Alliance Community Hospital
This packet is to be completed by college students who wish to observe at ACH for eight (8) hours or less.
Students should review and return entire packet to appropriate Program Coordinator; pages 2, 4, 6, and 8 should be signed prior to contacting Program Coordinator. Upon approval and department assignment, the remaining pages will be completed.
Students must thoroughly read this packet, sign all forms appropriately, and return to Program Coordinator.
Nursing Students:
Karen Campf- or Fax to (330) 596-7148 Attn: Karen
Pharmacy Students:
Nichole Thorne- or Fax to (330) 596-7042 Attn: Nichole
Physician/Therapy/Nurse Practitioner Students:
Connie Jones- or Fax to (330) 596-7079 Attn: Connie
All Other Students:
Amber Saviers: or Fax to (330) 596-7117 Attn: Amber
Alliance Community Hospital
STUDENT OBSERVATION CHECKLIST
Name of Student: ______
Student’s Contact Information:
Phone:
Email Address:
Name of College:
Program Name:
Program Advisor Contact Information:
______
Area(s) of Interest: ______
Emergency Contact Name: Phone #
Relationship: ______
Checklist
Signed HIPAA/Confidentiality Form
Signed Emergency Codes and HFAP Safety Form
Signed Observation Guidelines Form
ALLIANCE COMMUNITY HOSPITAL
PROGRAM COORDINATOR CHECKLIST
ACH Physician/Department Student will be Observing:
Mentor for Observation Student: ______
Date(s) that Student will be Observing: ______
Checklist
Received Above Signed Forms
Received Emergency Code Overview
Assigned Student Badge ______
Alliance Community Hospital
observation guidelines
Return to Program Coordinator
Requirements to Participate:
1. Must be enrolled as a college student
2. Observation only – no hands on involvement in any manner (patient, medical or office equipment, or the like)
3. Eight hours or less
About Alliance Community Hospital
ACH has adopted the Planetree philosophy of care, meaning we provide holistic, patient-centered care.
To provide our patients with a safe, comforting, healing environment through using the best people, providing the best service.
Student Guidelines:
1. You are not permitted to smoke on any ACH property as we are a non-smoking campus, including the outside grounds.
2. You are not permitted to use your cell phone or any electronic device, it must remain turned off or left in your vehicle.
3. You are assigned to parking lot #8. This is located on the north side of Rice Street, between the University of Mount Union and the old Hospital.
As an Observer:
1. You are required to remain with your mentor at all times while in the assigned department or on the assigned unit.
2. You will be provided with an ACH identification badge, which is to be worn at all times above the waist.
3. You must wear appropriate business attire, which means no jeans, shorts, spandex, or leggings etc. You must wear closed-toed shoes.
4. If you have any questions or concerns, contact your Program Coordinator: Amber Saviers in Colleague Relations at (330)596-7115, Connie Jones in Administration at (330)596-7014, Nichole Thorne in Pharmacy at (330)596-7040 or Karen Campf in Educational Services at (330)596-7141
Student Signature: _____ Date-Time: ______
Mentor’s Signature: _____ Date-Time: ______
Alliance Community Hospital
CONFIDENTIALITY OF PATIENT HEALTH INFORMATION
In a healthcare facility, Confidentiality is not a choice of life; it is a way of life essential to the best in patient care. Each colleague, volunteer, and student is responsible for upholding the code of ethics for this facility which includes:
“All information gathered regarding a patient, the patient’s personal life, and the care rendered to the patient, must be treated confidentially.” Each colleague, volunteer, and student has both a moral and legal obligation to guard against inappropriate release of confidential information.
Patients and their families must have assurance that their medical information as well as their personal quirks will not be passed on to others unless the patient specifically requests that the information may be released. The permission to release confidential information MUST be in writing.
“THINK BEFORE YOU SPEAK.” Colleagues, volunteers, and students must be aware of where, to whom, and what about they are speaking. Carelessness can lead to a breach of patient’s privacy. There is never a right way to say a wrong thing.”
Colleagues, volunteers, and students must guard against inappropriate viewing of a medical record. Not all colleagues are engaging in treatment of the patient and therefore, must have a bona fide reason to view the medical record. Viewing of medical record charts must be coordinated through Medical Records Services.
“WHEN IN DOUBT, DON’T GIVE IT OUT.” It is always better to not release information when there is a doubt. Colleagues, volunteers, and students are better protected by refusing to give information than they are if they breech confidentiality.
I understand the importance of and agree that in the performance of my duties as a colleague/volunteer/ student of Alliance Community Hospital, I must hold patient information in confidence. I also understand that my intentional or involuntary failure to maintain the confidentiality for this information and/or the security of the hospital’s medical records may result in my immediate dismissal from employment or the expulsion from the clinical program/observation experience by Alliance Community Hospital. I further understand that breach of confidentiality may result in possible legal action as may be imposed by State and Federal legislation which action might include possible fine or imprisonment.
Name of Student: ______
Signature of Student: ______Date: ______
Program Coordinator Initials: ______Date: ______
Alliance Community Hospital
Emergency management codes
Alliance Community Hospital is concerned for the safety of our patients, visitors, employees and staff. To protect them while they are in our facility we have established twelve Emergency Management Codes. These codes spell out exactly our responsibilities for each code situation.
The Twelve Codes:
1. CODE RED- This alert is explained on a page entitled HFAP Fire Safety Information.
2. CODE GRAY- This alert is our severe weather (tornado/thunderstorm). There are 3 phases of a code gray. Phase 1: Close drapes and blinds in rooms, remove items from window sills. Phase 2: Get blankets and sheets ready. Phase 3: Cover patients with sheets and blankets. Refer to emergency management manual.
3. CODE YELLOW- This alert is for a DISASTER, internal or external. We have four conditions for a yellow alert. Phase I: be aware of something in our area that may affect us. Go on with normal duties. Phase II: the hospital will receive 1-20 patients. Phase III:the hospital will receive 21-40 patients. Phase IV:the hospital will receive over 40 patients. Major treatment area is set up in the Emergency Department, Minor treatment area is set up in the Cafeteria.
4. CODE GREEN- This alert is for EVACUATION. We have two codes for evacuation. Partial evacuation and Hospital-Wide evacuation. Partial means we are going to evacuate a certain area, like Rehab or ICU. Hospital-Wide means we are going to evacuate everyone from the hospital.
5. CODE BLACK- This alert is for a BOMB THREAT. For a bomb threat the hospital may have to activate any of the other alerts.
6. CODE BLUE- This alert is for an ADULT EMERGENCY . The code blue team will respond.
7. CODE ADAM- This is to provide a mechanism to alert hospital personnel
of an abduction of a child or infant. To prevent the abductor from leaving the premises. and to assist in the recovery of the infant or child. Look and Listen for anything out of the ordinary and report it to security.
8. CODE VIOLET- This is to assist Security defuse a violent/combative patient or visitor in a non-violent
manner by a show of force. Day Shift: Protective Services, Engineering, Materials Management should respond. Afternoon and Midnight Shift: Engineering, Materials Management, Nursing, Environmental Services, Transport, Cardiopulmonary, Pharmacy, Imaging should respond. Refer to Emergency Management Manual.
9. CODE SILVER- This is for an Armed Assailant – If someone would enter the hospital with a weapon anyone can call a Code Silver and this will alert everyone to stay out of the area. Physicians should stay out of area and inform others to do the same.
10. CODE BROWN – This is for a Wandering or Missing Patient or Resident.
This is called if a patient or resident has left their room without permission and can’t
be found. All staff and security start looking for the patient or resident.
11. CODE ORANGE – This is for a large or small chemical or hazmat spill.
This is called if someone finds a chemical or hazardous waste spill.
12. CODE PINK – This is for a Pediatric Emergency
This is the same as a CODE BLUE for an Adult Emergency
Codes Designed Specifically for our Hospital:
Code Periwinkle: Stat C-Section - This code is limited to that time of day when operating room staff is not in house. The PBX operator will page OR Staff, On Call Anesthesiologist, Neonatology, OB/GYN who will all then report directly to the Obstetrical Unit.
Rapid Response: The idea behind a RRT is to assist with the prevention of codes and negative outcomes when concern over any patient’s change in status occurs. The RRT team works with nursing staff and attending physician to determine treatment before patient’s condition deteriorates into a “CODE” situation.
A Rapid Response accomplishes a reduction of Code Blues!
A Rapid Response CAN be called by Staff, Patient, Family or Visitor by Dialing 5555
Student Name: ______Date: ______
Student Signature: ______
Program Coordinator Initials: ______Date: ______
Alliance Community Hospital
HFAP - FIRE SAFETY INFORMATION
Introduction
This fire safety module contains information which is designed to provide you, a student in the Observation program at Alliance Community Hospital, with the basic knowledge
of fire safety procedures and defines your role in our safety program.
OBJECTIVES: Upon completing this fire safety module, you should be able to:
1. Explain or demonstrate the actions (R.A.C.E.) needed to be taken if you discover a fire or are present at the time of a fire drill.
2. Explain or demonstrate the actions (Alert, Confine) needed to be taken when you are remote to an announced fire or fire drill.
3. Define the three types of fires (A,B,C).
4. Select the proper fire extinguisher for the type of fire discovered.
Fire Safety
Fire prevention is our first line of defense at Alliance Community Hospital: Our first goal is to prevent fires and our second goal is to know how to react if a fire does occur. The basic steps for fire prevention are as follows:
· Observe ACH smoking rules. We are a non-smoking facility. Since over half of all hospital fires are caused by careless smoking, observing this rule and reminding others will reduce our fire potential dramatically. As a physician, your assistance is needed in reminding your patients that we are a non-smoking facility.
· Know the location of fire extinguishers and fire alarm pull stations in the areas you visit and work. Identify the location of the fire exits.
IN CASE OF FIRE: When a fire starts, it is difficult to remember what to do. We use the four letter acronym R.A.C.E. to describer the actions you are expected to perform if you discover a fire. The acronym stands for Rescue, Alert, Confine and Extinguish.
RESCUE: If you discover a fire, you should attempt to RESCUE any persons that may be in the immediate vicinity of the fire. Be sure to ALERT nearby staff before attempting a RESCUE so that assistance is on the way.
ALERT: There are two actions you must take to properly perform the ALERT task. You must activate the nearest fire pull station, and you must ALERT the staff of the area where you are working. DO NOT use the word “fire”. Use the CODE RED to avoid causing panic between patients and visitors. The staff is responsible for calling 5555 and notifying the operator of the CODE RED.
CONFINE: Smoke and fire generated gases cause the vast majority of facility fires. To minimize the spreading of smoke and fire gases it is imperative that all doors to patients rooms and hallway smoke doors are closed. This will CONFINE the smoke and fire to the area involved and slow the spread of the fire. Never reopen the door to the fire room. The in-rush of oxygen could cause explosive growth of the fire.
EXTINGUISH: If the fire is small, you should obtain a fire extinguisher appropriate to the type of fire and attempt to EXTINGUISH the fire. Normally the Fire Response Team will arrive before you get to this point and will handle the extinguishing of the fire.
If you are located near the actual fire scene ( next to, above or below ) you should remain ALERT to the announcement CODE RED, and make sure all doors are closed to CONFINE any smoke spread from the fire scene.
FIRE EXTINGUISHERS
There are three types of fires. A type A fire is one that contains wood, paper or fabric. In the healthcare setting, trash can is a type A fire. A type B fire is burning liquid similar to a grease fire. A type C fire is any fire involving electricity.
Alliance Community Hospital uses ABC fire extinguisher in all patient care areas of the hospital. These extinguishers will work on all typed of fires.
The ABC extinguisher uses a fine powder to smother the fire. Avoid breathing the dust from the powder. The extinguisher will create a loud noise as it expels it’s content. The extinguisher will not last long approximately 15-20 seconds.
To properly and safely use a fire extinguisher to put out a fire:
Remember another acronym P.A.S.S.
P. Pull the pin
A. Aim at the base of the fire
S. Squeeze the handle
S. Sweep side to side
Student Name: ______Date: ______
Student Signature: ______
Program Coordinator Initials: ______Date: ______
Alliance Community Hospital
emergency management overview
Student Name: ______Mentor Name: ______
Department Observing In: ______
Mentor is to Review with Observation Student
Return to Program Coordinator
______Code Red: Fire
______Code Gray: Severe Weather/Tornado
______Code Yellow: Disaster – Internal/External
______Code Green: Evacuation
______Code Black: Bomb Threat
______Code Adam: Infant/Child Abduction