Welcome to Summit Healthcare Regional Medical Center. We hope that you will have a positive experience in our organization. Please review the attached information to familiarize yourself with important regulatory, patient and staff safety and emergency response information. Renae Means and Fredda Kermes in Staff Development are here to assist you in whatever way we can. You can reach us at 537-6573, or 537-6368.
The following topics are presented in this orientation guide for your review:
- AIDET (click here to watch slideshow)
- Emergency Codes
- Nursing Departments
- Orientation Information
- Body Mechanics
- Sexual Harassment
- Workplace Violence
- Material Safety Data Sheets
- Radiation Safety
- Electrical Safety
- Infection Control
- Hand Hygiene
- Sharps Safety
- Blood borne Pathogens
- Patient Rights
- HIPAA (Health Information Portability and Accountability Act
- Corporate Compliance
- Advanced Directives
- Spiritual Care
- Cultural Awareness
- Patient Safety
- Medication Administration
- Restraints and Fall Prevention
- Alarm Monitoring
- Patient Smoking
- Latex Allergy
- Patient Education
- Patient Satisfaction
- Pain Management
- Guidelines for Calling Physician’s
- Wound and Skin Care
- Risk Management
- All Summit Healthcare policy and procedures can be accessed from the desktop computers in the patient care units. Look for the Hospital Manual icon for additional information.
All staff are expected to use proper body mechanics at all times. Aids for lifting patients include gait belts, sliding boards and electric Invacare lifts. Students, contract employee staff, and travelers who require a review of Body Mechanics and Transfer Techniques can find information in the Lippincott’s Nursing Procedures Manual: Body Mechanics and Transfer Techniques starting on p. 87. This manual is located in every nursing department.
Preventing Slips, Trips, Falls, and Other Injuries:
In order to prevent slips, trips, and falls from happening, all staff need to do the following:
- Wear appropriate rubber-soled footgear. Wearing weather-appropriate footwear is also very important during the winter months when snow and ice may be present.
- Wipe up all spills as soon as they occur. If you suspect the spill is a hazardous chemical, notify the charge nurse for initiating a hazardous clean up procedure.
- Be alert to any equipment (electric cords, oxygen tubing, worn carpet, objects that block walkways) that presents a potential hazard and correct these as soon as possible. Any equipment with frayed cords or that is not working properly must be immediately removed from service. In addition, notify the unit supervisor and the plant services department. A copy of the maintenance work order should be printed and attached to the broken piece of equipment.
- Use proper equipment when lifting, transferring, or ambulating patients.
- Ask for help when attempting to lift a patient or an object that is heavy.
- Use caution outdoors on uneven surfaces.
- Notify plant services immediately if ice is noted on sidewalks and parking surfaces.
- In the event that you are injured, report the injury immediately to the unit supervisor and your instructor and seek treatment in the emergency room if necessary. Students and contract labor staff are not covered by the Summit Healthcare Workman’s Compensation program. Your injury must be reported to the Quality Department via Quantros, the electronic incident reporting system. The unit supervisor can assist you with this.
Sexual Harassment is not tolerated at Summit Health Care. If you believe that you are victim of sexual harassment, please report this concern to your instructor and/or the unit supervisor immediately.
Summit Healthcare strives to provide a safe environment for all students, patients, staff and visitors. Please report all instances of workplace violence to security and the unit supervisor immediately. While security does patrol parking lots, grounds, and hospital areas at night, you can keep yourself safe by asking for an escort to your car at night and by utilizing the courtyard for outdoor breaks at night. Use caution when interacting with patients or family members who appear agitated, hallucinating, or appear to have substance or alcohol impairment. Report any concerns to the unit supervisor immediately. Summit Healthcare offers Non-Violent Crisis intervention training to facilitate the use of de-escalation techniques as appropriate. Any one who feels they are in imminent danger can call a Code Grey or Code Silver alert.
Material Safety Data Sheets
Material Safety Data Sheets are located at each nurse’s station and in the Emergency room. Report any chemical exposure to the unit supervisor immediately and refer to the MSDS manual as needed for further information. Please note: In the summer of 2010 Summit Healthcare purchased a web-based MSDS information program and the MSDS data format will be changing to an electronic format.
Staff/students are reminded to take appropriate precautions when assisting with radiological procedures. You are encouraged to leave the room during an x-ray procedure or wear a radiation-shielding apron. Any pregnant student or contract employee must inform the x-ray technician prior to a patient x-ray procedure. All students and caregivers must be familiar with and adhere to MRI safety procedures prior to entering the MRI suite. Patients must also be very carefully screened for any contraindications prior to receiving an MRI.
Patients are at increased risk related to electrical hazards. Report any frayed cords, loose wiring, broken plugs, broken equipment or other electrical hazards to the unit supervisor immediately. Remove any malfunctioning equipment from service and notify the unit supervisor immediately. Any electrical devices that patients may bring from home must be inspected by plant services prior to use in the hospital setting. Red colored outlets in hallways and patient care areas are utilized for any equipment that would be required in the event of a power failure or outage. Essential patient care equipment such as ventilators or monitoring equipment should always be plugged into the red outlets.
Infection Control: Protecting Patients, Staff, and Visitors from transmission of infection is a key intervention for all.
All students and staff are expected to follow Standard Precautions for all patients. Some patients are placed under additional isolation to prevent transmission of infection. These precautions may include:
- Contact isolation
- Airborne (droplet) isolation
- Droplet isolation
- Reverse isolation
Any student or staff not familiar with the proper use of personal protective equipment and isolation procedures must review these procedures with an instructor, unit supervisor, or Infection Control nurse. Pregnant students/ staff members are required to consult with the unit supervisor or Summit’s Infection Control nurse before caring for patients in isolation.
Hand washing is the most effective means to prevent the spread of infection. Washing hands before and after any patient contact, prior to performing any procedure, before and after eating, and after using the restroom is essential. The use of alcohol hand gel (when hands are not soiled) is also an effective method. Additionally anyone providing patient care should not wear artificial nails or maintain fingernails longer than ¼ inch in length. If your patient is positive for Clostridium difficile (C. diff), soap and water must be used, as alcohol gels are ineffective against C diff.
Needleless devices and systems to promote caregiver and patient safety are utilized whenever possible. Sharps containers are located in each patient room, in nursing areas, and on medication carts for easy disposal of all sharps. Recapping of any needle is prohibited. Any needle stick injury must be reported to the instructor or unit supervisor immediately and recorded in Quantros.
Blood borne Pathogens:
All students and staff are required to follow the Blood borne Pathogen Exposure Plan located in the Hospital Procedure Manual.
All patients have certain rights and responsibilities. These are communicated to patients and families during the admission process through the Summit Healthcare Patient Handbook. All staff are expected to uphold patient rights and act as an advocate for the patient and family.
HIPAA (Health Information Portability and Accountability Act)
All patients are entitled to have their protected information remain private. Please review the following key points:
- Health information is shared on a need to know basis between caregivers. Patient information in any form (written, verbal, fax, etc) is not shared with anyone who is not directly involved in the care of the patient. The patient or patient care partner are asked to identify and authorize family members or significant others who they desire to have information.
- Taking photographs without written permission from the patient is prohibited.
- Patient’s have the right to request that their name is not listed on the general census. These patients are designated as No Information Published (NIP), with no information released about them via phone or written identification. The patient is identified as NIP electronically, on census boards, and on the chart.
Medicare fraud and abuse is prohibited. Any concern should be reported to the unit supervisor, department director, Corporate Compliance Officer, or by utilizing the Corporate Compliance Hotline phone number located at multiple locations in the facility. Please note the signs designating the hotline number as you get oriented to the facility.
Federal regulations require that all patients over the age of 18 be given the opportunity to formulate Advanced Directives. Patients can formulate or change their Advanced Directives at any time during their hospitalization. Social Services can provide information, patient assistance and guidance regarding this patient right. Copies of Advance Directives are pulled forward to the most current medical record. If a telephone order for “DNR” (Do Not Resuscitation) is obtained, two nurses must listen to and sign the order. Student nurses are not permitted to take or witness telephone orders.
The spiritual needs of Summit Healthcare patients are met by offering clergy services as desired by the patient and family. Two non-denominational chapels are available. One is located adjacent to the patient tower near the elevators and the other outside the emergency room. A list of local clergy can be obtained by contacting the unit supervisor or Volunteer Services.
Summit Healthcare recognizes the diverse cultural make-up of our local population, and seeks to accommodate each patient’s cultural needs. Please speak with your unit supervisor as needed for resources to help meet your patient’s needs. The Cyracom interpreter phone is available on each nursing unit to assist with translation needs. In addition, the organization keeps a list of employees who can interpret; this list is available on each nursing unit and in Human Resources.
Summit Healthcare makes every effort to protect patients from injury. Patient and Family Centered care is a key element to encourage patients to be actively involved in their care. Safety information is included in the admission packet given to each patient and includes information regarding the Speak Up program. This program includes information to prevent falls, medication safety, and pain management. A white board is present in each patient room and serves as a communication tool for patients, families and care givers. All staff must advocate for safe care practices and ask questions and voice their concerns anytime there is a perceived safety risk.
While Summit Healthcare recognizes that medication misadventures may occur, the following steps are taken to minimize the risk of error:
- All licensed staff are required to follow the “Five Rights” of medication administration.
- Two identifiers are used prior to administering medication. These identifiers are the patient’s name and date of birth.
- Medication misadventures are reported to the unit supervisor immediately to identify system and process problems and/or staff learning needs.
- All verbal and telephone orders require read back to ensure accuracy or orders. This is indicated on the physician order sheet as “TOR” (Telephone Order Read back) or “VOR” (Verbal Order Read back) next to the order.
- Only approved abbreviations may be used. Refer to the hospital policy manual for a list of approved abbreviations.
- Medications are administered through the Omnicell automated dispenser. Nurses who are not familiar with this equipment will need to be guided by a unit superuser prior to accessing the system. Student nurses do not access Omnicell at this time.
- The flowchart below demonstrates the expected method of administering medications. Keep in mind that this flow chart does not apply to medications given in the emergency department or surgery.
Restraints and Fall Prevention:
Summit Healthcare strives to be a restraint-free environment. Restraints are used as a last resort and only if all alternative measures have been unsuccessful to prevent patient and staff harm. Protocols or prn orders for restraints are not allowed. When restraints are applied, the manufacturer’s directions are followed. Registry, traveler staff and students must check with the unit supervisor before applying restraints. Patients in restraints are assessed frequently to ensure that their safety, hydration, and toileting needs are being met. Restraints are removed as soon as possible based on frequent patient assessment. Documentation of restraints is an important regulatory requirement. Please review the Guidelines for the Use of Voluntary/Involuntary Immobilization policy located in the Hospital Manual (located on computer desktops in the patient care units.)
Summit Healthcare has a fall program to prevent patient falls. Patient’s who are at high risk for falls are identified by a yellow arm band and a card posted in the patient’s room. Patients must be assessed for fall risk every shift and as needed, and specific interventions to prevent falls must be documented. Please review the Fall Prevention Program policy listed in the Hospital Manual located on all computer desktops.
At the beginning of each shift, registry staff and students should check all monitoring equipment and become familiar with the tones of different equipment alarms and ensure that alarms are audible. Disarming an audible alarm is considered neglectful behavior. A few examples of equipment with alarm settings include:
- IV pumps
- PCA pumps
- Bed alarms
- Feeding pumps
- Apnea monitors
- Pulse oximeters
- Ambu alarms ( patient leg alarms)
- Infant security alarms in the obstetrics department
Summit Healthcare promotes a Tobacco Free Campus to prevent staff, patient, and visitor exposure to harmful second hand smoke. Patients who smoke are offered Brief Tobacco Intervention and nicotine replacement as ordered by the physician. Summit Healthcare staff, students, travelers, contract employees and visitors are required to leave the hospital campus to smoke during work hours. This policy is reinforced by all hospital employees in a courteous manner.
A latex free cart is available from Central Supply for use with patients who have latex allergies. Please ask the unit supervisor for information regarding protecting patients from latex allergy. Any student, traveler, or contract employee who exhibits symptoms of a latex allergy should contact the instructor or unit supervisor for follow-up.
It is the responsibility of all nurses/students to provide patients with education about their conditions, medications, and treatments. A variety of resources are available to accomplish this.
- Patient education packets on a variety of topics and top admitting diagnoses are available on each unit. Additional packets can be found in the Learning Lounges on the Medical Surgical Nursing Units. In addition, Staff Development can be contacted at 537-6574 for additional assistance regarding Patient Education.
- Patient education must be documented in the medical record.
- Specific Core Measure patient education is required for patients with CHF, pneumonia, and/or acute MI.
It is the goal of Summit Healthcare that every patient receives care and services that meet or exceed their needs and expectations. Everyone interacting with patients and families is required to communicate and interact effectively to meet this goal. Any patient or family complaint or concern requires careful attentive listening, acknowledgement, and appropriate follow up. Please notify the unit supervisor for any patient or family concern. The Patient Advocate can be contacted through the house supervisor or Quality Management department. Nursing department leaders conduct patient rounds routinely to assess patient needs and concerns. Patient satisfaction scores are shared with all staff and are available to the public via compare.net.
Effective pain management is an important patient right. Pain is assessed using pain scale assessment tools based on patient age and cognitive status. Non-pharmaceutical pain management measures such as distraction, music, and relaxation techniques are encouraged as appropriate. Re-assessment and documentation is necessary after any intervention. Remember that pain is subjective and is entirely the patient’s perception.Pain is what the patient says it is! Inform the unit supervisor if a patient’s pain is not effectively controlled to a level that is tolerable to the patient.
Guidelines for Calling Physicians:
Before calling physicians, please check with the unit supervisor and be sure you have all the patient’s necessary clinical information. Please verify that you are utilizing the physician’s appropriate contact preference. Physician preference lists are updated on the Hospital Wide icon on each pc desktop. Summit Healthcare requires the use of the Situation-Background-Assessment- Recommendation (SBAR) format.
Wound and Skin Care:
Summit Healthcare has a comprehensive program for preventing skin breakdown and caring for wounds. A wound care manual is available on each nursing unit. In addition, please carefully review the Wound and Skin Care and the Pressure Ulcer Policy and Procedures in the Nursing Policy Manual. Identifying wounds on admission and preventing development of pressure ulcers is a key nursing intervention. Special air mattress beds are available for patient’s identified at risk.
Incident reporting allows for early investigation of events that have or may have caused harm to patients, staff, students, or visitors at Summit Healthcare. Summit Healthcare utilizes the Quantros web-based incident reporting and feedback system located on each desktop pc. No log in ID or password is required. Incident reporting is anonymous. Please contact the unit supervisor for more information regarding reporting incidents or near misses. Summit Healthcare utilizes a “Just Culture” non punitive response to incident reporting. Trending of process problems are the basis for quality improvement initiatives.
Emergency Codes Response
Emergency Code Response announcements are announced overhead by calling dialing 44 on any phone and announcing the specific response code and location three times.Please note: Complete information regarding Hospital Safety Policies are located in the Hospital Policy Manuals. Emergency Procedure Information flip charts are also located in each unit.
Code Blue – Indicates assistance is needed for a patient who is pulseless, apneic, unresponsive, or who needs immediate emergency response for a rapidly deteriorating clinical condition. Code Blue response includes: ACLS RN providers from ICU and ER, the ER physician, the on-duty hospitalist, respiratory therapists, unit supervisor, Administrative Shift Coordinator (ASC), laboratory technician, radiology technician, on duty pharmacist, patient nurse, and unit techs. Students are welcome to observe the Code Blue, but this will depend on space available.
Rapid Response Team – Indicates assistance is needed for a patient who is exhibiting early changes in clinical condition. Rapid Response Team response includes: ER and ICU RNs, the hospitalist on duty, respiratory therapists, and the patients nurse. The initial response team will determine if the ER physician is needed. This response team does not require a full Life Support Team Response.
Code Pink – Indicates an infant or child missing or unaccounted for. An immediate head count of all pediatric patients is conducted and all available personnel respond to exits to prevent any persons from leaving until a “Code Pink – All Clear” is announced overhead.
Triage Internal or Triage External – Indicates a disaster is being announced. Disasters can be internal (occurring within the hospital) or external (occurring within the community). The unit supervisor will direct immediate unit responses to the disaster.
Code Red – Indicates that fire alarms or fire alert has been triggered. Summit Healthcare follows the RACE Response: R- Rescue, A- Alarm, C- Contain, E- Extinguish. Each unit supervisor will delegate individuals to respond to the fire alarm location with a fire extinguisher and fire blanket. In addition all patients and family members will be assured, all doors closed, and a patient headcount completed. In the event it is necessary to move patients, they will be moved horizontally to closest area away from the fire and smoke area, beyond the adjacent fire doors. A vertical evacuation is rarely necessary and would occur upon the order of the fire marshal with assistance from responding fire departments.
Code Gray – Indicates that additional personnel are needed for a combative patient/person. All available personnel trained in de-escalation techniques are asked to respond as quickly and safely as possible for the welfare of the patient and fellow employees.
Code Silver – Indicates that a combative patient/person has a weapon. Do not respond to the Code Silver location. Secure access to your area. Stay out of sight, in a locked area, if possible.
Code Yellow – Indicates a bomb threat has been received. Your instructor or unit supervisor will give you directions.
Code Orange – Indicates a hazardous spill. Do not enter the area of the spill.
Trauma Team – Indicates additional assistance is needed for care of trauma patients in the Emergency room. The Unit CNL will designate persons to respond to this alert.
Emergency Elevator Access – In the event of elevator failure with persons trapped in the elevator, the following procedures are implemented: The switchboard operator receiving the call from the elevator notifies the ASC Coordinator and Security staff on duty immediately and will assure the elevator passengers that assistance is on the way. If the patient is experiencing a medical emergency, the switchboard will notify the emergency room supervisor for immediate response.
Summit Healthcare welcomes travelers and seasonal employees! We welcome students and regard precepting students as a privilege. Students will need to contact their clinical instructor for any clinical questions they have. Summit Healthcare staff is also available to assist students in their learning experience. Our goal is to provide you with the best possible clinical experience.
This page is a pre-requisite to taking the Competency Quiz.