KPs Service Quality Credo Our Cause is Health

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KP’s Service Quality Credo: Our Cause is Health. Our Passion is Service. We’re here

KP’s Service Quality Credo: Our Cause is Health. Our Passion is Service. We’re here to Make Lives Better. RIVERSIDE AND MORENO VALLEY MEDICAL CENTERS 2017 SPOTLIGHT ON SAFETY KP Mission “Kaiser Permanente exists to provide affordable, high-quality health care services to improve the health of our members and the communities we serve. ”

KP VISION AND VALUES © 2017 Kaiser Foundation Education Department Riverside Service Area 2

KP VISION AND VALUES © 2017 Kaiser Foundation Education Department Riverside Service Area 2

KP VISION VALUES: WHAT GUIDES OUR BEHAVIOR Integrity ■ We build long-term relationships by

KP VISION VALUES: WHAT GUIDES OUR BEHAVIOR Integrity ■ We build long-term relationships by doing what’s right Partnership ■ We were born of a revolutionary partnership, and we live out that legacy in the way we do business every day. Diversity ■ We are richly diverse and cherish what we learn from one another. Accountability ■ We step beyond our boundaries to take responsibility for our organization’s success. © 2017 Kaiser Foundation Education Department Riverside Service Area Flexibility ■ We adapt quickly to address the changing needs of our customers. Innovation ■ We find the courage to take calculated risks. Quality ■ We hold quality as our highest priority. Service ■ We care about everyone like family. Results ■ We honor each other and our values as we produce results. 3

ICARE BEHAVIORS I: It begins with me R: Relationships ■ I take ownership ■

ICARE BEHAVIORS I: It begins with me R: Relationships ■ I take ownership ■ I demonstrate teamwork ■ I choose my attitude ■ ■ I create a safe environment I speak positively, building confidence and trust ■ I show up empathy for patients and peers C: Communication ■ I always show courtesy and respect ■ I use active listening ■ I acknowledge and convey expectations E: Engagement ■ I am a positive presence ■ I actively try to solve problems ■ I am an advocate for the patient A: Accountability ■ I take pride in my work ■ I show confidence ■ I am a master at service recovery © 2017 Kaiser Foundation Education Department Riverside Service Area 4

LABOR MANAGEMENT PARTNERSHIP LMP Is a operational strategy shared by Kaiser Permanente and the

LABOR MANAGEMENT PARTNERSHIP LMP Is a operational strategy shared by Kaiser Permanente and the Coalition of Kaiser Permanente Unions. LMP covers 115, 000 union-represented workers, 14, 000 managers and 19, 000 physicians. This joint commitment is designed to: deliver high-quality care and service to Kaiser Permanente members and patients continuously improve performance as measured by national standards involve unions and individual frontline workers in decisions about how to deliver the best care make KP more affordable by removing waste from care delivery systems preserve and improve upon industry-leading benefits and working conditions for employees © 2017 Kaiser Foundation Education Department Riverside Service Area 5

KP CULTURE OF SAFETY 6

KP CULTURE OF SAFETY 6

Workplace Safety Culture of Safety ■ Safety Conversations incorporate open-ended questions which: ■ Aides

Workplace Safety Culture of Safety ■ Safety Conversations incorporate open-ended questions which: ■ Aides in conversations that offers more accurate viewpoints on issues and concerns ■ Reduces response error and bias ■ Insights on emergent operational ■ Safety issues that can be pro-actively corrected and/or mitigated ■ Safety is a core and business value ■ All incidents are preventable- Our Goal is Injury Free ■ All employees are responsible for working safely and all managers are accountable for safety performance ■ Prevention is more effective and sustainable than “post injury” management ■ Managers are responsible for ensuring that the systems, equipment, training and support allow employees to work safely © 2017 Kaiser Foundation Education Department Riverside Service Area 7

Safety Check “Please” Safety Check: ■ Is a process for immediate intervention in any

Safety Check “Please” Safety Check: ■ Is a process for immediate intervention in any situation that poses a likelihood of harm to a patient or healthcare worker. ■ Can be initiated by a physician, KP employee, contract worker, volunteer, or student ■ Provide timely and appropriate care of the patient/member or healthcare worker is first priority, followed by resolution of concern. ■ Safety Check! Can be called by any person in the organization and will be respected by all present. Policy #04 -004 (RMC) and #04 -420 (MV) ■ Safety concerns or conflicts that are not immediately or easily resolved should be escalated using the established chain of command. © 2017 Kaiser Foundation Education Department Riverside Service Area 8

LOCKOUT/TAGOUT **All employees must be aware of Visual identification of the hardware involved (Locks

LOCKOUT/TAGOUT **All employees must be aware of Visual identification of the hardware involved (Locks and Tags)** All Kaiser Permanente facilities have implemented a hazardous energy control program to prevent injury to employees. This program is known as Tagout/Lockout ■ Tagout is a paper or plastic tag that is placed on a breaker/switch, or valve that warns ■ other people not to operate it. It is used when a Lockout cannot be used. ■ Lockout is a physical lock that holds a switch in the off position and shuts the valve so hazardous ■ energy cannot be released while the maintenance is occurring. Lockouts/Tagouts are not to be removed or bypassed for any reason. ■ The person who applied the Lockout or Tagout device is the only person who may remove it. If you see one, don’t touch it. Someone's life may be at stake! Tagouts are warning devices and provide no physical barrier to protect individuals. Tagouts have limitations. ■ Do not fall into a false sense of security when Tagouts are used. You should be aware that Tags are essentially warning devices affixed to energy isolating devices and do not provide physical restraints on those devices that is provided by a lock. Questions or problems: ■ If you see a problem with a Lockout/Tagout [e. g. , torn or ripped, fallen off], inform your supervisor / team leader and the maintenance person identified on the tag immediately. ■ If you have any other questions or concerns about the lock out tag out program, contact your local engineering department or your local Environmental, Health and Safety Department. 9 © 2017 Kaiser Foundation Education Department Riverside Service Area

UNIVERSAL WASTE SEGREGATION AND MINIMIZATION Health care organizations can be subject to severe penalties

UNIVERSAL WASTE SEGREGATION AND MINIMIZATION Health care organizations can be subject to severe penalties when waste is not segregated correctly by staff. Waste typically falls into some basic categories which are subject to regulations written and enforced by different government agencies. These categories include: ■ Medical Waste ■ Hazardous Waste ■ Universal Waste ■ Drain Disposal/Waste Water ■ Recyclable Waste ■ Non-hazardous – Regular Trash ■ PHI – Confidential Patient Health Information ■ Patient or member name PHI needs to be placed in locked waste Bin for shredding ■ MR # or SS # ■ Demographic information It is important that you know the local regulatory requirements and facility policies for waste segregation and disposal at your worksite. © 2017 KAISER FOUNDATION EDUCATION DEPARTMENT RIVERSIDE SERVICE AREA 10

What should you do if you are not sure if waste contains PHI? a.

What should you do if you are not sure if waste contains PHI? a. Take it home and place in personal garbage b. Put it in an ordinary garbage container c. Put it in confidential waste bin or Shredder 12

Pharmaceutical waste containers are: a. Green b. Blue or blue lid and Are labeled

Pharmaceutical waste containers are: a. Green b. Blue or blue lid and Are labeled pharmaceutical waste c. Black 13

RADIATION SAFETY Basic Safety Radiation Tips ■ RECOGNITION ■ Radiation sources are marked by

RADIATION SAFETY Basic Safety Radiation Tips ■ RECOGNITION ■ Radiation sources are marked by the International Radiation Hazard Symbol; a magenta trefoil on a bright yellow background. ■ Rooms containing X-ray producing machines are labeled “Caution X-ray. ” ■ DISTANCE ■ Stay at least six feet away from any radiation source. ■ SHIELDING ■ Do not remain or enter a room during X-ray exposures unless you are wearing a lead apron or are standing behind a lead shield. ■ TIME ■ Reduce your exposure time to radiation by making sure you plan in advance to complete all procedures near a radiation source as quickly as possible. 14 © 2017 Kaiser Foundation Education Department Riverside Service Area

RADIATION SAFETY Tips on avoiding Contamination ■ Wear gloves, a gown, and shoe covers

RADIATION SAFETY Tips on avoiding Contamination ■ Wear gloves, a gown, and shoe covers if indicated. ■ Avoid contact with objects or areas that may be contaminated. ■ Don't eat, drink, or smoke in areas where radioactive materials are in use. ■ Don't apply cosmetics or groom your hair while in the area. ■ Wash your hands when leaving the area. ■ Read and follow all signs and instructions. ■ Don't handle radioactive materials unless you are trained to do so! For Further information The Regional Radiation Safety Manual is the authoritative reference for radiation safety policies and procedures. ■ http: //medphys. kp. org/dirs/rsmcont. html ■ Radiation Safety officer for Riverside Dr. Alison Yee Ext. 4019 15 © 2017 Kaiser Foundation Education Department Riverside Service Area

ENVIRONMENTAL HEALTH AND SAFETY DEPARTMENT MEDICAL GAS & OXYGEN SHUT OFF VALVES CHEMICAL SPILLS

ENVIRONMENTAL HEALTH AND SAFETY DEPARTMENT MEDICAL GAS & OXYGEN SHUT OFF VALVES CHEMICAL SPILLS EMERGENCY VALVE SHUT OFF ■ In an emergency ANY staff member is permitted to turn off valves ■ Assure patients in the area/zone are off they system and on portable back up. ■ Access the zone shut off valves by pulling the ring assembly and removing the window from frame ■ Valves are operated by a lever type handle requiring only a quarter turn from the fully open position to turn off. CHEMICAL SPILLS ■ Department responsibility ■ Know the location of your departments spill kit and how to use ■ If spill is too big call Administrative Spill Response Team by dialing RMC -7777 MV – 300 ■ Safety Data Sheets (SDS) are located on the Kaiser Riverside Intranet. ■ These safety sheets can help you determine how to clean up a chemical spill © 2017 Kaiser Foundation Education Department Riverside Service Area 16

SHARP SAFETY Key points to remember about Sharp Safety ■ Always use dominate hand

SHARP SAFETY Key points to remember about Sharp Safety ■ Always use dominate hand to set safety ■ Keep your eye on the sharp ■ Focus on the task ■ Limit conversation when using a sharp ■ Anticipate patient movement ■ Watch for sharps left in the environment ■ Ensure safe disposal of sharps Beware of the stick - Be aware! © 2017 Kaiser Foundation Education Department Riverside Service Area 17

EMPLOYEE HEALTH Annual Health Screening, Health Questionnaire and PPD Skin Testing is : ■

EMPLOYEE HEALTH Annual Health Screening, Health Questionnaire and PPD Skin Testing is : ■ Required by the State & Kaiser Permanente Human Resources every 12 months for all employees and Physians ■ If Employee has positive TB skin test - just need to complete the annual health questionnaire and Follow up Chest X-ray Annually ■ If the TB skin test is received outside of Kaiser, employees/physicians are still required to complete the Kaiser Permanente annual health questionnaire Fit testing ■ The Respiratory Protection Program requires that all employees/physicians that work inpatient, OR, ED, perform/assist with intubation, bronchoscopies or might have contact with a patient on Respiratory isolation should be fit tested annually, including N 95 and PAPR. Blood Borne Pathogens Exposure (BBP) ■ ■ ■ ■ Needle stick, body fluid splash (urine, blood, emesis, etc. ), bite, and/or a scratch Make sure you wash the affected area thoroughly first Report to your immediate supervisor Obtain the name and MRN of source of exposure Get BBP package from supervisor to take to the physician visit Go to Urgent Care or Emergency Room within a 2 hour period Contact EHS, 8 -258 -4212 or pager 951 -774 -8668 Flu Vaccine ■ Kaiser mandates employees/physicians to be vaccinated against the flu. Riverside MOB III (3 rd Floor, Suite 346) 951 -353 -4525 tie-line 258 Moreno Valley Hospital (MOB 1) 951 -251 -6587 tie-line 299 © 2017 Kaiser Foundation Education Department Riverside Service Area 18

Kaiser Permanente 2017 New Emergency Codes

Kaiser Permanente 2017 New Emergency Codes

New Emergency Codes 20

New Emergency Codes 20

CODE RED -- THE PURPOSE: TO PROVIDE AN APPROPRIATE RESPONSE IN THE EVENT OF

CODE RED -- THE PURPOSE: TO PROVIDE AN APPROPRIATE RESPONSE IN THE EVENT OF A SUSPECTED OR ACTUAL SMOKE CONDITION OR FIRE IN ORDER TO PROTECT LIFE, PROPERTY AND VITAL SERVICES. CODE RED FIRE R Rescue those in immediate danger A Alarm Sound the alarm by pulling the nearest pull station and CALL For Riverside - 7777 Moreno Valley – 300 ** Off site clinics call 911* C Contain the fire by closing all doors E Extinguish the fire or Evacuate the area. KNOW THE FOLLOWING DEPARTMENT SPECIFIC INFORMATION ■ ■ ■ Disaster Plan Fire Evacuation Plan Location of Fire Extinguisher Pull Station Alarm Evacuation Equipment Evacuation Staging Location Keep Fire Corridors and Exits Clear !! Gurneys, wheelchairs and equipment must NOT obstruct exits! 21 © 2017 Kaiser Foundation Education Department Riverside Service Area

CARDIAC OR RESPIRATORY ARREST CODES TO PROVIDE AN APPROPRIATE RESPONSE TO A SUSPECTED OR

CARDIAC OR RESPIRATORY ARREST CODES TO PROVIDE AN APPROPRIATE RESPONSE TO A SUSPECTED OR IMMINENTE CARDIOPULMONARY ARREST OR A MEDICAL EMERGENCY FOR ADULT, CHILD OR INFANT For all CODES or Medical Emergency Adults, Child or Infants Call RMC 7777 MVMC 300 Offsite MOB’s Dial 911 White Code – (Infants up to 13 years) Code Blue – (14 year of age to Adults) 22

 ABDUCTION - CODE PINK / CODE PURPLE PURPOSE: PROVIDE AN APPROPRIATE RESPONSE IN

ABDUCTION - CODE PINK / CODE PURPLE PURPOSE: PROVIDE AN APPROPRIATE RESPONSE IN THE EVENT OF THE ABDUCTION, OR ATTEMPTED ABDUCTION OF AN INFANT OR CHILD FROM THE FACILITY Code Pink: Infant Abduction Code Purple Child Abduction 23

Code Silver and Code Yellow CODE YELLOW: BOMB THREAT Purpose: To provide an appropriate

Code Silver and Code Yellow CODE YELLOW: BOMB THREAT Purpose: To provide an appropriate response in the event of a bomb threat or the discovery of a suspicious device. Purpose: To provide an appropriate response in the event of an incident involving a person with a weapon or who has taken hostages within the facility (includes an “active shooter” incident). 24

CODE GRAY COMBATIVE PERSON Purpose: To provide an appropriate response to situations involving combative

CODE GRAY COMBATIVE PERSON Purpose: To provide an appropriate response to situations involving combative or potentially combative person(s). 25

CODE ORANGE: HAZARDOUS MATERIAL SPILL/RELEASE Purpose: To provide an appropriate response to an actual

CODE ORANGE: HAZARDOUS MATERIAL SPILL/RELEASE Purpose: To provide an appropriate response to an actual or suspected hazardous material spill or release in a manner that is safe for staff, patients and visitors. CODE GREEN: MISSING PATIENT/PATIENT ELOPEMENT Purpose: To provide an appropriate response in the event of a missing/eloping patient who is determined to be a danger to themselves or is identified as a safety risk. 26

CODE TRIAGE: EXTERNAL / INTERNAL DISASTER Code Triage: External Emergency Purpose: In response to

CODE TRIAGE: EXTERNAL / INTERNAL DISASTER Code Triage: External Emergency Purpose: In response to an event that has occurred outside the facility that has, or is likely to disrupt the facility’s normal operations. Purpose: To activate the organization’s Emergency Operation Plan (EOP) in response to an event that has occurred within the facility. 27

CODE “OB” AND SEPSIS CODE “SEPSIS” CODE “OB” Purpose: If a Code Sepsis is

CODE “OB” AND SEPSIS CODE “SEPSIS” CODE “OB” Purpose: If a Code Sepsis is activated indicating that there is a patient exhibiting signs and symptoms related to severe sepsis. anticipate the possible need for fluids, labs (including, but not limited to cultures and lactic acid), and antibiotics. Purpose: To provide an appropriate response if there is suspicion or evidence of acute changes in an obstetric patient. 28

CODE STROKE AND RAPID RESPONSE Purpose: If a Code Stroke is activated it is

CODE STROKE AND RAPID RESPONSE Purpose: If a Code Stroke is activated it is indicating that there is a patient exhibiting signs and symptoms related to a stroke. Please follow your facilities local policies and procedures pertaining to stroke patients to ensure timely intervention. Remember. . . Time is brain. Rapid Response Purpose: To provide an appropriate response if there is a patient showing signs and symptoms of hemodynamic distress. 29

FOR ALL EMERGENCY CODES REMEMBER THE NUMBERS TO CALL Offsite MOB’s Dial 911 RMC

FOR ALL EMERGENCY CODES REMEMBER THE NUMBERS TO CALL Offsite MOB’s Dial 911 RMC 7777 MVMC 300 30

PATIENT SAFETY INITIATES AND GOALS 31

PATIENT SAFETY INITIATES AND GOALS 31

PATIENT IDENTIFICATION BANDS Patient Wristband Identification Patient Identification: Does your patient have the correct

PATIENT IDENTIFICATION BANDS Patient Wristband Identification Patient Identification: Does your patient have the correct wristband on? White = Admit-Primary Patient Identification Green = Primary language other than English Door Sign Purple =Safe Patient Handling of a Combative Patient © 2017 Kaiser Foundation Education Department Riverside Service Area Green Blanket 32

FALL PREVENTION IN THE HOSPITAL Patient Safety is our Goal !!! ■ Patient falls

FALL PREVENTION IN THE HOSPITAL Patient Safety is our Goal !!! ■ Patient falls occur in the hospital because of: accidents, new surroundings and health related reasons ■ Each patient will be assessed regularly to determine who is at risk for falls ■ Patients will be banded with a yellow band ■ Patient and Family will be educated on fall prevention ■ Environment checks will be done regularly by staff and include: side rails, call lights in reach, bed locked and in low position, bedside table within reach, a raised toilet seat and bariatric commode Our Comprehensive Fall Program will help patients feel safe while in our facility. YELLOW = FALL RISK 33 © 2017 Kaiser Foundation Education Department Riverside Service Area

PERINATAL REMEMBRANCE LOGO Perinatal Loss Remembrance Logo ■ If you see this logo outside

PERINATAL REMEMBRANCE LOGO Perinatal Loss Remembrance Logo ■ If you see this logo outside the patients door, please be aware that the patient is experiencing a Perinatal Loss ■ Please be considerate of their feelings and off condolences if entering their room. ■ Each October a annual Memorial Service is done for families/staff that have experienced a Perinatal loss. © 2017 Kaiser Foundation Education Department Riverside Service Area 34

TEAM STEPPS Team STEPPS An evidence-based framework to optimize team performance across the health

TEAM STEPPS Team STEPPS An evidence-based framework to optimize team performance across the health care delivery system by Interaction between the outcomes and skills as the basis of a team striving to deliver safe, quality care and support quality improvement through simulation Scenarios or critical events training in huddles, Briefing & debriefing, etc. TEAM STEPPS Has 5 Key Principles ■ Team Structure ■ ■ Communication ■ ■ Maximize the activities of team members by ensuring that team actions are understood, changes in information are shared, and team members have the necessary resources Situation Monitoring ■ ■ Structured process by which information is clearly and accurately exchanged among team members (SBAR, CALL OUT, CHECK BACK, & HANDS OFF) Leadership ■ ■ Safe and efficient care involves the coordinated activities of a multi-team system. Process of actively scanning and assessing situational elements to gain information or understanding, or to maintain awareness to support team functioning Mutual Support ■ Ability to anticipate and support team members © 2017 Kaiser Foundation Education Department Riverside Service Area 35

SAFETY IS NUMBER ONE!! Safety Resources ■ KP COMPLIANCE CONNECTION HOTLINE 1 -888 -774

SAFETY IS NUMBER ONE!! Safety Resources ■ KP COMPLIANCE CONNECTION HOTLINE 1 -888 -774 -9100 ■ Patricia Gallarita (Lin) Compliance Officer (951 -353 -3478) ■ Corrie Sankey Safety Officer (951 -353 -5513) ■ Marie Kuzmyak -Patient Safety Officer (951 -353 -3026) EVERY EMPLOYEE IS RESPONSIBLE FOR THE SAFETY PROGRAM © 2017 Kaiser Foundation Education Department Riverside Service Area 36

NATIONAL PATIENT SAFETY GOALS Safety Goals ■ Goal 1: Identify Patients Correctly ■ Goal

NATIONAL PATIENT SAFETY GOALS Safety Goals ■ Goal 1: Identify Patients Correctly ■ Goal 2: Improve Staff Communication ■ Goal 3: Improve the Safety of Using Medications ■ Goal 6: Use Alarms Safely ■ Goal 7: Prevent Infections ■ Goal 15: Identify Patients at Risks for Suicide Universal Protocol: Prevent Surgical Mistakes 37 © 2017 Kaiser Foundation Education Department Riverside Service Area

AGE-RELATED COMPETENCIES You will encounter people of varying ages. Being equipped to meet the

AGE-RELATED COMPETENCIES You will encounter people of varying ages. Being equipped to meet the age related needs of our members will ensure quality care of patients of all ages. Ways to apply Age-Related Competencies include: ■ Considering cultural beliefs as they relate to age. ■ Utilizing interview techniques appropriate to the age of the patient and family members. ■ In the care plan and the evaluation of the effectiveness of care. ■ In the performance of patient care. ■ By how we approach patient education and the evaluation of comprehension, concerns, and compliance. ■ By being aware of the resources available on age-related development specific to patient needs. ■ By demonstrating age-related applications in annual skills validation. ■ Knowing normal value ranges for vital signs appropriate to all ages. ■ Obtaining appropriate sized equipment (blood pressure cuffs, crutches) for all age groups. ■ Positioning-proper body mechanics, assistance when needed. ■ Injections-phlebotomy-appropriate needle gauge and length, appropriate site. ■ CPR-compressions, depth and rate. 38 © 2017 Kaiser Foundation Education Department Riverside Service Area

MEDICATION SAFETY The purpose of a comprehensive program of hospital-wide surveillance is to identify,

MEDICATION SAFETY The purpose of a comprehensive program of hospital-wide surveillance is to identify, evaluate, report and prevent problematic drug experiences in an effort to maximize patient safety and enhance patient care. Requires discontinuing the drug What is an adverse drug reaction (ADR)? ■ Requires changing the drug therapy and or modifying the dose ■ Necessitates admission to a hospital ■ Prolongs stay in a health care facility ■ Necessitates supportive treatment ■ Significantly complicates diagnosis ■ Causes an allergic reaction ■ Negatively affects prognosis ■ Idiosyncratic reactions resulting in temporary or permanent harm, disability, or death ADR MUST be reported in UOR-O ADR Hotline MV: Ext. 6978 ed 39 © 2017 Kaiser Foundation Education Department Riverside Service Area

MEDICATION SAFETY Some symptoms that suggest an ADR may have occurred are: ■ Excessive

MEDICATION SAFETY Some symptoms that suggest an ADR may have occurred are: ■ Excessive sedation ■ Hypotension ■ Hives ■ Altered level of consciousness ■ Lethargy ■ Rashes ■ Excessive itching ■ Transfer to a higher level of care, or an abrupt discontinuation of medication order. If the patient experiences an allergic reaction during their visit or hospital stay: Notify physician for evaluation and treatment , then update the patient’s Allergy Section in Health Connect please enter the suspected medication and type of reaction observed. 40 © 2017 Kaiser Foundation Education Department Riverside Service Area

UNUSUAL OCCURRENCE REPORT – ONLINE UOR-O Our medical centers and out-patient clinics are committed

UNUSUAL OCCURRENCE REPORT – ONLINE UOR-O Our medical centers and out-patient clinics are committed to patient safety and identifying risks completing unusual occurrence reports-online (UOR-O). Examples of events that should be reported include ■ Medication errors ■ Falls ■ Pressure ulcers ■ Environmental injuries ■ Injuries related to equipment ■ Issues related to patient hand-offs ■ Criminal and behavioral issues related to patient care The system can be accessed at: http: //kpnet. kp. org: 81/california/qmrs/rm/UORO/index. html The system can be © 2017 Kaiser Foundation Education Department Riverside Service Area 41

Inpatient Primary Care Center Certifications 42

Inpatient Primary Care Center Certifications 42

PRIMARY STROKE CENTER ED / INPATIENT CODE STROKE ■ Code stroke is only activated

PRIMARY STROKE CENTER ED / INPATIENT CODE STROKE ■ Code stroke is only activated for ED and inpatient only. ■ RMC – Call x 7777 ■ MV – Call x 300 ■ Free standing outpatient MOB’s ■ For patients with stroke symptoms Call 911 ■ Stroke Facts: Majority of strokes are Preventable ■ 5 th leading cause of death in USA ■ 1 st leading cause of disability ■ 750, 000 strokes per year ■ 80% are ischemic (blood clot) ■ Costs $28 billion per year ■ Core Stroke Team: ■ Medical Director – Dr. Jorge Lipiz ■ Stroke Coordinator – Heather Byrd, RN SCPMG Clinical Reference Acute Stroke Management http: //cl. kp. org/pkc/scal/cpg 43 © 2017 Kaiser Foundation Education Department Riverside Service Area

ADVANCED MANAGEMENT OF INPATIENT DIABETES CARE CENTER WHAT INTERVENTIONS AND CARE IS REQUIRED WHEN

ADVANCED MANAGEMENT OF INPATIENT DIABETES CARE CENTER WHAT INTERVENTIONS AND CARE IS REQUIRED WHEN A DIABEIC PT IS ADMIITTED TO HOPSITAL? Assess for last A 1 C. ■ Hospitalized patients need A 1 C done within a 2 month period ■ Notify rounding physician for A 1 C order if needed ■ For A 1 C of 9 and above make sure referrals are completed as follows: ■ Inpatient Clinical Case Manager, Social Services, and Dietician HOW to Prevent Hypoglycemic Reaction BY Assessing : ■ Diet and document percentage of meals and snacks ■ Patients who are NPO for possible need of IV fluids with Dextrose, and order for reduction of basal insulin ■ Diabetes medications regarding onset, peak, and duration of action Diabetes Education ■ Assess for diabetes self-care management deficits, educate, document on the Diabetes NCP ■ Contact the Inpatient Clinical Case Manager regarding assistance with diabetes education for A 1 C of 9 and above, new diabetes diagnosis, or new insulin start © 2017 Kaiser Foundation Education Department Riverside Service Area 44

SOCIAL SERVICES ADVANCED DIRECTIVES 45

SOCIAL SERVICES ADVANCED DIRECTIVES 45

ADVANCE HEALTH CARE DIRECTIVES What is an Advance Health Care Directive (AHCD)? ■ It

ADVANCE HEALTH CARE DIRECTIVES What is an Advance Health Care Directive (AHCD)? ■ It is a legal document for adults 18 years of age or older. ■ The individual must have decision making capacity. ■ It identifies a “health care agent” (legally designated medical decision maker in case one loses capacity to make their own medical decisions). ■ And encourages the individual to express in a written directive, what he/she wants in terms of health care in certain situations, such as terminal illness, coma or decreased quality of life. ■ Members can obtain a free Advance Health Care Directive from admitting, membership services, social services, the wellness store, and KP. org. Legal AHCD’s are signed BY THE PATIENT, and either: ■ ■ ■ 2 witnesses (one not a related by blood, marriage or adoption). (KP medical care provider, or volunteer or may not serve as a witness for members). A notary And Long term care Ombudsman if completed in a Skills Nursing Facility (SNF). Where Can You Find the AHCD in the Chart? ■ AHCD’s are located in Healthconnect at Chart Review/Media Tab/Document Type “Advance Directive”. If patient/family states that they have an AHCD, check to see if it is in Healthconnect. If not in medical record, ask family to bring a copy of AHCD to hospital at first opportunity. Members can obtain a free Advance Health Care Directive from admitting, membership services, social services, the wellness store, and KP. org. © 2017 Kaiser Foundation Education Department Riverside Service Area 46

POLST The California POLST form (Physician Orders for Life Sustaining Treatment) was created with

POLST The California POLST form (Physician Orders for Life Sustaining Treatment) was created with the intent is to make patient treatment choices clear, accessible and honored in any health care treatment setting. It is printed on bright pink cardstock in a standard format so that it is easily recognized and located by family, Emergency Medical Services and hospital staff. POLST is a: ■ Physician or PA or NP Order recognized throughout the medical system in CA ■ Directive for a range of end-of-life medical treatment and honoring the form is mandatory in all health care settings ■ Portable document that transfers with the patient throughout the medical system. POLST addresses three important health care questions: ■ Does a person without pulse or respirations want CPR or DNR? ■ Does a person is in a declining condition want “Full Treatment”, “Selective Treatment”, or “Comfort-Focused Treatment”? ■ Does a person want “Long term”, “Time-limited” or “No artificial means” of nutrition (feeding tubes, TPN)? The POLST does not assign a legal “health care agent”, as the Advance Directive does. If a patient presents at any Kaiser Permanente facility with a completed POLST form or Advance Directive, nursing 4 7 should inform the treating physician immediately so appropriate hospital orders can be written. Then check to see if the form is available in Health Connect (Chart Review/Media tab/Document Type). Forms will be made widely available through Social Services, Bioethics, Clinics and hospital units. Social Workers, Nurses and Bioethics can assist with the explanation and completion of a POLST. ■ BUT a physician, PA or NP must review with the patient for understanding and clarity before signing. © 2017 Kaiser Foundation Education Department Riverside Service Area

SOCIAL SERVICES DEPARTMENT HIGH RISK SCREENING AND REPORTING Child Abuse Is the neglect of

SOCIAL SERVICES DEPARTMENT HIGH RISK SCREENING AND REPORTING Child Abuse Is the neglect of mistreatment of a minor under the age of 18, which puts the minor at risk for physical or emotional harm. ■ Types of Abuse Include: ■ ■ ■ Reasonable Suspicion ■ ■ ■ Physical Abuse (i. e. – Bruises, abrasions or other injuries that do not appear consistent with mechanism described) Sexual Abuse Neglect (i. e. – Failure to provide adequate food, clothing, shelter or medical treatment such that the child’s health/life is endangered. ) Emotional Abuse Child Protective Services must be called to report the case & discuss the disposition of the patient. Complete Report Form SS 8572 and then call Child Protective Services. Significant Physical Findings- Physician must document the findings on Form OES 900, photograph all suspicious findings. Child needs protection– Call Police and Child Protective Services and Hospital Security for Immediate response. How to Report and Abuse Forms ■ are available on the Kaiser Permanente Riverside Family Prevention Website at http: //kpnet. kp. org/scal/violenceprevention/riverside. html 48 © 2017 Kaiser Foundation Education Department Riverside Service Area

SOCIAL SERVICES DEPARTMENT HIGH RISK SCREENING AND REPORTING CHILD SEXUAL ABUSE REPORTING Suspected Sexual

SOCIAL SERVICES DEPARTMENT HIGH RISK SCREENING AND REPORTING CHILD SEXUAL ABUSE REPORTING Suspected Sexual Abuse to Child ■ If abuse occurred More than 72 hours ago ■ Call Police, Notify and Fax form to the Medical Social Work Department. ■ Complete Report Form SS 8572 and then Call Child Protective Services. ■ If Abuse Occurred less than 72 hours ago ■ If there are significant physical findings - Police or Sheriff will transfer patient immediately to Evidentiary Exam with Riverside Regional Medical Center. Suspected Sexual Abuse to Adolescent, between 14 and 18 years old: ■ Stranger or Date Rape– Call Police. Then ask and encourage patient to give consent for exam. ■ Incest (Abuse by a Family Member) – Call Police and Child Protective Services. ■ If Abuse Occurred less than 72 hours ago – Use same protocol as above. If family refuses consent, Child Protective Services will give permission. ■ Complete Report Form SS 8572 and then Call Child Protective Services. Consensual Sexual Activity – if the patient meets the criteria below: ■ ■ Sexual intercourse between a minor who is under 14 years old and a partner 14 years old or older. Sexual intercourse between a minor who is 14 to 15 years old and a partner who is 21 years old or older. Complete Report Form SS 8572 and then Call Child Protective Services. Notify and Mail form to the Medical Social Work Department. REVIEW THE POLICY – Suspected Child Abuse and Neglect (Number 03 -196). 49 © 2017 Kaiser Foundation Education Department Riverside Service Area

SOCIAL SERVICES DEPARTMENT HIGH RISK SCREENING AND REPORTING ELDER and DEPENDENT ADULT ABUSE Suspicion

SOCIAL SERVICES DEPARTMENT HIGH RISK SCREENING AND REPORTING ELDER and DEPENDENT ADULT ABUSE Suspicion of Abuse: ■ You have identified one or more of the following: ■ Physical Abuse- (bruises, poor medical care) ■ Physical Neglect- (unkempt appearance, poor hygiene) ■ Emotional Abuse- (complains of name-calling, fearful) ■ Material / Financial Abuse- (complains of others withholding funds for care, missing personal funds) ■ NOTIFY- the Medical Social Work Department. ■ ASSESS - decision-making capacity of the elder or dependent adult. ■ SEPARATE – the elder or dependent adult from abuser if in immediate danger. ■ COMPLETE REPORT– complete Form SOC 341 and then Call Adult Protective Services. ■ EMERGENCIES – extreme abuse and/or adult may die - Call Police and Adult Protective Services. ■ ABUSE THAT OCCURS IN CARE FACILITY OR ADULT DAY CARE CENTER ■ Call Adult Protective Services and Riverside Ombudsman. ANY ABOVE SITUATION - NOTIFY and MAIL form to the Medical Social Work Department. 50 © 2017 Kaiser Foundation Education Department Riverside Service Area

SOCIAL SERVICES DEPARTMENT HIGH RISK SCREENING AND REPORTING Intimate Partner Violence and Domestic Violence

SOCIAL SERVICES DEPARTMENT HIGH RISK SCREENING AND REPORTING Intimate Partner Violence and Domestic Violence ■ Assess for Suspicion of Violence: ■ Screen ■ Remember H. I. T. S. (Hurt, Insulted, Threatened and Screamed) ■ (How often does your partner…) ■ Physically hurt you? ■ Insult or talk down to you? ■ Threaten you with harm? ■ Scream or cures at you? ■ Treat Any Injuries and Document In Medical Record ■ Use patient’s own words. ■ Obtain consent to photograph. ■ Include history of abuse. ■ Describe visible injuries specifically. ■ ASSESS RISK ■ Gun or other weapon involved? ■ Does he/she think it’s safe to go home? ■ Are there any children in the home affected by this behavior? ■ NOTIFY ■ Contact the Medical Social Work Department. ■ NOTIFY and MAIL form to the Medical Social Work Department. All materials needed for abuse/neglect can be found on the Kaiser Permanente Family Violence website at http: //kpnet. kp. org/scal/violenceprevention/riverside. html. On this webpage you can find, forms, resources, education videos etc. Social services can be called during the weekday to discuss the case. 51 © 2017 Kaiser Foundation Education Department Riverside Service Area

EMTALA-Emergency Medical Treatment & Active Labor Act ■ ■ ■ A section of the

EMTALA-Emergency Medical Treatment & Active Labor Act ■ ■ ■ A section of the Consolidated Omnibus Budget Reconciliation Act (COBRA) Enacted by Congress in 1986 Regulated by HCFA (Health Care Financing Administration), a branch of the Department of Health and Human Services (DHS) The EMTALA Education Plan ■ A process that is followed by all staff members to assure that every person seeking emergency care is directed to the Emergency Department ■ A method by which we ensure compliance with the EMTALA regulations How can I help? ■ Remember, Kaiser Emergency Departments are open to the public ■ We provide emergency medical screening and stabilizing treatment to the members of the community regardless of their ability to pay ■ Listen to what the patient says. Anyone who thinks they are having an emergency should be directed to the Emergency Department 52 © 2017 Kaiser Foundation Education Department Riverside Service Area

HOMELESS Homeless Patient is ■ An individual who lacks a fixed, regular, and adequate

HOMELESS Homeless Patient is ■ An individual who lacks a fixed, regular, and adequate nighttime residence; and an individual who has a Primary nighttime residence that is… ■ A supervised publicly or privately operated shelter designed to provide temporary living accommodations (including sober living facilities, welfare hotels, congregate shelters, and transitional housing for the Mentally ill) ■ An institution that provides a temporary residence for individuals intended to be institutionalized; or a public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings ■ If he or she is being discharged from an institution where he or she has been a resident for 90 days or less and the person resided in a shelter or place not meant for human habitation immediately prior to entering that institution ■ Individual or family is being evicted within 14 days from a private dwelling and no subsequent residence has been identified ■ All disciplines involved in care must document all interventions. © 2017 Kaiser Foundation Education Department Riverside Service Area 53

CULTURALLY RESPONSIVE CARE 54

CULTURALLY RESPONSIVE CARE 54

CULTURALLY RESPONSIVE INTERPRETATION - SPOKEN LANGUAGE ■ KP must provide interpretation services that are

CULTURALLY RESPONSIVE INTERPRETATION - SPOKEN LANGUAGE ■ KP must provide interpretation services that are free of charge and available 24 hours/day, 7 days/week. ■ KP staff must always offer patients free interpreter services and document the use or refusal of such services. ■ Members/Patients may not be asked to bring their own interpreter. ■ The use of adult family member and/or friends as interpreters is highly discouraged ■ A patient may opt to use a family member or friend (age 18 or over) to interpret. However, a Provider can elect to have a qualified interpreter present to ensure effective communication. The patient’s preference must be documented in the medical record, which includes the name and association of the member’s interpreter. ■ Qualified Bilingual Staff (QBS) are KP employees qualified, through testing and training, to provide language assistance and are identified with their ID badge. 55 © 2017 Kaiser Foundation Education Department Riverside Service Area

 CULTURALLY RESPONSIVE CARE TRANSLATION SERVICES - WRITTEN LANGUAGE Translation is the conversion of

CULTURALLY RESPONSIVE CARE TRANSLATION SERVICES - WRITTEN LANGUAGE Translation is the conversion of written text of one language into another language. All English translations into another language must be translated by an approved KP vendor. A member has a right to request a document to be translated into their primary language. The translated document must be received by the member within 21 days of the request. Refer to your manager for additional details, requests are to be sent to Health Education at Translation. Request-KPSCRIV@kp. org along with the Translation Request Form, and they will keep a log of such requests. Qualified Bilingual Staff are not qualified to perform written translations. Documents not immediately available in a target language can be sight translated by a QBS employee. Approved Translation Vendors For a list of approved translation vendors go to https: //epf. kp. org/wps/portal/hr/kpme/diversity >> select “Translation Services” link under “Language and Translation Services” 56 © 2017 Kaiser Foundation Education Department Riverside Service Area

 CULTURALLY RESPONSIVE CARE FACE-TO-FACE - INTERPRETATION SERVICES Qualified Bilingual Staff (QBS) QBS or

CULTURALLY RESPONSIVE CARE FACE-TO-FACE - INTERPRETATION SERVICES Qualified Bilingual Staff (QBS) QBS or face to face interpreters should especially be used where visual cues are important, for sensitive or complex visits, Mental Health services, physical or visual components, or if multiple limited English speaking individuals are present. ■ Staffing can assist in finding QBS staff scheduled to work ■ QBS Listing - For a current list of QBS employees, locations and levels: ■ Go to My HR > KP & ME tab, select “Diversity” go to “Qualified Bilingual Staff Listings” link under Diversity Resources, where you will find the QBS IDENTIFIER WEBSITE ■ QBS Staff Listings can also be found on the Riverside Share Drive in the folder titled “QBS - Bilingual Staff”. ■ Or on the Docushare intranet website at: http: //dms. kp. org/docushare/dsweb/View/Collection-258217 Certified Health Care Interpreter – RIV Specialty Depts ONLY ■ (See Interpreter Guideline for assistance on when to utilize CHCI) Spanish Interpreter – Over the phone Interpretation – x 6976 Pager (951) 774 -7807 (for same day requests only)Riv-Spanish-Interpreter@kp. org or 8 -258 -4556 (for future appointments) INTERPRETER SERVICES PHONE TREE ■ If no QBS staff are immediately available there are multiple options to choose from; determine if face-to-face is required due to the complexity of the conversation or if visual aids are included, if not refer to the over-thephone options. See details below for options. RMC or outlying clinics x 1975 MVMC 8 -258 -1975 57 © 2017 Kaiser Foundation Education Department Riverside Service Area

 CULTURALLY RESPONSIVE CARE DOCUMENTATION - CULTURAL AND LINGUISTIC The following must be documented

CULTURALLY RESPONSIVE CARE DOCUMENTATION - CULTURAL AND LINGUISTIC The following must be documented in the patient’s medical record: Language preferences (written, spoken and interpreter need) for obtaining health/medical care services The use or refusal of interpreter services at each encounter The vendor’s or QBS’ name and I. D. number or the family/friend’s name/association when providing interpreter services Language preferences (written, spoken and interpreter need), as applicable, of the patient’s caregiver, guardian or legal decision maker Race and ethnicity (as self-identified by the patient) If the patient is a minor, incapacitated, or has a designated advocate, the communication needs of the parent or legal guardian, surrogate decision-maker, or legally authorized representative is documented in the medical record. ALTERNATIVE FORMAT SOLUTIONS The Hearing Impaired see attached PDF for more specific situations and resources. 58 © 2017 Kaiser Foundation Education Department Riverside Service Area

INFECTION CONTROL 59

INFECTION CONTROL 59

INFECTION CONTROL Standard Precautions ■ FIRST TIER of precautions for care of ALL patients

INFECTION CONTROL Standard Precautions ■ FIRST TIER of precautions for care of ALL patients at ALL times regardless of their diagnosis or presumed infectious status. ■ Requires PPE when anticipating contact with the patient’s blood or body fluids, non-intact skin and mucous membranes. Personal Protective Equipment (PPE) ■ Protects skin, eyes, mouth or other mucous membranes while providing care. ■ Based on the type and degree of risk associated with the task being performed. Types of PPE ■ ■ Gloves Mask Eye Protection Impervious Gown Disposal of PPE ■ Place PPE in regular trash unless grossly contaminated with blood or body fluids. ■ When drippy or caked with blood or other potentially infectious materials, PPE should be discarded in a biohazard container. ■ PPE contaminated by chemotherapeutic agents is disposed in a chemo container. 60

INFECTION CONTROL Hand Hygiene ■ Is the most important way to decrease the incidence

INFECTION CONTROL Hand Hygiene ■ Is the most important way to decrease the incidence of Hospital Acquired Infections. Five Moments for Hand Hygiene: ■ ■ ■ Before patient contact Before an aseptic task (i. e. foley catheter insertion) After body fluid exposure After patient contact After contact with patient surroundings Effective hand hygiene can be achieved by two methods: ■ Soap and Water ■ Use when hands are visibly soiled or when providing care to a patient with Clostridium difficile. Wash with soap and water for a minimum of 15 seconds. ■ Alcohol Degermer ■ Hand decontamination with an alcohol based degermer has proven to be effective in killing microorganisms and can be used if hands are NOT visibly soiled. ■ Apply alcohol degermer and rub hands together to cover all surfaces, including between the fingers, thumbs and nail beds, until dry. © 2017 Kaiser Foundation Education Department Riverside Service Area

INFECTION CONTROL Multidrug Resistant Organisms (MDROs) ■ Transmission of these organisms can occur through

INFECTION CONTROL Multidrug Resistant Organisms (MDROs) ■ Transmission of these organisms can occur through ■ Direct unprotected contact with a patient wound, urine, or any other site of infection ■ Touching contaminated surfaces such as bed rails, IV pumps, over bed tray, door knobs, etc. ■ Patients with Multidrug Resistant Organisms (MDRO) ■ Will be placed on Contact Isolation to help prevent the transmission of infection. ■ Will be flagged on the banner bar in Health. Connect. 62 © 2017 Kaiser Foundation Education Department Riverside Service Area

INFECTION CONTROL Clostridium difficile Infection (CDI) ■ Most often occurs in patients taking antibiotics.

INFECTION CONTROL Clostridium difficile Infection (CDI) ■ Most often occurs in patients taking antibiotics. ■ Can live on surfaces and in the environment for an extended period of time. ■ Can spread from person to person on contaminated equipment and on the hands of HCPs. C. Diff Prevention strategies include: ■ Careful use of antibiotics ■ Use of dedicated patient care items and equipment ■ Clean and disinfect shared items between patients with bleach based product or Oxycide ■ Using Contact Plus Precautions for patients suspected of a positive lab test for C. diff. ■ Hand hygiene before and after donning PPE ■ Hand Hygiene with soap and water after caring for patient (do not use alcohol degermer) ■ Use of hospital-approved product for daily cleaning and on discharge ■ Obtaining stool specimen on patients suspicious for C. diff infection ■ Repeat C. diff testing is not recommended. ■ Providing educational material for patients and family members regarding C. diff. © 2017 Kaiser Foundation Education Department Riverside Service Area 63

INFECTION CONTROL ENVIRONMENTAL AND EQUIPMENT CLEANING ■ Maintain a clean and sanitary patient environment

INFECTION CONTROL ENVIRONMENTAL AND EQUIPMENT CLEANING ■ Maintain a clean and sanitary patient environment at all times. ■ Cleaning of the environment or patient care equipment is done using a hospital approved germicide per hospital policy. ■ Know the product you are using and the required dwell time per manufacturer’s recommendations. ■ Two common products used ■ ■ PDI AF 3 Wipe Clorox Brand Bleach Wipe. 3 minute contact time © 2017 Kaiser Foundation Education Department Riverside Service Area 64