MRCH Student Orientation Documents and Forms
· Please review and sign as indicated all documents contained in the Student Orientation Forms link (approx. 20 pages). All signed forms should be filed in your school’s files.
· On the first day of your in-person orientation in MRCH staff development, please print and bring with you three items from the Student Orientation Forms link: “Check-off Attestation Sheet” completed and signed by you and your instructor (immediately below), “Day One Checklist,” and “Tour/Scavenger Hunt.” Please also bring your “Student Online Orientation Post-test” that is taken after you review the online student orientation power point.
· You will hand in the “Check-off Attestation Sheet” to MRCH staff development. We will discuss the “Student Online Orientation Post-test” during your MRCH in-person orientation. “Day One Checklist” and “Tour/Scavenger Hunt” will be completed during orientation to your hospital unit, unless informed otherwise.
********************************************************************
I have reviewed and understood the content of the documents and forms listed immediately below. I will comply with these standards of MRCH.
Name: ______College: ______
This student has reviewed the materials listed below and signed items as indicated. These are kept in the school’s files.
Name of Form / Student Initials (indicating you have read the specific material) / Date(of review of the
particular material)
Day One Checklist - Print and bring to in-person orientation / n/a / n/a
Tour/Scavenger Hunt- Print and bring to MRCH in-person orientation / n/a / n/a
Restraints
HIPAA/Confidentiality Statement & Agreement (3 documents)
Patient Rights & Responsibilities/ Visitation Policy
Abuse Reporting
Age Specific Competencies
SBAR Communication
Organ Donation Overview
Date: ______Instructor signature: ______
DAY ONE CHECKLIST
Students complete sections of this checklist relevant to their student placements
Purpose: The Day One Checklist describes the general employment and work safety information to be discussed on or before your first day of work in your department.
Directions: Please check the column when you have been oriented to that topic by your instructor, department manager/director, or preceptor.
This must be completed and returned to manager of first day of work.
Department Overview / Department Safety Procedures1. Job Description & performance standards reviewed / 8. Hazardous substance program discussed to include:
o Hazardous substances in the department
o Location of MSDS sheets
o Disposal & spill procedure (Code Orange)
2. Department/unit scope of service/care described. / 9. Utility failure: Action to take if the following fail:
o Water system
o Phone system
o Medical gas
o Electric power
3. Policies related to employment discussed:
o Work hours
o Lunch/break time
o Overtime policy
o Timecard Completion-edit/transmittal book
o Schedule Requests
o Sick call
o Dress code
o Personal phone calls
o Reporting concerns
o Fair treatment policy
o Confidentiality
o Harassment / 10. Emergency codes discussed to include how to enact & role in each:
o Code Blue ○ Code Red
o Code Yellow ○ Code Gray
o Code Purple ○ Code Silver
o Code Pink ○ Code Orange
o Dr. Strong ○ Code Security
o Code Orange ○ Triage Internal
o Triage External ○Code Security
o Code Shelter-in-Place
o Rapid Response Team
4. Introduced to work associates & volunteer staff. / 11. Hospital/individual security measures described:
o Wearing name tags, securing belongings
5. Phone System discussed/demonstrated:
o Hold
o Transfer
o Paging
o Courtesy / 12. Infection control information provided:
o Location of protective equipment
o Department specific measures
o Waste disposal procedures
o Clarify nasal swab policy
6. Electrical Safety Discussed:
o Location/purpose of emergency outlets
o Reporting malfunctioning equipment / 13. Sharps Safety Devices
7. Fire Safety information Provided / 14. Department Specific
Verification of Day One Checklist: I have received and understand the above information.
Employee/Student Name Date
Department Manager/Director, Preceptor, or Instructor Date
THIS PAGE LEFT BLANK!
PLEASE SEE FORMS AND OTHER ITEMS BELOW.
Tour / Scavenger Hunt
Please check the boxes when you have located the following, some of which is covered during student orientations:
Physical Layout: Kitchenette :□ Spoons
□ Crackers
□ Ice / Water Machine
□ Fridge
Mini Central :
□ Foley Cath
□ Dressing Supplies
□ Hygiene Supplies
□ Restraints
□ Index / Rolodex of Supplies / Supply Location:
□ Manual B/P Cuffs
□ Linen
□ Thermometers
□ IV Fluids
□ IV antibiotics
□ Med Fridge
□ Pharmacy / IN Box
□ Pharmacy / OUT Box
□ IV Start supplies
□ Alcohol Swabs
□ Narcotics Draws
□ Isolation Carts
□ Wheel Chairs
Patient Room Orientation (if applicable)
□ Bed Controls
□ Call Light
□ TV
□ White Erase Board
□ Suction
□ Oxygen – air dispensers (green/yellow trees)
□ Bathroom
□ Patient Closet / Resource Materials:
□ Infection Control Manual
□ Human Resource manual
□ Hospital –Wide ORG Manual
□ Environment of Care (EOC) Manual
□ Employee Health Manual
□ Department – Specific Manual
□ IV Drug Books
□ Patient Ed Documents/Krames-on-Demand
Department Safety Features:
□ Location of emergency power outlets
· Fire Alarms, Extinguishers, Fire Doors, Exits, Flashlights
· Crash Cart, Ambu Bags
□ MSDS Sheets
· Personal protective equipment
· Medical gas shut off valve location / Documentation:
□ Bedside charts, Virtual charts
□ 24-Hour MAR
□ Graphic I & O
□ Assessment flowcharts
□ Care Plans
□ H&P
□ Labs
□ Physician Orders
□ Medication Reconciliation
Equipment Location:
□ Supply Rooms (other than mini central)
□ Dirty Linen
□ Red Bagged Waste
□ Dirty Equipment
□ Dirty Dishes
□ Room 131
□ Standing Scales, O2 Tanks and Foot Cradles
□ Central Sterile Supply
□ Purchasing Department / Telephones / Fax / Copies:
□ Patient Rooms
□ Nurses Station
“Restraint of Patients” policy in Nursing Administration manual
on MRCH Intranet (accessed August 2017) (excerpts with slight edits)
When to use: Patients in this facility have the right to be free from restraint and seclusion. When necessary, restraints are an intervention for the protection of the staff, patient, or others from harm. . . . The restraint must be the least restrictive intervention effective for the protection of the patient or staff from harm. [Restraints can be physical or chemical.]
Who may apply: Staff RN/LVN’s specifically trained to apply and monitor a patient in restraints in accordance with hospital policy, may restrain a patient in the event of behavior that directly threatens safety of staff or the patient.
Required orders: If restraints are to be continued after immediate safety has been secured, a physician/ licensed independent practitioner (LIP) order must be obtained at that time, and a plan of care established. . . . Restraint orders are never a “standing” or an “as needed” basis. . . . When the order is not written by the attending physician, the physician must be consulted as soon as possible. . . . Orders for restraint[s] that apply only for the physical safety of a patient must be renewed every 24 hrs.
Documentation must include the:
· Patient condition or symptom that warrants restraint use,
· Patient behavior and type of restraint used,
· Alternative or other less restrictive methods used,
· Patient response to the intervention and the rationale for continued use.
Patient safety monitoring is documented every two hours.
[The restraint documentation form helps you follow the appropriate process. Please see forms on unit/in CPSI. It also may be shown during student orientation.]
Other items, pertaining to physical restraints:
Never tie restraint to a movable object or movable part of bed.
Pad bony prominences as needed.
Maintain good body alignment.
Ensure the restraints are not too tight (e.g., two fingers b/n restraint and skin).
If tying, use a knot that easily can be released (and test to make sure knot will both hold well enough and release).
I have read and understood the above:
Signature of Student:______Date:______
HIPAA
Definition: Health Information Portability and Accountability Act
Background: Passed in 1996 as the Kennedy-Kassebaum Health Care Reform Act, HIPAA requires the health care industry to:
· Use a standard format when sharing data electronically;
· Protect the patient’s privacy.
PHI – Protected Health Information: The privacy rule defines PHI as individually identifiable health information in any form (electronic, paper, verbal, etc). PHI cannot be shared without authorization from the patient, except for TPO access (see below).
TPO – Treatment, Payment, or Health Care Operations: One of the few times that PHI can be shared without authorization from the patient would be if it were for TPO.
Minimum Necessary Disclosure: When PHI is released for TPO, only the absolute minimum necessary information is disclosed to accomplish the task at hand (e.g., to help treatment move forward, assure payment, or assist with performance improvement programs).
How HIPAA Laws Affect You:
Ø Never share our passwords, and log off of programs immediately when it contains PHI.
Ø If visitors request information about a patient, refer them to the charge nurse.
Ø Always put waste paper with patient identifiable information in the shredding box.
Ø Do not take scrap paper/notebook paper home that has patient identifiable information on it.
Ø Do not leave charts on the counter where the patient’s name can be viewed by visitors.
Ø Never talk about patients or their health condition in the lunch room or other public areas, including hallways.
M ad River
Community
·Hospital
*Confidentiality Statement and Agreement*
I agree to accept the responsibility and obligation to follow all Mad River Community Hospital's policies and procedures. I acknowledge that in the course of my clinical experience with MRCH, I may have access to confidential, sensitive, or proprietary information relating to the business of MRCH and to patient identifiable health information. I acknowledge that unauthorized use or disclosure of such information is prohibited and could cause MRCH to sustain significant and irreparable damage.
Accordingly, I understand and agree to the following:
1. I will not in any way divulge, copy, release, sell, loan, revise, alter, or destroy any confidential information except as properly authorized within the scope of my clinical experience with MRCH.
2. I will use and safeguard confidential information as necessary and in a manner that is appropriate to perform my legitimate duties.
3. I will not misuse, misappropriate, or disclose any such information directly or indirectly, to any person during my clinical periods, nor at any time thereafter, except as required in the course of my clinical experience or as required by law.
4. I will utilize appropriate safeguards and destruction methods including utilizing shred boxes, shredders, and logging off of workstations, when I leave the immediate area.
5. I will not share my password(s) or user code(s) with any other person, and I will change my password when automatically prompted. Further, I will not use any other person's password or user code.
6. I understand that the confidentiality of all patient information is required by law including information such as that pertaining to mental health, infectious diseases such as HIV, and chemical dependency such as drug and alcohol abuse.
7. I will only access information for which I have a "need to know" in the scope of my duties, and I understand that my access to electronic patient information (as applicable) will be routinely audited to ensure that I am accessing only the patient information to which I am authorized.
8. I may be subject to disciplinary action should I violate MRCH policies and procedures and compliance agreement.
9. I am responsible for immediately reporting any known or suspected violation of compliance and/or MRCH policies and procedures.
Name (print):______
Date: ______
Signature: ______
ACKNOWLEDGEMENT OF CONFIDENTIALITY OF HOSPITAL RECORDS AND DOCUMENT /
PROPERTY REMOVAL POLICIES
Caring for patients is confidential in nature and all information pertaining to patients is considered privileged. I understand that I may not provide information about, or in any way discuss patients including their illnesses, treatment or physicians- with anyone except those persons who are entitled to receive such information in order to provide patient care. Any violation of this policy will lead to disciplinary action.
I also understand that I may not remove property, documents or other materials belonging to the Hospital from the premises. If I believe it is necessary to remove such property belonging to the Hospital, I understand I must first obtain approval from Administration. I understand that the Hospital’s supervisors and the Administration are authorized to inspect packages and other items in the possession of any employee entering or leaving the Hospital.
Furthermore, I understand that all information relating to the business operation of the Hospital is to be held in the strictest confidence. This includes, but is not limited to, financial matters and business associates.
Name______Date______
Signature______
Patient Rights and Responsibilities
Mad River Community Hospital supports and protects the basic human, civil, constitutional and statutory rights of each patient. Patient rights incorporates the requirements of the Healthcare Facilities Accreditation Program; Title 22, California Code of Regulations, Section 70707 and 74743 and Medicare Conditions of Participation.
As a patient you have the right to:
1. Considerate and respectful care, and to be made comfortable. You have the right to respect for your cultural, psychosocial, spiritual and personal values, beliefs and preferences. Title XXII 70707(b)(2)
2. Have a family member (or other representative of your choosing) and your own physician notified promptly of your admission to the hospital. Code 482.13(b)(4) HFAP 15.01.09(D)