AND ACLS
  • A – Airway
  • B – Breathing
  • C – Circulation
  • D – Defibrillation
initiating a code blue
INITIATING A CODE BLUE
  • Dependent on 4 factors:
    • ? Normal duty hours
    • ? Non-duty hours
    • ? Adult
    • ? Pediatric
initiating a code blue102
INITIATING A CODE BLUE
  • ADULT – NORMAL DUTY HOURS
    • FIRST PERSON
      • Assess the patient
      • Overhead Page by dialing 2-0 and announce “CODE BLUE and LOCATION” twice.
      • Initiate CPR by using the ABCD assessments of BLS and ACLS
initiating a code blue103
INITIATING A CODE BLUE
  • ADULT – NORMAL DUTY HOURS
    • SECOND PERSON
      • Activate the code if necessary
      • Assist with CPR until team arrives
initiating a code blue104
INITIATING A CODE BLUE
  • PEDIATRIC – NORMAL DUTY HOURS
    • FIRST PERSON
      • Assess the patient using the ABCD of BLS
      • Perform CPR for 1 minute if necessary
      • Overhead Page by dialing 2-0 and announce “Pediatric Code Blue and Location” twice
      • Resume CPR
initiating a code blue105
INITIATING A CODE BLUE
  • PEDIATRIC - NORMAL DUTY HOURS
    • SECOND PERSON
      • Activate code if necessary
      • Assist with CPR until team arrives
initiating a code blue106
INITIATING A CODE BLUE
  • ADULT OR PEDIATRIC AFTER HOURS
    • Dial 9-911 and report if the coding patient is adult or pediatric and the location of the patient.
    • Ambulance services will be the sole responders.
who responds to a code blue
WHO RESPONDS TO A CODE BLUE??

Normal duty hours:

  • All available credentialed providers
  • Ambulance Services paramedic and technician
  • X-ray, pharmacy and laboratory technicians.
  • Pediatrician or PALS-trained Pediatric Nurse Practitioner for children under age 16 (pediatric code)
  • Available clinic nursing staff and two clinic technicians
who responds to a code blue108
WHO RESPONDS TO A CODE BLUE??
  • NON-DUTY HOURS
    • Ambulance Services Paramedic and Technician
    • Patient will be transferred downtown
location of adult crash carts
LOCATION

Dental Clinic

Internal Medicine

COVERAGE

2ND Floor

1st Floor Clinics

All areas of the facility

LOCATION OF ADULT CRASH CARTS
location of pediatric crash carts
LOCATION

Pediatric Clinic (GREEN TEAM)

COVERAGE

Clinic areas of MDOS

All areas of the facility

LOCATION OF PEDIATRIC CRASH CARTS
after a code blue
AFTER A CODE BLUE
  • Pharmacy will restock the drugs
  • Unit personnel should inventory and restock all other supplies
  • Pharmacy will issue a new lock for the crash cart
words of wisdom for code blues
WORDS OF WISDOM FOR CODE BLUES
  • Most Pediatric Codes start with the airway, so remember the ABCDs. Airway is always first.
  • Don’t wait too long to call a code. If you think a patient is in trouble, call a code. It is the fastest way to get help.
summary
SUMMARY
  • KNOW THE LOCATION OF YOUR CRASH CARTS AND BE FAMILIAR WITH THE CONTENTS
  • REVIEW THE USE OF THE LIFEPACK 12 DEFIBRILLATOR
  • REMEMBER TO DIAL 2-0 FOR HELP DURING THE DAY AND 9-911 AFTER HOURS
questions114
Questions?
  • Education & Training #723-5662
medical equipment maintenance

MEDICAL EQUIPMENTMAINTENANCE

5 MDSS/SGSLR

723-5256

training objectives
Training Objectives
  • User Responsibilities
  • Medical Device Related Incidents
  • Service/Calibration Label
  • Medical Maintenance Services
  • Electrical Safety
  • Emergency Procedures
overview
Overview
  • Equipment operators (YOU) have a key role in managing the equipment in the facility
    • Insuring the equipment is used for its’ intended purpose
    • Insuring any staff members using medical group equipment are trained
medical device related event
Medical DeviceRelated Event
  • A medical device related event is when a medical device (supply or equipment):
    • Has caused or may have contributed to the injury, illness, or death of a patient, visitor or staff member
medical devices event common causes
Medical Devices Event Common Causes
  • Equipment malfunction
  • Operator error
  • Poor device design or inadequate labeling
  • Defects in laboratory or imaging equipment
  • Sterilizer spore tests inaccurately indicating proper sterilization
  • Utility problems (electricity, medical gases, plumbing)
operator preventive maintenance
Operator Preventive Maintenance
  • Preventive Maintenance Checks

- Check case/housing for damage

- Replace leads/hoses/tubing, as required

- Replace batteries/bulbs if accessible without tools

- Perform function checks; report deficiencies

- Reference manufacturer’s operator manuals

- Keep equipment clean

- Ensure battery-operated devices are plugged

in to maintain charge & prevent internal damage

medical devices event user responsibilities
Medical Devices Event User Responsibilities
  • Remove item(s) from service
  • Do not change settings
  • Keep accessories with unit
  • Recover any accessory packaging (lot number/date information)
  • Notify section supervisor
  • Notify Medical Maintenance and Quality Control immediately
service calibration verification label
Service/CalibrationVerification Label
  • Visual reminder that equipment is certified to operate within manufacturer’s design parameters
  • You are responsible for checking the “Date Due” PRIOR TO use of equipment to assure equipment is calibrated
  • If expired service label is found, do not use the equipment.
    • Contact Medical Maintenance at 723-5256

Service Due Date

services provided by medical maintenance
Services Provided byMedical Maintenance
  • Provide or arrange for all maintenance services for medical equipment
  • Assembly and installation of equipment
  • Operator training on equipment during initial issue or upon request
  • Hazard surveillance for medical equipment
equipment supported by medical maintenance
Equipment Supported byMedical Maintenance
  • Medical, Dental, Lab, Radiological, and Veterinary devices used in the diagnosis, treatment or rehabilitation of patients
  • Not supported: Ice makers, coffee pots, refrigeration systems, televisions, typewriters, computers not connected to medical equipment, nurse call system, desk lamps, beepers, or locks
  • When in doubt, please call us at 723-5256.
electrical safety
Electrical Safety
  • Extension cords, outlet strips, and outlet adapters are prohibited from use with medical equipment
    • Tripping Hazards
    • Fire Hazards
    • Electrical Safety Hazards
  • If a longer power cord is necessary to operate equipment, contact us for assistance.
summary126
Summary
  • User Responsibilities
  • Medical Equipment Events
  • Service/Calibration Label
  • Medical Maintenance Services
  • Electrical Safety

723-5256

MSgt Jim Britt

SSgt Chasity Force

SrA Patryk Gasiewski

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