Clinical Learning Department

Harris Regional Hospital

Swain County Hospital

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TABLE OF CONTENT

Welcome……………………………………………………………………………………………………………………………4

Instructions…………………………………………………………………………………………………………………………..4

Tobacco-Free Campus…………………………………………………………………………………………………………..4

Accreditation………………………………………………………………………………………………………………………4

Diversity……………………………………………………………………………………………………………………………...5

Workplace Behavior………………………………………………………………………………………………………………5

General Safety……………………………………………………………………………………………………………………..6

Safety………………………………………………………………………………………………………………………6

Lifting and Carrying……………………………………………………………………………………………………..6

Needle Stick, Sharps Injury, Bloodborne Pathogens Prevention……………………………………………….6

Infection Control…………………………………………………………………………………………………………………..7

Standard Precautions………………………………………………………………………………………………….7

Personal Protective Equipment………………………………………………………………………………………7

Hand Washing…………………………………………………………………………………………………………...8

Nails………………………………………………………………………………………………………………………..9

Isolation Procedures………………………………………………………………………………………………………………9

Contact Precautions…………………………………………………………………………………………………...9

Droplet Precautions…………………………………………………………………………………………………….9

Airborne Precautions…………………………………………………………………………………………………..9

Corporate Compliance and Risk Management………………………………………………………………………….10

Code of Conduct……………………………………………………………………………………………………..10

Patient Rights……………………………………………………………………………………………………………10

EMTALA (Emergency Medical Treatment Active Labor Act)……………………………………………………………11

HIPPA (Health Insurance Portability and Accountability Act)…………………………………………………………...11

Ethics………………………………………………………………………………………………………………………………..12

Occurrence Reporting………………………………………………………………………………………………………….12

Advance Directives……………………………………………………………………………………………………………...12

Living Will/Declaration of a Desire for a Natural Death………………………………………………………...12

Healthcare Power of Attorney………………………………………………………………………………………12

Medical Order for Scope of Treatment (MOST)....………………………………………………………………13

Recognizing and Reporting Abuse and Neglect………………………………………………………………………….13

Medical Abbreviations – Do Not Use List…………………………………………………………………………………….14

Pain………………………………………………………………………………………………………………………………….14

Patient Complaints and Grievances…………………………………………………………………………………………14

Complaint……………………………………………………………………………………………………………….14

Grievance……………………………………………………………………………………………………………….15

Your Role in Quality and Patient Safety……………………………………………………………………………………..15

2014 Hospital National Patient Safety Goals……………………………………………………………………………….15

Emergency Codes………………………………………………………………………………………………………………17

Security and Safety Review……………………………………………………………………………………………………18

Personal Protection……………………………………………………………………………………………………18

Property Protection……………………………………………………………………………………………………18

Facility Protection…………………………………………………………………………………………………….. 18

Parking and Traffic Control…………………………………………………………………………………………..18

Information Security……………………………………………………………………………………………………………..18

Computer Access……………………………………………………………………………………………………………….18

Password…………………………………………………………………………………………………………………………..19

Log off the Computer Station…………………………………………………………………………………………………19

Utilities Interruption……………………………………………………………………………………………………………….19

Radiation Safety………………………………………………………………………………………………………………….19

Hazardous Materials – Material Safety Data Sheets (MSDS)…………………………………………………………….20

Lost and Found…………………………………………………………………………………………………………………...20

Corporate Image………………………………………………………………………………………………………………..20

Organizational Guidelines……………………………………………………………………………………………………..20

Identification Badges…………………………………………………………………………………………………20

Grooming……………………………………………………………………………………………………………….20

Tattoos……………………………………………………………………………………………………………………21

Hair………………………………………………………………………………………………………………………..21

Artificial Nails…………………………………………………………………………………………………………....21

Dress and Uniforms…………………………………………………………………………………………………….21

Shoes……………………………………………………………………………………………………………………..21

Jewelry/Make-Up/Fragrances………………………………………………………………………………………21

Attendance…………………………………………………………………………………………………………….21

Cell Phones……………………………………………………………………………………………………………..21

Tablets……………………………………………………………………………………………………………………21

Electrical Safety…………………………………………………………………………………………………………………..21

Policies and Procedures………………………………………………………………………………………………………..22

Medical Waste Disposal………………………………………………………………………………………………………...23

Appendix A: Privacy and Confidentiality Statement…………………………………………………………………….24

Appendix B: Compliance Agreement………………………………………………………………………………………25

Appendix C: Academic Affiliation Clinical Orientation Post – Test……………………………………………………26

Appendix D: Academic Affiliation Clinical Orientation Manual Evaluation Form…………………………………29

Appendix E: Information System Student/Faculty Assess Form (only if charting in the medical record)……...30

WELCOME

Welcome to WestCare Health System comprised of two hospitals: Harris Regional Hospital located in Sylva and MedWest Swain located in Bryson City; and WestCare HomeCare, WestCare Hospice, and the MedWest Physicians Network including many physician office practices. WestCare is committed to providing students with excellent clinical experiential training and sponsors multiple academic affiliation agreements with many in-state and out of state colleges and universities covering a wide variety of specialties. As is our mission, we are dedicated to provide personalized, compassionate, and quality healthcare to our patients and the communities we serve. Additionally, we aim to provide a high level of service for all of our customers. During the time you are guests of the WestCare Health System, you will be treated as one of us, and accordingly you are responsible for the safety and welfare of our patients and visitors. Knowledge of the material covered in this manual is vital to assure that safety.

This orientation manual provides important information that will assist you during your clinical rotation and acquaint you with facility policies and procedures. If you have questions related to any of the information included in this manual, please direct them to your faculty or any staff member who can assist you.

INSTRUCTIONS

In order to facilitate your on-site clinical experience with WestCare you must review this entire orientation manual and complete the required documents prior to your arrival at your designated facility. Please follow the instructions below. This manual and appendices may be printed for your personal use.

Completion of this orientation package is mandatory for all faculty and students participating in clinical site rotations at any WestCare facility. Please review the information carefully; then print, sign and/or complete the following:

  • Appendix A. Confidentiality and Privacy Statement
  • Appendix B. Sign Agreement of Compliance
  • Appendix C. Orientation Competency Exam
  • Appendix D. Online Orientation Manual Evaluation Form
  • Appendix E. Information Systems Student/Faculty Access Form

Present all completed or signed forms to your instructor. Faculty will forward the completed forms to the WestCare Student Liaison prior to the start of the clinical rotation. Failure to complete this orientation and submit required documents may delay the start of the clinical experience.

All students must submit to a complete background check at minimum 4 weeks in advance of the start of the clinical experience. Your instructor can provide you with information on how to complete this requirement. Failure to meet this requirement will result in delayed or denied clinical rotation.

TOBACCO-FREE CAMPUS

WestCare Health System is tobacco-free. Smoking and the use of smokeless tobacco is prohibited anywhere on any campus, including private vehicles while on the premises. Please ask your faculty advisor or a staff member about the facility’s policy if you have any questions.

ACCREDITATION

WestCare facilities are accredited by the Joint Commission on Accreditation of Healthcare Organizations and licensed by the State of North Carolina.

DIVERSITY

Many factors make each of us unique as individuals including appearance; ethnicity and culture; family life; religious, spiritual, philosophical beliefs; income or social status; physical and mental abilities; and life experiences and education.

Prejudices and stereotypes hurt everyone and often contribute to barriers to quality care for patients. When making judgments about an individual without getting to know them, we pre-judge or contribute to prejudicial behaviors. Stereotyping is assuming everyone in a certain group is the same and results in the inability to provide individualized care.

In order to deliver high quality care to our diverse patient population and maintain a respectful and healthy work environment, the following recommendations are offered:

  • Remain open to differences among us
  • Treat each person as they want to be treated – ask their preferences
  • Be respectful
  • Avoid stereotyping
  • Learn and understand each person’s unique views
  • Seek information about the diversity among patients that seek care at WestCare Health System
  • Don't assume anything
  • Don't tell inappropriate or off color jokes

Celebrate diversity! Take pride in your own uniqueness and welcome others as individuals with special qualities. If you fail to respect diversity recognize that mistakes can happen - especially when people are under stress. And always remember service excellence - apologize if you have offended or been guilty of prejudicial behaviors.

WestCare has language line services for non-English speaking patients. Do not interpret for patients or use family members as interpreters. Ask staff in the department where you are assigned how to obtain and use the language line equipment. Nursing Supervisors are also available 24/7 at Harris to assist you.

WORKPLACE BEHAVIOR

WestCare Health System is committed to providing a work environment that respects the rights, dignity and cultural differences of its employees, contractors and agents. Harassment or abuse of any form (i.e. physical, mental, or verbal) is inappropriate and will not be tolerated. Any individual who feels he/she has been harassed or is aware of this type of behavior should report the alleged act immediately to his/her faculty and the supervisor in the department. If you are uncomfortable in reporting this to the supervisor, contact Human Resources.

All allegations of harassment will be investigated promptly, impartially and discreetly. On completion of the investigation, appropriate action will be taken. No individual will suffer retaliation for reporting instances of harassment. Any individual who believes they have suffered from any form of discrimination including sexual, religious, racial, color, nationality, disability, or age please notify your faculty and the supervisor in the department.

All faculty, students and staff are required to maintain professional decorum when serving patients, families, and colleagues. Please ensure you align with WestCare policies and procedures regarding personal interactions and professional attire. Failure to abide by facility policy may result in dismissal from the clinical environment.

GENERAL SAFETY

It is the goal and intent for all faculty, students, and staff to do all that is reasonable to provide a safe and healthy environment for delivery of patient care. To attain and maintain this goal cooperation and commitment at all levels is necessary. Safety is a shared responsibility of all team members of WestCare Health System. Know the hazards that you may encounter on the job.

Safety

  • Maintain a positive safety attitude
  • Practice safe work habits
  • Maintain safe work conditions
  • Know the WestCare facility emergency codes listed in this manual and policy manuals
  • Know your duties and responsibilities during an emergency situation (Your clinical preceptor can inform you of your responsibilities)
  • Follow approved procedures for all job functions
  • Report all accidents/incidents to the appropriate person
  • Obey all safety signs and notices
  • Keep work areas neat and clean
  • When in doubt, ask

Lifting and Carrying

The practice of good body mechanics is required for all. The following recommendations will assist you in utilizing proper techniques when lifting to avoid injury. Remember it takes the same amount of time to use safe lifting techniques as it does poor techniques.

ALWAYS:

  • Think about the load you will be lifting and ask these questions: (1) Can you lift it alone? (2) Do you need mechanical assistance? (3) Is the item too awkward for one person to handle?
  • Keep your feet apart
  • Tuck in your pelvis by tightening your stomach muscles which will help your back stay in balance while you lift
  • Bend your knees instead of your waist. This assists in keeping your center of gravity and uses your strong leg muscles do the lifting
  • Keep your chin up
  • Keep the load as close to your body as possible
  • Avoid twisting - Keep hips, shoulders and torso pointed in the same direction
  • Make multiple trips instead of one heavy one
  • Get assistance if you need it
  • Make sure you have firm footing and a clear path
  • Use same technique to set your load down as you used to pick it up
  • Use a gait belt
  • Push rather than pull

Needle Stick, Sharps Injury, Bloodborne Pathogen Prevention

Sharps are instruments that are capable of breaking the skin such as needles, scalpels, broken glass, guide wires, etc. Every sharp should be treated as if it is a dangerous instrument and capable of transmitting a bloodborne disease. To avoid being injured by a sharp:

  • Handle sharps as little as possible
  • Do not bend or break contaminated sharps
  • Always direct the sharp away from you
  • Be aware of others around you when you are handling sharps
  • Use syringes and needles with safety devices
  • Do not recap needles
  • Dispose of needles in the proper container immediately. Sharps containers should be changed when they are ¾ full
  • Be alert for sharps that may have been discarded in the trash, linen hamper or lying around on the floor, bed or bedside table
  • Do not reach inside a waste container or push trash down with your foot or hand
  • Handle all linen and trash bags with caution
  • Dispose of infectious waste in an appropriate manner
  • Environmental surfaces and patient care items are cleaned and disinfected with the hospital approved germicide after all patient contact, following the manufacturer’s directions.

Blood and body fluid spills are cleaned immediately with the approved germicide. Spill cleanup is the responsibility of everyone.

  • Linen and trash is placed in appropriate leak-proof bags and are tied in such a manner as to prevent spilling of contents. Bags should not be overfilled. Linen is checked for patient care items prior to placing in a laundry bag.
  • Communicable diseases or suspicion of communicable diseases reportable to the Health Department and any infectious processes are to be reported to the Infection Control department, and appropriate control measures implemented. Specific situations that require notification include:
  • Any physician-diagnosed or suspected infection at the time of admission (e.g. hepatitis, meningitis, tuberculosis, encephalitis)
  • Any infection that develops after admission (e.g. pneumonia, UTI, surgical site, sepsis, IV site infections)
  • Positive cultures for MRSA, VRE, VRSA, or other multi-drug resistant pathogens.

INFECTION CONTROL

Bloodborne pathogens are small organisms that maybe present in human blood and can cause disease. Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV) are two examples of bloodborne diseases that occur frequently when infected blood/ body fluids or infected tissue enter your blood stream. Your exposure while in the workplace is prevented through the use of Standard Precautions, wearing of personal protective equipment (PPE), engineering controls and following policy and procedures. Leave all isolation precaution signage in place when patient is discharged and notify environmental services of contaminating organism for appropriate cleaning.

Standard Precautions

Standard precautions are work practices that assist in preventing contact with patient blood and other body fluids. Standard Precautions assumes that certain areas of the body are colonized with disease – causing microorganisms that, if transmitted to others, could cause disease. The intent of standard precautions is to prevent the healthcare worker and all patients/visitors from any germ- causing diseases.

Personal Protective Equipment Standard

Precautions require the use of protective barriers, called Personal Protective Equipment, to prevent contact with infectious agents that may be present in blood and body fluids. PPE are your best protection against bloodborne pathogens and should be used whenever you anticipate contact with blood or other infectious agents.

PPE includes the use of gloves worn as a protective barrier. The wearing of gloves does not replace hand washing. Gloves may contain small imperceptible defects, may be torn during use, or hands can become contaminated when being removed. Gloves must be changed between patient contacts and hand hygiene must be performed after gloves are removed.

Face and eye protection include various types of masks, goggles, and face shields. These can be worn in combination and are designed to provide a protective barrier for mucous membranes that must be covered during procedures that are likely to produce splashes, sprays of blood, body fluids, secretions or excretions.

Gowns and protective apparel are worn to provide a protective barrier to prevent contamination of clothing and to protect the skin from contact with blood or body fluid exposure. Protective clothing—including gowns, shoe covers, boots, and leg covers—should be utilized when splashes or large quantities of infective materials are present or anticipated.

You must use the appropriate PPE for each task and each time you perform the task. All PPE is changed between patients, when grossly contaminated, after each patient contact and prior to leaving the work area. Do not reuse PPE and ensure that all PPE is disposed of in the appropriate container. PPE will be provided to protect against contact with blood and potentially infectious materials. It is your responsibility to ask for, correctly use, and dispose of PPE.

Any exposure must be reported immediately to your faculty or supervisor for occurrence reporting and treatment.

Hand Washing

Bacteria can be transmitted by hospital personnel from patients with infections to other patients. Hand washing is the single most important and effective way to prevent the spread of infection in healthcare facilities. The spread of hospital-acquired or nosocomial infections can be prevented by all care providers and personnel washing their hands:

  • prior to coming to work
  • before and after contact with each patient, the patient’s environment and items that have come in contact with the patient
  • when moving from a contaminated site to a non-contaminated site when providing care
  • when hands are visibly dirty
  • after removing gloves
  • after going to the bathroom
  • before and after eating
  • after covering your mouth or nose when you sneeze
  • before leaving work

Two recommended methods for cleaning hands:

  • Soap and water: Use vigorous motion and friction for minimum of 15 seconds making sure you cover all parts of your hands. Rinse under running water and dry thoroughly with paper towel. Turn off the faucet with a paper towel.
  • Waterless Agent/Hand Sanitizers (alcohol based): Apply product to palm of one hand. Rub hands together covering all parts of the hands. Rub until hands are dry or minimum of 15 seconds. Recommend use with no visible contamination (example: after covering of nose or mouth post sneezing).

Provide visitors education and information on appropriate hand hygiene while visiting.

Nails

No artificial nails or extenders are worn when working in a patient care area or when having direct patient contact. Nail polish must be intact, no chips or cracks.

ISOLATION PROCEDURES

There are three major categories of precautions: 1) contact precautions, 2) droplet precautions, and 3) airborne precautions.

Contact Precautions:

Contact precautions are required for patients known or suspected to have serious illnesses easily transmitted by direct patient contact or by contact with items in the patient environment. Examples include gastrointestinal, respiratory, skin or wound infections, or colonization of multi-resistance to antimicrobial drugs, including MRSA (Methicillin resistant staphylococcus aureus), ESBL (Extended-spectrum beta-lactamase), and PRSP (Penicillin- resistant streptococcus pneumonia). Healthcare workers could become infected or carriers and spread the infection to other healthcare workers or patients/visitors. Immediate response to bloodborne exposure: