Cone Health

1. Cone Health • 8,600 employees • Largest private employer in Guilford County • 5 hospitals (1,017 beds) • 60+ Physician Practices • Three Urgent Care Centers

2. Greetings From Our Chief Nursing Officer “Welcome! I am excited as you embark on your new professional journey. My wish is that you will sincerely enjoy working at Cone Health and will thrive in our practice environment.” Theresa Brodrick , RN, PhD, CNS, CNA Chief Nursing Officer

3. Vision Cone Health will be a national leader in delivering measurably superior healthcare.

4. Strategic Plan Our MissionWe serve our communities by preventing illness, restoring health and providing comfort, through exceptional people delivering exceptional care.Goal:Be in the top 10% nationally for: Quality Service Cost

5. Our Expectations To provide the best healthcare possible, we believe that everyone mustbe committed to the Cone Health Values and our New Operating Principles and Practices.

6. Our Values

7. Cone Health Operating Principles In caring for our patients, each other and our communities: • I use evidence based practices to provide safe and exceptional patient care. • I communicate honestly and directly with care and respect. • I include people with diverse backgrounds, experiences, and points of view. • I see it, own it, solve it, do it, and celebrate it!

8. Six New Practices • I keep patients safe by practicing the 4 R’s (right patient, right place, right time, right service). • I practice AIDET (acknowledge, introduce, duration, explain, thank you) for every patient interaction. • I assume the best intention and seek to understand. • I do not gossip; I take issues to the person who can do something about it. • I do what I say, when I say, and communicate.  If I can’t I clean it up. • I thank someone every day.

9. Our philosophy summarizes our beliefs Our beliefs are the basis for how we deliver care Our Model of Care outlines how we conceptualize our beliefs This model is based on theories of caring Professional Model of Care

10. Care Delivery Model • Our Relationship Based Care Delivery Model is how we operationalize our Model of Care and Philosophy • This model is patient and family centered Focuses on 3 Key Relationships • Self • Colleagues • Patient & Families

11. HIPAA and Corporate Compliance Special Note XXX “xxx” in front of the patient’s name = Strict Privacy When someone asks for that person by name, state, ”There is no record of that person being in the facility.”

12. HIPAA and Corporate Compliance Report Privacy Violations • Reports of a privacy violation are entered into the electronic Safety Zone Portal (SZP). Discuss first with your instructor, charge nurse or Cone Health Privacy Officer Safety Zone Portal

13. HIPAA and Corporate Compliance Gifts from Patients • • Patients who would like to honor a student should be referred to the Office of Fund Development.

14. Patient Care Partnership A Acknowledge I Introduce D Duration E Explanation T Thank You

15. Patient Care Partnership Acknowledge the patient and visitors. Say “hello.” A Introduce yourself and state your business. Why you are there and what you hope to accomplish. I Duration- If there is a delay in treatment tell the pt. how long the wait will be. D ExplanationTell the pt. why you are doing the treatment and/or giving the medication etc. E ThankYou- Thank the pt. for allowing you to care for him/her. T

16. The Patient Care Partnership Hourly Rounding with a Purpose 8 Behaviors important to Hourly Rounding with Purpose: • Use warm acknowledgement to reduce anxiety • Perform scheduled tasks • Address the 3 Ps (Pain, Potty, Positioning) • Assess additional comfort needs • Conduct an environmental assessment of the room • Prior to leaving the room, ask, “Is there anything else I can do for you?” • Tell each patient when you will be back • Document the round on the chart

17. Infection Control Hand Hygiene The expectation is that each healthcareworker (including students) will perform proper hand hygiene with and without wearing gloves Upon entering and exiting the patient’s room Cone Health policy Only use alcohol gel / foam provided by Cone Health, or soap and water.

18. Policies and Procedures • Cone Health Nursing Policies and Procedures are available online on the Intranet Homepage under the Resources tab. The Intranet is available on every department computer desktop directly or through Citrix. • Click on the icons for Citrix or the CH Intranet Homepage.

19. Policies and Procedures • CareNotes: Electronic Patient Education Resource • CareNotes provide information in English and Spanish on a • variety of topics: • Medications • Tests • Diagnosis • Labs • Procedures • You can find a link to • CareNotes on the Intranet • Homepage under Applications.

20. Policies and Procedures Computer Training Faculty should contact the Staff Education Department in order to schedule training (832-8173) Nursing students and faculty will be given computer instructions and access codes upon successful completion of the training exercise. .

21. Policies and Procedures Documentation Standards Do not sharecomputer IDs or passwords. Do not look atinformation in patient medical records unless you are assigned to the patient. (HIPAA Privacy Laws) Cone Health Employees must use the computer password assigned as student/faculty for documentation and not their employee password when in the student/faculty role.

22. Policies and Procedures • CBG Training • Nursing students/faculty will not perform patient glucose testing at this time. • Faculty and/or Students who are Cone Health employees are notpermittedto perform the testing while in the faculty/student role. • Students may work with the primary nurse/instructor in order to intervene as necessary r/t blood glucose test results and may chart the results in the patient’s documentation record.

23. Policies and Procedures • Risk Management • Any incident, which may have adverse consequences for patients, visitors, faculty/student should be reported immediately to Leadership on the department and a safety Zone Portal entry completed. • SAFETY ZONE PORTAL • Events that are inconsistent with Cone Health Policies & Procedures, or not part of routine care • Goal: Improve Quality & Safety • Leads to appropriate follow up • Event to be documented in patient chart • Do not document SZP record in patient’s chart

24. Policies and Procedures • Sentinel Event • A Sentinel Event Is: • An unexpected occurrence involving death or serious physical or psychological injury or the risk thereof • These events should be reported immediately. • Work with the clinical instructor and the patient’s primary care nurse to report. • See the “Sentinel Event” policy in the Administrative and Patient Care Manual)

25. Policies and Procedures

26. Policies and Procedures Red Rules • RED Rules are requirements that must be followed each and every time the occasion or situation arises • Because they are such a priority, they are considered REDto signify their importance. • RED Rules are rules that CANNOT be broken. • They are few in number and easy to remember. • They are associated with processes that can cause serious harm to patients.

27. Policies and Procedures Cone Health Red Rule #1 • A time out is completed before all invasive procedures. • Invasive procedures are described in policy number IV-P-39 located in the Administrative Policy Manual. Cone Health Red Rule #2 • All inpatients receiving medication or blood products, or undergoing any procedure, will have an identification band in place and identification will be confirmed.

28. Policies and Procedures Patients in Cone Health are identification by both: Name AND Medical Record #

29. Policies and Procedures • Ethical Issues • Cone Health offers Ethics Consultation for patients, families, medical staff and ancillary staff involved in patient care. • The patient’s primary nurse and your instructor can contact Pastoral Care to request an Ethics Consult The American Nurses Association (ANA) Code of Ethics for Nurses provides guidelines for practice.

30. Policies and Procedures • Rapid Response Team (RRT) • Provides early and rapid intervention for patients outside the ICU setting whose condition is deteriorating. • Critical Care team responds to a call for critical care expertise to the patient’s bedside to assist with stabilizing and transferring to a higher level of care as needed • CONDITION HELP • A Safety Net Program for Patients and Families • WHAT- Ability for patients and families to activate a Rapid Response Team to come to your room to work with your current healthcare team to address your concerns. • HOW - CONDITION HELP – Dial 2-1666 from any hospital phone

31. CONE HEALTH EMERGENCY CODES

32. Emergency Codes Code Gray – Restricted Access • What isCode Gray? • Response to an incident of civil unrest withinCone Health that threatens the safety of patients, visitors and staff. • Potential reasons to activate Code Gray include, but are not limited to: • Heightened emotional or behavioral response, even after de-escalation attempts • Visible weapons • Physical altercations • Hostage situations • Communication of threats

33. Emergency Codes • Code Gray – RESTRICTED ACCESS • When a “Code Gray” is announced: • Ancillary services and support staff avoid the area until “Code Gray – All Clear” is announced • All staff authorized to enter the restricted area must present appropriate identification

34. Emergency Codes Code Pink – Abduction When Code Pink is announced, some departments have specific assignments.All other available employeesshould: • Come into the hallways and stairwells. • Keep an eye on any nearby exits. • Call Security to report any activity that seems suspicious.

35. Cone Health isa Certified Chest Pain & Stroke Center Heart Attack Symptoms How to Recognize & What to Do

36. Chest Discomfort May Be a Sign of a Heart Attack • Pressure, heaviness • Squeezing, tightness • Burning • Lasts more than 2 minutes • May come & go Sometimes Heart Attacks only cause Pain in … • One or both arms. Back. Neck • Shortness of breath. Breaking out in a cold sweat • Nausea, vomiting. Light headedness • Extreme weakness, fatigue Other Signs of a Heart Attack

37. If a guest or employee has symptoms of a heart attack:- Notify an RN or other healthcare provider- Assist him into a wheelchair- Take him to the Emergency Department- If there is no ED available, call 911 for emergency careIf a patient has symptoms of a heart attack:- Notify the patient’s nurse or medical caregiver immediately

38. A Stroke Looks Like… Stroke Signs and Symptoms: • Numbness or weakness of the face, arm or leg…especially on one side! • Trouble seeing in one or both eyes!

39. A Stroke Looks Like… Stroke Signs and Symptoms: • Trouble walking, loss of balance or coordination! • “The Worst Headache of my Life” with no known cause!

40. Notify a Nurse or other Healthcare Provider! Callif you are not at the hospital! 911 What should you do if you think a patient or visitor is having a STROKE? Get Help Fast!

41. “Be FAST” You can make a difference in a stroke patient’s life! Facial Droop Eyes Double Blurred Speech TIME! Balance Arm Leg Weakness REMEMBER…

42. Banding Together for Patient Safety Cone Health is participating in the statewide program to implement standardized armband colors for improved safety.

43. Banding Together for Patient Safety BLUE: Blood Bank Bracelet The blood identification bracelet is now a blue armband. The armband will continue to have a patient identification number. Patient identification is done by the white arm band.

44. POLICY: All patient transfer/ lifting will be done safely and appropriately to protect the employee and patient from injury. All patient lifting, shifting, or transferring will be completed based on assessment, utilizing mechanical lift equipment and/or other approved patient handling aids. Consult with the Patient’s Primary Care Nurse and your nursing instructor for guidance. Safe Patient Handling

45. Tubes/ Slides Tubes & slides reduce friction and provide a safer, more comfortable move for patients and caregivers. Blue orOrangeTUBE - Lateral transfer - bed to stretcher MAXI SLIDE – boost patient in bed Students refer to clinical instructor and patient’s primary nurse for questions/instruction Safe Patient Handling

46. Safe Patient Handling • Maxi Move- Lifting and transfer device for the totally dependent individual • Able to lift from floor, bed, chair, toilet/bathing area and other areas • Safe to use as a transportation device throughout the facility • Able to double-task procedures - weigh individual during lifting and transfer activities • Has selection of standard sized slings from x-small to x-large and various specialty slings (e.g. amputee slings) • Refer to clinical instructor and patient’s primary nurse for questions/instruction.

47. Only approved abbreviations may be used. The list is found in Citrix / Resources / Policies & Procedures / Approved Abbreviations List. Also ‘Do Not Use’ list can be found on MD Order Sheet. Cone Health Guidelines Cone Health Approved Abbreviations

48. General Guidelines Team Communication Tools SBAR – Effective communication tool. Consistent and organized to promote patient safety Gather information prior to communication • Situation • Background • Assessment • Recommendations

49. General Guidelines Team Communication Tools HAND-OFF / HALL PASS • Internal and external transfer of care • Shift Report • Coverage for lunch / breaks • Critical Lab and Radiology Results • Uninterrupted time • Requires ability to ask questions

50. General Guidelines Student Parking Carpooling is strongly encouraged on each campus. Moses Cone Hospital– Students and faculty are required to part in the Wendover and Church Street parking lot. Wesley Long Hospital– Students must park in the employee parking lot located off N. Elam and Friendly avenues. *May have temporary modifications; confirm with Instructor* Women’s Hospital– Students may park in the Women’s Education Center parking lot. Turn onto Lendew Avenue from Green Valley Road. Park in the lower area of the parking lot. Annie Penn Hospital –Students may park in the employee parking lot located adjacent to the South Main Street exit of the hospital lot. Behavioral Health Hospital – Students must park in the upper middle lot and to the left of the building.