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ANNUAL MANDATORY UPDATE TRAINING

Complete AMUT and Win a Prize. In an effort to attain 100% completion goal,the staff education department is holding a drawing. Each employee who successfully completes AMUT and find the total

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ANNUAL MANDATORY UPDATE TRAINING

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    1. 1 ANNUAL MANDATORY UPDATE TRAINING

    2. Complete AMUT and Win a Prize In an effort to attain 100% completion goal, the staff education department is holding a drawing. Each employee who successfully completes AMUT and find the total # of bouncing AMUT Dogs will be entered into a drawing. The winner of the drawing will receive a prize and bragging rights in the leadership bulletin! Entry forms are located at the bottom of the AMUT Completion form. Send your name and # of bouncing to attn: Kelli Houston (Staff Education- PC). Entries must be received by December 31st. The winner will be announced on Monday, January 3, 2011.

    3. 3 Age Appropriate Care 1. Which developmental age group fluctuates in their willingness to participate in care because of their need for independence and approval? A. School age children B. Adolescents C. Middle Adult D. Older adult/Geriatric Correct answer: B. Adolescents 2. The Joint Commission requires that staff members have the knowledge and skills necessary to meet age-specific needs. True False Correct answer: True 3. To maintain competencies in age-specific care, you must be updated on new technologies, procedures or therapies for your patients. True False Correct answer: True 4. Children cooperate much better when they are not told a procedure may hurt beforehand True False Correct answer: False Age-related competency means having the knowledge and skills required for a specific developmental group of patients. What are the developmental groups, their behaviors, and the best approaches for care? Infant (Birth through 12 months): Clings to parents and cries when they leave Handle infant gently and speak in a soft, friendly tone of voice Toddler (1 to 2 years): Experiences separation anxiety Give the child simple, direct, and honest explanations just before treatment or surgery Pre-school (3 to 5 years): Experiences separation anxiety; may panic or throw tantrums, especially when parents leave Use simple, neutral words to describe procedures to the child School Age (6 to 12 years): Alternatively converts to adult standards and rebels against them Explain logically why a procedure is necessary Adolescence (12 to 18 years): Shows concern of how procedure may affect appearance Give scientific explanations using body diagrams, models, or videotapes Young Adult (19 to 39 years): Directs and participates in his/her own care Use problem-centered teaching Middle Adult (40 to 64 years): Directs and participates in care Involve in decision-making Older Adult/Geriatric (over 65): Demonstrates anxiety over new procedures or a change in routine Use simple sentences, concrete examples, and reminders such as pillboxes

    4. 4 Americans with Disabilities Act (ADA) Which of the following would be considered an “inappropriate” action when serving a physically disabled member who uses a wheelchair? A. Calling the department next door to use their wheelchair weight scale as your department does not have one. B. Assume you will need the lift team to help transfer the member to a gurney. C. Crouch to make yourself shorter when speaking to the member. D. Waiting for the member to respond after asking if they need assistance moving about in their chair. Correct answer: B The Americans with Disabilities Act (ADA) was enacted on July 26th, 1990 by the United States Congress. This federal law prohibits discrimination and ensures equal opportunity for persons with disabilities in: 1) Public accommodations 2) Employment 3) Transportation 4) State and local government services and 5) Telecommunications (e.g. Telephone Device for the Deaf) Under the ADA Act, disability is defined with respect to an individual as “a physical or mental impairment that substantially limits one or more of the major life activities of such individual; a record of such an impairment; or being regarded as having such an impairment.” Major life activities includes functions such as activities of daily living, walking, seeing, hearing, breathing and working to name a few. In health care the ADA definition of a disability is expanded to include individual’s temporary limitations which include: Temporary Disabilities Many members may not have permanent disabilities, but have a condition that affects them temporarily. The same suggestions for accommodation and rules of etiquette should be followed whether the disability is experienced on a permanent or temporary basis. Physical Disabilities A physical impairment as defined by the ADA is “any physiological disorder or condition, cosmetic disfigurement or anatomical loss affecting one or more of the following body systems: neurological, musculoskeletal, special sense organs, respiratory (including speech organs), cardiovascular, reproductive, digestive, genitourinary, lymphatic and blood systems, skin and endocrine.” Proper Disability Etiquette Crouch or sit when possible to converse at eye level. Ask before pushing/assisting with a wheel chair, and wait for a response. Do not make assumptions about what a person can or cannot do based on his or her disability. All people with disabilities are not alike and have a wide variety of skills and personalities. Reporting Member Disability Issues Local issues and concerns regarding members with disabilities that cannot be resolved through your manager should be reported to one of the PC ADA Representatives (Dionne Hunte, ext 3439, Bill West, ext 2020, or Debby Weissman, ext 2979) and/or the Member Services Department. Visit the ADA Compliance Website for more info http://kpnet.kp.org/ada/

    5. 5 Ergonomics/Body Mechanics 1. The potential for back injury can be reduced by understanding your back anatomy, maintaining correct posture and using correct body mechanic during activities True False Correct Answer: True When working in a sitting position which of the following applies: Sit close to your work Maintain one static position for as long as possible Arrange your work to the side so you can twist back and neck Maintenance of the spine’s three natural curve is not necessary in sitting Correct Answer: A Which of the following would be considered “inappropriate action” when carrying a load: Using your feet to change direction Carrying a load over your head Setting the load down and resting for a few moments Keeping your back straight or slightly arched Correct Answer: B Ergonomic tips for sitting at a computer:

    6. Fraud Awareness and Prevention In the simplest terms, fraud occurs when someone lies to gain benefit or advantage. An example of fraud is when someone uses another person’s medical identification card to receive treatment. Preventing fraud protects our member’s health, our resources, and our reputation. There are many fraud risk areas throughout the organization. If you work with members, you may find medical-identity theft or members enrolling ineligible dependents. If you work with vendors you may see conflicts of interest or kickbacks. If you work with drugs you may see drug theft or forged prescriptions. If you work with claims you may discover suspicious or false claims by members or providers. If you work with other employees you may see fraud, waste and abuse such as cash theft, timekeeping fraud, misuse of assets or personal business on work time. As part of your job, you are required to report all instances of non-compliance. To maintain competencies in age-specific care, you must be updated on new technologies, procedures or therapies for your patients. Privacy and Security Our members’ trust depends in large part on how we protect the confidentiality and security of their information. Even though your job may not directly involve caring for patients or working with members, you may come into contact with protected health information (PHI) and other confidential information in your daily work Compliance Expectations Achieving compliance takes everyone’s commitment. Here are some compliance expectations for all workforce members: Use the Principles of Responsibility, our formal code of conduct, as a tool for making decisions about compliance and ethics issues. Identify potential fraud, waste, and abuse and take appropriate action. Protect the confidentiality and security of patient information. Report potential instances of noncompliance as part of your job. The Principles of Responsibility You should understand The Principles of Responsibility (or POR), Kaiser Permanente’s code of conduct, applies to everyone and is meant to help each of us accomplish the organization’s mission in an ethical work environment. A few of the topics included in the Principles of Responsibility are: Non-Retaliation - Kaiser Permanente has a clear non-retaliation policy. We do not tolerate retaliation against individuals who refuse to participate in or report illegal and unethical acts to KP or government agencies. Anyone who retaliates against these individuals is subject to disciplinary action, up to and including termination. Conflict of Interest - Conflicts of interest have the potential to damage the reputation of both you and the organization. A conflict may arise when your personal or financial interests influence—or appear to influence—your judgment or interfere with your work responsibilities. Safeguarding our Assets - Our organization’s assets are intended for business purposes. These assets include buildings, equipment, furniture, supplies, company funds, electronic assets, knowledge, and information. We are all responsible for protecting them against misuse, waste, damage, loss, impairment, and theft. Confidential Information - We require passwords as part of our security to limit access to confidential information. It is very important to not let others use your password or account. Employees have been terminated for sharing passwords.

    7. Avoid Conflicts of Interest, Do the Right Thing What is a Conflict of Interest? A conflict of interest arises when personal or financial interests influence your professional judgment, business decision-making, or interfere with your Kaiser Permanente responsibilities. In addition, a potential conflict of interest exists when it might appear to others that personal or financial interests could influence professional judgment or decision-making. For instance, Jane is a senior registered nurse who assists physicians in the Emergency Department (ED). As a senior nurse, Jane is well-respected, and other employees, including physicians, rely upon her expertise and advice to keep the ED running smoothly. Recently, Jane befriended John, a contractor who sells emergency room equipment to hospitals and has previously sold products to Kaiser Permanente. John has offered Jane a gift, a high-quality digital camera in a case with the vendor's name and logo on it. The value of the camera is more than $25, and Jane knows John would like to sell his products at her facility. The above scenario demonstrates a conflict of interest for Jane because her personal relationship with John may cloud her loyalties to Kaiser Permanente, and interfere with her job responsibilities. The right thing for Jane to do is to decline the gift and inform her manager in writing of the relationship and the potential contracting issue. Other Conflicts of Interest Examples Here are some conflicts of interest examples. They occur when an employee has: A financial interest with organizations doing business with Kaiser Permanente. Accepted gifts or benefits for work related presentations. Influenced business decisions with organizations in which they or their family hold a direct financial interest. Supervised a member of his or her family as a job responsibility. Served as an officer or member of a board of directors of another organization that could pose a conflict as an employee of Kaiser Permanente. Here are some frequently asked questions and answers to clarify some of the more common misconceptions: Can I look up my coworker’s address in the system to send him/her a get-well card? NO. You must not look up this information for personal reasons. When it comes to the privacy and security of protected information, accessing demographics is no different than accessing clinical information. You should contact the employee’s manager for instructions. Can I look up my 5-year old daughter’s lab results? NO. As the parent of a 5-year old you do have a right to this information; however you must obtain it the same way a non-Kaiser Permanente workforce member would obtain it. I work in an open area with three other employees. When I leave my workstation, I don’t lock it up (Ctrl-Alt-Del buttons). Is that okay? NO. Although your coworkers are employees, this does not automatically give them access to the information on your computer. Use the minimum necessary principle. You must only use, access or disclose the minimum amount necessary to get the job done. Always lock up your workstation whenever you step away. The consequences for inappropriately accessing medical records can be severe. Employees have been terminated for this very reason. In addition, individuals can be fined up to $25,000, per a new state law (SB 541) Reporting Compliance Concerns At KP, we foster a culture of compliance. In the POR, under Where to Get Help you will find several methods for reporting potential compliance concerns: We encourage you to go to your supervisor first, however we realize sometimes this may not be possible so there are other internal resources available to you. If your supervisor is not available, or if speaking with him or her did not produce results, speak to a higher-level manager. If you are unable to speak to a higher-level manager, you can talk to Human Resources, or your Compliance Officer. If you are uncomfortable using any of the resources above, you can always call the KP Compliance Hotline at 1-888-774-9100.

    8. 1. The KP Code of Conduct is my guide for telling me how to work honestly and ethically at Kaiser Permanente, and I understand it is my obligation to report something that is a violation of the Code of Conduct, to my supervisor, manager, my Compliance Officer, or call the Compliance Hotline. True False Correct answer: True According to the KP Code of Conduct, the principle that tells me that I cannot take cash or gift cards from vendors is: The Principle for Respecting Confidentiality, Privacy and Security The Principle for Safeguarding and Proper Use of KP Assets The Principle for Protecting the Environment The Principle for Conflict of Interest Correct answer: D When, How to Report Conflicts of Interest Whenever you become aware of a potential conflict of interest, you are required to disclose it in writing to your manager, supervisor, medical center compliance officer, Human Resources representative, chief, or department administrator. If you become aware of a conflict of interest that is currently taking place in your work environment, you may also call the anonymous Kaiser Permanente Compliance Hotline, 888-774-9100 (toll free). KP has a non-retaliation policy that protects employees who report conflicts or potential conflicts of interest in good faith. Learn More about Conflicts of Interest Refer to our Principles of Responsibility, Kaiser Permanente's code of conduct Contact your Compliance Officer Visit the Southern California Compliance Web site Send an e-mail to SCAL-Compliance-and-Privacy-Office@KAIPERM.

    9. 9 Customer Service 1. Our members expect a smile, eye contact, attentiveness, and a pleasant tone of voice to demonstrate courteous behavior. True False Answer: True 2. Proactive offering of help is a key element of patient satisfaction True False Answer: True 3. Listening attentively demonstrates caring and empathy True False Answer: True 4. Kaiser Permanente’s Service Quality Credo says, “Our cause is health. Our passion is service. We’re here to make lives better.” True False Answer: True KP Members have listed the following qualities and behaviors when describing excellent service: What are the developmental groups, their behaviors, and the best approaches for care? Show Courtesy By — Treating members politely and with respect. Being friendly and greeting each member warmly. Engaging the member in conversation to reinforce your personalized, focused attention on them. Conversations with co-workers should end immediately when a member approaches you. Smiling and making eye contact. Using a pleasant tone of voice. Taking your time with each member and not rushing them through the check-in process. Show Helpfulness By — Offering to help before being asked. Proactively offering instructions about where to wait, what to do with forms, giving directions to other KP departments and location (pharmacy, lab, parking, nearest exit, etc.). Walking members to their destination whenever possible. If you can’t leave your work area, provide members with a campus map and show them where they need to go. Maps are available online at http://voices-pc. Always asking, “Is there anything else I can do for you today?” Following up on requests made by the member. Show Care and Concern By — Creating a cheerful, non-threatening environment that puts the member at ease and helps them to relax. Talking to the member and reducing any anxiety they may have about their visit. Asking the member what else we can do to make them comfortable. Answering any questions they may have about their provider, and reassuring them that that they are receiving the highest quality care.

    10. 10 Culturally Responsive Care The United States, already one of the most diverse societies in the world, is becoming increasingly multicultural and multilingual. Immigrant, refugee, limited-English and non-English proficient (LEP/NEP) populations are continuing to grow. According to the 2000 U.S. Census, 47 million residents were non-English speaking and this population is expected to reach 40% by the year 2030. For health care organizations, providing linguistic and culturally appropriate health care services that ensures quality of care to diverse populations has becoming increasingly imperative and complex. At Kaiser Permanente, we believe it is our responsibility to protect a patient’s right to receive the information necessary to make informed health care decisions. To continue providing quality of care to our patients’, especially those that are limited-English and non-English speaking, effective communication is key to the delivery of culturally competent health care. Qualified Interpreter Services available: Qualified Bilingual Staff (QBS) Level 1 (L1) interpreter - can be used to provide language assistance to patients/members at a basic conversational level excluding medical terminology. Qualified Bilingual Staff (QBS) Level 2 (L2) interpreter - can be used to provide language assistance to patients/members in encounters including those that are clinical interactions with the use of medical terminology. Telephone Language Line Interpreter for all languages can be accessed 24 hours, 7 days a week. Only qualified, tested, and trained bilingual staff for Spanish, Tagalog, and Armenian can be used to provide interpretation services to members. Bilingual staff speaking a language outside of the three Panorama City Approved languages cannot provide interpretation to patients. For language services where Qualified Bilingual Staff (QBS) is not available, the Language Line Service must be used (please see How to Use the Language Line below). All providers, managers, and staff should be aware of how to assist limited-English proficient (LEP) members needing language interpretation and to assist those needing American Sign Language (ASL). LEP – In the absence of qualified bilingual staff to provide interpretation in the Panorama City approved and tested languages (Spanish, Tagalog, and Armenian), assistance shall be provided through the Language Line Service (LLS). ASL – The Communications Department is the designee for arranging for outside sign language interpreters. When interpreter services are needed for the deaf or hard of hearing, contact Communications at 8-350-2218. The use of adult family members and/or friends to provide interpretation for patients is discouraged. We must first offer qualified language assistance to the patient via a Qualified Bilingual Staff (if available) or the Language Line. If the member/patient refuses or declines language assistance services offered, consideration will be given to member/patients request for use of a family member and/or friend (18 years or older) for interpretation. The refusal by the patient to utilize language assistance services must be documented in the patient’s medical record. If we use a Qualified Bilingual Staff member to provide interpretation, this must also be documented i.e. the name of the QBS employee and QBS Level.

    11. 11 Culturally Responsive Care How to Use the Language Line: Telephone Interpreting Services (non-English language only) 1. Establish a conference call between you, the member/parent and the language interpreter service. Language Line Services: 1-800-523-1786 Client I. D: #136520 (Panorama City & outlying MOBs) #295204 (Antelope Valley only) 2. When you reach the Language Line Representative, you will be asked for a client identification code (Client I.D.) You must also give her/him your full name, your department and the language that the member/parent speaks. If you are not sure what language the member/parent speaks, use the Language Identification Card to assist you in identifying the language. For Language Line Identification cards, please contact Dionne Hunte, x3439. 3. Within minutes you will be connected to an interpreter. Stay on the line with the member/parent until you are sure that the interpreter and the member/parent have connected. 4. When using two hand held phones: Give one to the patient Provider/Staff uses the other Begin dialogue between yourself, patient, and interpreter 5. When using a Speaker Phone: Once the interpreter is connected press the “Speaker” function on the phone, hang up the headset and begin the conversation. Remember, if you are in a patient care area to close the door to protect the patient’s privacy. 6. When using a dual hand held phone: When the interpreter comes on the line, give one of the phones to the patient. For Clinical interactions where medical terminology is used, what type of Qualified Bilingual Staff member may be used for interpretation? A. Language Line B. QBS Level 1 C. QBS Level 2 D. Family Member/Friend Correct answer: C. QBS Level 2 2. The language line can only assist in the following languages: Spanish, Tagalog, and Armenian True False Correct answer: False

    12. 12 Emergency Management When a disaster strikes, the Medical Center may become a center of activity: The community may look to the organization for leadership and safety The injured may be brought for treatment The facility itself may also be directly affected by the disaster If a disaster strikes, Medical Center employees are expected to follow the Medical Center’s Emergency Operation Plan (EOP) and know what is expected. Here are some of the roles that you may need to perform during and emergency: Provide care to the injured Minimize confusion by being calm and knowledgeable Provide support and services to other staff involved in disaster response The Medical Center has developed an Emergency Operation Plan (EOP) for dealing with disasters and emergencies. The EOP outlines what you and your Department are expected to do if a particular situation arises. Disaster drills are also conducted at least two times each year. Knowing what to do will help you stay calm in a disaster. Be prepared: Locate where the Emergency Operation Plan (EOP) in DMS Be familiar with the plan’s contents Respond to each drill as if it were a real disaster When a disaster strikes, the normal operation at the Medical Center may change. Response to the emergency is generally directed by a Command Center, Emergency Operations Center, or some other designated group. This helps promote effective communication and safety. Disasters and emergencies are generally classified as “external” and “internal.” External disasters are emergencies that take place outside your facility. Internal disasters and emergencies that take place inside the facility.

    13. 13 Emergency Management Review the information in the EOP that applies to you and your department prior to a disaster. Knowing what to do will help you respond calmly and effectively. Depending on the scope of the situation, expect to: Maintain normal working patterns, but stand by. DO NOT plan to leave the facility unless you are released by your manager If directed, stop nonessential functions and prepare for reassignment When a disaster strikes, the Medical Center’s Emergency Operation Plan (EOP) may be activated: Typically, a message is sent out on the overhead paging system to indicate what type of disaster has occurred. The paging code for disaster is code Orange. Review the information in the EOP that applies to you and your department prior to a disaster. Knowing what to do will help you respond calmly and effectively. Depending on the scope of the situation, expect to: Maintain normal working patterns, but stand by. DO NOT plan to leave the facility unless you are released by your manager If directed, stop nonessential functions and prepare for reassignment In certain types of disasters, internal utility system interruption may occur. Downed power lines can cut electrical power to lighting and equipment. Broken pipes cause loss of running water and toilet flushing. Phone lines can overload or be damaged. This will require you to use other methods of communication. If oxygen lines break, alternate oxygen sources will be needed for oxygen-dependent patients.

    14. 14 Fire & Life Safety Life Safety Fire can only occur when Fuel, Heat and Oxygen combined in a fire triangle. By keeping these elements from coming together, you can prevent fires. In a fire, think P.C.A.E P – Patients are to be removed from immediate danger C – Contain the fire by closing doors A – Activate the alarm system by pulling the fire alarm box and by dialing extension 2222 E- Extinguish the fire with a fire extinguisher only if safe to do so Fire safety calls for a team effort. A fire plan, fire drills, and working with the local fire department are parts of that effort. The most important part of the team, however, is you. Hospital fires can be dangerous because moving patients is not easy. The key will be to gain time. Even if the fire does not look big, after removing the patient from immediate danger, contain the fire by closing the door and pull the alarm and dialing extension 2222. Smoke can make it hard to see, breathe and think. Smoke can make it harder to escape. Closing doors will contain the fire and limit the spread of smoke in the hospital, giving you the time needed. This simple action can gain 20-40 minutes of safe time. It is important to know your surroundings if a fire occurs. Do you know where these items are in your department? Alarm pull stations Extinguishers Fire Doors Patient transportation equipment Exits Can you close your eyes and picture where the alarms and extinguishers are in your work area? When you are done with this newsletter, the first thing you should do is locate these items in or near your work area. Knowing where these items are in advance will help you act quickly and prevent the loss of life and property. When moving or evacuating patients in an extreme emergency, move people to a smoke-free area on the same floor. Move those closest to the fire first. Use the stairs to move down to a floor that is safe. Do no allow anyone to use the elevators. Smoke can confuse you, making escape more difficult. Smoke is lighter than air and rises, so stay low where you can breathe the best air even if it means crawling. Patients who are able to walk should be moved in a group. Provide blankets or towels for protection as they move to safety. Since beds can block halls, they should not be used to move patients unless nothing else can be used. Use techniques taught in the fire certification class to get patients to safety. Although you must get people away from the fire, you must also move to an area that can support any necessary medical equipment. Think ahead of time where that will be or bring the medical equipment with you. Take patient records with you so that you can account for everyone later and to facilitate the necessary on-going treatment. If you need to open a door on the way to your exit but you are not sure is there is fire burning behind it, first feel the door with the back of your hand first. If hot, do not open it, since a burst of flames could come at you. If you must open the door, stand behind it to protect yourself, and open slowly. Always remove the patient first in the event of any type of fire if it is safe to do so. An ABC extinguisher can be used for all types of fires. Never use a type A or water extinguisher to fight electrical fires. Check what kind of extinguishers you have in your work area. Never block fire doors from closing by the placing of either equipment or doorstops. A piece of improperly stored equipment could slow down or even prevent exit in a fire. Fires occur when you least expect, so keep passages and exits clear at all times. Remember P.A.S.S. when operating a fire extinguisher P: Pull the pin on top of the extinguisher. A: Aim at the base of the fire. S: Squeeze the extinguisher trigger. S: Sweep over the fire. Don’t try to put out a fire that is too big for you. Your time will be better spent alerting others. The fire extinguisher will only last for a few seconds, so remember to aim carefully. A sweeping motion will ensure that the base of the fire is saturated. In a fire, thing P.C.A.E. Familiar yourself with the written fire plan for your department. For any questions contact Security or Environmental Health & Safety.

    15. 15 PC Facility Codes

    16. 16 Hazardous Communications If a container has lost its label, and the liquid is clear and has no odor. If it’s unlabeled, assume it’s unsafe. Also, many hazardous chemicals have no smell, so never sniff anything on purpose. Flammable is a physical hazard because it tells you that the chemical can be ignited easily. Toxic is a health hazard, meaning it could cause sickness or even death. Explosive could cause physical harm from a rapid and violent expansion of gases. A sensitizer is a health hazard because it causes a large portion of exposed people to develop an allergic reaction after repeated exposure. An irritant is a health hazard because it causes a reversible inflammatory reaction at the site of contact. A carcinogen is a health hazard. Carcinogenic chemicals are those considered to cause or promote cancer. Compressed gas represents a physical hazard because if tanks are handled improperly, they could be propelled with enough force to blast through a wall. Corrosives are a health hazard because they erode things they touch and can cause damage at the site of contact. Corrosives are commonly found in cleaners and solutions, and in many pharmacy or laboratory products. Keep containers tightly closed when not in use and in their proper storage location. Don’t put yourself or co-workers in danger. Keep work areas clean and dispose of chemicals you no longer need using approved disposal procedures. You should not eat, drink, chew gum, apply make-up, etc. in areas where hazardous substances are in use. Some chemicals will have long term or chronic effects. Others have immediate or acute effects like nausea/vomiting, rash, headaches, and more. If a hazardous substance splashes in your eyes, you should immediately rinse with water for 15 minutes and then seek medical attention. Your eyesight is priceless. Remember, if you think you could get splashed, wear the appropriate personal protective equipment. For a hazardous spill, take quick action with the appropriate spill kit and communicate the occurrence to your supervisor. Don’t let untrained employees clean up a spill for a chemical they have not received training on. Many chemicals don’t pose a risk, but others can be harmful if handled improperly. To reduce the risk of chemical illness and injuries caused by chemicals, the Hazard Communication Standard has been developed by the Occupational Safety and Health Administration (OSHA). You have “THE RIGHT TO KNOW” about the hazards you are exposed to at work and a responsibility to use safe practices at all times. Chemicals come in solid, liquid and gas form. When handled improperly, some chemicals can cause illness ranging from skin rashes to more serious health hazards. Other chemicals can cause physical hazards like fires or explosions. The purpose of the Hazard Communication Standard is to provide information. You receive this information from labels and from Material Safety Data Sheets (MSDS). Always read the label before and every time you use any chemical. The label and MSDS inform you about safe handling practices of the chemicals you work with. The Medical Center is required to have a written Hazardous Communication Program. It should contain information on: OSHA Standards Safe procedures List of hazardous chemicals Labels and MSDS forms Training procedures Steps to be taken in an emergency Labels provide an immediate source of information and tell you whether or not a chemical is hazardous through warning works like “corrosive” or “toxic.” They communicate the chemical’s name, who made it, emergency phone numbers, why it’s hazardous and how to protect yourself. Labels come in many forms. A box on the label itself is sometimes used to represent levels of risk for health, fire and reactivity with a numbers ranging from 0 (minimal hazard) to 4 (severe hazard). An additional box can tell you about special hazards. Study it carefully. A Material Safety Data Sheet or MSDS is an important source of current and reliable information on hazardous materials. It contains more complete information than a label. Manufacturers supply MSDS to the Medical Center. Although they can differ in format, they all must provide the same information. If you don’t know where MSDS forms or the written Hazardous Communication Program are in your work area, check with your supervisor. They should be readily available to you on your shift.

    17. 17 Hazardous Communications Section VI – Health Hazard Data Chemicals can enter your body through breathing, skin contact, or swallowing. Section VI tells you how you could get exposed, what effects to expect if you are exposed, and what to do about it. Remember, it’s important to know what to do in an emergency before you get into the emergency. Section VII – Precautions for Safe Handling and Use Section VII gives you vital information on handling and use. Here you will find out exactly how to handle a spill, the method of waste disposal, and any special precautions you need to take. Section VIII – Control Measures Section VIII details how to prevent exposure through the use of protective clothing. These include face shields, respirators, gowns/suits, gloves and boots. Remember, Safety First Most accidents occur when you’re in a hurry. Even if it’s inconvenient, your safety is important. Read the MSDS. Protective clothing can be uncomfortable and hard to work in when you’re not used to it, but wear it anyway. It’s more comfortable than getting injured. Looks can be deceiving. If you don’t know what the substance is, assume it’s unsafe. Some chemicals cannot be recognized as hazardous by their look or smell. Check with Environmental Health & Safety to find out how detection and the release of these gases are monitored, if needed, in your work environment. Read the label and MSDS before using a chemical. Remember, when in doubt about a substance’s use or handling, ask your supervisor or Environmental Health & Safety. NFPA label Red = Fire Hazard (Flammable chemicals such as gasoline, oxygen, etc.) Blue = Health Hazards (Carcinogens and similar dangers to health.) Yellow = Reactivity Hazard (Radioactive dyes and other substances.) White = Other Hazards (Poisons, corrosive materials, explosives, etc.) Reactivity tells you that the substance reacts violently with water or can explode at higher temperatures. Use the following information to help you become familiar with the MSDS (Material Safety Date Sheet). This standard form with 8 sections has been developed by the Department of Labor: Section I The Basics Section I contains the basics. It tells the name of the product or chemical, who made it, and what phone number to call for technical information or emergencies. Section II – Hazardous Ingredients/Identity Information Section II tells you the chemical and brand names of the components of a substance unless it is a trade secret. Assume a substance is as dangerous as its most hazardous component. Section III – Physical/Chemical Characteristics Section III describes physical characteristics of the substance including boiling and melting points, evaporation rate, solubility and normal appearance and odor. Chemicals can change with age, evaporation, and temperature. Beware! Changes could indicate trouble. Section IV – Fire and Explosion Data Section IV explains fire and explosion hazards, and can help you understand the physical risks you face when working with a substance. The flashpoint tells you when to worry about flammable vapors. The lower the flashpoint, the more dangerous the substance. Section V – Reactivity Data Section V tells you how reactive or unstable a substance is, and what conditions to avoid. Remember, never mix chemicals unless trained to do so because some mixtures could produce hazardous gases or worse.

    18. 18 Electrical Safety Medical Center employees need to think and act when they see electrical hazards. Everyone needs to keep the workplace safe from electrical hazards. Report all accidents and equipment problems immediately. Hospital Grade Plugs and Cords must be used where there are patients. These plugs have three prongs and a green dot. Both the plug and the cord are heavy duty. The three prong plug grounds the electrical current through the third prong. The heavy duty cord and plug are not as easily damaged as ordinary plugs. The hospital grade cords and plugs provide additional protection from short circuits and electrical current leakage. Hospital grade outlets provide stronger prong tension which secures the plug more firmly in the socket. NEVER USE ADAPTER (or “CHEATER”) PLUGS. The hospital maintains documentation that its electrical Equipment is safe. But you should also check for hazards every time you use electrical equipment. Biomedical Engineering inspects the Medical Center’s medical equipment. Be sure to check that the item has been inspected by looking for the inspection sticker or tag. As long as the equipment is not outside the inspection period, it is fine to use. A visual inspection for loose parts and cracks in the plastic should be made each time you use an outlet. Likewise, outlets should be tested each time you use a plug to make sure that the plug stays securely in place. Cables, especially on movable equipment, need to be checked for wires that have become exposed and insulation that has become frayed. You should always unplug a cable or cord by the plug, never yanking it by the cord. You should always coil your cords to avoid kinking and damage. Electricity travels through water easily and can give you a shock if you touch an electrical machine at the same time that you touch water. You should never run over a cord or the plug with a rolling cart. DO NOT USE EXTENSION CORDS. If there arises the need for one, contact the Biomedical Engineering for assistance . Patient electrical equipment is maintained by two departments: Biomedical Engineering Responsible for all patient care equipment external to the wall, removable and electronic. Engineering Services Responsible for all electrical equipment and wiring within the wall and all non-patient care equipment. Problems with electrical equipment should be reported to the appropriate department, and an appropriate work order completed.

    19. 19 LMP Workplace Safety Kaiser Permanente and the Coalition of Kaiser Permanente Unions believe that an injury –free workplace is the goal and responsibility of every physician, manager and employee, and an essential ingredient of high-quality, affordable patient care. Working in Partnership, we are establishing the health care industry standard by setting the goal of eliminating all causes of work-related injuries and illnesses, so as to create a workplace free of injuries. Our goal is to eliminate workplace injuries throughout Kaiser Permanente. Foster a Culture of Safety by engaging all staff Reduce workplace injuries Involve employee safety in Operations Discuss Safety issues at department staff meetings What Role can you play in Workplace Safety (CWPSS)? Be accountable for your personal safety Help keep your co-workers safe Work Safely at all times Report all safety hazards and incidents immediately Follow all safety rules and safety procedures Encourage safety awareness, work safely and injury prevention Safety Observations and Incident Investigations are the keys to reducing injuries in the workplace environment. Safety Observations are a fundamental component in creating a culture of safety. Why Safety Observations? Focuses on preventing injuries by observing employees working in their normal environments Are Proactive instead of reactive Assumes employees will change their behaviors as a result of a verbal interaction Serves to heighten the general awareness of safety as an expectation Identifies risks in both actions and conditions Above all, gives managers and staff an opportunity to focus on doing work safely

    20. 20 LMP Workplace Safety Kaiser Permanente and the Coalition of Kaiser Permanente Unions believe that an injury –free workplace is the goal and responsibility of every physician, manager and employee, and an essential ingredient of high-quality, affordable patient care. True False Correct answer: True 2. Our goal at Kaiser Permanente is to eliminate workplace injuries. What and how can you contribute? A. Discuss Safety Issues at dept staff meetings B. Be accountable for your personal safety C. Report all Safety Hazards and incidents immediately D. Think “Safety Begins With Me!” E. All the Above Correct answer: E 3. The ultimate purpose of the incident investigation is to find the root cause and recommend an action plan to prevent recurrence. True False Correct answer: True 4. When an injury occurs the employee reports injury to the manager immediately. The Manager reports the incident within 24 Hours and the document findings from the Incident Investigation are conducted within 7 days. True False Correct Answer: True 5. How much is the fine for not reporting injured workers who are hospitalized? $100 $7,000 $1,000 Correct answer: $7,000 Incident Investigations The purpose is to establish and maintain an effective workplace safety incident investigation process in a way that ensures methodical examination, determination of facts and key contributing factors, and appropriate measures to prevent recurrence of incidents. The Incident Investigation process contains 10-Steps: Employee is injured and immediately notifies their Supervisor/Manager Manager Reports the Incident within 24 hours An investigation team is formed Determine the facts Determine the key factors 6. Determine systems to be strengthened 7. Recommend an Action Plan to prevent recurrence 8. Document findings within 7 days 9. Communicate findings 10. Follow-up and close action plan If your Injured at Work, What should you do? Report it to your Supervisor, Manager, or floor Supervisor right away and seek Medical Attention. You will also receive a Division of Workers Compensation Claim Form (DWC-1) within 24 hrs. For Needle Sticks and First Aid, visit Employee Health, located North 3, lower level (818) 375-3744. For other work related injuries, visit Occupational Health, located North 2, (818) 375-3767 After Hours & Weekends, visit Urgent Care or the Emergency Room. Please inform the receptionist you are seeking care because of a workplace injury. REMEMBER: If there is any hospitalization or fatality, your manager needs to report the Injury immediately within 8 hours to the EH&S Manager. If it is not reported within the specified time, there could be a Cal-OSHA fine of $7,000 that will be charged to the department.

    21. 2010 Joint Commission National Patient Safety Goals Patient Safety Goal #1: Improve the accuracy of patient identification Use at least two patient identifiers when providing care, treatment or services. Prior to the start of any invasive procedure, conduct a final verification process (such as a “time out”) to confirm the correct patient, procedure, site, using active – not passive – communication techniques. Label containers used for blood and other specimens in the presence of the patient. Patient Safety Goal #2 : Improve the effectiveness of communication among caregivers. For verbal or telephone orders or for telephonic reporting of critical test results, verify the complete order or test result by having the person receiving the information record and “read back” the complete order or test result. Measure, assess, and if appropriate, take action to improve the timeliness of reporting, and the timeliness of receipt by the responsible licensed caregiver, of critical tests and critical results and values. Standardize a list of abbreviations, acronyms, symbols, and dose designations that are not to be used throughout the organization. Implement a standardized approach to “hand-off” communications, including an opportunity to ask and respond to questions. “REMEMBER”: When reading back a number, sound out each number such as “one, five” (15) not fifteen, or “five, zero” (50) not fifty when reading back orders. Patient Safety Goal #3: Improve the Safety of using medications. Label all medications, medication containers (for example, syringes, medicine cups, basins), or other solutions on and off the sterile field. Reduce the likelihood of patient harm associated with the use of anticoagulation therapy. Identify and, at a minimum, annually review a list of look-alike/sound-alike drugs used by the organization, and take action to prevent errors involving the interchange of these drugs. Patient Safety Goal #7 : Reduce the risk of health-care associated infections Comply with current World Health Organization (WHO) Hand Hygiene Guidelines or Centers for Disease Control and Prevention (CDC) hand hygiene guidelines. Manage as sentinel events all identified cases of unanticipated death or major permanent loss of function associated with a heath care-associated infection. Wash your hands for a least 15 seconds.

    22. 2010 Joint Commission National Patient Safety Goals 1. How do we know that we have the correct patient? Correct answer: Check their ID band and ask the patient to state his or her name. 2. What two identifiers are used when administering medications or taking/giving blood? Correct answer: The patient’s Name and MRN on the order form and ID band 3. What is the process for taking verbal or telephone orders and critical test results that requires verification? Correct answer: Write the order out in its entirety “read” it back and wait for confirmation from the person giving the order/critical test result. 4. When does labeling of medication need to happen? Correct answer: Anytime you do not have continuous contact with the medication. 5. What are two easy and most effective ways to prevent the spread of infection? Correct answer: By washing your hands and if you take care of patients, by removing artificial nails. 6. When is medication reconciliation initiated? Correct answer: On admission 7. When a patient with suicidal ideation is admitted, what is completed on admission? Correct answer: Safety Screening Checklist for Patients at Risk for Suicide, located in DMS Policy/Procedure 1745. 8. Before starting a procedure, what 3 elements should you double check to make sure that they are correct? Correct answer: Patient (name, MRN), site, and procedure.

    23. 23 Security & Threat Management Which of the following are examples of skills and techniques for de- escalation? A. Stay professional and in control B. Remain non-threatening C. Provide choices and consequences D. All of the above E. None of these above Correct answer: D 2. All Physicians and employees are obligated to report any incident of threatened violence True False Correct answer: True At Kaiser Permanente, we want to ensure a safe environment for all employees, physicians, members, students, volunteers’ contractors and visitors in which to ensure the best care possible. Kaiser Permanente will not tolerate Acts and/or threats of violence. Acts and/or threats of violence include physical assaults and actions or statements which, either directly or indirectly, by words, gestures, symbols, intimidation, or coercion give reasonable cause to believe that the personal safety of the affected individual or others may be at risk. Intimidation includes behavior, which has the purpose or effect of inspiring fear in a reasonable person. All physicians and employees are obligated to report any incident where they believe they have been the subject of threatened violence arising out of their relationship with Kaiser or if they observe or otherwise learn of such conduct by any person employed by Kaiser, using Kaiser services or on Kaiser premises. Reports can be made to any of the following: Department Manager/Supervisor Human Resources Security Any employee or physician who is reporting acts and/or threats of violence must fill out the Threat Management Form. No retaliation of any kind will be taken against anyone who, in good faith, reports acts or threats of violence, or who participates in any action or investigation related to such complaints. Skills and Techniques for De-escalation: Acknowledge your own physical responses – try not to let them overwhelm or distract you. Stay professional and in control of yourself – remain calm. Remain non-threatening – verbally and physically. Listen carefully and empathetically for clues to the conflict – try to understand how the other person feels. Neutralize language to lower the emotional levels – try to restate accusations, blame and insults so they are more neutral statements of behavior that can be addressed. Don’t respond to manipulative or threatening behavior – focus on ending the conflict. Provide choices and consequences you can enforce – clear choices, clearly understood consequences. For more information, talk to your department manager, or contact the Security Department.

    24. 24 Radiation Safety Radiation Protection Concepts: The ALARA acronym is “As Low As Reasonably Achievable.” This program is in place to reduce the risk of the possible harmful effects of radiation. Every effort is made to keep the exposure levels well below federal and state limits. Time –If you decrease the amount of time you spend near the source of radiation, you will decrease the amount of radiation exposure you receive. Distance –The farther away you are from a radiation source, the less exposure you will receive. Shielding –If you use shielding (gloves, aprons, lead barriers) correctly you will decrease your exposure. Dosimeters: If you are required to wear a radiation monitoring device (badge) do not take them home, leave them in your car, put them in the wash, share them, or leave them near the source of radiation. Turn them in for monitoring in a timely fashion. Recognition – Radiation sources are marked by the International Radiation Hazard Symbol; a magenta trefoil on a bright yellow background. Did you know…..? There are sites to help you calculate your annual dose. One example is: http://www.oversight.state.id.us/radiation/ yourraddose.htm Barium used in medical imaging is not radioactive. In X-ray the machines generate the source of radiation. In Nuclear Medicine, the radioactive isotopes are the source of radiation, not the machine. In medical imaging, at a six-foot distance from the radiation source, the radiation reading is substantially reduced. This is why the cord on the portable x-ray machine will stretch to six feet. Only someone who is properly certified by the state may activate a x-ray machine or work with radioactive items. Not all lead aprons are made out of lead. To make them lighter they are made out of a lead equivalent. Remember: You will not glow after an x-ray. Ionizing Radiation: Defined: Energy and/or energetic particles that are emitted from radioactive atoms and/or x-ray machines that can ionize tissue. This ionizing radiation, if absorbed, may cause damage to tissue. Radiation to humans is measured in dose units traditionally called “rem.” The new Standard International (SI) term is “sievert” (Sv). Sources of Ionizing Radiation: Natural Sources of Ionizing Radiation: Approximately 80% of human exposure to radiation comes from natural sources: radon gas, the human body, outer space, rocks and soil. An average American is naturally exposed to 300 mrem/year or 3 mSv/year . Man-Made Sources of Ionizing Radiation About 20% of human exposure to radiation comes from man-made sources. Approximately 15% of this man-made radiation comes from medical imaging. Classification of Hospital Workers: Non-Radiation Workers: These are hospital workers who do not work with radiation as part of their daily activities. (Example: receptionist, transporters, and EVS staff.) Non-radiation workers are limited to 100mrem/year (1 mSv). Radiation Workers: People who work with or near radioactive materials or radiation producing machines and equipment. State and Federal exposure level for a radiation worker is 5000 mrem/year (50mSv), or 5 rem Effective Dose Equivalent. Kaiser’s level in 1000 mrem/year and 150 mrem per month. Sources of Ionizing Radiation from Medical Imaging Include: X-ray producing equipment found in departments such as radiology, orthopedics, surgery, ER, and mammography; from x-ray producing equipment, such as portable x-ray machines and c-arm fluoroscopy units, and from Diagnostic Radionuclides (radioisotopes) usually found in the Nuclear Medicine Department.

    25. 25 Radiation Safety 1. The average American is exposed to how much ionizing radiation from natural sources? 100 mrem/year 200 mrem/year 300 mrem/year 2. Non-radiation hospital workers have an ionizing radiation exposure limit of ? 100 mrem/year 200 mrem/year 300 mrem/year Tips To Avoid Contamination from Radioactive Material Wear gloves Avoid contact with objects or areas that may be contaminated Don’t eat, drink, or smoke in areas where radioactive materials are in use Don’t apply cosmetics or groom your hair while in the area Wash your hands when leaving the area Read and follow all signs and instructions Don’t handle radioactive materials unless you are trained to do so

    26. Quality Improvement

    27. 27 Infection Control

    28. 28 Infection Control 1. What is the single most important way of stopping the spread of MRSA that a person can do? A. Wash hands or use alcohol foam B. Eat more vegetables C. Exercise frequently Correct answer-A 2. What other ways is there to protect the patients and staff from the spread of infection besides Standard Precautions? A. Take a bath B. Use transmission based precautions C. Eat more vegetables Correct answer B

    29. 29 Airborne Transmissible Diseases

    30. 30 Tuberculosis For Patients with Known or Suspected TB Patients admitted to the hospital are placed in a negative pressure room with the ventilation to the outside. The “Airborne” signage provides instructions for visitors and healthcare workers. These rooms are entered by all through the anteroom not the hallway entrance The negative pressure room must be monitored with results recorded daily while in use. If the patient must leave his/her room for treatments or procedures, provide standard procedure/surgical masks to the patient, with instructions to wear it over the nose and mouth. Are there any special considerations in discharging a patient with known or suspected TB? Before a patient with known or suspected active TB can be released (discharged or transferred), an approval from the Department of Health Service — TB Control for the county or city in which the member resides, must be obtained. This is to ensure the patient will not expose others in the community. The discharge planner, infection preventionist, and the physician will work together to ensure TB Control has approved the patient’s release before discharge. Where can I find a copy of the Blood borne Pathogen Standard Policy? This Plan can be obtained on request from your Supervisor, Infection Prevention, Employee Health, and is available on the Kaiser Intranet Documentation Management System (DMS). What information does the Blood borne Pathogen Standard Policy provide? The facility’s Blood borne Pathogen Exposure Plan explains the employer and healthcare worker responsibilities in preventing exposure to organisms/pathogens that are transmitted by blood or other potentially infectious materials (OPIM). It includes information on: Types of Blood borne Pathogens Transmission risks Exposure prevention Work Practice Controls Engineering Controls Exposure and Post-Exposure treatment Use of Personal Protective Equipment (PPE) Reporting requirements

    31. 31 Blood borne Pathogens Besides blood name 2 other body fluids that are considered other potentially infectious material (OPIM) (choose 2) Possible correct answers: Fluid from around the heart Joints Lung Amniotic Semen Vaginal secretions 2. TB is caused from bacteria A. Mycobacterium Tuberculosis B. Avian Flu C. Streptococcus Correct answer A

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