Mandatory Education and Training MEAT

1
Mandatory Education and TrainingMEAT

• 2009

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Tuberculosis (TB)

• TB is caused by a tiny germ (mycobacterium
  tuberculosis) that is spread through the air when
  people with active disease cough, sneeze, sing or
  laugh. Nearby people may inhale these germs and
  become infected. Clothing, bedding or other
  personal items that a person may touch do not
  spread TB. Common symptoms of TB are
• Cough that last for more than 3 weeks
• Coughing up blood
• Fever
• Night sweats
• Unexplained weight loss
• Chest x-ray showing evidence of TB in lungs.

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Question 1

• TB is spread through the air when someone with
  active TB disease coughs, sneezes, sings or
  laughs.
• A. True
• B. False

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TB Airborne Precautions

• When an inpatient is suspected of having TB
• They are placed in Airborne Precautions in a
  negative pressure isolation room with the door
  kept closed.
• Air in room is exhausted to outside and not mixed
  with air in the hospital.
• In ambulatory care settings, patients should be
  isolated from other patients.
• All patients should be instructed to cover their
  mouth with a tissue when they cough or sneeze.
• Patients should not leave their room unless it is
  medically necessary and if this is the case, they
  must wear a surgical mask.
• Staff must put on a N95 respirator (formally
  called HEPA respirator) before entering a TB
  isolation room.
• You should be fit tested yearly for N95
  respirator to insure proper fit.

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Question 2

• When a patient is suspected of having TB, they
  should be instructed to covering their nose and
  mouth when sneezing or coughing.
• A. True
• B. False

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Question 3

• You need to wear a N95 respirator when caring for
  a patient in Airborne Precautions.
• A. True
• B. False

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Question 4

• You need to be fit tested every year to wear a
  N95 respirators.
• A. True
• B. False

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Question 5

• Patients should wear a surgical mask if they need
  to go outside of the negative pressure room.
• A. True
• B. False

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TB Someone is Diagnosed

• Patients diagnosed with TB are treated with
  several medications.
• After taking TB medications for about 2 weeks,
  patients are not considered not to be infectious.
• 3 Daily Acid Fast Bacilli (AFB) smears should be
  ordered.
• Airborne precautions can be discontinued after
  all the ABF smears are negative.
• The patient must take TB medications for at least
  6 months to totally clear the disease.
• If patients dont take their medication as
  prescribed, the TB germ may become resistant.
• TB patients are monitored by Public health to
  ensure they take their medications properly.

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TB Skin Test

• The Centers for Disease Control and Prevention
  (CDC) recommends that we have a yearly TB skin
  test (PPD) if we have patient contact.
• If PPD test is positive, employee is infected
  with TB germ.
• If no symptoms are present, the body was able to
  stop the bacteria from growing and that is called
  latent TB. Persons with latent TB cannot spread
  TB.
• If you have a positive TB skin test, you will be
  asked if you have any signs and symptoms of TB.
• People who have latent TB can take TB medications
  to prevent developing TB disease.

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Corporate Compliance

• Bay Regional Medical Center (BRMC) and local
  affiliates are committed to conducting business
  in an ethical and legal manner through the
  development of a compliance program. Education
  and training are key elements of this plan. The
  Board of Directors is committed to ensuring that
  all employees, volunteers, physicians,
  contractors and vendors (workforce members)
  associated with BRMC understand the rules that
  govern our actions and the conduct of business.
  General compliance education and training is
  conducted at new employee orientation and at
  least annually thereafter. Periodic compliance
  education will be offered to workforce members.
  Each employee must annually receive between 1-3
  hours of compliance training as outlined in his
  or her Department Compliance Plan. Attending the
  Annual MEAT Training, is part of this annual
  training requirement. Department meetings, and/or
  continuing education sessions fulfill the balance
  of the annual training requirements. Specialized
  compliance training will be provided to
  departments/individuals that work in identified
  risk areas, e.g., coding, billing, laboratory and
  finance. New employees will receive compliance
  and HIPAA training as part of their general
  orientation

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Question 6

• All employees are required to receive between 1-3
  hours of compliance training each year.
• a. True
• b. False

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Question 7

• Specialized training is provided employees in
  high risk areas such as
• a. Coding
• b. Billing
• c. Finance
• d. All of the above

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Corporate Compliance

• Department directors are responsible for ensuring
  that all employees in their department/area
  receive the required annual amount of training. A
  report is submitted annually to the Compliance
  Officer on the percent of compliance with
  orientation, annual and specialized training
  programs.
• All employees have an obligation to actively
  participate in annual compliance training by
• Attending staff meetings
• Reading compliance information distributed by
  your department representative
• Recognizing potential compliance problems in the
  course of your daily activity
• Reporting suspected violations
• Asking questions

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Question 8

• Who is responsible for ensuring all department
  employees receive the required amount of
  training?
• a. Department Director
• b. Compliance Representative
• c. Department Supervisor
• d. Compliance Officer

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Question 9

• How can employees actively participate in their
  compliance training?
• a. Attend staff meetings
• b. Read information distributed by the
  department compliance representative
• c. Recognize potential compliance problems
• d. All of the above

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Corporate Compliance

• All employees have an obligation to report
  suspected violations. Any employee can report a
  suspected compliance violation by
• Contacting your director or supervisor
• Contacting your department compliance
  representative
• Contacting the compliance officer
• Calling the Compliance Hotline [phone])
• Reporting is confidential. Under no circumstances
  will any person, who in good faith reports a
  possible violation, be subject to any form of
  reprisal.
• Mike Jamrog is BRMCs Corporate Compliance
  Officer and Privacy Officer.

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Question 10

• You can be subject to reprisals if you report
  possible compliance violations.
• a. True
• b. False

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Hazard Communication

• Hazardous chemicals are located in many areas of
  our facilities. As a health care employee, it is
  important that you understand your
  responsibilities when working with hazardous
  chemicals. By doing so, you are protecting our
  patients, yourself, and your fellow employees
  from potential injury.

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MiOSHAs Hazard Communication Program

• Often referred to as Right to Know designed to
  protect employees from exposure to hazardous
  chemicals in the workplace.
• There are 5 main components to the hazard
  communication program
• - employee education
• - container labeling
• - material safety data sheets (MSDS)
• - inventory list
• - personal protective equipment (PPE).

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Question 11

• The MSDS acronym stands for
• A. Master Safety Data Sheet
• B. Material Safety Data Sheet

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Question 12

• MiOSHAs hazard communication program is often
  referred to as Right to Know.
• A. True
• B. False

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Question 13

• There are 5 components to hazard communication
  programs employee education, container
  labeling, material safety data sheets, inventory
  list and person protective equipment.
• A. True
• B. False

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Material Safety Data Sheets (MSDS)

• Contain pertinent information on hazardous
  substance such as the chemical name, hazardous
  ingredients, precautions for safe use, required
  safety equipment for use, first aide procedures,
  and spill and disposal procedures.
• Where applicable, MSDSs are located in every
  department.
• A master MSDS book is kept in Risk Management
  (BRMC East, BRMC West and Bay Special Care
  Hospital).
• MSDSs specific to your area are kept in your
  department MSDS book and are available 24 hours a
  day/7 days a week.

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Question 14

• MSDSs are available 24 hours a day/7 days a week
  in your department.
• A. True
• B. False

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Emergency Preparedness

• External Disaster Its one or more events that
  occur outside of the hospital and result in a
  large number of casualties coming to the
  Emergency Department. Examples include fire,
  explosion, tornado, transportation accident,
  civil disorders or chemical spills.
• Internal Disaster Its one or more event within
  the hospital that severely reduce the ability of
  one or more essential services to function
  normally. Examples include internal fire,
  utility disruption, chemical spill or bomb threat.

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Question 15

• An external disaster is one or more events that
  occur outside of the hospital and result in a
  large number of casualties coming to the
  Emergency Department.
• A. True
• B. False

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Question 16

• Examples of an internal disaster would include
  internal fire, utility disruption, chemical spill
  or bomb threat.
• A. True
• B. False

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BRMC Emergency Codes

• Code Red Fire
• Code Weather Alert Tornado/Severe Weather Watch
• Code Weather Tornado/Severe Weather Warning
• Code Blue Cardiac Arrest Adult
• Code Blue Pediatric Cardiac Arrest Pediatric
• Code Triage External Alert Potential External
  Disaster
• Code Triage External External Disaster
• Code Triage Internal Internal Disaster
• Code Yellow Alert Bomb threat has been received
• Code Yellow Suspicious item has been found

• Code Pink Infant Abduction
• Code Purple Pediatric Abduction
• Code Orange Hazardous Material Response
• Code Green Biological/Chemical Response
• Code Silver Hostage Situation
• Dr. Strong Additional personnel needed
• Rapid Response Team Multi-disciplinary
  emergency team
• Stroke Response Team Stroke patient
• Dr. Heart Acute Myocardial Infarction
• Condition H Family/Patient initiated Rapid
  Response
• Code Clear All Clear

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Your Responsibility During a Code

• Know your role/responsibility for each code.
• Participate in all code announcements as if they
  were real.
• Know your departments initial response
  procedures.
• Know your departmental evacuation plan.
• Know the number to call in case of an emergency
  (East West Campus 2-2-2-2-2 or Off Site
  9-1-1

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Hazard and Vulnerability Analysis (HVA)

• BRMC is required to complete a Hazard and
  Vulnerability Analysis (HVA) each year. Based on
  our HVA, the following are the tops risks
  identified for our hospital
• Ice Storm
• Severe Thunderstorm
• Blizzard
• Fire, Internal
• Flood, Internal

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Question 17

• Which one of the following risks has been
  identified as a high risk at Bay Regional Medical
  Center?
• A. Earthquake
• B. Hurricane
• C. Blizzard

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Prevention of Injuries (Lifting)

• Keep the load close to your body
• Keep your head, shoulders and hips in a straight
  line
• Lift with your legs, not your back
• Avoid twisting as you lift
• Get assistance with lifting when needed
• Always use lifting equipment
• Never overfill trash/linen bags

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Question 18

• When you lift a patient, equipment, trash or a
  heavy object you should
• A. Keep the load close your body
• B. Lift with your legs, not your back
• C. Get assistance with lifting when needed
  and/or use lifting equipment.
• D. All of the above

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Slips/Trips/Falls

• Wipe spills promptly
• Be observant of wet floors and icy parking lots
• Wear proper footwear
• Watch where you walk
• Report unsafe conditions immediately, i.e.,
  spills, icy sidewalks, etc.

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Handling of Needles and Sharps

• Dispose of needles and sharps immediately after
  use in proper sharp containers
• Use the safety features on sharps correctly to
  eliminate exposures to blood/body fluids
• Do not recap needles
• Empty sharp container when ¾ full
• Do not discard expired medications in the sharp
  containers
• Wear appropriate personal protective equipment
• Use caution when placing sharps into sharp
  containers

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Reporting of Injuries

• If you are injured while on duty, report the
  injury immediately to your department/manager/supe
  rvisor. All injuries should be reported no
  matter how significant they may seem to you.
• The Manager/Supervisor, Employee Health Service
  or Human Resources will authorize initial medical
  examination/treatment.
• Document the injury by completing the employee
  section of the Employee Incident Report form as
  soon as possible or by the end of your shift.
• Employee Incident Report forms are available
  from your Manager/Supervisor or Employee
  Occupational Health Service.

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Question 19

• If you are injured at work, what is the first
  thing you should do?
• 1. Report the injury immediately to your
  Manager/Supervisor
• 2. Keep working
• 3. Go home

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Reporting Bloodborne Exposures

• If you have a percutaneous (needle), mucous
  membrane or open wound exposure to blood or body
  fluids from another person, NOTIFY YOUR
  MANAGER/SUPERVISOR IMMEDIATELY.
• If a small puncture or laceration, milk the wound
  so it bleeds freely then wash with copious
  amounts of soap and water mucous membranes,
  rinse with copious amounts of water eye splash,
  irrigate with copious amounts of water.
• Advise your Manager or Supervisor of source
  patients name so they can order laboratory
  testing immediately on the patient. If indicated
  by patient history, you can be counseled and
  started on prophylactic treatment.

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Question 20

• If you have a percutaneous (needle), mucous
  membrane or open wound exposure to blood or body
  fluids of another person, you should
• 1. Notify your Manager/Supervisor immediately.
• 2. Milk the wound so it bleeds freely, then wash
  with large amounts of soap and water, rinse
  mucous membranes with large amounts of water,
  irrigate eye splash with large amount of water.
• 3. Tell your Manager or Supervisor the name of
  the patient or person you were exposed to so
  their blood can be tested for HIV and Hepatitis.
• 4. All of the above

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Bloodborne Pathogens

• Health care workers could be exposed to
  bloodborne pathogens by accidental needlesticks
  and splashes. The most common bloodborne
  pathogens (BBP) are Hepatitis B Virus (HBV),
  Hepatitis C Virus (HCV) and Human
  Immunodeficiency Virus (HIV). Because BBP can
  cause serious, even fatal diseases, MIOSHA
  (Michigan Occupational Safety and Health
  Administration) has written rules and regulations
  about BBP these rules can be found in Human
  Resources, Infection Control and Employee Health
  Service offices. Along with the MIOSHA rules, Bay
  Regional Medical Center (BRMC) has written an
  Exposure Control Plan for BBP, available on the
  BRMC Intranet (Administrative policy 211).

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Question 21

• HIV, Hepatitis B and Hepatitis C are bloodborne
  pathogens.
• A. True
• B. False

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Bloodborne Pathogens (BBP)

• HIV causes AIDS which disables the bodys immune
  system to fight off infections. HBV and HCV
  infects the liver and may lead to fatal illnesses
  such as liver cancer. These BBP can be found in
  blood, blood products (plasma), semen, vaginal
  secretions, amniotic fluid, fluids surrounding
  the brain, spine, heart, joints, chest, abdomen
  and other fluids containing visible blood. BBP
  are transmitted by
• needlestick injuries
• infected body fluids that has contact with breaks
  in the skin (cut, scrapes)
• splashes in the mouth, nose or eyes from blood or
  body fluids that are infected with BBP
• sex
• using dirty drug needles
• pregnant woman can pass a BBP to her baby
• Since healthcare workers could be exposed to a
  BBP, they must follow Standard Precautions. This
  means treating all blood and body fluids as if
  they are infected with a BBP and use safer
  practices and sharp devices to protect from
  exposures from occurring.

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Bloodborne Pathogens (BBP)

• Personal Protective Equipment (PPE), such as
  gloves, goggles, gowns, and masks are available
  throughout BRMC work sites. PPE should be worn
  any time contact with blood and body fluids is
  possible. PPE should be discarded after removed.
  Other important work practices are hand hygiene
  before and after removing gloves, use safe sharp
  products and devices with safety features when
  ever possible, and use protective resuscitation
  devices when providing rescue breathing. Sharps
  containers are available throughout BRMC. Place
  needles, broken glass or sharp objects into sharp
  containers. Change sharp containers when ¾ full.
  Do not recap needles. Never reach into trash
  containers to retrieve item or compress contents.
  Take special care when handling, collecting or
  transporting blood or other potentially
  infectious materials. These materials must be
  stored in leak-proof containers clearly labeled
  with red or orange biohazard labels to protect
  others from exposures.
• To clean a blood/body fluid spill, wear gloves,
  use disposable towels and hospital disinfectant
  to wipe spills up. If you have not already
  received Hepatitis B vaccine, consider being
  vaccinated. The series of three injections is
  provided to BRMC employees with no cost.

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Question 22

• Gloves, disposable towels and hospital
  disinfectant are all used to clean up a blood
  spill.
• A. True
• B. False

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Bloodborne Pathogens

• If exposure to blood/body fluid occurs, wash area
  with soap and water and report the incident to
  your supervisor immediately for proper follow-up
  testing and treatment. It is important that we
  know how the incident occurred and what device
  was involved.
• The Safe Sharp Task Force studies all sharp
  related injuries looking for trends and makes
  recommendations for safer medical devices and
  monitoring of safety devices. In addition to key
  management personnel, the task force members
  include Nursing Practice Council members,
  laboratory and other front line staff that are
  potentially exposed to injuries from sharps.

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Question 23

• Exposures to BBP should be reported to your
  supervisor immediately.
• A. True
• B. False

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Question 24

• BRMC has a Safe Sharps Task Force that includes
  front line staff.
• A. True
• B. False

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Medical Equipment

• Employees who utilize medical equipment at Bay
  Regional Medical Center related subsidiaries
  play a major role in assuring that medical
  equipment operates correctly and safely. They are
  normally the first to become aware that repairs
  are needed due to breakdown or improper
  operation. They are also instrumental in
  identifying potential problems i.e., exposed
  wires, broken cases, excessive noise or
  vibrations, burning smells, missing safety
  guards, etc.
• When a piece of medical equipment is found to be
  in need of repair, it is vital that the device be
  tagged defective to prevent further use. The tag
  should include the name and phone number of the
  person reporting, and include a brief description
  of the problem. Then initiate the appropriate
  repair process with the department responsible
  for servicing the equipment.

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Question 25

• If you become aware that a piece of equipment is
  in need of repair, you should
• a. Push it aside and grab another machine.
• b. Apply defective label with appropriate
  information.
• c. Make your own repairs with tape, etc.
• d. Throw it into the dumpster.

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Question 26

• Why is it important to tag defective equipment?
• a. It informs others not to use the equipment
• b. It describes what needs to be repaired.
• c. It identifies who can be contacted for more
  information
• d. All of the above

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Medical Equipment

• The Safe Medical Devices Act of 1990 (SMDA) is
  a law requiring a special report if it is
  believed that a piece of equipment may have
  contributed to death, serious illness or serious
  injury of a patient. If this type of event is
  believed to have occurred, ensure the patient has
  received all possible care to minimize injuries.
  When possible, the machine should be left in its
  original condition with settings unchanged. All
  accessories and any packaging available
  (disposable and reusable) should also be saved.
  Contact Risk Management and fill out an
  Improvement Report describing the event.

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Question 27

• If a death, serious illness or injury occurs
  involving equipment, you should
• a. If possible, leave machine and controls in
  original settings.
• b. Save all accessories (both disposable and
  reusable)
• c. Contact Risk Management
• d. All of the above

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Transmission-Based Precautions

• To help prevent the spread of certain contagious
  diseases in addition to Standard Precautions,
  BRMC uses Transmission-based precautions. There
  are 3 categories, Airborne Precautions, Droplet
  Precautions and Contact Precautions. When
  patients are in any these precautions, there will
  be a colored sign on their door describing what
  the additional precautions are.

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Airborne Precautions

• Airborne Precautions (pink sign) is used for
  patients known or suspected to be infected with
  germs that are spread through the air. Examples
  are tuberculosis (TB), chickenpox, smallpox,
  plague and measles. Patients requiring Airborne
  Precautions will be placed in a negative pressure
  room (rooms 481, 479, 431, 429, 331, 329, 295,
  293 and 217). ED patients are placed in room C or
  G. N95 respirators should be worn by anyone
  entering the room of patients with TB or
  smallpox. Regular surgical masks should be worn
  for patients with chickenpox, plague or measles.
  Only staff who is immune to chickenpox, measles
  or smallpox should enter the room of patients
  suspected or confirmed to have that infection.
  Avoid transporting patients who are in Airborne
  Precautions. If transport is medically necessary,
  patients should wear a surgical mask. Visitors
  should wear the necessary personal protective
  equipment that staff is required to wear when
  visiting patients in Airborne Precautions.
• These infections also require Contact Precautions

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Question 28

• Airborne Precautions require patients to be in a
  negative pressure room.
• A. True
• B. False

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Droplet Precautions

• Droplet Precautions (orange sign) is used for
  patients known or suspected to be infected by
  germs that travel in the air for a short distance
  (3 feet) such as influenza, bacterial meningitis,
  pertussis, SARS, strept throat, scarlet fever,
  rubella, Haemophilus influenza, and diphtheria.
  Patients in droplet precautions will be placed in
  a private room. Surgical masks should be worn for
  everyone coming within 3 feet of the patient.
  Patients in Droplet Precautions should not go
  outside of their room unless medically necessary
  and if so, they must wear a surgical mask.
  Visitors should wear the necessary personal
  protective equipment that staff is required to
  wear when visiting patients in Droplet
  Precautions.
• this disease also requires Contact Precautions

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Contact Precautions

• Contact Precautions (green sign) is the most
  commonly used precaution at BRMC. Contact
  Precautions is used for patients with MRSA, VRE,
  C. difficle, scabies, lice, shingles, RSV, viral
  meningitis, patients with infectious diarrhea
  (Shigella, Norovirus, Hepatitis A, rotavirus, E.
  coli O157H7) and patients with hemorrhagic
  fevers. Patients should be placed in a private
  room or cohort with a patient who has the same
  organism. Gloves and gowns should be put on
  before entering the room. Gloves should be
  changed and hand hygiene performed after contact
  with infected body substances. If the patient has
  C. difficle, hand hygiene should be performed
  with soap and water. Avoid touching any surface
  that might be contaminated. Remove gloves and
  gown right before leaving the room. Perform hand
  hygiene after removing gloves and gown. Designate
  noncritical equipment for patients in Contact
  Precautions and leave them in the patient room.
  Clean and disinfect this equipment after the
  patient is discharged. If the patient needs to
  leave the room, remind patient to avoid touching
  surfaces or equipment. Visitors of patients in
  Contact Precautions will need to wear gloves and
  gowns if they participate in any patient care
  activities.

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Question 29

• If the patient has C.difficile, hands should be
  washed with soap and water.
• A. True
• B. False

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Question 30

• Contact precautions require staff to wear gloves
  and gowns prior to entering patients room.
• A. True
• B. False

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Transmission-Based Precautions

• Disposable dishes are NOT required for patients
  in any of the above precautions. No special
  requirements are needed for laundry. Cubical
  curtains do not have to be changed unless they
  are visibly soiled or if the patient had a bad
  case of head lice. No special terminal cleaning
  of the walls is required.

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Question 31

• Disposable dishes are not required for any
  patient in precautions.
• A. True
• B. False

63
Security

• Bay Regional Medical Center related
  subsidiaries do not tolerate any verbal or
  physical aggression directed toward any employee
  intentional or unintentional. Security and/or
  Risk Management review all Security and
  Improvement Reports and staff will be encouraged
  to pursue criminal charges if applicable. If
  someone demonstrates aggressive behavior
• BRMC East Campus - Contact Security in the event
  the behavior is directed at the employee or
  another person or property and is escalating. If
  STAT (emergency), dial 2-2-2-2-2. With the
  help of Security, assist in bringing the
  situation under control. If Security was not
  contacted to bring the situation under control,
  Security will need to be contacted to document
  same. A Dr. Strong will be called to request
  additional manpower in the event Security cannot
  control the situation.
• West Campus - Contact police via 9-1-1
  (remember to dial 9 before dialing
  9-1-1)After the situation is resolved, contact
  Security at Ext. 43762 and report behavior
  encountered

64
Question 32

• To contact Security in an Emergency Situation at
  the East Campus, dial
• 1. 0
• 2. 2-2-2-2-2
• 3. 43762

65
Security (Lost Found)

• Checking a patients area thoroughly before being
  discharged or transferred will help reduce the
  number of lost and found problems. Upon
  notification of a patients loss of personal
  belongings, a thorough search of the area where
  the loss occurred must be made by personnel. If
  you do not find the item, contact Security. They
  will complete the necessary lost report.
  Security will investigate and be responsible for
  determining if reimbursement is needed. Do not
  tell the patient that they will automatically be
  reimbursed. If an item is found, attempt to
  identify the owner. You will need to contact
  Security to either pick up the item or drop the
  item off in Security. Include the identity of the
  patient and location found if known. Please do
  not leave the article in the department where it
  was found.

66
Question 33

• Checking a patients area thoroughly before
  discharge or transfer will help reduce the number
  of lost and found problems.
• A. True
• B. False

67
Life Safety

• Fires that occur in the healthcare setting
  require rapid, efficient response by healthcare
  staff to limit physical damage and reduce the
  risk of injuries or fatalities. Health care
  fires present a unique challenge to responding
  staff because many of our patients are unable to
  ambulate on their own, and rely on us to rescue
  them from the fire. To help protect our
  patients, visitors and yourself, think of the
  acronym R-A-C-E if you discover a fire.

68
Life Safety

• R rescue anyone in immediate danger or relocate
  people from harm.
• A activate the pull station alarm and dial
  2-2-2-2-2 at Bay Regional Medical Center East
  and West Campus. If you are at one of the
  entities, dial 9-1-1 and give the exact
  location. (Remember to dial 9 before you dial
  9-1-1 if applicable)
• C - confine or contain the fire by closing the
  doors to rooms and corridors. Employees working
  in outside buildings need to close doors on the
  way out of the building.
• E - extinguish if fire is small, evacuate the
  danger area if needed.

69
Question 34

• RACE is used to describe actions to take if you
  discover a fire.
• A. True
• B. False

70
Life Safety

• Be sure you know the locations of all fire
  extinguishers, fire alarm pull stations, and fire
  exits in your department. If you need to use a
  fire extinguisher, think of the acronym
  P-A-S-S
• P pull the pin
• A aim the nozzle
• S squeeze the handle
• S - sweep back and forth at the base of the fire

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Question 35

• To use a fire extinguisher, you should
• A. First make sure you have had your annual
  training.
• B. Pull the pin, aim the nozzle, squeeze the
  handles and sweep back and forth at the base of
  the fire.
• C. Only fire fighters can use extinguishers.
• D. Roll it on the floor for 10 seconds to mix up
  the solution inside.

72
Life Safety

• The life safety components of a building provide
  a fire safe environment of care for patients,
  visitors and staff. This includes not only the
  fire alarm systems but also how we react to a
  Code Red condition. The components of a fire
  alarm system include detectors, pull stations,
  sprinkler systems, chimes and strobes, fire
  dampers in ductwork and fire doors. During a Code
  Red drill it is important to observe the system
  components in your area for proper operation.
  Please report any problems on observation reports
  to Security.

73
Utilities

• There are a number of critical utility systems
  present within the health system including
  electrical, heating/cooling, plumbing, boiler and
  steam, ventilation, medical gas, communication
  and transport systems. To report a utility
  outage, contact Facilities at Ext. 43755.

74
Question 36

• To report a utility outage, Facilities management
  should be contacted at Ext. 43755.
• A. True
• B. False

75
Utilities

• There are a number of different types of
  ventilation systems within the hospital and other
  health system sites depending upon the type of
  room usage. Ventilation systems bring in varying
  amounts of outdoor air, filter and condition it.
  Many areas have systems which exhaust the air
  outside without re-circulating it. These areas
  include bathrooms, isolation rooms, Lab,
  Pharmacy, Dietary and some utility room hood
  systems. Temperatures are controlled by
  thermostats throughout the building. Most
  thermostats control more than one room. For
  patient care areas, thermostat settings should be
  at 72-75 degrees. This is the comfort level of
  most patients.

76
Question 37

• Exhaust fan systems are found in
• A. Bathrooms
• B. Lab, Pharmacy, Dietary hoods, and utility
  room hoods
• C. Isolation Rooms
• D. All of the above

77
Utilities

• Care should be taken to avoid spreading harmful
  odors and fumes into the wrong ventilation
  system. If a new chemical is being used by a
  vendor or your department or operation, the MSDS
  should be reviewed for ventilation related
  concerns. The Facilities Management Department
  should be contacted when you have concerns over
  the warnings that are present on the MSDS.
  Ventilation system vapors can spread to other
  areas within the hospital and within other BRMC
  buildings. If a chemical spill occurs, Facilities
  Management should be notified to secure
  ventilation systems, to avoid the fumes from
  spreading to other areas.

78
Utilities

• Another common contaminant is diesel fumes. At
  the Main Campus diesel fumes are generated at the
  old ED entrance, new ED entrance and the
  Receiving Dock. At the West Campus they usually
  originate during emergency generator operation.
  Any odors should be reported to Facilities
  Management immediately.

79
Question 38

• Sources of diesel fume contamination at the East
  Campus include
• A. Receiving Dock, Old ED Entrance, and new ED
  Entrance
• B. Monitor Sugar

C. I-75
80
Ergonomics Working Safely

• Ergonomics is the Science of fitting the task to
  the worker. Ergonomics helps reduce the
  incidence of Musculoskeletal Disorders (MSDs).
  MSDs are injuries, usually associated with
  overuse, that result in damage to the muscles,
  nerves, ligaments, joints, tendons or spinal
  discs. Some examples you may have heard of
  include carpal tunnel syndrome tendentious low
  back pain rotator cuff syndrome sciatica
  trigger finger.
• Some common signs and symptoms of MSDs are
• Pain
• Stiffness
• Numbness
• Decreased range of motion
• Tingling
• Decreased grip strength
• Burning
• Cramping
• Loss of muscle function

81
Question 39

• Which of the following is not a symptom of a MSD?
• a. Pain
• b. Numbness
• c. Burning
• d. Hair loss

82
Ergonomics

• MSDs are usually a result of overuse both at
  home and at work. You can help reduce your risk
  of developing MSDs by taking some simple steps
  to change the way you do things at home as well
  as in the workplace. Everyone is at risk for
  MSDs.
• 1. Avoid heavy lifting and use correct body
  mechanics.
• 2. Make sure your workstation is adjusted
  correctly for you. (Ask your supervisor if you
  are not sure)
• 3. Take a break from sustained postures at least
  every 15 minutes
• 4. Report symptoms early
• 5. Always use available lifting equipment to
  reduce manual lifting and handling tasks.

83
Question 40

• What can YOU do to reduce the risk of developing
  a MSD?
• a. Report symptoms early
• b. Avoid heavy lifting and use good body
  mechanics
• c. Using lifting and handling equipment whenever
  possible.
• d. All of the above

84
Question 41

• What professions are at risk for MSDs?
• a. Nurse
• b. Therapist
• c. Department Secretary
• d. All the above

85
Ergonomics

• If MSD symptoms are not reported early, lasting
  problems or even permanent disability may result.
  If you experience any of these symptoms and you
  feel them during or after performing your work
  activities, you should report to your supervisor
  or manager immediately. If they are not
  available, report to Occupational Health (Ext.
  43159).

86
Service Recovery

• Service Recovery is the process of regaining
  customer confidence after a service failure. The
  best way to accomplish this is by following the
  H.E.A.R.T. approach. You can do this by
• Hear Listen attentively. Most people just want
  to be heard.
• Empathize Use statements such as I can see why
  you feel that way or I see what you mean.
• Apologize I am sorry this happened to you.
  Do not become defensive or blame others.
• Respond Take ownership. Try to resolve the
  issue yourself or involve others who can help.
  Assure the person that you will follow up on the
  problem quickly. If possible. Follow up with
  them.
• Thank Thank you for sharing your concern so
  that we can continually improve our services.

87
Question 42

• In Service Recovery, what does H.E.A.R.T. stand
  for?
• a. Harass, engage, acknowledge, rehearse and
  trick
• b. Help, empower, apologize, respond and thank
• c. Heckle, explore, analyze, repair and think
• d. Hear, empathize, apologize, respond and thank.

88
Patient Safety

• Bay Regional Medical Centers Patient Safety Plan
  was developed by the Patient Safety Committee to
  improve patient safety and reduce risk to our
  patients. We use a coordinated and collaborative
  approach to establish mechanisms that respond to
  occurrences, provide ongoing proactive reduction
  in medication errors, and integrate safety
  priorities into all processes, functions and
  services of Bay Regional Medical Center.
• Errors or occurrences usually occur because the
  system or process is too complicated, not because
  of personal skill. All staff, including
  physicians and volunteers are required to report
  actual or potential safety problems to their
  manager or supervisor or any member of the
  Patient Safety Committee. Problems may be
  identified as near misses, medication errors,
  adverse drug reactions, transfusion reactions,
  hazardous conditions, sentinel events or any
  other identified problem that could affect
  patient safety. The Patient Safety Committee
  will analyze the data and make recommended
  changes to the system so errors will be
  eliminated.

89
Question 43

• Errors usually occur because of
• a. Lack of skill on the part of the caregiver
• b. The system is too complicated
• c. The caregiver does not care and is a sloppy
  employee.

90
Question 44

• Who is responsible to ensure that our patients
  are safe?
• a. Nurses
• b. Physicians
• c. Environment Services Staff
• d. All of the above

91
Patient Safety

• Proactive Risk Assessment The Patient Safety
  Committee conducts a proactive risk assessment on
  a high-risk process every year. Failure Mode and
  Effect Analysis (FMEA) is the method used to
  evaluate this high-risk process. The 2008 risk
  assessment was Pneumonia and Influenza Vaccine.
• Sentinel Event A sentinel event is any process
  variation that resulted or could have resulted in
  a serious adverse patient outcome including a
  patient death. A sentinel event needs to be
  reported to Risk Management immediately.

92
Question 45

• What process does the Patient Safety Committee
  use to assess one high risk process every year?
• a. Plan, Do, Check, Act (PDCA)
• b. Failure Mode and Effect Analysis (FMEA)

93
Patient Safety

• Reporting Errors What do you do if your know of
  an actual error or potential error? If it was an
  actual error, first, support the patients
  clinical condition. Second, contact the
  patients physician. Preserve any information
  related to the error and report the error to your
  manager or supervisor. If you are uncomfortable
  reporting the error to your supervisor, you may
  report the error via the Hot Line. If you
  chose to report via our Hot Line, you need to
  leave enough information so the Patient Safety
  Committee can investigate if a process needs to
  be changed.
• Disclosure If an error occurs, and patient harm
  results, it is required that the patient be
  informed of the error and the outcome of the
  error. The physician or his or her designee is
  required to inform the patient.
• Non-punitive Environment We encourage all staff
  to report all errors and potential errors. We do
  this so we can get the information we need to
  determine if a process needs to be altered. Bay
  Regional Medical Center has adopted a
  non-punitive policy in that if an individual
  makes an error, they will not receive discipline.

94
Patient Safety Goals

• JCAHO National Patient Safety Goals for 2009
• 1. Improve the accuracy of patient
  identification.
• 2. Improve the effectiveness of communication
  among caregivers.
• 3. Improve the safety of using medications.
• 4. Reduce the risk of health care acquired
  infections.
• 5. Accurately and completely reconcile
  medications across the continuum of care.
• 6. Reduce the potential of patient harm
  resulting from falls.
• 7. Encourage patients active involvement in
  their own care as a patient safety strategy.
• 8. The organization identifies safety risks
  inherent in its population.
• 9. Improve recognition and response to changes
  in a patients condition.

95
Question 46

• How many Joint Commission National Patient Safety
  Goals exists?
• a. 7
• b. 8
• c. 9

96
Age Specific Guidelines

• Age-related stages describe key conflict or core
  problems from which after successful completion
  or mastery of one problem, the individual moves
  on to the next problem. No core problem is ever
  really completely solved. With each new
  situation the core problem demands another
  resolution and thus is the development of the
  person. How we treat each person takes into
  account the development or stage of the person we
  are treating. This assists the caregiver in
  providing treatment that is age appropriate.
  Each age group also has specific risks one should
  be aware of.
• Newborn Birth to discharge from the hospital.

97
Age Specific Guidelines

• Infants any child up to 1 year. The infant is
  in the Trust vs. Mistrust stage. Mistrust
  evolves from inconsistent care and unmet needs.
  Infants are totally dependent on daily care. They
  need their basic needs met. These include
  sleeping, feeding, sucking, bathing, cleanliness,
  and affection. Infants have rapid physical
  growth.
• Safety risks include water safety,
  childproofing, and motor vehicle injury
  prevention.
• Toddler- 1-3 years old. Toddlers are in the
  stage of Autonomy vs. Shame Doubt. In this
  stage it is important to ensure safety by keeping
  the side rails up. Toddlers are fearful
  therefore speak in a soothing tone, cuddle an
  upset toddler, encourage parents to stay with
  toddlers and assist with care. Explain procedures
  to parents and the toddler in simple terms. Let
  the toddler touch equipment and try the procedure
  on a doll or stuffed animal. Have parents
  demonstrate procedures to show understanding.
  Remember that toddlers are afraid of strangers.
  The toddler is more fearful than the preschooler.
• Safety risks include injury
  prevention, water safety, playground safety,
  stranger safety, motor vehicle injury prevention,
  violent behavior and firearm safety as well as
  the risk for abuse.

98
Age Specific Guidelines

• The Preschooler 3-6 years old. Preschoolers
  are in the Initiative vs. Guilt stage. In this
  stage it is important to explain procedures and
  objects in ways that the child can understand.
  Avoid words that are scary. Reassure the child
  that the procedure is not a punishment. Show the
  child how the equipment is used by using visual
  aids. Allow the child to assist with the
  equipment. Give the child the chance to express
  feelings and ask questions through talk and play.
  The child may want a security item such as a
  blanket or doll.
• Safety risks include same as toddler.
• School age 6-12 years old. School age children
  are in the Industry vs. Inferiority stage. In
  this stage growth is slower until they have a
  spurt usually at puberty. Procedures and
  treatments need to be explained in advance.
  Utilize correct terminology as well as visual
  aids. Allow the school age child to help as much
  as possible. Privacy is very important to these
  children. School age children are ready to learn
  about health and safety, this includes education
  on alcohol, tobacco, and drugs. Praise positive
  behavior as it helps build their self-esteem.
  Friends are important so allow time to interact
  with their friends.
• Safety risks include alcohol and
  substance abuse, diet and nutrition abuse, injury
  prevention, motor vehicle injury prevention,
  violent behavior and firearms safety. Also
  depression/suicide and violence and abuse.

99
Question 47

• The School Age Child needs positive behavior
  praised to help self-esteem.
• a. True
• b. False

100
Question 48

• The toddler is often more fearful than the
  preschooler.
• a. True
• b. False

101
Age Specific Guidelines

• Adolescents age 13-17 years old. Adolescents
  are in the Identity vs. Role diffusion stage of
  development. They are focusing on developing an
  identity thus they have emotional swings
• and face peer pressure. Adolescents are
  very concerned about body image and are
  self-conscious. They should have the same sex
  caregiver. Adolescents can be taught by
  utilizing correct terminology and visual aids.
  Adolescents need to be involved in their care and
  decision-making regarding their care. Teaching
  is important at this stage. Adolescents are
  ready to learn about nutrition, safety, and
  health risks such as sexually transmitted
  diseases, alcohol, and drugs.
• Safety risks infectious
  disease prevention/STDs, alcohol/substance abuse,
  tobacco, diet/nutrition, eating disorders, injury
  prevention motor vehicle injury prevention,
  violent behavior/firearms safety, depression,
  domestic violence/abuse, parenting and sexual
  activity safety.

102
Question 49

• The Adolescent stage has many emotional swings.
• a. True
• b. False

103
Age Specific Guidelines

• Young Adults- 18-30 years. The stage this group
  is working on is Intimacy vs. Isolation. Young
  adults are very dedicated to education and
  occupation. Encourage young adults to talk about
  their feelings and concerns and how illness or
  injury may affect their plans, family, and
  finances. Young adults have strong ties. Involve
  the young adult and their family in decision
  making and education. Young adults may deny or
  mask symptoms so assess their readiness to learn.
• Safety risks injury, family
  violence/abuse, conception counseling,
  alcohol/substance abuse, tobacco, diet nutrition,
  obesity, infectious diseases/STDs, water safety,
  motor vehicle injury prevention, violent
  behavior/firearms and depression/suicide.

104
Age Specific Guidelines

• Middle Adults 30-64 years old. Generativy vs.
  Stagnation is the stage these adults are
  experiencing. Middle-age adults begin to
  experience physical changes, such as decreased
  endurance. Assistance with care may be
  necessary. Illness interferes with plans.
  Chronic illnesses begin to develop. Middle-age
  adults are interested in learning and are
  independent so encourage self care as much as
  possible. Teach middle age adults about healthy
  lifestyles such as stress and weight management.
  Involve the middle age adult and their close
  family in decisions about care.
• Safety risks cancer screening,
  cholesterol, hypertension, diabetes screening,
  infectious diseases, sensory screening (ears
  eyes) family violence/abuse, water safety alcohol
  and substance abuse, conception, menopause
  management, osteoporosis diet nutrition, obesity,
  motor vehicle injury prevention, violent
  behavior/firearms, and depression/suicide.

105
Age Specific Guidelines

• Geriatric age 65 and older. Integrity vs.
  Despair is the stage these adults are
  experiencing. Geriatrics adults begin to
  experience changes in skin, muscles, and sensory
  abilities. They are at a higher risk for
  infection. Geriatrics may have reduced attention
  spans, and may make decisions slowly as well as
  need more time to learn. Speak clearly and avoid
  background noise when talking. Use larger print
  and ensure enough light. Give information in
  short segments and repeat as needed. Do not rush!
  Encourage the patient and his/her family to take
  an active role in their care. Give geriatrics
  time to reminisce. Safety is a concern in this
  age group therefore keep areas clear to avoid
  falls.
• Safety is a concern in this age
  group, therefore, keep areas clear to avoid
  falls. Cancer screening, cholesterol,
  hypertension, diabetes screening, infectious
  diseases, sensory screening (ears eyes) family
  violence/abuse, water safety, alcohol and
  substance abuse, conception, menopause
  management, osteoporosis diet nutrition, obesity,
  motor vehicle injury prevention, violent
  behavior/firearms, and depression/suicide.

106
Hand Hygiene

• Hand hygiene is the 1 way to prevent infections
  yet several studies showed that healthcare
  workers are only 40 compliant with hand hygiene.
  With the use of alcohol-based hand rubs, it is
  easier to comply with hand hygiene requirements.
  Compared to soap and water hand washing,
  alcohol-based hand rubs have the following
  advantages
• takes less time (about a fourth of the time less)
• is more accessible than sinks
• causes less skin irritation and dryness
• are more effective in reducing bacteria and
  viruses on hands

107
Question 50

• Why should you perform hand hygiene?
• a. It is the 1 way to prevent infections
• b. To remove germs from your hands
• c. All the above

108
Hand Hygiene

• When washing hands with soap and water, wet
  hands, then apply soap (one pump is all you
  need), rub hands vigorously for at least 15
  seconds, covering all surfaces of the hands,
  rinse and dry with a disposable paper towel. You
  should use the paper towel to turn off the
  faucet. Hands should be washed with soap and
  water when
• they are visibly dirty or soiled
• the patient you care for has diarrhea (especially
  caused by C. difficle)
• before you eat
• after using the restroom

109
Question 51

• When should you wash your hands with soap and
  water?
• a. When your hands are visibly dirty
• b. When caring for a patient with C. Difficle
• c. After using the restroom
• d. All the above

110
Hand Hygiene

• To perform hand hygiene with an alcohol-based
  hand rub, apply product to one hand (using only
  one pump) and rub hands together, covering all
  surfaces of hands and fingers, until hands are
  DRY. Hands need to be dry before touching any
  electrical or oxygen device. Hands should be
  decontaminated when
• right before entering a patients room
• before donning sterile gloves to insert an
  invasive device or change a dressing
• after contact with a patients skin (when taking
  a pulse or blood pressure and when lifting a
  patient)
• after removing gloves
• after touching surfaces in patients room
• when leaving a patients room
• Also, you can not wear artificial fingernails or
  extenders and you can not have your fingernail
  tips be more than ¼ inch long. Studies have
  shown false nails as a source of infections.

111
Question 52

• When should you perform hand hygiene with an
  alcohol-based hand rub?
• a. After removing your gloves
• b. Upon entering a patients room
• c. After taking a blood pressure
• d. All of the above

112
MRI

• MRIs are safe machines, as long as you follow
  certain rules and dont bring metal into the
  room. EVERYONE who could potentially access the
  MRI area needs to be informed of the potential
  dangers. Every death and most severe injuries
  reported to the FDA by MRI users were due to not
  following established safety procedures and/or
  adequate screening of patients.
• Magnetic Resonance Imaging uses a magnet up to
  30,000 times stronger than the earths magnetic
  field. The magnetic field generated by the MRI
  magnet is incredibly powerful. You cannot see
  the magnetic field, you cannot feel it, and you
  wont detect it until a MAGNETIC metal is ripped
  out of your hands. NOTE not all metals are
  magnetic. Aluminum, for instance, isnt
  magnetic. Many alloys of stainless steel are
  safe in the MRI environment, but a number of
  other stainless steel alloys are very magnetic
  and, therefore, dangerous.

113
Question 53

• You cannot see the magnetic field, you cannot
  feel it, and you wont detect it until a MAGNETIC
  metal is ripped out of your hands.
• a. True
• b. False

114
MRI

• Strong magnetic fields used by MRI scanners may
  cause injury or death. Large MAGNETIC objects
  are potentially deadly. A gurney from the floor
  could easily pin a MRI tech against the magnet.
  Even small objects (pins, earrings, paper clips,
  etc). can seriously injure patients or staff. A
  bobby pin can be accelerated to over 35 miles per
  hour before it reaches the center of the magnet.
  TAKE HOME DO NOT BRING ANY METAL INTO AN MRI
  ROOM EVER. Only MRI staff should make that
  decision.
• Specifically, to be SAFE, anyone wanting to enter
  the magnet room should
• Screening All personnel must be screened.
• Absolutely No pacemakers or non-removable
  electronic devices. The magnet will make them
  malfunction.
• Ferromagnetic Equipment Not permitted in the
  magnet room.
• Empty pockets and remove jewelry.

115
Question 54

• Even small objects (pins, earrings, paper clips,
  etc.) can seriously injure patients or staff.
• a. True
• b. False

116
Question 55

• No pacemakers or electronic devices are allowed
  to enter the magnetic room.
• a. True
• b. False

117
MRI

• Code Procedures
• The MRI staff will activate the hospital CODE
  BLUE procedure.
• The MRI staff will remove the patient from the
  magnet room.
• The code response team should not enter the
  magnet room.
• Suffocation Danger
• The MRI magnet contains about 75 gallons of
  liquid helium. If the magnet ruptures, the
  liquid helium will turn to vapor and displace
  oxygen. If the container ruptures (as happened
  at St. Marys in 1989), the room can be flooded
  with very cold Helium vapor. Breathing the
  sub-zero vapor can freeze the lungs, cause severe
  skin frostbite, and if the staff does not
  evacuate quickly, cause asphyxiation.

118
MRI

• If you hear the magnet ROARING or if you walk
  into the magnet area and begin talking like
  Donald Duck
• Drop to your hands and knees
• Waste no time
• Crawl quickly outside
• Take everyone in the area with you!
• MRI has a set of potential dangers of which
  everyone must be made aware. By following these
  guidelines, we can assure the safety of staff and
  patients when in the MRI suite.

119
False Claims Act

• The Federal False Claims Act, as amended in 1986,
  prohibits fraud and abuse of any federally funded
  contract or program, excluding income tax fraud.
  Liability is imposed on any person or entity who
• makes a false or fraudulent claim to the federal
  government for payment to which they are not
  entitled
• makes a false record or statement to get a false
  or fraudulent claim paid by the government
• conspires to have a false or fraudulent claim
  paid by the government
• withholds government property with the intent to
  defraud the government or to willfully conceal it
  from the government
• makes or delivers a false or fraudulent receipt
  for government property
• buys government property from someone
  unauthorized to sell the property or,
• makes a false statement to avoid or deceive an
  obligation to pay money or property to the
  government.

120
False Claims Act

• The Act applies to all types of government
  claims, but the top two areas where most qui tam
  cases occur are in the health care and defense
  industries. Qui tam is short for a Latin phrase
  meaning he who sues on his own behalf as well as
  for the King. The Act allows a private citizen
  who has knowledge of fraudulent activity to file
  a qui tam lawsuit on behalf of the government,
  and to share in the proceeds if the lawsuit is
  successful.
• There are a variety of types of fraud prohibited
  by the False Claims Act. Most important to
  healthcare are Medicaid and Medicare violations.
  Any violation of Medicare laws or the Medicare
  Fraud and Abuse Statue are also violations of the
  False Claims Act. For example, inappropriate
  billing for services that were never provided,
  making misrepresentations about the type of
  services provided, or providing substandard
  medical care are all violations of the Act.

121
Question 56

• The Federal False Claims Act allows a private
  citizen to file a qui Tam lawsuit on behalf of
  the government.
• a. True
• b. False

122
False Claims Act

• The Act was also modified to add protection
  against retaliation for any person who blows the
  whistle against fraudulent activity.
  Specif