As people age, they continue to experience physical and emotional changes. These changes are the result of themany experiences and influences, including the genes we inherit and the lifestyles we choose. This review will outline the common changes that occur with age. It will provide some tips for helping you to remain sensitive to ourpatients.
Early Older Adulthood (60-75 years)
The average American lives to be 77.2 years old. Most adults will live well into early older adulthood. People in early older adulthood usually have at least one chronic disease. High blood pressure, arthritis, heart disease and cancer are the most common. Most people in this age group will need eyeglasses to read. Many will suffer from the loss of hearing associated with old age. Most women have gone through menopause. Many in this group require daily mediations.
People in this age group are beginning to lose friends and loved ones to the inevitable process of death and dying. Hospitalization may cause fear as patients confront their mortality. Other concerns relate to limited income, since many have retired. Fear of permanent disability may be a worry for hospitalized patients in early older adulthood. Arthritis is common in this age group. Older adults often experience both chronic and acute pain. Consistent use of the pain scale will help older adults evaluate their pain.
You can help to create an environment that is friendly to aging patients. Adjust lighting to help patients better navigate the hospital environment. Provide extra time for learning to help older adults retain the information presented. Use verbal as well as written instruction to help them learn. Make sure the telephone is within reach, the call light is close by and that the room is clutter-free to promote safety and independence.
Middle Older Adulthood (75-85 years)
The average 75-year-old has three chronic conditions and takes about 5 medications a day. Many in this group feel their body is “wearing out.” Almost all need glasses to see. Most have reduced hearing. Hospitalization can be frightening in particular ways for this group. Many have been struggling to live independently and most do not want to be placed in a nursing home. As a result of these fears, patients may make health decisions that are not in their best interest, like ignoring signs of disease, because they are afraid of the consequences.
People in this group are vulnerable to depression which may not be obvious to you. Assessment should include an evaluation of coping skills. Providing spiritual and social services can be especially helpful for this age group, sinceit can take time to get someone to open up about these issues.
Many patients in this group, like those in the previous group, live with arthritis pain. They may not talk about this pain unless you specifically ask about joint or muscle aches. Good pain management will help them participate in physical activities like walking and physical therapy.
Late Older Adulthood (85 plus years)
With age the number and severity of disabilities increases. Chronic diseases progressively get more severe and many patients are diagnosed with new illnesses. Most in this group are frail and increasingly dependent on other people to assist them with their daily tasks. Older adults fear changes to their routine, so a hospitalization can be particularly stressful.
Care for adults at this stage in life should focus on improving or maintaining function. Allow the patient to express needs and then tailor the care environment to meet those needs. Maintaining a user-friendly environment will promote independence.
Some older adults may not report pain due to fear of losing independence. Others have been living with arthritis andother pain so long that they no longer express their discomfort verbally. Look for nonverbal signs of pain including confusion, inability to ambulate, grimacing, and decreased range of motion. Adults in this age group have decreased cough ability and decreased swallowing skills. Aspiration precautions should be used with all frail older adults. In this age group, skin becomes thin. Patients become at risk for skin tears and pressure ulcers.
People of any age can become confused while hospitalized, but the likelihood is greater for older patients. Memory loss is not necessarily a part of the aging process. So if you speak with someone who seems to be losing memory, that patient should probably be evaluated for underlying illness. In many cases, we can find a cause and a solution. Confusion that is normal at admission may develop into delirium. This condition may indicate an underlying illness, such as infection, that needs to be treated. Frequent reminders about time, date, season and weather may help older adults regain a sense of security and confidence.
Patients who have lived this long have experienced many losses. Life review is common in this group. Many will enjoy telling you about “how it used to be.” Reviewing the past can help people achieve closure. Pastoral care and social work can provide assistance to patients beginning this profound and affecting final journey.
EMERGENCY TREATMENT OF PATIENTS (EMTALA)
Federal law requires that a facility take care of any patients who need emergency care, regardless of their ability to pay for care. Unless the patient is pregnant and in labor, a facility can transfer the patient to a more appropriate hospital once the patient has been stabilized and once the facility has verified that that the next facility has room.
First Connect Center LLC provides special education with regards to this legislation. You should be aware that if someone asks you about getting emergency treatment for any condition, you should refer that person to the Emergency Department or call the House Supervisor. It is against the law to send a patient away who seeks treatment for an emergency condition.
If you will be working in ER, please make sure you receive and complete First Connect Center LLC’s education module on EMTALA.
THE HIPPA PRIVACY RULE
A patient's right of privacy and confidentiality is protected by law. No one, including spouses, friends, or attorneys, is permitted to review the patient's medical record without prior written authorization, except as required by law (court order or subpoena) or other regulation.
To decrease the risk of uninvolved persons overhearing or seeing confidential patient information:
What is HIPAA?
The HIPAA Privacy Rule is a Federal Law that went into effect on April 14, 2003. The law protects the confidentiality of our patients’ protected health information, or PHI. Protection of patient privacy and confidentialityis also required by the Center for Medicaid Services (First Connect Center LLC) and the Joint Commission.
Healthcare has a tradition of privacy. People have kept patient information private as far back as the fourth century BC with the Hippocratic Oath. However, with the advanced communications technologies in use today, safeguarding the privacy of patient information is more of a challenge. The HIPAA Privacy Rule reflects these new concerns.
The HIPAA law is complex. Protecting patients’ healthcare information involves two considerations:
Privacy and Security. There are differences between the two that you should know.
“Privacy” is concerned with the disclosure of information about a patient to the patient directly, or to those to whom we reasonably believe the information can be disclosed if it is consistent with good health care professional practices. (See HIPAA Privacy.)
“Security” is concerned with the processes, procedures, and technologies that we use to make sure that the people viewing or changing the information are really the ones who are authorized to do so. (See HIPAA Security.)
What information is protected?
All patients (including celebrities and our own employees) have the right to privacy, and this extends to their personal health information, referred to in the HIPAA Privacy Rule as "Protected Health Information," or PHI.
What types of information is protected?
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Paper records
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Computerized information
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Oral communication
What are examples of PHI?
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Face sheets
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Results of exam/evaluation
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Test results
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Treatment and appointment information
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Patient bills
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Photographs
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Paper records
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Computerized patient records and information
RELEASING PATIENT'S PROTECTED HEALTH INFORMATION (PHI)
What information can be released only with the Patient's approval?
As a general rule, Medical Records can only be released to outside parties with the patient's approval, or if there is alaw requiring release. (See following section, below.) Again, as a general rule, this information can be released to outside parties only by the Health Information Management Department (Medical Records), or in some cases, the Records Custodian of each department.
Who are the Records Custodians?
Each department or unit that maintains PHI has a "records custodian" to approve access to PHI, for purposes otherthan routine treatment, payment or operations purposes. Records Custodians may include department leaders and supervisors, unit secretaries, or other persons designated by department leaders
What are the Authorization Requirements?
A written authorization, signed by the patient or legal representative, must be obtained for any release
of informationexcept when the release is required by law, or when the information is used for the routine purpose of treatment, payment, or operations. For example, we are permitted to share our patients' PHI with other providers such as physicians to treat the patient, or we may submit PHI to insurance companies to obtain payment, all without patient authorization.
What about releasing Patient's Protected Health Information (PHI) verbally in discussions with friends and family?
When the patient is present and has the capacity to make his or her decisions, we may disclose PHI to friends andfamilies, if one of the following conditions is met:
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We obtain the oral agreement of the patient or legal representative;
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We provide the patient with an opportunity to object to the disclosure, and the patient does not object;
When the patient is not present, or when the patient is incapacitated due to an emergency, it's okay to make the disclosure if our decision is consistent with good health care professional practices. For example, when a patient is brought to the emergency room, we may inform relatives and others involved in the patient's care that the patient has suffered a heart attack and we may provide updates on the patient's progress and prognosis when the patient is unable to make decisions about such disclosures.
Whatever information we disclose to the patient's friends or families should be directly relevant to that person's involvement. For example, a neighbor picking up a patient can be told that the patient is unsteady on his feet; however, the neighbor should not be told that a tumor was removed.
How is Protected Health Information handled for Minors?
If a patient is a minor (under 18 years of age), the patient's parents or guardian may receive or direct use anddisclosure of PHI on behalf of the patient, except for "Emancipated Minors."
Emancipated Minors are children who have been released from the control of parents or guardians, and may control their own PHI, in the same manner as an adult:
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Anyone who is not yet 18 years old, but has been legally married and is now divorced, or a widow or widower.
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Anyone who is not yet 18 years old but is maintaining his or her own residence and is self- supporting. Areasonable effort to contact parents must be made.
Minors Who Are Not Emancipated: Any minor (under 18 years of age) may without parents' consent, approval, or notification have the right, in the same manner as an adult, to protect their health information for the voluntary treatment of:
BODY MECHANICS
With the use of proper body mechanics and ergonomics (the undersigning of the work place to fit the worker), most injuries are preventable. The following prevention points, when adhered to, will promote safety.
Lifting
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Assess the situation and plan how to accomplish it before beginning.
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Use the muscles of the legs, hips and arms – the strongest in the body. Keep a neutral spine.
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Bend knees and hips avoid bending at the waist, and lift with your legs, not you back
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Keep feet at shoulder width to provide a broad base of support.
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Make sure the object is close to you, do not-over reach, and carry the load close to you.
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Avoid lifting higher than your waist.
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Push and don’t pull.
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Ask for help.
Sitting
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Use chairs that provide support to the back, particularly the lower back.
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Both feet should be able to rest flat on the floor.
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Avoid slouching, walk around and stretch occasionally, or change position often to avoid strain.
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Avoid twisting and over-reaching
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Position yourself directly in form your work and make sure your work is at eye-level to avoid neck strain.
Standing
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Stand close to your work area with your back erect, chin in, pelvis tucked under and knees slightly flexed.
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Maintain a broad bas with your feet and ensure even weight bearing.
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Avoid prolonged positions and slouching – stretch occasionally.
Back Care and Points for Prevention
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Use good posture at all times and proper body mechanics.
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Change position frequently.
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Exercise regularly and eat a well-balanced diet to control your weight.
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Ensure enough rest at night.
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Practices stress reduction techniques, such as yoga and relaxation.
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Ask for help in lifting or moving heavy objects.
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Keep work area safe – clean up spills, wet floor signs; ensure no loose equipment, boxes or flooring, noloose power cables, close drawers. Notify appropriate personnel immediately, such as maintenance.
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Wear shoes with non-skid soles.
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Walk and don’t run.
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Report any accidents to staff patients or visitors to supervisor immediately.
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Monitor safety of patients closely.
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Ensure breaks are applied to wheelchair or bed when moving patients.
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Adjust height of bed or table waist / mid-to-upper thigh level when moving patient.
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Maintain ergonomics at all times.
UNDERSTANDING CULTURAL DIVERSITY
Ineffective culturally diverse relations can lead to prejudice, discrimination and racism.All three are due to a combination of factors.
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Lack of understanding of culturally diverse groups other than one’s own.
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Stereotyping of members of culturally diverse groups without consideration of individuals within the group.
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Judgment of culturally diverse groups according to standards /values of one’s own group.
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Assigning of negative attributes to the members of other culturally diverse groups.
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View of the quality and experience of other groups as inferior to those of one’s own group.
ETHNOCENTRISM
Because culture influences people so strongly including the way they feel, think, act, and judge the world is not typical for people to subconsciously restrict their view of the world to the point of inability to accept other cultures. This is called ethnocentrism.
Ethnocentrism can prevent one from accepting others and can lead to clash of values, shaky interpersonal relationships and poor communication.
APPROACHES TO MINIMIZE CULTURAL CONFLICTS IN THE MEDICAL SETTING
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Deliver patient care that emphasizes the interrelationships among persons, cultures, health andmedicine.
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Facilitate the medical employees/client’s relationship though the development of special resources suchas translators and multicultural workforce.
CROSS CULTURAL COMMUNICATION FOR HEALTHCARE EMPLOYERS
In the business of healthcare, 90% of activities involve communication. Achieving effective communication is a challenge to managers even when the workforce is culturally homogenous. Communication is the exchange of meaning. Communication includes any behavior that another human being perceives and interprets. The meaning interpreted by the receiver may be different from the information being conveyed by the communicator. Translating meanings and behaviors, that is into meaning is based on a person’s cultural background and is not the same for each person. The greater the differences in backgrounds between the sender and the receiver the greater the difference in meaning attached to particular words and behaviors. Cross-cultural communication occurs when a person from one culture sends a message to a person from another culture.
There are ways to increase the chances to accurately understanding people who speak a different language.
VERBAL BEHAVIOR
NON-VERBAL BEHAVIOR
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Visual restatements (use pictures, graphs, etc.)
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Gestures (use facial and hand gestures).
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Demonstration: Act out the themes
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Pause, more frequently
ATTRIBUTION
COMPREHENSION
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UNDERSTANDING: Do not assume that they understand. Assume that they do not
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CHECK: Have the people repeat their understanding
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BREAKS: Take more breaks, second language comprehension is exhausting.
MOTIVATION
STRATEGIES TO COMMUNICATE EFFECTIVELY
Strategies to overcome our natural parochial tendencies do exist. With care, the default option can be avoided. We can learn to understand and control our own cultural conditioning. In facing foreign cultures, we can emphasize description rather than interpretation or evaluation and thus minimize self- fulfilling stereotypes and premature closure. We can recognize and use our stereotypes as guides rather than rejecting them as simplification. Effective cross-cultural communication pre-supposes the interplay or alternative realities. It rejects the actual or potential domination of one reality over another.
Miscommunication is a frequent problem in healthcare organizations. The most obvious case is when the patient and the hospital personnel do not speak the same language. Also patients and staff’s may operate on different beliefs, values, clocks, causing confusion and resentment for all parties.
TIME
When is the right time? People of different cultural background may give different answers to this question. Some people count time by a watch. They see time as money saved, spent, squandered. Others see only the rhythm or cycles of growth of people or things.
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Make allowances for the fact that differences about time can be legitimate cultural differences. Do not jump to conclusions that others are irresponsible. Do not assume that you are stupid or insensitive because you don’t manage time the way they do.
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If you cannot adapt to the other person’s sense of time, negotiate something that will for both of you.
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Remember that culture runs deep. It is one thing to make an agreement and another to create a habit. Changes here will take patience, persistence with others and yourself.
SPACE
How large space is depends on your background and culture. Getting too close may make another think you are intrusive, aggressive, or pushy. Staying too far may give them the impression that you are cold, impersonal, afraid ordisinterested.
TOUCHING
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I have power
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Hello/Goodbye
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I want you to understand
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I like you
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I want to congratulate
COMMUNICATE
When you communicate, be aware of:
DISCHARGE PLANNING
This Fact Sheet discusses a hospital’s responsibilities to assist with nursing home placement and right to challenge hospital discharge decisions. All of the information applies only to persons on Medicare, although there are similar rights under other health insurance programs.
WHAT IS HOSPITAL DISCHARGE PLANNING?
Hospital discharge planning is a service to assist patients in arranging the care needed following a hospital stay. Discharge planners help arrange services including home care, nursing home care, rehabilitative care, out-patient medical treatment and other help. Hospital discharge planning is usually handled by the hospital’s Social Services Department.
If a patient needs help arranging nursing home care, ask the doctor to contact the Social Work Department. If a hospital discharge planner does not contact the patient within a short time, contact the Social Work Department directly for assistance.
Discharge planning services in Medicare certified hospitals must meet the following standards:
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Hospitals must identify and evaluate persons who may need discharge planning assistance.
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The evaluation must be done on a timely basis and must determine the need for services after the hospital stayand the availability of these services.
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The results of the evaluation must be discussed with the patient or patient’s representative.
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If requested by the patient’s physician, the hospital must help develop and implement a discharge plan for thepatient.
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Discharge planning must be provided or supervised by a social worker, registered nurse or other appropriatelyqualified person.
If a patient needs nursing home care, the hospital’s discharge planner should provide information about
local nursinghomes, and should help identify homes that have vacancies.
The hospital cannot force a patient to go to any particular nursing home or discharge a patient to a nursing home without the patient’s legal representative’s consent. If the hospital believes that a patient no longer needs hospital care and is refusing appropriate discharge, it must issue notice to the patient of its determination. This notice can cause the patient to become responsible for payment of continuing hospitalization, subject to the patient’s right to appeal. The notice and appeals rights are discussed below.
PATIENT RIGHTS AND RESPONSIBILITIES
First Connect Center LLC employees must uphold their role as advocates and recognize the consumer/patients’ right to dignity, individual value systems, access to medical care and confidentiality. In being that advocate, nurses should be able to speak up to protect the health and safety of patients in their care without fear of retaliation.
THE PATIENTS’ BILL OF RIGHTS
The Patients’ Bill of Rights was conceived in 1998 by the U.S. Advisory Commission on Consumer Protection and Quality in the Heath Care Industry. Its purpose is to promote healthcare quality, and support the public as they navigate through the healthcare system. The seven areas of rights and responsibilities are:
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Information Disclosure: Patients have the right to accurate and easily-understood information about their healthplan, health care professionals, and health care facilities. If a patient speaks another language, has a physical or mental disability, or just don’t understand something, assistance must be provided so that the patient can make informed health care decisions.
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Choice of Providers and Plans: Patients have the right to a choice of health care providers who can providehigh-quality health care when needed.
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Access to Emergency Services: Patients who have severe pain, an injury, or sudden illness that convinces themthat they are in serious danger, they have the right to be screened and stabilized using emergency services. These services should be provided whenever and wherever needed, without the need to wait for authorization and without any financial penalty.
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Participation in Treatment Decisions: Patients have the right to know their treatment options and to take part indecisions about their care. Parents, guardians, family members, or others that a patient selects can represent them if they cannot make their own decisions.
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Respect and Non-discrimination: Patients have a right to considerate, respectful care from doctors, health planrepresentatives, and other health care providers without discrimination.
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Confidentiality of Health Information: Patients have the right to talk privately with health care providers and tohave their health care information protected. Patients also have the right to read and copy their own medical record. Patients have the right to ask that a doctor change their record if it is not accurate, relevant, or complete.
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Complaints and Appeals: Patients have the right to a fair, fast, and objective review of any complaint they haveagainst their health plan, doctors, hospitals or other health care personnel. This includes complaints about waiting times, operating hours, the actions of health care personnel, and the adequacy of health care facilities.
THE SIX ETHICAL PRINCIPLES OF THE PATIENT’S BILL OF RIGHTS
The Patients' Bill of Rights supports six basic principles of ethics:
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Autonomy: Independence, self-direction, and freedom of choice. When patients choose a healthcare provider, a healthcare facility, or make decisions about treatment, they are exercising autonomy. The Patients' Bill of Rights supports autonomy by supporting the patients' right to the choice of plan and healthcare providers that ensures access to appropriate health care. The healthcare professional's duty is tosupport patients' autonomy by ensuring that patients understand their treatment options.
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Beneficence: Acts of charity or kindness. As a principle of ethical care, it means that treatment provided is for the good of the patient. The principle of beneficence means that patients should receive considerate and respectful care and have the opportunity to let healthcare workers know when they are not receiving the quality or value of care necessary. Healthcare professionals should assist patients to voice their concerns through a complaint procedure. The principle of beneficence indicates that healthcare providers must provide competent care so the patient is safe and is treated with respect.
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Confidentiality: Private or secret. As a principle of ethical care, it means that information about patients and their care is protected and shared only with those who have the right or the need to know. The patient also has a right to know how information about him will be used by others, and who will receive that information. The principle respects that patients have the right to know about their treatment and to reviewtheir own records.
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Fidelity: Faithfulness, as in a pledge or duty. As a principle of ethics, it means healthcare workers have a duty to be patients' advocates and to protect patients' rights. Fidelity is demonstrated by upholding the Patients' Bill of rights.
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Veracity: Truthfulness. As a principle of ethics, it means supporting both information disclosure and the right to make treatment decisions as described in the Patients' Bill of Rights. Correct and truthful information helps patients to make informed choices.
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Justice: Impartiality or fairness. As a principle of ethics it means that all patients and their families are treated the same, without favoritism or discrimination based on race, color, gender, economic status, social status, or any other personal trait. All people have the right to fair and unbiased treatment.
INFORMED CONSENT
Informed consent is a process in which consent is obtained for a treatment or healthcare service when the patient knows about and understands the treatment, including its implications, benefits and risks, and the alternatives. The patient must know they have the right to accept or refuse the treatment or service.
Before undergoing treatment, patients must give consent. Some patients may not be capable of giving consent because of age, mental competence, or other possible factors. As such, a designated guardian (such as parent, relative, friend or caregiver) represents that patient. Healthcare workers must ensure that the consent is "informed"and signed by either the patient or the guardian.
ADVANCE DIRECTIVES
Advance Directives: Documents written in advance of serious illness or injury which state choices for medical treatment or names someone to make treatment decisions on behalf of that individual should he/she become unable to make or communicate such decisions. Advance directives promote an individual’s control over his/her own healthcare decisions. All patients entering the healthcare system must be given the opportunity to complete an advance directive document which will define the patients' preferences in end-of-life decisions or at any time that they are unable to convey their own wishes regarding healthcare. Advance directives are voluntary and are supported by the Patient's Bill of Rights Dependent upon state law, there may be two or more types of advance directives: the living will and the durable state of attorney/healthcare surrogate, as examples.
Living Will: A "Living Will" is a document that gives direction about the medical care, and limitations of medical care, desired by the patient when he or she is either in a permanent vegetative state with no hope of recovery or has an imminently terminal condition AND is unable to make his or her needs known.
Healthcare Surrogates/Durable State of Attorney: A document which names someone to make medical care dictions for another, should that person become unable to make them for themselves. This document may includeinstructions about treatments and individual may or may not want, should he/she become seriously ill or injured.
Guidelines
Written information regarding advance directives may be available to anyone and most often is administered
through the admission department, Social Work department, Pastoral Care department, Medical Records department. It is the responsibility of the registered nurse to assure this documentation is available in the medical record.
Any competent patient may sign a living will or durable power of attorney for healthcare. Witnesses to a living willmay not be:
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Related to the patient by blood or marriage
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The patient’s physician or employee of the physician
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An employee of the hospital if the employee is providing direct care to the patient or is involved in thehospital’s financial affairs
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Be a patient of the hospital
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Have a claim against the hospital
Witnesses to a durable power of attorney for healthcare may not be:
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The person appointed as agent in the document
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A provider of health or residential car
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The operator of a community care facility
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An employee or operator of a healthcare facility
Each adult (or their representative), who registers as an inpatient, should be asked if they have living will and/or durable power of attorney for healthcare. If the patient has a living will and/or durable power of attorney for healthcare, it shall be noted on the appropriate form and be made part of the medical record.
If a patient decides to revoke a written advance directive, the appropriate department should be notified by the patient’s physician or staff nurse. Said department shall explicitly mark the advance directive as being revoked and should clearly document the date of the revocation. A patient may revoke an advance directive at any time, regardless of the patient’s mental state of competency.
UTILITY MANAGEMENT
Utilities are basic building services. They include:
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Electricity: Emergency Electrical Service is supplied from a hospital’s emergency powerhouse generators. When normal service fails, the generators support essential building systems, fire safety systems and pre- designated medical equipment. Most hospitals have an Uninterruptible Power Supply (UPS) System. If permits power sensitive equipment to function normally during transitions in power supply.
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Water: Water is needed for drinking, cooking, bathing, cleaning, flushing the toilet, steam production, heatingand cooling systems and cooling some clinical equipment.
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Sewer: The Sewer Service allows for waste disposal from the facility.
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Natural gas: Hospitals use natural gas as the primary fuel for the boilers to make steam and hot water. Natural gas also supports food service and lab processes. The hospital may have a backup diesel fuel supply to fire theboilers if the natural gas supply fails.
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Piped Medical gases: Medical gases include oxygen, nitrogen, nitrous oxide and carbon dioxide. They are supplied from the hospital medical gas storage systems. Medical Gases are distributed to specific outlets throughout the hospital. Medical Air is also distributed via special outlets throughout the hospital.
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Heating, Ventilation and Air Conditioning Systems (HVAC): The functions of HVAC include heating to support room comfort, ventilation to support air quality and infection control and cooling to support humancomfort and in some locations, equipment function.
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Fire Protection System: Fire protection systems are operated and maintained by the Hospital’s Physical Plant and Maintenance Departments. Smoke detection systems are designated to operate at all times. Fire sprinklers turn on when a defined temperature is reached. Fire alarms are triggered by either the smoke detection of fire sprinkler systems. They produce audible alarms and visual strobe signals.
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Pneumatic tube systems
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Telephones
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Computers
Code White: Utility Failure
The purpose of a Code White is to alert employees to a hospital-wide failure of one or more of the above utility systems. All departments and units have Utility Failure Plans that identify what action you need to take in the eventof one of more utility failures. Make sure you know the location of the Utility Failure Plan and contact the hospital Safety management, Department Manager or Safety Coordinator if you have any questions.
PATIENT EDUCATION
Patient/family teaching has been recognized as an essential activity fundamental to every nursing, medical and allied specialty. The growing awareness that individuals can be more responsible and participate in their own health is prompting the providers, policy makers, regulatory agencies and payers to strengthen patient and family education inevery phase of patient care.
Patient and family education is interactive and appropriate to the patient’s age and length of stay. It
includes, but is not limited to:
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Helping the patient adopt or function more independently
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Information about access to additional resources
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When and how to obtain further treatment
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Safe and effective use of medication and medical equipment
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Potential drug – food interaction
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Nutrition information/counseling on modified diets as appropriate
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Rehabilitative techniques, including activity and assistive devices
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Maintenance of good standards for personal hygiene and grooming, including brushing teeth, bathing,caring for hair and nails, and using the toilet
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Information on patient/family responsibilities for the patient’s health care need (e.g. self- care, signs andsymptoms to report, etc.) including the knowledge and skills to carry out these responsibilities.
How is Patient/Family Education Implemented?
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Patient teaching is based on assessed learning need
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Assessment includes consideration of cultural and religious practices
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Barriers to learning are identified
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Age-appropriate teaching is matched with developmental stage
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Education is provided by the appropriate health care professionals (Pharm D, MD, RN, LCSW, RD, RCP,RT, OT, SLP and other disciplines involved with the patients care)
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Educational materials (video and print) utilized are medically current, instructionally correct, cost effectiveand developmentally coordinated through the Patient Education Committee.
The Nurse Role in Patient Education
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Asses/re-assess patient including cultural and religious beliefs
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Identifies learning barriers
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Identifies learning need
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Provides in room orientation
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Plans for patient teaching in collaboration with patient/family and involves interdisciplinary team
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Demonstrates use of equipment, rehabilitative techniques, assistive devices
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Explains treatment plan, verifies patient’s knowledge about procedures
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Explains medication in collaboration with clinical pharmacist
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Teaches/demonstrates self-care, personal hygiene
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Provides discharge instructions such as:
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Follow up appointment with physician
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Danger signals and symptoms to report
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Medications, food-drug interactions
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Provides patient with education materials
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Self-care
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Activity, assistive devices
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Access to resources
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Pain Management
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Return to work and driving
MEDICAL EQUIPMENT MANAGEMENT
The Safe Medical Devices Act, in an effort to monitor incidents involving equipment, requires all healthcare personnel to follow up on problems or incidents involving equipment promptly. If a piece of equipment does not function properly:
In order to provide quality patient care with the least amount of risk possible, all Facilities have developed an Equipment Management Program. All equipment (clinical or non-clinical) must be inspected by the Facilities Management Department prior to its initial use. "Equipment" is defined as all equipment, fixed or portable, that is used for the diagnosis, treatment, monitoring or care of patients, which could pose a physical and/or clinical riskto a patient and/or operator during use.
CLINICAL EQUIPMENT
In order to provide quality patient care with the least amount of risk possible, the Facilities ManagementDepartment has developed a Clinical Equipment Management Program.
Clinical equipment is defined as all equipment, fixed or portable, that is used for the diagnosis, treatment, monitoring or care of patients, and which could pose a physical and/or clinical risk to a patient and/or operatorduring use.
All equipment (clinical or non-clinical) must be inspected by the Facilities Management Department prior to itsinitial use.
Many different types of clinical equipment are used to help treat patients in your facility. Some of these are:
Clinical equipment can be an important part of a patient's treatment, but there are things that can go wrong. There are three types of risk factors, or potential problems, that can arise in the use of clinical equipment:
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Malfunction
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Improper use
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Damage to equipment
It is important that you do not use any equipment that you have not been trained to use. You need to know the following information about any equipment you use:
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How to operate it
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The purpose of the equipment and the intended results
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Monitoring and observation activities - what to observe, frequency precautions, and adverse reactions
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Contraindications - warning signs
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Troubleshooting - including how to respond to alarms
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Care and maintenance
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Backup procedures and equipment
In addition to proper training, there are other things you can do to help ensure that equipment functions properly andsafely:
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Teach patients and their families about any equipment, including how it works, its purpose, safetyprecautions, signs of problems, what to do if problems arise, and when to notify staff.
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At the first sign of a malfunction, take equipment out of use. Label it so that others do not use it, and followthe policy of your facility for repair.
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If equipment has a battery backup, keep it plugged in whenever possible so that it stays fully charged.
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Remove equipment from rooms when it is no longer needed to prevent it from being damaged and to make it available for others to use. Follow the policy of your facility to prepare the equipment for use with another patient, including disinfecting, cleaning, re-inspecting, and recalibrating where required.
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If any equipment is dropped, take it out of service immediately. Even though it may seem intact, theremight have been damage to some components that could pose a safety hazard.
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Cellular phones have been found to interfere with some electrical equipment. Your facility may have a policy that bans cell phones in the facility or within certain areas.
PAIN MANAGEMENT
Pain management is a complex, subjective and highly unpleasant sensory or emotional experience caused by a physical, neurological or emotional response to noxious stimuli. Pain can be acute or chronic in nature. No two people experiences or express their pain alike. The most reliable indication of the existence and intensity of pain is the patient’s testimony, and its measurement is considered the 5th vital sign. Many factors can influence the severity of pain, including the personal meaning of pain, additional anxiety, tension, depression, fatigue, and sleeplessness. Chronic pain is the most frequent
cause of reduced quality of life. Untreated acute pain in hospitalized patients can cause longer hospital stays, delayed healing and fear and anxiety.
When you are providing care, moving, lifting a patient or performing procedures, ask the patient if they are having pain. Do not assume a patient is not in pain just because he or she doesn’t speak up. Often, careful moving or re- positioning may help.
Patient pain level will be assessed using ETRMC’s Universal Pain Assessment 10-point scale. Pain management includes main assessment, planning, intervention, reassessment of patient responses to pain management measures, and education of patient and family regarding pain management. Patient assessment, reassessment and education must be documented on the medical record.
Pain control measures fall into two categories:
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Pharmacological interventions
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Non-pharmacological interventions
Pharmacological interventions are pain control methods that use medications. These include:
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Opiates, such as morphine and codeine
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Non-opiates, such as acetaminophen
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Adjuvants, a variety of drug types that are usually used to supplement opiates or non-opiates.
Non-pharmacological interventions are alternative measures that do not use drugs. The methods that are selected will depend on the needs of the patient. Non-pharmacological pain management methods include:
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Relaxation and distraction techniques
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Physical interventions.
Relaxation and distraction techniques
These techniques work best if they are practiced before they are needed for pain relief. They include:
Physical Interventions
Physical interventions that can help in the treatment of pain include:
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Massage
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Exercise (especially for chronic pain)
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Application of heat or cold (not longer than 20 minutes; be careful of extremes of heat or cold that coulddamage tissue)
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Acupuncture
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Position change
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TENS unit (trans-electrical nerve stimulation therapy).
A TENS unit controls pain by stimulating the nerves at the pain location and helping to block pain signals.
When using drugs to control pain, the best strategy is to use the least strong drug which still gives adequate painrelief. If the intervention does not relieve the pain, it may require:
Usually, pain control measures begin with non-opiates (non-narcotic) drugs. Non-opiates, such as acetominophen (Tylenol) are generally available in both over-the-counter and prescription strengths.
Non-opoids are usually taken orally or by suppository. The most common side effect of acetaminophen is hepatotoxicity (liver involvement). This is most common with an overdose.
Non-opiates also include NSAIDS (non-steroidal anti-inflammatories), such as Advil and Motrin. These may also beused in combination with opiates. The most common side effects of NSAIDS are:
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Gastric irritation
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Prolonged bleeding time.
The name, opiates, refers to drugs that are based on opium. They can be either natural or synthetic. Opiates are usedfor moderate to severe pain.
Pure agonists
One class of opiates, known as "pure agonists", which refers to their specific mechanism for pain relief, includes:
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Morphine
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Hydromorphone (Dilaudid)
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Fentanyl
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Codeine.
Increased dosage of pure agonists provides increased analgesia (pain relief) and side effects. Side effects include:
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Euphoria
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Sedation
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Constipation
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Nausea
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Vomiting
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Itching
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Urinary retention
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Hypotension
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Respiratory distress.
Over time, patients may develop a tolerance for opiates, meaning they require higher dosages to achieve the same pain relief. However, the usual reason for increasing dose is because of disease progression. Patients who have received opiates for a long period of time may experience withdrawal when the drug is stopped. This means that patients should not be taken off the drug suddenly but should gradually decrease the drug level over several days.
There are two important things to remember about opiates and other pain drugs:
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Drug-seeking behavior is NOT a sign of addiction.
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Drug-seeking behavior IS a sign of inadequate pain relief.
Other opiates
Other types of opiates, nalbuphine (Nubain) and butorphanol (Stadol), provide less analgesia, but also fewer side effects. There is also a limit to their effectiveness. After a point, higher doses do not increase analgesia. These drugs are sometimes used to reverse analgesia and side-effects caused by pure agonists.
Administration of opiates
Opiates can be given orally. As pain level increase, they are administered in other ways which deliver a higher levelof pain relief:
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Bucally (placed in the cheek area if patient unable to swallow)
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Dermal patch (for continuous release)
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Intravenous (IV) by continuous infusion or intermittent dosage
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Patient-controlled analgesia (PCA) using intravenous delivery
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Intramuscular or subcutaneous injection
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Suppository.
Adjuvants
Other drugs that may help in pain control are called adjuvants. These include:
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Corticosteriods
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Antidepressants
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Local anesthetics
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Anticonvulsants.
These drugs are used to:
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Enhance the effectiveness of a primary analgesic
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Limit the side effects of a primary analgesic (usually an opiate)
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Treat concurrent symptoms that increase pain
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Provide analgesia for certain types of pain that are not relieved by opiates.
RADIATION SAFETY
Time, Distance and Shielding prevent unnecessary exposure to radiation. Spend only the needed time in the radiation area, keep your distance from the source of radiation and use proper shielding when radiation equipment is being used. To do this, routine testing and evaluation of equipment, procedures, personnel monitoring and continuing education are critical. Those involved with Radiation need to attend an annual refresher course on Radiation Safety. The classes are listed in the Memorial Academy catalog.
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Always observe radiation warning signs
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Enter areas employing radioactive sources only for authorized and necessary purposes.
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Do not attempt to clean up spills on floors and counter tops labeled “Caution: Radioactive Materials.”These may be radioactive and require special clean-up procedures.
FALL PREVENTION
Most facilities have developed a Fall Prevention Program to identify those patients who are at highest risk to fall, with the intent of reducing injuries.
A patient fall may also result in:
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Longer hospital stays
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Permanent injury
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Disability
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Death
There are things you can do to help prevent patient falls:
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Orient patients to their surroundings.
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Show them how to use the call light and explain how and when to get assistance
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Ensure good lighting in rooms and bathrooms
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Keep beds at a low height
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Make sure path to bathroom is clear
You can also learn to recognize patients who are at risk for falls. These include:
Infants and young children
These patients are immature, and they often do not understand what they should or should not do. Their motor skillsare still developing, so they can fall easily. They are also full of curiosity.
Older adults
The majority of falls occur in patients over 65 with the highest number in the 80-89 age group. These patients maybe unsteady on their feet. They may also have problems with hearing and eyesight.
Sedated patients
Patients who are sedated may not be able to understand instructions. They often cannot recognize dangers and maybecome confused.
Patient education can also help prevent falls. Teach patients and their families about:
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The hospital environment
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Potential hazards
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Equipment being used.
In addition to patient falls, there are other types of injuries. These include injuries from misuse of equipment andburns from hot liquids. These injuries are less frequent than falls, but all have one thing in common:
Most injuries can be prevented!
There are several things you can do to help prevent injuries:
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Identify and correct safety hazards.
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Take care in using equipment.
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Follow the standard of care when doing procedures and treatments.
Identify and correct safety hazards
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Slips, such as water on the floor, should be cleaned up.
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Trips, or obstacles, should be removed.
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Sharps, such as needles or glassware, should be properly disposed of.
COMPLAINT RESOLUTION (STAFF AND CUSTOMER)
A Customer Service Complaint is any complaint and/or concern from one of our valued customers regarding a situation or incident that results in dissatisfaction of that customer. The purpose of our complaint policy is to:
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To have a positive impact in improving customer service and satisfaction.
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To understand the causes that underlie a complaint and to focus on making changes to systems andprocesses to reduce the probability of a similar complaint in the future.
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To prevent potentially compensable events and to protect corporate financial resources potentiallyjeopardized by customer dissatisfaction.
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To analyze and trend data to identify opportunities for organizational performance improvement.
All First Connect Center LLC patient care providers and internal office staff are entitled to full and equal accommodations, advantages, facilities, privileges and services provided by the company.
First Connect Center LLC accepts complaints from persons who believe that they have experienced a violation of their rights. The following guidelines shall be followed in resolving complaints.
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Complaints must be filed within 30 days of the alleged act.
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The complaint is the written document that describes the occurrence and why the person filing thecomplaint believes the action or incident was in violation of his/her rights.
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An individual seeking to file a complaint needs to contact First Connect Center LLC management. An intake interview or phone interview will be conducted with the complaining party.
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After a careful screening process, the complaint is investigated to determine if there is sufficient evidence to support the allegation. The complaint documentation must contain a claim which constitutes a violation of the complaining person’s rights.
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A complaint may be settled at any time after it is filed. Opportunities will be given to all parties involved to ask questions, provide information, and suggest witnesses in order to resolve the complaint.
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As the investigation proceeds, individuals will be interviewed and pertinent records and documents will be reviewed.
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The person filing the complaint must cooperate fully by providing accurate information and by supplying documents to support the allegations.
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All information gathered in the course of an investigation is subject to disclosure unless otherwise protectedby the individual’s right to privacy (e.g. medical records).
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If the complaint is substantiated, a reconciliation conference to settle the complaint will be scheduled. Settlement terms may require:
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Restoration of previously denied rights.
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Compensation of any out-of-pocket losses incurred by person filing complaint
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Correction of other harm(s) resulting from the violation(s).
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Modification of practices that adversely affect persons protected under law
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Other actions to eliminate the effects of violation of rights.
Our goal is to always provide you with a consistent level of service. If for any reason you are dissatisfied with our service or the service, we encourage you to contact the First Connect Center LLC Management to discuss the issue. First Connect Center LLC has processes in place to resolve complaints in an effective and efficient manner. If the resolution does not meet your expectation, we encourage you to call the First Connect Center LLC corporate office at (866) 495-4770. A corporate representative will work with you to resolve your concern. Any individual that has a concern about the quality and safety of patient care delivered by First Connect Center LLC healthcare professionals, which has not been addressed by First Connect Center LLC management, is encouraged to contact the Joint Commission at www.jointcommission.org or by calling the Office of Quality Monitoring. First Connect Center LLC Staffing. demonstrates this commitment by taking no retaliatory or disciplinary action against employees when they do report safety or quality of care concerns to the Joint Commission.
HUMAN RESOURCES: EMPLOYMENT APPLICATION PROCESS
In keeping with our standard of excellence, First Connect Center LLC’s initial application process and ongoing quality assurance initiatives are designed with the primary goal is to provide the highest quality of nursing professionals possible. Our objectives include:
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To recruit and employ those professionals who are dedicated to quality care with proven skill histories.
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To provide a thorough orientation for each nurse so that he/she may perform his/her work in a safe and effective manner.
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To provide consistent opportunities for staff education via our in-service training and staff development program.
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To monitor the quality of nursing performance through regular on-site evaluations
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To work closely with clients while modifying our service concepts to meet their needs.
Each applicant undergoes a stringent screening process to verify skills and commitment to nursing excellence.
PROOF OF CITIZENSHIP OR ABILITY TO WORK AS REQUIRED BY LAW
First Connect Center LLC verifies eligibility to work in the United States. The U.S. Immigration and Naturalization Service require that employees show proof of citizenship/eligibility to work by completing an Employment Eligibility Verification Form (I-9). Failure to produce the necessary proof according to the applicable laws will result in the postponement of employment.
BACKGROUND CHECKS:
First Connect Center LLC performs criminal background checks on applicants, which include at a minimum a felony and misdemeanor search in the state of California, and may also include states and counties of residence/employment for the previous 7 years. Criminal background checks can also be conducted post-employment based upon a reasonable suspicion of criminal activity.
In addition, First Connect Center LLC verifies that applicants are not included in the Office of Inspector
General’s (OIG) or the Excluded Parties List System (EPLS) databases of excluded providers.
LICENSE/CERTIFICATION/EDUCATION VERIFICATION
At a minimum, applicants are required to provide valid, original professional licenses to practice their profession in the state of California, Basic Cardiac Life Support (BCLS) certification and any other professional certifications required for the practice of their specialty. First Connect Center LLC conducts primary source verification of all professional licenses in all relevant states with the appropriate licensing bodies to verify issue date, expiration date, active status of license and to determine if a license has ever been suspended, revoked, restricted, reprimanded, sanctioned or disciplined. Any disciplinary action on a professional license can be terms for non-employment with First Connect Center LLC and falsification of any documentation will render applicant completely ineligiblefor employment with First Connect Center LLC
Positions that require a specific educational requirement and/or certification must have verification of such. Where education and licensure are required, but the license may not be obtained without meeting the education requirements, it is not necessary to confirm education, but only to verify the license (Specific example would be an RN where state licensure is required and completion of an approved nursing program or completion of a certain number of continuing education units. In this
case, the individual may not obtain state licensure or renewal without completion of an approved program or continuing education units, therefore only license verification would be required. If the position requires state licensure as an RN and a Master’s degree, then both the licensure and the education would need to be verified).
It is the employee’s responsibility to maintain a current valid license. Failure to do so will result from removal from duties and progressive discipline. Employees are required to immediately notify First Connect Center LLCif a license/certification is suspended or revoked prior to education.
REFERENCE CHECKING
First Connect Center LLC verifies at least two references from previous employers and requires a satisfactory evaluation from former supervisors of an applicant regarding position, knowledge and applied job skill proficiency. Dates of employment and position are also confirmed.
PRE-EMPLOYMENT SKILLS ASSESSMENT/COMPETENCY EXAMINATIONS
To ensure that work is performed safely and efficiently in the hospital setting, all applicants are required to complete a competency self-assessment for every unit and specialty to which they will be assigned. All competencyassessment tools are maintained in their personnel file.
Applicants must also complete a competency examination for every specialty to which they would like to be assigned and receive a passing score of at least 80%. Any applicant not receiving a passing score on their first time will be given one additional opportunity to re-take the competency exam and pass. Failure to achieve a passing score of at least 80% within the first two attempts is automatically ineligible for employment with First Connect Center LLC. In addition, all staff must complete a Pharmacology examination and receive a passing score of at least 80%. Any applicant not receiving a passing score on their first time will be given one additional opportunity to re-take the Pharmacology exam and pass. Failure to achieve a passing score of at least 80% within the first two attempts is automatically ineligible for employment with First Connect Center LLC.
First Connect Center LLC’s Clinical Liaison shall assess applicant competency through review of all competency self-assessments, competency examination, references and in-person or telephone interview. A position description that specifies job duties, expectations, qualifications and special requirements commensurate with the position are reviewed with each applicant as well.
ADDITIONAL QUALIFICATIONS OF NURSING PERSONNEL
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All applicants must be BCLS certified
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Nurses working in ICU, CCU, PACU, ER and Telemetry must be ACLS certified
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Nurses working in ER, PEDS and PACU must be PALS certified
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Nurses working in NICU and Nursery must be NALS/NRP certified
HEALTH SCREENING
Applicants must go through a screening process to demonstrate that they are free from communicable disease and are free from any health impairment that is of potential risk to the patient, caregiver, other employees, or that may interfere with the performance of duties. All applicants must provide:
Mandatory:
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Drug Test: 10 panel drug screen for amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, meperidine, Methadone, Opiates, Phencyclidine, Propoxphene
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Tuberculosis Test: Conducted within the last twelve months prior to hire date. The TB test must show a negative result to a two-step TB test. Applicants who test positive as a tuberculin reactor are required to submit documentation of a negative chest x-ray showing no abnormalities and/or provide proof of prophylactic antibiotic therapy. Repeat testing of a negative TB test will be required annually. Repeat chest x-rays ever two years are required for those who present positive TB results. Applicants with positive TB results must also complete a TB questionnaire upon hire and annually thereafter.
Optional/Depending on Client Requirements
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Vaccinations/Declinations: Submit proof of exposure to or immunization to Rubella, Rubeola, mumps and Varicella zoster.
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Hepatitis B: Must provide proof of vaccination to Hepatitis B or sign waiver/declination. The Hepatitis B vaccine and vaccination series shall be made available at no cost to all employees. Employees shall not receive the vaccination if they have previously received the Hepatitis B vaccination series or have antibody resting which reveals the employee is immune or for whom the vaccine is contraindicated for medical reasons.
*** If any of the health screening requirements cannot be furnished by applicant, First Connect Center LLC will provide all testing procedures at no cost to applicant at any participating U.S. Healthworks facility.
*** Please note that random drug screening and drug screening for cause may occur at any time.
INTERVIEW AND EDUCATION
Applicants are interviewed by the Clinical Liaison. Interviews are designed to determine applicant’s knowledge, competence and skills in specified areas of expertise. Interviews are based on actual events and circumstances that applicants are likely to encounter in the work environment.
Applicants are also oriented to First Connect Center LLC’s general policies and procedures, as well as specific administrative policies on overtime and scheduling. Orientation for select hospitals is also provided, as specified by select client hospitals.
Applicants are also oriented and tested on a variety of topics, including, but not limited to:
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Medication: administration, safety and prevention of errors
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Abuse: Child, elder and reporting, SCAN
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Sexual and domestic violence, assault, rape
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Drugs in the workplace, workplace violence
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Safety: electrical, fire, environmental, safety signals
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Hazardous materials
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Infection control and CDC Hand Guidelines
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OSHA and bloodborne pathogens
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Dress code and fingernail policy
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JCAHO education, National Patient Safety Goals, List of Abbreviations/Do-not-use
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Patient rights/advance directives
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Emergency preparedness
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End-of-life care
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Code situation policies
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Sentinel event policies and procedures
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Restraints
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Age-specific education
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HIPAA
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Pain Management
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Body Mechanics
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Documentation: of patient care, transcribing of physician orders
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Conscious Sedation
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Patient safety and education
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Fall prevention
The completion of orientation shall be documented and signed by the applicant. And the form will be retained in the employee’s personnel record.
Maintaining Nursing Personnel Files
All personnel files are maintained by HR via a computerized Records Management System, which monitors relevant requirements and expirations of any requirements. Requirements are kept current through daily alerts of soon-to- expire or expired requirements.
Orientation
First Connect Center LLC will provide all new employees with an orientation to the company’s policies and procedures. Each employee will receive an Employee Handbook.
Some facilities require some form of orientation. The amount of time required by each facility varies. Some facilities require computer training classes and orientation prior to the first shift worked. The staffing coordinator will explain required orientation to all employees prior to scheduling first shift with a facility. Orientation time worked at the facility is paid at the orientation rate. (Usually less than regular pay rate)
Some facilities require that their specific pre-employment orientation “packets” be completed by the prospective caregiver at First Connect Center LLC before the first shift is worked, and there is no pay for this required activity.
The first time you visit a facility the following guidelines should be followed:
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Report approximately one (1) hour early for orientation (it may vary for each facility).
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Carry photo ID for evidence of identity when reporting for assignment
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Take your nursing license and certifications with you
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Report to the appropriate supervisor
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It is expected that the healthcare practitioner locates and comply with the facility policy and procedures manual,locate fire pulls, crash cart, med. room, linen cart, and appropriate exits before your shift starts.
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Always dress in proper attire when working at the facility. Orientation is only paid when the time has beenproperly verified by facility staff.
Occasionally, a First Connect Center LLC employee may show up early as directed for orientation shift and no one is available for orientation. Please take it upon yourself to utilize this time to become familiar with the floor layout and the location of vital items you may need in order to function effectively on your shift. It will be to your advantage to have knowledge of the location of the policy and procedures manual, fire pulls, crash cart, med. room, linen cart, and appropriate exits prior to the onset of your shift.
First Connect Center LLC attempts to provide a comprehensive and thorough pre-employment orientation and in service training that reflects current compliance and promotes safe healthcare delivery. The program includes, but is not limited to the following:
PERFORMANCE IMPROVEMENT AND EDUCATION PROGRAM
The purpose of performance management is to enhance the knowledge, skills and behaviors of all employees. This is accomplished by providing a means of measuring employee’s’ effectiveness on the job; identifying areas of development where employees are in need of training, growth, improvement and/or additional resources; maintaining a high level of motivation through feedback with management and establishing individual performance goals.
INITIAL ASSESSMENT
Upon hire, First Connect Center LLC’s director of nursing/Clinical Supervisor must meet with all new hires to inform them of the competencies that must be met. For the initial assessment, the competency self-assessments will serve as the baseline assessment. Review and education for errors on any competency exams, pharmacology exams and additional examinations will also serve as areas of improvement.
ON-THE-JOB ASSESSMENTS
First Connect Center LLC has implemented a continuous, systematic and coordinated approach to measureand assess hospital’s feedback on all agency personnel being utilized. The following assessments are utilized to ensure employee performance and customer satisfaction:
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Initial Shift: Nurses are assessed by the charge nurse, nurse manager or hospital designee at the completion ofthe first shift. Assessment focuses on professionalism, safety, patient care, compliance, assessment, planning and documentation.
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Random: Nurses are assessed by the charge nurse, nurse manager or hospital designee at random. Assessmentfocuses on professionalism, safety, patient care, compliance, assessment, planning and documentation.
Any unsatisfactory scores will be reviewed and discussed with each nurse and methods for improvement recommended by First Connect Center LLC’s Clinical Liaison. For more information on First Connect Center LLC’s Progressive Discipline Program, please see Progressive Discipline Program.
PERIODIC ASSESSMENTS
First Connect Center LLC’s Clinical Liaison conducts ninety-day and annual assessments of all staff. TheClinical Liaison evaluates employee job performance based on the functions and standards as outlines in the job descriptions. Together, the Clinical Liaison and employee will identify strengths, accomplishments and areas for improvement and development. All hospital reviews, including initial
and random assessments are also incorporated into the ninety-day and annual performance review. Employees will also update their competency self-assessments at this time.
If a Performance Plan is required, a plan identifying the performance expected will be created and will be used to gain the employee’s commitment to perform to those expectations. The Clinical Liaison will provide coaching, resources and suggestions to assist the employee in working toward the performance expectations established in this phase. In the event that a Performance Plan is created, it is expected that the Clinical Liaison conduct Progress Checks, or informal reviews of performance to determine if the agreed-upon goals and objectives are being achieved, to recognize achievements, to discuss developmental needs, and/or to provide assistance in the accomplishment of performance goals.
EMPLOPYEE PERFORMANCE REVIEW
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Every healthcare professional employed by First Connect Center LLC, who has worked in the last year, will have an annual performance evaluation carried out by the First Connect Center LLC, on or around your anniversary date.
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First Connect Center LLC will attempt to obtain feedback from client representatives regarding clinical staff competence and ongoing performance of professional employee. Unfortunately, some clients will not cooperate with First Connect Center LLC in this regard, so First Connect Center LLC follows a competence by exception philosophy. In the absence of client feedback, unless there is evidence of a performance issue, we assume that our employees are meeting performance expectations.
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Feedback from our clients regarding clinical and/or professional performance is addressed with our employees immediately. Follow-up with our clients is completed within an appropriate time frame.
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Annual skills checklists which apply to specialty area of work will be completed by every health professional employed by First Connect Center LLC.
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When training needs are identified, an opportunity to complete the training will be provided at the earliest possible occasion.
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The company assesses aspects of employee's competence at hire, at performance evaluation and as needed or required by state licensing agencies, to ensure that employees have the skills or can develop the skills toperform and continue to perform their duties.
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Clinical Liaison is responsible to ensure that any areas of development are identified and addressed.
EDUCATION
Ongoing continuing education is the responsibility of First Connect Center LLC employees to ensure that all clinical staff has a current knowledge and practice base. First Connect Center LLC maintains information on available resources for BLS, ACLS, PALS, etc. Evidence of continuing education and annual required in-service education are part of the ongoing competency assessment program and will be maintained in your personnel file. Please provide First Connect Center LLC with copies of your continuing education certificates.
First Connect Center LLC encourages all staff to further their skills and knowledge as nursing professionals.First Connect Center LLC facilitates ongoing education of staff through:
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Annual in-services on:
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Customer service and satisfaction
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Joint Commission National Patient Safety Goals
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HIPAA
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Infection Control
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Safety: fire, life and general
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Education reimbursement
DISCIPLINARY ACTION
First Connect Center LLC has established workplace standards of performance and conduct as a means of maintaining a productive and cohesive working environment. A positive, progressive approach is
taken to solve discipline problems, which appeals to an employee's self-respect, rather than create the fear of losing a job. Our system emphasizes correction of the offensive behavior. If correction of the problem and sustained improvement does not occur, termination may result.
The following may be grounds for disciplinary action, up to and including termination:
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Accepting an assignment and not reporting to work or not notifying us.
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Unauthorized possession, use, or removal of property belonging to First Connect Center LLC orany client of First Connect Center LLC
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Failure to comply with all safety rules and regulations, including the failure to wear safety equipment wheninstructed.
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Reporting to work under the influence of alcohol, illegal drugs, or in possession of either item oncompany premises or work sites of client companies.
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Lewd, unacceptable behavior, possession of weapons or explosives and provoking, instigating orparticipating in a fight is prohibited at First Connect Center LLC and/or at its client hospitals.
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Violation of the harassment policy.
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Insubordination of any kind is grounds for immediate termination. (For example, refusal to carry out yoursupervisor's reasonable works request).
-
Leaving an assignment without notice i.e., patient or assignment abandonment.
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Falsifying records, including but not limited to time records or claims pertaining to injuries occurring on company premises or work sites of client companies or personnel records.
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Disclosing confidential information without authorization.
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Disregard for established policies and procedures.
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Excessive cancellations or tardiness.
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Discourtesy to clients or fellow employees.
DO NOT SEND POLICY AND PROCESS
First Connect Center LLC is committed to providing a higher standard of service to our clients and to the delivery of safe, quality patient care. As a First Connect Center LLC employee, you play a very valuable role in our success in delivering excellent customer service and in our ability to achieve Joint Commission Certification. We are implementing a “Do Not Send” Prevention Program.
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Following the Termination Policy are the Do Not Send Prevention Curriculum and the Do Not SendPrevention Quiz
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You will be held responsible for the information in the curriculum and quiz in both your clinical and professional / behavioral performances every time you work for First Connect Center.
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Please take the quiz and return only the answer sheet to us within 14 days in the enclosed self-addressed-stamped-envelope.
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When a performance issue arises, First Connect Center LLC will use the point system outlined below. As you can see, significant performance issues or ongoing performance issues could result in termination. By implementing this program, it is our goal to reduce the number of performance issues and/or Do Not Sends.
Termination Policy
The following point system is used to determine termination as a result of Do Not Sends.
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1 Points
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2 Points
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3 Points
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4 Points
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Illegal Behavior (Includes false identity; falsified documentation,use of or distribution of controlled substances etc.)
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Pt. abandonment. When nurse is under investigation for above behavior theywill be considered terminated until exonerated from all accusations.
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Error resulting in Pt. Death or Permanent physical or mental damage
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Self-terminating travel assignment without proper notice to facility or StaffingAgency.
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A nurse who receives
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5 Points
Please feel free to contact the First Connect Center LLC office, if you have any questions
Do Not Send Prevention: Curriculum
Do Not Sends are usually subjective in nature. However, there are things we as Agency nurses can do to avoid DoNot Sends.
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Be on time to all shifts.
Be 30 to 45 min early, arriving to the floor, when working at a hospital for the first time. To ensure being on time, preparation begins the night before, or day of your night shift. Have clothes, nursing tools, lunch etc. prepared before sleeping.
Get to bed early to ensure 8 hrs of sleep.
Awake early enough to eat before you leave for shift.
Make sure you have accurate directions and facility phone number before you begin driving to the shift.Do not sign in and out at the same time!
Rationale: Arriving early allows the Agency nurse to familiarize themselves with the unit, get organized, meet the Charge Nurse and make a positive first impression. Signing in and out at the same time is fraud.
Head to toe, system by system, Neuro to Skin.
Review your patient’s charts, (ten to twenty minutes per chart) after report, and before lunch.
Rationale: This is of paramount importance! Sets the tone for the start of the shift, provides the foundation forthe plan of care, focus of initial assessments and interventions.
Taking a detailed report and reviewing the pt’s chart during the first half of your shift also
prepares the Agencynurse to give a knowledgeable, relevant report.
Find the Charge nurse, introduce yourself, ask to be shown around, and inquire who your resource person maybe for the shift (if initial shift @ facility), if not the Charge nurse.
Communicate early and often any relevant information to the Charge nurse such as: changes in patient condition,difficulty with or questions about; assignment, staff, equipment or documentation tools.
Rationale: Allows Charge nurse to make adjustments or provide assistance in a timely manner, in order toprovide the safest patient care and prevent a delay in patient treatment.
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Avoid handling personal business during shift.
Talking on mobile phones or using facility information systems for personal use (other than in an emergency oraway from patient the care area during breaks) is a sure way to make an impression that will reflect poorly on the Agency nurse.
Rationale: This behavior often leads directly to a Do Not Send.
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When in Rome… Make every attempt to do things, the way the Facility you are working in, does things.
Some Facilities want two nurses to sign off on all insulin administration, narcotic administration and labspecimens.
Please respect all of our facilities policies and procedures, without complaint or argument.
However, if you have been asked to perform a task or procedure you feel will place a patient in danger or you feel unqualified to perform, contact your immediate supervisor and/or go up the chain of command until you feel you have been able to express your concern professionally and respectfully.
If one of us as agency nurses encounters a situation in which you feel obligated to challenge a request, in order to maintain the safest patient care environment. It is of vital importance that you:
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Communicate with AGENCY Staffing Services
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Document the incident in your own words before leaving the facility.
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Furnish signed and dated, copies of your documentation of the incident to AGENCY Staffing Services, the Nursing Supervisor of the facility in which you were working, and retain a copy for yourself.
Rationale: Knowledge of, and compliance with each facilities policy and procedures are fundamental elements of professionalism, providing safe patient care and creating an impression that makes a facility ask fora Agency nurse by name.
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Practice the 6 rights of medication administration.
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Right Patient
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Right Medication
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Right Dose
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Right Time
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Right Route
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Right Rate
If an agency nurse is confused regarding any aspect of the medication administration process, clarification with the physician becomes an immediate priority, to ensure safe medication administration.
Rationale: Medication errors are serious, and can lead to negative patient outcomes, extended hospitalization, severe injury and death. Most importantly for a careful, knowledgeable and conscientious Agency nurse, medication errors are almost always preventable.
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Be conscious of Joint Commission National Patient Safety Goals in your practice.
A complete and current set of National Patient Safety Goals should be posted or easily accessible on any unit inany Acute Care Facility.
Rationale: “The mission of Joint Commission is to continuously improve the safety and quality of care provided to the public” through the “support of performance improvement in healthcare organizations.”
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Ask the Charge nurse to Audit your Charting a few hours before end of shift.
Having the charge nurse review our documentation, within a couple of hours of the end of our shift, displays exceptional accountability, reduces the healthcare provider and facility’s exposure to liability. Thorough documentation also helps convey important information to the following shift, and ensures the necessary facts will be available when and if the chart is reviewed in the future.
Rationale: Complete documentation, is an essential component of effective, efficient nursing. Since many Agencies nurses work in multiple facilities in a short period of time, it is not an easy task to dot every “I” andcross every “t”, without help from a knowledgeable source.
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Practice excellent customer service.
Customer service extends further than our patients and their families; it includes every person we come onto contact with while we are working. Our customers are every nurse, pharmacist, physician, respiratory care practitioner, etc. Every time we interact with another human being at work it is imperative that we greet thatperson with a friendly and helpful attitude.
Rationale: Treating our patients, their families, our colleagues and interdisciplinary team members with friendliness, respect and kindness creates an environment where being helpful and taking the extra step to solvesomeone’s problem is not the exception but the “norm”.
Do Not Send Prevention: Quiz
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Its 4:45 a.m. and La Tasha Davis has just been confirmed for the day shift at a Medical Center across town from her. La Tasha lives in across town from and has never been to the Medical Center. Which of the sequences will below provide La Tasha with greatest chances of making a great first impression and having a successful shift?
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Wake up at 6:15 a.m., take a shower, get dressed, hit the road @ and head in general direction ofthe facility and call for directions from the car.
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Get out of bed at 0500 obtain detailed directions and the nursing office phone number. Eat a smallhealthy breakfast, shower, dress neatly, gather nursing tools (ID badge, medication book, stethoscope etc.) and be on the road by 0545.
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Get out of bed at 0500 go to the gym, come home, shower, get dressed, walk the dog, be on theroad at 0705, call the staffing firm and say she got lost.
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Refuse to go to the Medical Center located across town, call the staffing firm at 0730 and ask ifthe hospital she usually works at has any late call needs.
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Lynn Carson RN is alone at the Nursing station in a facility in which she has been working twice a week, for over year, she is faxing a new order to the Pharmacy. Before Lynn leaves the Nursing station the phone rings, and several lines are blinking. Which of the following answers is the best example of excellent customer service?
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Lynn looks around and sees the unit secretary speaking to the charge nurse, the nurse manager, and two executives with hospital badges and wearing suits and yells out to the secretary that the“phones are ringing!” and walks away from the Nursing station.
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Lynn answers the phone lines and politely explains to every caller that she is not the unit secretaryand cannot help them before hanging up, and walking away from the Nursing station.
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Lynn finishes faxing her new medication order to the Pharmacy, doesn’t acknowledge
any of thephones ringing and walks away from the nursing station.
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Lynn sits down at the nursing station answers all the lines and directs the calls courteously and professionally. Lynn then remains at the nursing station, handling the phones for a few minutes until unit secretary returns. Lynn then passes along all relevant information upon being relieved.
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Kenny Slater RN has an extremely heavy assignment working day shift in a very busy Telemetry unit for the first time. Kenny’s patients tell him he has done a great job. However the night shift Charge Nurse makes Kenny a Do Not Send, stating incomplete documentation as the reason. Which of the options below is the most reliable way to prevent this from happening in the future?
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Kenny could have communicated the condition of his patients, explained how busy he was, askedfor help and requested the dayshift Charge Nurse to audit his charts several hours before his shift ended.
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Kenny could have avoided fulfilling his pts requests, not followed up on MD orders, and missingmedications and made completing his documentation his first priority.
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Kenny could have stated that his assignment was unfair and unsafe then complained to his patientsand their families.
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Kenny could have done nothing more; it wasn’t his fault. It was the hospital’s fault for giving him such a hard assignment and not showing him all the details of the documentation process in the first place. An MD on a pediatric floor orders .1mg of M.S. prn q 1o and a Dig level QD. Please write in the correct versions of the abbreviations used above, which comply with Joint Commission National Patient Safety Goals.
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0.1mg of Morphine Sulfate prn q 1 hour, Digoxin level daily
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Its 0930 and Ude Amin RN, who also works as a Real Estate agent, is working in the ICU. At the end of her morning break, Ude checks her voice mail. Ude finds out an offer for a 2 million dollar property, from one of her clients, has been accepted! Which of the following actions would be appropriate?
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Ude tells the Charge RN she has a severe family emergency and leaves the facility immediately.
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Ude excitedly calls the seller’s broker back from the Nursing station, and asks him
to fax thecounter offer to the ICU, so she can fax it to her client right away.
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Ude waits until her lunch break to call the seller’s broker back. She uses her mobile
phone outsideof the hospital.
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Ude uses the nursing station computer, logs on to the internet, and prints out pictures of the 2million dollar house she just sold. She then borrows another RN’s calculator to estimate the commission she expects to earn from the sale.
REPORTING ANY ISSUES
Issues may arise while an employee is on assignment for First Connect Center LLC. As a representative
of First Connect Center LLC and as a responsible and mature nursing professional, it is important that professionalism and integrity are maintained throughout the conflict resolution process and that above all, patient safety is the priority.
Common issues that may arise are:
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Conflict with hospital staff
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Conflict with patient and/or patient family members
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Unfair patient assignments, or “dumping”
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Assignment to a unit for which you are incapable of safely performing your duties
In the event of any of the above events:
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Contact the nursing supervisor for assistance
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If escalation is required, contact First Connect Center LLC for mediation
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Complete an incident report at the facility (if required)
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Complete an incident report at First Connect Center LLC (if required)
BLOOD BORNE EXPOSURE
An exposure incident to blood borne pathogens involves specific eye, mouth, mucous membrane, or parenteral contact with blood or other potentially infectious materials that result from the performance of an employee’s duties. All employees involved in direct patient care should be familiar with appropriate decontamination procedures.
In the event of exposure to any bloodborne pathogens:
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Adhere to appropriate decontamination procedures
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Contact the charge nurse or nursing supervisor for assistance
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Inform First Connect Center LLC immediately of exposure
First Connect Center LLC shall make immediately available a confidential medical evaluation and follow-upthe exposed individual. Post-exposure follow-up shall be:
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Made available at no cost to the employee
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Performed by or under the supervision of a licensed healthcare professional who has a copy of all relevantinformation related to the incident.
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Made available at a reasonable time and place.
First Connect Center LLC’s post-exposure and follow-up, shall include the following:
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Documentation of the route(s) of exposure, and the circumstances under which an exposure incident occurred.
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Identification and documentation of the source individual
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Collection and testing of blood for HIV and HBV serological status
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Post-exposure prophylaxis, as recommended by the U.S. Public Health Service
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Counseling
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Evaluation of reported illness
The company maintains confidential medical records for each employee with occupational exposure. Records are kept for the duration of employment plus thirty (30) years. Each record shall contain the employee’s name, social security number, hepatitis B vaccine history, and a record of all post-exposure follow-up.
CLINICAL INCIDENTS AND SENTINEL EVENTS
As a healthcare provider, it is your duty and responsibility to promptly report any unsafe condition, sentinel event orunusual event that can result in a sentinel event. Everyone is expected to participate in maintaining a safe environment for patients, visitors, physicians and their coworkers. This means taking an active role in reporting anyand all unsafe conditions, unusual or sentinel events. All such events should always be reported immediately to your charge nurse, nursing supervisor and First Connect Center LLC’s Clinical Liaison.
Clinical staff must recognize the importance of following effective procedures and are encouraged to speak up ifsomething has compromised or might compromise patient safety and quality.
A Clinical Incident is any event or series of events that resulted in or had the potential to result in an adverse patient outcome. Clinical staff should notify First Connect Center LLC of any clinical incidents that occur while onassignment, regardless of an adverse outcome.
A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase “or the risk thereof” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.
Such events are called “sentinel” because they signal the need for immediate investigation and response.
EXAMPLES OF CLINICAL EVENTS
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Omission of treatment
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Deviation from policy
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Medication errors
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Improper equipment usage
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IV or Blood complications
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Patient fall
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Inaccurate clinical assessment
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Patient or physician complaint
EXAMPLES OF SENTINEL EVENTS
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Any patient death, paralysis, coma or other major permanent loss of function associated with a medication error
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A patient commits suicide within 72 hours of being discharged from a hospital setting that provides staffedaround-the-clock care.
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Any elopement, that in unauthorized departure, of a patient from an around-the-clock care setting resulting in atemporally related death (suicide, accidental death, or homicide) or major loss of function.
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A hospital operates on the wrong side of the patient’s body.
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Any intrapartum (related to the birth process) maternal death.
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Any perinatal death related to a congenital condition in an infant having a birth weight greater than 2500 grams.
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A patient is abducted from the hospital where he or she receives care, treatment or services.
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Assault, homicide, or other crime resulting in patient death or major permanent loss of function.
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A patient fall that results in death or major permanent loss of function as a direct result of the injuries sustainedin the fall
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Hemolytic transfusion reaction involving major blood group incompatibilities
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A foreign body, such as a sponge or forceps that was left in a patient after surgery
JOINT COMMISSION’S SENTINEL EVENT POLICY
The Joint Commission has defined a sentinel event policy that you should be aware of. This policy has four goals:
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To have a positive impact in improving patient care, treatment and services and preventing sentinel events
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To focus the attention of an organization that has experienced a sentinel event on understanding the rootcauses that underlie the event, and on changing the organization’s systems and processes to reduce the probability of such an event in the future.
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To increase the general knowledge about sentinel events, their causes, and strategies for prevention.
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To maintain the confidence of the public and accredited organizations in the accreditation process
In the event of deviation of practice according to the professional practice act, fraudulent behaviors, narcotic abuse or deviation and/or other aberrant or illegal behavior, each event is documented and a report is made, which includes information from the customer. The Clinical Liaison reports each situation according to the guidelines of the appropriate professional association.
ACKNOWLEDGEMENT FORM
I acknowledge that I have received a copy of First Connect Handbook.
I understand that in processing my application with First Connect an investigation may be made in which information is obtained through personal interviews, and a review of information held by law enforcement or other government agencies. I authorize you to verify my past employment and education, criminal records, motor vehicle records, personal references, and other job-related data provided on this application, or via the interview process. I authorize appropriate individuals, companies, institutions or agencies to release information, and I release them from any liability as a result of such inquires or disclosures. A consumer report may be generated summarizing this information. I further understand and waive my right of privacy in this investigation and release and hold harmless First Connect from any liability. I agree that any decision to hire me is contingent upon the results of my report and certify that all statements and answers on my application, resume, or interview are true and complete to the best of my knowledge. I understand that if any statements are false or that if information has been omitted, this will be cause for disqualification and immediate termination of my employment. If employed, I further authorize First Connect to check my credit and conviction records, as needed, on a continuous basis as it relates to my employment. I am granting First Connect authorization to release confidential medical information upon the request from First Connect clients while I am actively working at the client’s facility and /or during the profiling and placement processes.
I understand that First Connect goal is to always provide me with a consistent level of service. If for any reason I am dissatisfied with First Connect or the service provided by one of First Connect Clients, I am encouraged to contact the local manager to discuss the issue. First Connect has processes in place to resolve customer complaints in an effective and efficient manner. If the resolution does not meet my expectation, I am encouraged to call the First Connect Corporate office at (866) 495-4770. A corporate representative will work with me to resolve my concern. I understand that any individual or organization that has a concern about the quality and safety of patient care delivered by First Connect healthcare professionals, which has not been addressed by First Connect management, is encouraged to contact the Joint Commission at www.jointcommission.org or by calling the Office of Quality Monitoring. First Connect demonstrates this commitment by taking no retaliatory or disciplinary action against employees when they do report safety or quality of care concerns to the Joint Commission.
I have read and understand First Connect policies and my requirements as a First Connect employee. I understand that if I have any questions and/or need clarification for items addressed in the handbook, it is my responsibility to contact the First Connect office to discuss.
