Downey 2014 KP S.A.F.E. (Safety Awareness For Everyone) Training

The entire Kaiser Permanente community, which includes members, patients, co-workers, and the local areas we serve have a stake in our annual SAFE Training.

Improving workplace and patient safety is an ongoing process, and whether new information is being imparted or current procedures are being reviewed, it's important for all of us to focus on this training and take a proactive role in maintaining a healthy, injury-free environment.

SAFE Training benefits everyone, and it is most effective when each one of us is dedicated to the goal of creating a safe Kaiser Permanente where we all THRIVE.

DirectionsRead this publication.

Answer the post test questions and return the certificate of completion to your manager or supervisor. Consult your content experts or your manager if you have any questions related to the content of this education publication or post test.

Thank you.

Staff Educational Services

Aerosol Transmissible Disease (ATD)

Cal/OSHA Standard 5199, Aerosol Transmissible Disease Standard, can be obtained from the Safety Department. Call 8-324-4043. Aerosol Transmissible Disease (ATD) is a disease or pathogen that can be spread by droplet or airborne routes: “Droplets” are relatively large in size and can result from coughing, sneezing, or talking. “Airborne” refers to relatively small particles, which can remain suspended in the air and can

travel great distances. Signs and Symptoms of ATDs that require further medical evaluation include: Fever with rash Fever with cough Headache or neck stiffness or sensitivity to light

When these symptoms are identified and an ATD is suspected, initiate precautions to prevent exposure and spread based on the modes of transmission. Modes of transmission:

Droplet ATDs: Are spread by large droplets (carrying infectious pathogens) that generally do not travel very far

(about 3 to 5 feet from the infectious person) Transmit infection when they travel directly from an infectious person to someone else Are generated when an infected person coughs, sneezes or talks Also generated during procedures such as suctioning, endotracheal intubation, cough

induction, and cardiopulmonary resuscitation

Airborne ATDs: Are spread by very small infectious particles These particles can stay suspended in air and may travel long distances on air currents. Can transmit disease when someone inhales them

Source Control Procedures/Procedures to Prevent Exposure:

Educate visitors and patients to cover nose and mouth with a tissue when they cough or sneeze, and to perform hand hygiene after coughing or sneezing. Posters and/or direct communication are excellent educational methods.

Provide respiratory “etiquette stations” at facility entrances and public waiting areas; stocked with hand sanitizer and tissue and/or surgical masks.

Personal Protection: Depending on the type of ATD, Personal Protective Equipment (PPE) is worn to protect the health care worker while providing care or working in the environment with a patient with an ATD. PPE is only effective if appropriately selected, correctly and consistently worn, and properly cleaned, stored or discarded. PPE creates a physical barrier from exposure to ATD pathogens, including facial protection for droplets and respiratory protection for airborne particles. Contaminated PPE may be a source of infection. This PPE may include:

• Gloves• Mask• Gown• Eye protection• N95 Mask---Use with a known or suspected TB or other Airborne ATD when entering the room

of a patient on Airborne Isolation Precautions, or within one hour of when the room wasoccupied by the patient.

• Personal Air Purifying Respirator (PAPR)---Use when participating in high hazard procedures onpatients suspected to have an Airborne Infectious Disease. High hazard procedures includesputum induction, bronchoscopy, and intubation, aerosolized administration of Pentamidine orother medications, and autopsy, clinical, surgical and laboratory procedures that may generateaerosols.

N95 Mask Fit Testing and PAPR Training • Fit testing for N95 mask is provided by Employee Health Services on hire and every year if you

are a staff member whose duties make ATD exposure likely.• PAPR training is provided by each department for staff members whose duties make ATD

exposure likely.

A PROPER FIT IS KEY! A proper fit of the respirator is necessary to ensure all the air inhaled by the user is filtered. Each time the respirator is worn, the proper fit is assured through fit checking by the user.

When disposing the N95 mask (removed after leaving the patient room) and other PPE after use, please discard it in the trash receptacle and perform HAND HYGIENE.

Decontamination and Disinfection: Disinfect surfaces with approved germicidal solutions. Disinfect surfaces frequently and between patients.

VACCINES FOR ATDs! Employee Health Services is responsible for administering vaccinations (FREE OF CHARGE) ATD vaccines include:

• Tetanus, Diphtheria (Td) with Pertussis (Tdap)• Varicella• Influenza• Measles, Mumps, Rubella

The Aerosol Transmissible Disease Exposure Control Plan is Policy MCW 7610.00. This plan describes the program management, exposure prevention, exposure control, surveillance, fit testing, and supplies related to prevention of ATD transmission. If you have recommendations for the ATD Exposure Control Plan content, contact Infection Prevention and Control. Related information of interest:

Infection Prevention and Control Response Plan for an Influx or Surge of Infectious PatientsPolicy MCW 7205.00.

Tuberculosis - TB

What is TB?

Tuberculosis (TB) is an infectious and potentially life-threatening bacterial infection caused by Mycobacterium Tuberculosis. Commonly thought of as a respiratory illness, TB can involve many organs or tissues.

TB is very contagious. It is spread primarily when people with active lung disease expel bacteria from their lungs into the air through coughing, singing, talking, or sneezing. Other people breathe the infectious droplets into their lungs, where the bacteria may begin to multiply and spread.

Most people can be cured by taking a combination of medications. Stopping medicines early or taking them only occasionally sets the stage for drug-resistant bacteria to develop.

TB is a major concern for the health of the general public. Law requires persons with suspected and with active TB disease be reported to their local Health Department. They assure thorough and complete treatment of infected TB patients and evaluate other close contacts for TB.

TB skin tests, chest x-rays, and examinations of TB sputum cultures are used to see if an active TB infection exists. Understanding the difference between TB infection and TB disease is important.

TB Infection

TB Infection (“latent”, “non-contagious”) means the person was exposed to and infected by the TB germs. This is usually detected by a positive skin test without the presence of signs and symptoms of TB.

TB Disease

TB disease (“active”, “contagious”) means the germs have multiplied and invaded organs and tissue, producing signs and symptoms of TB. At this point, the disease can be spread to others.

Aerosol Transmissible Disease Exposure Control Plan

Symptoms of TB Disease

Chronic cough (longer than 3 weeks) Night sweats Bloody sputum Fever Unexplained weight loss Chills Loss of appetite Fatigue

Care of Patients with Known or Suspected TB

Patients admitted to the hospital are placed in a negative pressure room with the ventilation to the outside. The "Airborne Precautions" sign provides instructions for visitors and healthcare workers to check at the nurse's station before entering the room. The negative pressure gauge or alarm must be on.

If the patient must leave his/her room for treatments or procedures, provide standard surgical masks to the patient with instructions to wear it over the nose and mouth.

Discharging the TB patient

Before a patient with known or suspected active TB can be released (discharged or transferred), an approval from the local Department of Public Health (DPH) - TB Control for the county or city in which the member resides, must be obtained. This is to ensure the patient will not expose others in the community.

The discharge planner, infection preventionists, and the physician will work together to ensure TB Control has approved the patient's release before discharge.

A 60 minute wait time is indicated for a person to enter into a room without appropriate respiratory equipment after an airborne isolation patient has been discharged from the room.

People at Risk

HIV infected persons / immuno-compromised Immigrants from countries where TB is common Medically under-served persons who don’t receive needed medical care Persons in crowded living conditions (prisons, shelters for the homeless,nursing homes) Health care workers

TB Surveillance

Employee Health Services is responsible for:

Employee TB screening All health care workers are screened initially upon hire and annually thereafter. (In some

locations the need for annual screening is determined by the results of the annual riskassessment.)

Screening may consist of symptom review questionnaire, TB Skin test (TST), and/or chest x-ray Providing evaluation and follow up after employee exposure to TB or other ATD Note that immune-compromised individuals can have a false negative TB test result.

Employee is responsible for:

It is your responsibility to complete your TB screening annually. You will receive a notificationfrom your manager regarding this screening (TST or questionnaire).

Complete scheduled health screening through Employee Health Services. Report TB or ATD exposures to your manager IMMEDIATELY. Your manager will report the exposure to Infection Prevention and Employee Health Services.

Post-Exposure Evaluation • A post-exposure evaluation is performed to determine the nature and extent of exposure,

including circumstances of event, source patient information and other details. It may involvetesting of exposed employee or physician

Medical follow-up may involve

Testing Preventive therapy: medications or vaccinations Other procedures if indicated (for example, a chest x-ray) Follow-up when referred for preventive

therapy: you are responsible for taking medication as ordered and obtaining lab work and /orchest x-rays, as prescribed. Do not stop your therapy without the direction of your provider.

Article expert: Jennifer Cox

Hand hygiene is the most effective way to prevent the spread of disease. Hand washing consists of soap, water and friction for 15 seconds when hands are visibly soiled, before eating and after

using the bathroom.

An antiseptic hand cleaner (alcohol degermer) may be substituted for soap-and-water hand cleansing if hands are not visiblysoiled. Follow the manufacturer's directions; it may take about 15 seconds to rub in.

Hands must be washed with soap and water after 10-12 uses of the alcohol degermer or when visibly soiled or when caringfor a patient with Clostridium difficile (C. diff) active infection or before eating or handling food.

Anytime your patient has diarrhea wash your hands with soap and water instead of using alcohol degermer.

Gloves may not provide complete protection. Hands must be cleansed immediately after gloves are removed (hand wash oralcohol degermer).

Hand Hygiene

Infection Prevention and Control Is the responsibility of the ENTIRE Health Care Team, physicians, nursing, respiratory therapy, EVS, nutrition, etc. The goal of infection prevention and control is to identify and reduce the risk of infection in patients and health care workers. The goal of this section is to increase employee awareness of: • Prevention of healthcare acquired infections (nosocomial)• Blood borne disease transmission, prevention and control

Standard Precautions

We can not always tell that our patients have infectious diseases. For this reason, we follow Standard (Universal) Precautions. Standard Precautions are simple infection prevention measures used by ALL healthcare workers during ALL care with ALL patients, and when there is anticipated contact with blood or Other Potentially Infectious Materials (OPIM). These precautions emphasize the need to treat ALL blood and body substances from ALL patients as potentially infectious.

Standard Precautions are required by California Occupational Safety and Health Administration (Cal-OSHA) and recommended by the Centers for Disease Control and Prevention (CDC). They are designed to reduce the risk of transmission of germs from both recognized and unrecognized sources of infection in our work setting

Personal Protective Equipment (PPE)

Appropriate barrier garments, called Personal Protective Equipment (PPE), such as gloves, masks / eye and face protection, and gowns / aprons, must be used to prevent skin or mucous membrane exposure to blood or other body substances of ANY patient, regardless of whether the patient has signs or symptoms of infection. PPE place a barrier between you, blood and OPIM. The PPE must be removed when finished with care at the patient’s bedside or replaced when moving from contaminated to clean parts of the patient’s body. Wear Gloves when:

• Your hands have open cuts or abrasions • Performing venipuncture and other vascular access procedures

(e.g. starting IVs) • Anticipating contact with patient’s mucous membranes, non-intact

skin or moist body substances (e.g. blood, wound drainage, vaginal secretions, amniotic fluid, oral secretions, sputum, urine, feces)

• Handling items or surfaces soiled with blood or body substances (e.g. handling the placenta or the infant before the first bath and during care of the umbilical cord)

Gloves are not a substitute for hand hygiene. Gloves do not need to be worn for all patient contact. If you are touching dry, intact skin, gloves do not need to be worn and/or unless the patient is in Transmission Based Precautions.

At KP Downey Medical Center, we follow the World Health

Organization’s 5 MOMENTS OF HAND HYGIENE This serves as a guideline for when hand hygiene is required, to keep yourself safe and your patient safe

IMPORTANT: After glove removal, hands

MUST be washed or degermed with alcohol gel

immediately.

Mask and Protective Eyewear A mask, in combination with an eye protective device, should be worn during procedures likely to generate splashes, sprays, splatter or droplets of blood and other bodily substances. A mask prevents exposure to your mouth, nose and eyes. Patient care providers need to be fit tested for and wear an N95 respirator when providing care for a known TB or suspected TB or other ATD (Aerosol Transmissible Disease) patient. A PAPR (Powered Air Purifying Respirator) needs to be worn if performing aerosol generating procedures on known TB or suspected TB or other ATD patients. Protective eyewear includes goggles, full-face shields, masks with shields, and glasses with solid side shields. Reusable eyewear or face shields given to health care workers should be decontaminated with soap and water and wiped with an appropriate disinfectant per manufacturer recommendation. Gowns and Apron Fluid-resistant gowns or aprons should be worn during procedures likely to generate splashes, sprays, spatter droplets (e.g. surgical, labor and delivery, cardiac lab procedures, hemodialysis, radiology procedures.) Additional Measures Engineering Controls and Work Place Controls are additional measures which create a barrier between you and the blood borne pathogens. They reduce the likelihood of occupational exposure: Examples are sharps disposal containers, safety-engineered sharps, Ambu bag, Resuscitator Device, mouthpiece and other ventilation devices used during CPR and in Negative Pressure rooms. Work Practice Controls reduce the risk of exposure by the precautions taken when a task is performed. Examples include hand washing, the use of PPE while cleaning used instruments, wearing gloves when drawing blood and starting IVs, emptying Foley catheters, safe injection practice and prohibiting recapping of needles by a two-handed technique. Article expert: Jennifer Cox

Respiratory Etiquette Program Education and supplies should be provided for all patients/members in the Inpatient and Ambulatory setting.

Respiratory Etiquette includes:

• Covering the mouth and nose when coughing and sneezing

• Wearing a standard mask to protect others

• Hand hygiene after coughing or sneezing

• Providing tissues, masks for coughs, and alcohol degermer

• Trash receptacles for used tissues

Influenza Prevention Influenza is a serious disease that affects all ages of people and is associated with high rates of illness and death. In the United States, an estimated 5% to 15% of the population is affected by the virus each year.

Symptoms of flu include: Fever (mild to severe) Muscle aches Headache Dry cough Extreme tiredness Runny /Stuffy nose Sore throat Stomach symptoms - nausea, vomiting, and diarrhea-more common in children than adults

Some people, such as the elderly, young children, and people with certain health conditions, are at high risk for serious flu complications. Complications of flu can include bacterial pneumonia, ear infections, sinus infections, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes.

Flu viruses spread mainly from person to person through coughing or sneezing of people with influenza (respiratory droplets). Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose. Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.

The single best way to protect against the flu is to get vaccinated each year. The flu vaccine contains different influenza virus strains - and it changes each year, based on international surveillance and scientists’ estimations about which types and strains of viruses will circulate in a given year. October or November is the best time to get vaccinated, but you can still get vaccinated in December and later. Flu season can begin as early as October and last as late as May. About 2 weeks after vaccination, antibodies that provide protection against influenza virus infection develop in the body.

Vaccines for ATDs Employee Health Services is responsible for administering vaccinations:

• A simple blood test will determine if you have immunity • Vaccinations are available at no cost to employees without immunity • Vaccines are a safe and an effective means of preventing some ATD transmission

ATD Exposure Incident: Reporting and medical follow-up Reporting an ATD Exposure Incident:

• ALL exposure incidents must be reported to your manager immediately. • Proceed to Employee Health as soon as possible for appropriate evaluation and medical follow-

up. Post-Exposure Evaluation: A Post-Exposure Evaluation is performed to determine the nature and extent of exposure, including circumstances of event, source patient information and other details. It may also involve testing of exposed employee or physician. Medical follow-up may involve:

• Testing • Preventive therapy: medications or vaccinations • Other procedures if indicated (for example, a chest x-ray)

Facility Surge Plan Epidemics or other events may create a surge situation. For this training to be compliant, you must know your facility’s procedures under these circumstances, including the plan for:

1. Surge receiving and treatment of patients 2. Patient isolation procedures 3. Surge procedures for handling of specimens, including specimens from persons who may have

been contaminated as a result of a release of a biological agent 4. How to access supplies needed for the response including PPE and respirators 5. Decontamination facilities and procedures 6. How to coordinate with emergency response personnel from other agencies

These procedures will be covered during your facility’s disaster drills, which will include a surge scenario at least annually. To access YOUR facility’s Emergency Operations Plan and find specific information regarding the items listed above, talk to your Department Manager or contact Environmental, Health & Safety, Infection Prevention and/or Employee Health. Good health habits like covering your cough and washing your hands often can help prevent respiratory illnesses like the flu. Article expert: Jennifer Cox

Keeping your environment clean Why it’s important: A clean patient care environment is important for patient safety and infection prevention. The environment in which patients receive medical and nursing care can be a source of indirect transmission of a variety of significant organisms including Methicillin Resistant Staph Aureus (MRSA), Vancomycin resistant enterococci (VRE), Clostridium difficile and other Multi-Drug Resistant Organisms (MDRO). Objects in the patient care areas that could be a cause of indirect transmission include: Furniture in procedure rooms or exam rooms (e.g. exam tables,

mayo stand, counter tops) Equipment that frequently moves from patient to patient (e.g.

electronic thermometers, IV poles, blood pressure cuffs, glucometers)

Keeping the environment Clean Keeping the patient’s environment clean is everyone’s job. It takes a strong and active effort by all individuals in the healthcare setting to provide a safe and clean environment.

Emphasis for cleaning and disinfection should be placed on surfaces that are most likely to become contaminated with pathogens; particularly high touch surfaces (notice the red X on the pictures). Cleaning refers to the removal of visible soil and organic contamination from a device or environmental surface using the physical action of scrubbing with the approved disinfectant. Disinfection is accomplished by applying a disinfectant and allowing the disinfectant to remain wet on the surface for an adequate amount of time. Gross soiling needs to be removed prior to applying disinfectant to the surface, otherwise any remaining organic material may reduce or nullify the disinfectant’s “kill” power.

KILL TIME (CONTACT TIME): Estimated time to neutralize an organism ITEM MUST BE

WET FOR THE SPECIFIED AMOUNT OF TIME

Virex 256

10 minutes contact time

CAVI Wipes

2 minute contact time

Sani-Cloth 3 minute

contact time (5 minutes for TB)

Clorox Bleach Wipes 1 Minute contact time

(3 minutes for C. difficile)

What’s LURKING in your procedure / exam room?

X

X X

X X

Organism duration of persistence on dry inanimate surfaces (range) Acinetobacter 3 days - 5 mon VRE 5 days – 4 mon C. difficile 5 mon Influenza 1 – 2 days E. coli 1.5 hr – 6 mon MRSA 7 days – 7 mon

In Review: How often should procedure / exam room be cleaned?

Between every patient When should the glucometers be cleaned and how?

Between every patient with a hospital approved disinfectant wipe. What cleaning product do you use for C. difficile patients?

Bleach Cleaning refers to removal of germs on surfaces by what means?

Physical action of scrubbing or friction with approved disinfectant.

True or False. MRSA can live on a surface for up to 24 hours. False. If not properly cleaned, MRSA can live on a surface from 7 days to 7 months.

Article expert: Jennifer Cox

Good Hand Hygiene + Environmental Cleaning = Patient Safety

Pharmacy Waste When pharmaceutical waste is likely to be generated by departments such as the pharmacy and medication rooms, it shall be segregated for disposal and placed in a rigid blue container with a white lid. That container shall be labeled with the words "incineration only". The department generating the waste is responsible for properly segregating the non-RCRA pharmaceutical waste into the appropriate pharmaceutical waste containers that has the words "incinerate or incineration " on it. RCRA waste such as chemotherapeutic agents and arsenic trioxide must be managed as hazardous waste and placed in a black container with the content name and accumulation start date. Environmental Services can be called when the black container is full or approaches the 1 year.

date.Do not dispose of waste pharmaceuticals down the drain or down the toilet. This includes any prescription or nonprescription substances intended to be swallowed, inhaled, injected, applied to the skin or eyes, or otherwise absorbed.

Event Related Sterility

Items sterilized by Sterile Processing and Operating Room are considered sterile unless there is some indication that the integrity of the package has been compromised. A package that is clean, dry and intact will remain sterile indefinitely (no expiration date).

A package that becomes wet, torn, has a broken seal, has extended exposure to sunlight or heat, or is damaged in any way must not be used.

Multiple Drug Resistant Organisms (MDROs)

Organisms that have shown resistance to specific antibiotic drug treatment include:

• Methicillin Resistant Staphylococcus Aureus (MRSA) • Vancomycin Resistant Enterococcus (VRE) • Gram-negative bacteria such as Pseudomonas, Klebsiella, Proteus, Enterobacter, etc. have developed resistant

strains. These include ESBL (Extended Spectrum Beta Lactamase) producers that are resistant to third generation cephalosporins (i.e. ceftazidime, cefotaxime, and ceftriaxone)

Clostridium difficile (C. diff) is a formidable pathogen that is technically not considered an MDRO, but it is managed in the same way in terms of isolation. Soap and water hand washing is better than an alcohol degermer for removing C. diff spores

Contact Precautions as well as Standard precautions are required for MDRO infections or colonization, and may include:

• Private room (where a sink is immediately available)

• Gown and gloves for anyone entering the room, if contact with the patient or contaminated surfaces is anticipated

• Dedicated stethoscope, blood pressure cuff or disinfection after use • Disposable thermometers • Decontamination of equipment prior to leaving the patient’s room

Article expert: Jennifer Cox

DON’T RISK BEING INFECTED!

1. Protect yourself with a safe and effective Hepatitis B Vaccine (HBV). HBV protects 98% of people who get

the 3 shot series; it cannot cause Hep B infection. The HBV is available at no cost to you and is offered to all

employees. Contact your Employee Health Department to obtain the vaccine. You will be asked to sign a

waiver if you decline the vaccine.

2. Protect yourself from used/soiled linen by holding linen away from your body and clothing, handling it with

minimum agitation and placing it in bags that prevent leakage.

3. Protect yourself from spills of blood and Other Potentially Infectious Materials (OPIM) by wearing gloves

during cleaning and decontaminating procedures. Use the medical center approved disinfectant solution as

directed. Follow your facility’s protocol for containment and cleanup.

Occupational Exposures to Blood and/ or Body Fluids Federal standard 29 CFR 1910.1030 requires: Employers shall ensure that all employees with occupational exposure participate in a training program which must be provided at no cost to the employee and during working hours. Training shall be provided as follows:

• At the time of initial assignment to tasks where occupational exposure may take place• At least annually thereafter• Annual training for all employees shall be provided within one year of their previous training• Employers shall provide additional training when changes such as modification of tasks or procedures or

institution of new tasks or procedures affect the employee's occupational exposure. The additionaltraining may be limited to addressing the new exposures created. Health Care Workers are at risk foroccupational exposure to blood borne pathogens, including Hepatitis B Virus (HBV), Hepatitis C Virus(HCV), and Human Immunodeficiency Virus (HIV)

• The Bloodborne Pathogen (BBP) Exposure Control Plan, MCW 7601.00, provides guidelines to help protect healthcare workers against occupational transmission of blood borne pathogens. An exposure includes contact with skin, eye, mucous membrane, or needle sticks with blood or body fluids.

Factors that contribute to the risk of occupational transmission of a blood borne pathogen include:

• The pathogen involved• The type of exposure• The amount of blood involved in the exposure• The amount of virus in the patient’s blood at the time of exposure

Any of the following may carry disease-causing germs:

• Blood (fluid, dried or caked) • Body fluids (serum, tissues, sputum, saliva, urine, feces, gastric secretions, semen, amniotic fluid, vaginal

secretions, cerebro-spinal fluid) • Non-intact skin (skin with cuts, weeping or draining wounds) • Everything except sweat - whether or not it contains visible blood • Mucous membranes • Other biohazardous wastes

In case of exposure:

• Wash the exposed area immediately • Notify your supervisor at the time of exposure • Fill out the Bloodborne Pathogen Report form in the Blood/Body Fluid Exposure Packet at your treatment area and

a Workers' Compensation form • Report to the Emergency Department or designated health professional immediately (within 2 hours) after the

exposure, as medication may be required as soon as possible

The Blood and Body Fluid Exposure (BBPE) Hotline # 562-461- 6143 (8-325 tie)

If you have any questions regarding bloodborne pathogens, please call the Infection Control Department at 562-657-9707 and/or Employee Health Services 562-461-4500 Article expert: Jennifer Cox

Needle Stick Prevention

Before Injection/Procedure

• Prepare by having needed supplies on hand along with a sharps container.

During Injection/Procedure

• Communicate with your patient and ask for their cooperation.

• When giving injections to children, ask for assistance to keep the child steady.

• During procedures, do not hand off sharps to staff. Designate a neutral zone where the sharps can be dropped off and picked up.

After Injection/Procedure

• Activate safety devices on needles using a single-handed technique, do not recap.

• Dispose of the needle/sharp immediately.

Points To Practice

Caution reminders

• Do not withdraw needle from catheter hub before pressing the white button.

• Needle should be retracted prior to disposal in a puncture-resistant, leak-proof sharps container.

• Never reinsert needle into the catheter as this could shear the catheter.

• Do not use scissors at or near the insertion site.

Universal and Electronic Waste Universal waste is waste that poses a lower risk to people and the environment than other hazardous wastes. Examples include spent batteries, fluorescent light tubes, non-empty aerosol cans and mercury thermometers. Battery buckets should be used to collect and segregate various types of batteries in the department and must identify the type of waste (e.g. alkaline batteries or lithium batteries) and accumulation start date. Mixing different types of batteries in the same container poses a fire risk. Universal waste can be kept in the department for 1 year.

Electronic waste or e-waste – If a piece of equipment has an electrical plug or requires batteries, it cannot be thrown in the trash and must be managed as e-waste. Arrange for pick up by calling 8-324-4040 or by putting in a request into the Easy Net system.

Environment of Care

Kaiser Permanente is dedicated to providing a safe, functional and effective environment of care. The term Environment of Care (EC) is used to describe characteristics of all physical areas where patients receive care. EC comprises a variety of key elements and systems which contribute to the way space and equipment used in our healthcare system feels, looks and works. It takes everyone to effectively manage these elements and ensure job safety. Besides safety, we want a comfortable and welcoming environment which supports you as the caregiver and contributes to a positive care experience for patients and visitors.

The scope of EC commonly refers to systems, equipment and activities that support medical care processes and services, but EC also includes things like proper lighting, access, signage, privacy, patient care and flow.

The following information outlines your responsibilities under the specific EC functions of General Safety, Workplace Safety, Hazardous Materials and Waste, Security, Life Safety, Emergency Management, Utilities and Medical Equipment.

The Environment of Care (EC) committee is a multi-disciplinary group which carries out analysis of safety related findings and ensures resolution and improvement. The goal of the EC is to identify and eliminate hazardous conditions, control the risk of injury and illness and to ensure compliance with regulatory and quality/performance standards. You may see EC representatives visit your work area to inspect the physical conditions of the facility, equipment and systems. We call this function Continuous Compliance Rounds.

General Safety Work Practices

• Immediately report all work-related injuries/illnesses and hazardous or unsafe conditions toyour supervisor. Safety concerns can also be reported to the Safety Director at 8-324-4043.

• To anonymously report non-urgent safety issues, leave a message on the Safety Hotline at(562) 904-7888 / tie line 8-324-7888.

• Medical treatment for work-related injuries should be managed by Kaiser on the Job (KOJ). Ifyou would like to pre-designate a physician to treat your work-related injury, contact HumanResources for a Physician Pre-designation form as soon as possible and prior to any injury.

• Know and heed the Safety Always Rules established by your department.

• Be familiar with equipment and machinery you use and use it safely.

• Be familiar with your area and the locations of exits, fire alarm boxes, fire extinguishers,medical gas shut off valves, etc.

• Pay attention to wet floor caution signs.

• Be cautious at blind corners and congested areas. Keep your eyes on path and avoiddistractions such as texting while walking.

• Know what to do in an emergency.

• Hold on to the handrail when going up or down stairs.

• Allow ample time to do the job, avoid rushing.

• When repositioning or moving patients, use lift equipment or get additional help.

• Wear proper clothing and footwear.

• If a task has a potential for splashes of bodily fluids or chemicals, wear appropriate PersonalProtective Equipment (PPE) for the job.

Article expert: Socorro Cottle

Hazards, accidents or other safety concerns are to be immediately reported to your chief/supervisor. Safety concerns can also be reported to the Safety Director at 8-324-4043, the Safety Hotline at 8-324-7888, or the DMC OOPS line at 8-325-6677.

We are committed to providing a work environment that is safe. To that end, labor and management work in a partnership to develop, organize and implement several initiatives and programs designed to prevent occupational illnesses and injuries.

The Medical Center Labor-Management Partnership (LMP) Workplace Safety Team plans and oversees global injury reduction programs. These programs are carried out and monitored at the local medical center level through the Environment of Care Committee and Workplace Safety Steering Committee. Examples of injury reduction interventions and activities include:

• The Safety Patient Handling Committee and Lift Technicians to coordinate and assist in safe patient handling using proven techniques, proper body mechanics and approved lift equipment.

• Injury/Accident Reporting to determine root causes and improvement opportunities. Supervisors page the Workplace Safety Consultant On call (562-272-3310) when they receive notice of an injury/illness and prior to completing a Supervisors Report of Injury form

• The Injury Data collection and analysis is used to assess risk and proactively focus resources where they will do the most good.

• Comprehensive Workplace Safety Systems (CWPSS) are designed to help identify high risk departments. The system focuses on hazard identification, risk assessment, safety observations, incident investigations, and control measures. The outcome is ultimately the development of written injury prevention plans.

Right to Access Exposure Records

• You have the right to review your relevant occupational medical and exposure records.

• The Employee Health Services (EHS) Department (8-325-4500) maintains medical record exposures such as TB and Bloodborne Pathogens. The Safety Department (8-324-4043)

Safety Management

After New Employee Orientation, periodically, and as hazards are

identified, your department manager will give you additional, specific

training on potential job hazards. You will also be given the equipment

and skills you need to prevent work related injuries and illnesses.

maintains exposure monitoring records for chemical exposures. Requests for records must be made in writing to these departments.

To access the OSHA standard, contact the Safety Department to see Cal/OSHA Standard 3204 and the related appendices.

Hazardous Materials and Waste You have a “right to know” about the chemical products that you work with or are around at the workplace. This is why Cal - OSHA (California Occupational Safety and Health Administration) enforces the law referred to as the Hazard Communication Standard. This regulation requires KP to have a written program, container labels and other appropriate hazard warnings, Safety Data Sheets (SDS), formerly known as MSDSs, and training.

In addition to your “right to know” about chemicals, all employees have a right to personally receive information about hazardous substances to which they may be exposed (without fear of reprisal or discrimination), as well as a right to have their physician or union receive such information. Employees can speak with their supervisors or the Safety Officer if there are questions about hazardous substances.

Our written Hazardous Materials Program and a comprehensive catalogue of the MSDS can be found electronically on the Document Management System (DMS), MCW Policy 6050 Hazardous Material and Waste Management. This policy contains the Hazard Communication Program. Your manager or supervisor can tell you how to access your departments’ specific list of potentially hazardous chemicals.

In our daily work, a variety of chemicals are used in order to provide high quality medical care. These chemicals range from cleaning, disinfecting, and instrument sterilization, to laboratory and photographic diagnosis and chemical treatments. It is very important to know about the chemical products and hazardous substances used in your work, so they can be used safely.

Your department manager will inform you about the specific chemical products used in your workplace, the associated potential hazards, and how to protect yourself and the environment.

Some key information sources about potential hazards are found from the:

• Container label, which provides the names of the active chemical ingredients and hazard warnings.

• Product manufacturers’ SAFETY DATA SHEETS (SDS) which contain detailed safety information about each chemical product. These are electronically accessible to you in your department through DMS.

• Safety Director/Safety Officer 8-324-4043 Key questions to review with your supervisor include:

• How do I detect the presence or release of the chemical? • How do I protect myself against exposure? • How do I handle spills or leaks? • How do I manage waste? New primary Container Labeling Requirements (2015 requirement)

Safety Data Sheets (SDSs) will replace MSDSs (2015 requirement)

Labels will require:

• Signal words to denote the level of hazard (i.e. “Danger” or “Warning”)

• Pictograms to illustrate the specific hazards of a chemical

• Hazard statements to describe the nature of the hazard of the chemical

• Precautionary statements to describe recommended measures that should be taken to minimize or prevent adverse effects resulting from:

• exposure to a hazardous chemical; and

• improper storage or handling

• Product identifier name or number used for a hazardous chemical on a label or in the SDS, which provides a unique means by which the user can identify the chemical

• Name, address, and telephone number – of the chemical manufacturer, importer, or other responsible party.

The example below shows a label meeting the new HazCom requirements

SDSs - Labeling requirements, OSHA’s revised HazCom standard requires that manufacturer’s transition to use of standardized Safety Data Sheets (SDSs) with a standard 16-section format replacing MSDSs (2015 requirement).

Standardized SDS will include the following required sections:

• Product Identification

• Fire fighting measures

• Physical & Chemical Properties

• Disposal measures

• Hazard Identification

• Accidental release

• Stability/Reactivity • Transport Info

• Composition • Handling & Storage

• Toxicological Info • Regulatory Info

• First Aid Measures

• Exposure Controls/PPE

• Ecological info • Other Information

Article expert: Socorro Cottle

Ergonomics Safety Begins with Me Ergonomics, a mixture of many branches of science, is also used to help reduce the risks of musculoskeletal disorders (MSDs). In addition to having a proper work environment, the way we work becomes essential in reducing the risk of injury. Employers provide safe working environment for all staff, and employees have the responsibility to use the proper equipment, technique and posture to prevent injuries from happening.

In order to be an injury-free environment, we need to make sure that we practice safe lifting techniques. Lifting objects safely can be done by everyone. Move in close to an object; use a staggered stance for stability. Position your hands shoulder width apart, and securely grasp object. Ease it in and move it close to your chest, then turn by moving your entire body, do not twist. Avoid back strain by moving the object closer to your center of gravity. Avoid fast,

jerky movements and lift items smoothly. Know your limitations and get more help when necessary. Ergonomics Risk Factors and Symptoms Ergonomics is the science of designing work environments and technology to fit the employee rather than requiring the employee to adapt to the environment and technology.

Ergonomic Risk Factors include:

• Repetition

• Extended Duration

• Excessive Force

• Awkward Positions

• Over Reaching

• Poor Environment

• Individual Factors Workstation Ergonomics and Ergo Info At a workstation, correcting ergonomic problems is simple, and is something that you can do yourself. This link has instructions on how to make ergonomic adjustments to your workstation. If you cannot adjust your workstation so that it is comfortable for you, or if you are experiencing pain which you believe is caused by incorrect ergonomics, it is important that you notify your supervisor and find out how to request an ergonomic evaluation at your facility.

Workplaces injuries can be avoided especially slips, trips and falls. The four common causes are: human error/attitude, environmental factors, cleaning hazards, and footwear.

• Human Error/Attitude – failing to pay attention, carrying too many objects at once, allowingchairs to slip out from under you.

• Environmental – wet spots in the morning, weather related slippery conditions• Cleaning – spills that are not immediately or are improperly cleaned, items left in doorways,

stairwells or other areas that are not picked up and put away immediately• Footwear – wearing inappropriate shoes for the job or wearing shoes without proper ankle

support or proper soles and/or treads

Always keep safety in mind. Clean up all spills immediately, so that you or others will not slip on the surface. Stay off freshly mopped floors. Secure electrical and phone cords out of traffic areas; remove tripping hazards from open walking pathways. Use handrails when walking down stairs. Wear shoes with good support and slip-resistant soles. Never stand on a chair, table or other surface on wheels; use a step stool to reach higher surfaces. Safety is up to you.

If you are uncomfortable at your workstation, try this quick and easy ergonomic self- check: http://insidekp.kp.org/ergoinfo/

Article expert: Iris Dulay

Asbestos Notification

As you probably know, asbestos was commonly used in construction prior to the late 1970s. Since 1979, asbestos has essentially been banned in all new construction due to potential health risks. The most significant health hazard from asbestos is when airborne fibers are inhaled into the lungs. The government strictly regulates the management and disposal of any asbestos in existing buildings. The California Asbestos Notification Law (Health and Safety Code ß25915) requires KP to inform employees, who may work within or enter areas of our facility which have Asbestos Containing Material (ACM), of the specific locations and conditions of the asbestos.

KP has implemented exposure control programs incorporating standard safety management practices that meet or exceed OSHA regulatory controls. Such programs include proper training of personnel having to come in contact with ACM, engineering and other exposure controls, supply and use of personal protective equipment where needed, and ongoing inspection, evaluation and assessment of known ACM.

Whenever construction, remodeling, or other work is done in an area known to have ACM, adequate safeguards are taken to prevent contact with, and disturbance of the ACM. Building occupants within adjacent or potentially impacted areas are notified of the nature/scope of the project, how to recognize related (restricted) areas, exposure control measures used, emergency contacts and readily visible warning/caution signs are posted until the area is certifiably safe to enter.

KP continues to inspect areas which contain ACM in our buildings and to safely remove asbestos before starting construction/demolition in any area of any building. You will be notified anytime we learn of the presence of ACM in other buildings, either through studies or by notification from the owners of buildings in which we lease space.

If you have concerns or questions regarding this notice or wish to review the written asbestos management plans, please contact the Plant Services Department, the area construction manager, or your local safety officer.

We remain committed to providing and maintaining a safe and healthy work environment.

Chemical Spills Special training for chemical spill clean-up is provided for departments that work with hazardous chemicals. These general rules apply to all hazardous chemical spills.

To handle small or “incidental” spills, quickly and carefully use the approved absorbent and/or neutralizing materials and follow your department procedures.

In case of a chemical spill which cannot be handled with the spill kit or if anyone

shows signs of exposure-burning throat, burning eyes, dizziness-follow these steps:

DO NOT touch the spill

GET OUT of the affected area – take patients with you

SECURE the area

CLOSE doors

ALERT your immediate supervisor

Call your local security department to report the spill

PREVENT others from entering the spill area

Contact your local Telecommunications Department to give your location Complete a Hazardous Material Spill Report, available electronically on DMS. MSW policy #6060 Article expert: Socorro Cottle

EMERGENCY MANAGEMENT

Emergency Codes

Kaiser Downey Medical Center has a system of codes by which we announce and respond to emergency situations. The codes are typically paged overhead to alert and mobilize staff without creating panic among patients and visitors. On the main campus, all of the following emergency codes can be activated at the Medical Center by calling our local emergency operator at 79999.

The Medical Center has an EMERGENCY OPERATION PLAN which has four phases:

Mitigation: Proactive efforts to prevent or lessen the severity of an emergency event

Preparedness: Planning, incident command structure, policies and drills

Response: Actually managing an event

Recovery: Efforts to resume our routine business of providing quality care

A CODE ORANGE is announced when a crisis or disaster event may impact our ability to continue to deliver patient care. The Medical Center's 'Hospital Command Center' (HCC) is then activated to coordinate disaster response activities.

YOUR role includes:

• Assess the situation at hand• Evaluate the conditions in your immediate area• Reassure patients/members/visitors• Follow your supervisor's instructions• Use your department's disaster plan• If at home, report to work for your next scheduled shift unless otherwise instructed

Evacuation

Evacuation is a very serious matter, particularly in hospitals, and should only be considered under the gravest situations. Know where the nearest areas of refuge are for your work area. If necessary and if directed, evacuate first to the nearest area of refuge beyond a set of fire doors.

Types of evacuation include:

Initial Evacuation:

Takes place in response to the very beginning of a fire or other emergency. The person discovering the fire should retreat with threatened people from the affected room(s) in an orderly fashion and, if retreating from a fire, close the doors behind you to contain it, and shut off the supply of fresh oxygen to it.

Partial Evacuation: If additional movement from the danger area to a safer location is required, the preferred method is horizontal (same floor). However, if necessary, a vertical (to a different floor) evacuation may be required.

Total Evacuation:

If the danger is very extensive and serious, the entire building may no longer be suitable for occupancy and a total evacuation cannot be avoided. This requires continuing medical care away from the building until a suitable alternate site can be found, or a return is authorized. Great care and careful teamwork must be exercised. For details, refer to the Hospital Evacuation Plan.

A QUICK GUIDE TO THE TYPES OF CODES:

CODE BLUE - Adult and pediatric life-threatening condition, cardiac or respiratory arrest CODE PINK - Neonatal (0-28 days old) life-threatening condition, cardiac or respiratory arrest CODE SECURE - Infant abduction/kidnapping; a missing infant CODE RED - Fire CODE ORANGE - Internal and/or external disaster condition CODE DRY - City Water System Failure, conservation of water usage CODE CAMPUS - Assistance to a member (ie: trips/falls) at the hospital

RN STAT – Assistance to a member (e.g. trip/fall) at a Medical Office Building (MOB)

Article expert: Socorro Cottle

LIFE SAFETY AND FIRE PREVENTION

CODE RED – FIRE

R – RESCUE

A – ALARM

C – CONTAIN

E – EXTINGUISH IF SAFE TO DO SO AND YOU HAVE BEEN TRAINED.

Do not place yourself or others at risk by fighting a fire alone.

When calling for HELP

Remember TACT- ful. TACT is an acronym for:

T – Type of emergency

A – Address

C – Cross-street (Nearest Intersection)

T – Telephone call back number and Your Name

Being TACT-ful when reporting an emergency will help rescuers prepare and locate you quickly. When calling for help, whether calling 79999 from the Medical Center or 9-911 from the outlying Medical Offices and other offsite buildings, remember to be TACT-ful.

Questions you need to discuss with your supervisor before a fire or disaster occurs include:

Where are fire extinguishers/pull stations in my work area? Where are my departments disaster supplies (if any) stored? What protocols are used if there is Code ORANGE? Where are the nearest exits if we need to evacuate? What is my department's call back system? Who can turn off medical gases? When, where to and how to evacuate?

Outlying Medical Offices

• Use overhead paging system (if any) to page “Code RED” and report location of fire three (3)times

• Dial 9-911 and then

• Dial 8-327-9999 (hospital operator emergency number) to report the location of a fire in anoutlying Medical Office Building

PORTABLE FIRE EXTINGUISHERS

REMEMBER: PASS Pull the pin Aim the nozzle Squeeze the trigger handles together Sweep the spray at the base of the fire

Portable fire extinguishers are provided throughout our buildings for emergency use by employees.

Look for the ABC on the label; this indicates it is intended for common fires. Specialized extinguishers for use on liquid substances (Class B) and electrical fires (Class C)

may be located in some areas. Always hold an extinguisher in a vertical position, like an aerosol can. Approach the fire from a safe distance (6-10 feet) and gradually move toward the fire while

‘sweeping’ the base of the fire away from you until it is out. The contents of an extinguisher are under a great deal of pressure. Blasting

the fire at close range could spread the fire! Make certain the extinguishing agent is applied to the entire surface area of the fire starting

from the leading edge. Never step into an area that had just been extinguished to get to a burning area. If the fire

re-flashes, you could literally get caught in a ring of fire.

Remember:

Stand between the exit and the fire to escape if needed. Never place yourself or others in jeopardy by attempting to extinguish a fire. If it is not SAFE to extinguish a small fire, or if smoke becomes hazardous, leave the area!

Hospital Smoke Compartments

Each floor of a hospital is divided into separate Smoke Compartments. Each smoke compartment is surrounded by walls and doors with added protection against smoke and fire, and will provide a barrier between you and the area which is burning. You should know the boundaries of your smoke compartment and the smoke compartments adjacent to your unit.

EARTHQUAKE

In Southern California, earthquakes can occur at any time. Preparation is key to surviving a major quake. BEFORE a quake happens, perform a safety check of your work area. Q: What are my potential exit routes if I need to evacuate? A: Walk your department to determine exit routes. Q: Are bookcases, shelves, files, computers anchored? A: If No, then notify your chief / supervisor. Q: Are your heaviest materials, books, binders stored below shoulder level?

A: If No, then find a safer place to store them. Q: Is your desk near a window? A: If Yes, then have an action plan for where to retreat during a quake. DURING a Quake:

If indoors

• Drop, cover, hold on to whatever you can, and protect your head & neck • Take cover under a desk or table, if possible • Stay away from windows and objects that may fall on you • Remain calm • Don‘t use elevators • DON’T try to run outside

If outdoors

• Do not run indoors • Move away from buildings, utility wires and overhead obstructions

AFTER a MAJOR Quake

Seek help if you are injured Find out if anyone else is injured; administer first aid or call for help Check for fires and extinguish them or call for help Don't use the elevators Expect aftershocks Follow your departmental disaster plan as outlined in the Emergency Operations Plan and

report your status to the Command Center (HCC) Use the telephones ONLY when absolutely necessary Check for potential chemical or other hazards, gas leaks or broken water lines. If necessary, remove yourself and others from the area and call for help

Article expert: Socorro Cottle

Utilities Management & Electrical Safety

Coordinated through the Plant Services Department, our utilities management programs are designed to furnish a care environment that is safe, controlled, and comfortable.

Utilities systems include:

Electrical distribution and emergency power Communication systems (phones, nurse call button) Heating, air conditioning and ventilation (including systems to ensure everything from comfort,

isolation, and infection control) Medical gases (oxygen, medical air, nitrous oxide, nitrogen, and vacuum) Domestic and rain water systems

Additionally, the Plant Services Department works in collaboration with Infection Prevention and Control, Safety, and Facilities Services (Construction) to control potential exposures to pathogens through the management of water systems, ventilation and construction/demolition projects.

As an employee, it is important to understand the capabilities and limitations of the utility systems you use. Learning the location of critical shut-off valves, such as medical gas valves in your work area can help in the event of an emergency. However, the Nursing Supervisor, Plant Services and/or Fire Department are responsible for shutting off the gasses. It is important to know the capabilities and limitations of the utility systems you use.

Electrical Safety

If your department experiences a utility system failure or loss:

Contact your supervisor or manager. Immediately check and manage patients who may be impacted. Implement your disaster contingency plans as applicable.

In the healthcare setting, electricity, with its numerous applications, allows wide usage of equipment and appliances. Despite its usefulness, electricity is one of the leading causes of injury and fire at work because it becomes an unseen danger in which only light and fire can be observed.

To prevent an electrical fire or injury:

Unplug appliances by holding onto the plug, not by pulling the cord Examine wires and plugs for defects, cracks, frayed insulation and broken connectors When using microwaves, do not put metal objects or linen in the oven. Also NO POPCORN! If an electrical appliance sparks or smells of smoke, or is otherwise malfunctioning, DO NOT USE

IT. Remove it from service, Lock it out or tag it out then report it to your supervisor immediatelyand call 8-324-4040 for removal

Plug essential equipment and life support devices (e.g. ventilators) into RED outlets which are connected to the emergency power system

Lock Out Program (LOTO) “Lock Out- Tag Out” LOTO protects lives and ensures human safety!

To prevent injuries to employees working on equipment, a lock out device is applied to an electrical circuit or valve to prevent the equipment from being energized or used. Plant engineers, technicians or vendors that are authorized to service the equipment perform the LOTO procedures. Only the person who placed the LOTO devices on the equipment may remove it.

A LOCK OUT is a physical lock that holds a switch in the off position or holds a valve shut so hazardous energy cannot be released while the maintenance is occurring.

A TAG OUT is a paper or plastic tag that is placed on a breaker/switch, or valve that warns other people not to operate it. Tag Outs are used when a lock out cannot be used. If you see LOTO device, DO NOT TOUCH IT! Someone’s life may be at stake. Article expert: Socorro Cottle

Biohazard Waste

Biohazardous means an agent, such as an infectious microorganism, or a condition that presents a threat to humans.

Biohazardous waste includes blood or other potential infectious material (OPIM) which includes human body fluids such as: semen, vaginal secretions, cerebrospinal, synovial, pleural, pericardial, peritoneal, and amniotic fluids. Biohazardous waste also includes sharps, laboratory cultures, pathology specimens and recognizable anatomical remains (special handling required).

Syringes with or without needles should be disposed of in sharps containers. Items designated as Biohazardous Waste should be should be placed in a RED BAG.

Red bagged biohazardous waste must be tied in a single Gooseneck knot so that if the bag is turned upside down, no waste or blood will leak out. Rabbit Ears are not the proper way to tie off a red bag.

Gooseneck – Correct Way Rabbit Ears – Wrong Way

Using appropriate personal protective equipment (PPE), carefully discard bulk blood, suctioned fluids, excretions and secretions not contained within a disposable unit by carefully pouring down a drain connected to the sewer system.

Biohazard Symbol

This symbol on biohazardous waste containers, refrigerators, or freezers indicates that the content is biohazardous. Use appropriate personal protective equipment to handle the contents. Biohazardous waste does NOT include:

Paper Band-aids/cotton balls Wrapping from sterile items Paper towels Gloves Paper gowns

Aricle expert: Socorro Cottle

MRI Safety Review

Magnetic Resonance Imaging The MRI scanner contains a very powerful magnet and is always on – even when the machine isn’t scanning! The magnetic field is invisible, odorless and silent. Without caution, the imaging device can cause serious injury or death. The magnet attracts ALL ferrous (iron) containing metal including implanted medical devices. The magnet is so strong it will pull heavy items (such as oxygen cylinders, chairs, beds, and gurneys) into the scanner. This is called the “projectile effect”. Patients, staff or other persons can be seriously injured if struck by a projectile if precautions are not taken.

Special MRI Equipment allowed in suite Tools and patient-care equipment specially designated for the MRI suite are made without ferrous (iron containing metal) material. These items are clearly labeled. When in doubt, LEAVE IT OUT!

Examples of Dangerous Ferro-magnetic Materials: Patients Related

o Oxygen Cylinders

o Wheelchairs/walkers/canes/crutches

o Stretchers/beds

o IV poles & drug pumps

Staff Related

o Firefighting equipment

o Cleaning equipment

o Hand tools

o Keys/jewelry/watch

MRI Safety Precautions for Staff and Patients Patient and staff pre-screening

o Mandatory MRI pre-screening form

Note MRI safety signs

Check for implants

o Dental, pacemaker, orthopedics device, clips, pins, etc

Check pockets for ferrous containing items

o Keys, coins, wallets, paper clips, hemostats,

Always see MRI staff before entering the MRI scan area.

Even in an emergency situation, NEVER rush into the MRI Suite.

Article expert: Devin Grissom

PAIN ASSESSMENT IS MORE THAN A NUMBER

Pain is subjective; no objective test can measure it. The caregiver must accept the patient's report of pain.

In 2001 the Pain Management Standards became part of the survey and accreditation process of the Joint Commission. These standards direct health care facilities to:

• Recognize the right of patients to appropriate assessment and management of pain. • Assess pain in all patients. • Record the assessment in a way that facilitates regular reassessment and follow-up. • Educate patients, families, and providers about effective pain management. • Establish policies that support appropriate prescription or ordering of pain medications. • Include patients' needs for symptom control in discharge planning. • Collect data to monitor the appropriateness and effectiveness of pain management.

The Gold Standard of Pain Assessment is: The Patient’s “Self Report”.

• In the presence of pathology that usually causes pain; assume pain is present. • Watch for pain related behaviors: crying, grimacing, moaning, guarding, changes in activity

levels. Don’t be afraid to use a surrogates report of behavior.

Assume Pain is Present

• Unresponsive patients with underlying pathology thought to be painful (e.g., surgery, intubation, cancer).

o Highest risks for pain are those patients with no behaviors and non-verbal. An assumption may be needed! Start at the “starting dose”.

• Patients undergoing painful activities or procedures (e.g., turning, physical therapy, wound care, ambulation).

o Remember that the peak time for most oral pain medications is an hour and IV route is ½ hour.

Downey Medical Center’s Standardized age-cognitive specific pain assessment tools are used as aids to monitor and manage pain.

• For Adults: 0-10 Pain Intensity Scale (Appendix 2, mcw 2380) • For Pediatrics: More than 3 years: Use 1-10 Faces Scales. (Appendix 3, mcw 2380) • For Pediatrics: Less than 3 years or nonverbal adults: Use FLACC (Appendix 4, mcw 2380) • For Neonate/Term Newborns: Use N-Pass (Appendix 4, mcw 2380)

Pain Assessment, subsequent pain re-assessments, and patient response to pain interventions should be documented in Health Connect as per Medical Center Wide policies.

THE SINGLE MOST PAINFUL PROCEDURE IN THE HOSPITAL IS TURNING/REPOSITIONING

References: KFH, Downey – Medical Center Policies & Procedures – mcw 2380.00 Internet sources: Lippincott’s Nursing Procedures and Skills: http://procedures.lww.com/lnp/view.do?searchQuery=pain%20management&pId=1820478 Article expert: Terri Aimerito, RN, BSN / Janet Allen, RN, MSN, PHN, CHPN

DMC Inpatient Palliative Care Nurse

KP Model for Performance Improvement

EXPECTATION

All Kaiser Permanente employees have the responsibility to work in a safe and prudent manner. We all need to follow the established codes of safe practice.

Directions

To complete your required annual safety review using this material, you will need to:

1. Read this publication 2. Answer the post test questions and return it to your manager or supervisor 3. Consult your content experts and your manager if you have any questions related to the

content of this education publication or post test

Education & Consulting 8-324-4111

Safety Director 8-324-4043

KP Promise

To consistently provide high quality, affordable health care in an easy and convenient manner with a personal touch

Performance improvement is at the foundation of Kaiser Permanente's mission to provide affordable, high-quality health care to our members and the communities we serve. No matter where we work, improving processes affecting patient care experiences is our responsibility. The method used at DMC in conjunction with our Unit Based Teams [UBT] to improve processes and outcomes is called the Rapid Improvement Model (RIM).

The model of improvement is driven by three questions:

1. What are we trying to accomplish? 2. How will we know that change is an improvement? 3. What change can we make that will result in an improvement?

A key tool used in improvement work is through the application of small tests of change or Plan, Do, Study, Act (PDSA) cycles. PDSA cycles consist of the following steps: (P) Plan - Determine your objective. What do you think will result in an improvement? Plan to carry out the cycle (who, what, when, where). Plan for data collection.

(D) Do - Carry out the test, document test and collect data.

(S) Study - Review the data and summarize what was learned. (A) Act - Make changes and perform another test, repeating the cycle until the desired goal is reached. RIM can be applied to clinical and operational performance improvement efforts in your department such as improving screening for breast cancer, decreasing workplace injuries, and improving attendance. Did you know that every department is involved in performance improvement? Ask your manager or Unit Based Team Co-Leads about specific improvement efforts in your department, and how you can become involved in making a difference.

Article expert: Paula Jamison

Drug Free Workplace

As a provider of health care, KP recognizes chemical dependency is a chronic disease that can have tragic consequences for individuals, families, and the workplace. Our organization's position is reflected in SCAL HR Policy 5.03: Alcohol and Drugs. As a condition of employment, all employees are expected to abide by the organization's policy which prohibits the use and/or abuse of drugs, including alcohol in the workplace.

Chemical dependency is a chronic disease and rehabilitative treatment is available. KP supports the use of such treatment, and will provide it when conditions and circumstances warrant. Additional assistance is available such as KP's confidential Employee Assistance Program (EAP) at 562-622-3895, and/or disability plans, rehabilitation programs, and health coverage plans as are appropriate.

Article expert: Gina Dalrymple

HealthCare Ombudsman/Mediator Program Conflicts that arise in the course of patient and provider interactions are inevitable in today's increasingly complex health care environment. Complications and unexpected outcomes are more frequent and more common than we would like. The HealthCare Ombudsman/Mediator (“HCOM”) assists patients and providers with concerns about unanticipated adverse outcomes, medical errors, and dissatisfaction with treatment outcomes. The HCOM understands the dynamics of patient-provider communication and the relational aspects of dispute resolution. To address patients' need for information about concerns, the HCOM makes informal inquiries within the organization and facilitates discussions between patients and providers. As warranted the HCOM will assist the provider with an apology, to frame a thoughtful response, coach practitioners on the most appropriate approach to disclosing an unexpected adverse outcome, expressing empathy, providing and linking the provider to support, and restoring trust with the member/family. The HCOM relies heavily on subtle diplomacy, problem solving, mediation, and interpersonal communication skills. Referrals should be made directly to the HCOM by the provider and not through the patient, family or health connect. Leny Ambruso, DMC HCOM can be reached at 8-327-8883 or pager 310-609-0935. Article expert: Leny Ambruso

Suicide The 8th Leading Cause of Death in America

Although you cannot predict death by suicide, you can identify people who are at increased risk for suicide behavior, take precautions and refer them for effective treatment.

All employees need to be aware of the risks as patients can say or do something in any setting with anyone that could indicate that they may be considering suicide—to the EVS worker cleaning their room, to the MA in the clinic who is taking their BP, to the clerical support when they are being admitted for treatment, to the Phlebotomist in the Lab while they are having labs drawn—anyone in any setting could be the one who hears something or the one who notices some behavior that might indicate the potential for suicide.

The following are statistical data on suicide risk:

o Elderly adults have rates of suicide more than 50% higher than that of the nation as a whole. o Youth (ages 15-24) suicide rates increased more than 200% from the 1950's to the late 1970's. Since

then, suicide rates for youth have remained stable. o White suicide rates are approximately twice those of non-whites. o Females have generally been found to attempt suicide 3 to 4 times more than males. However, males

complete suicide at a rate 4 times that of females. o Groups/diagnoses at particular risk include: depression, schizophrenia, drug and/or chemical

dependency, and panic disorders. o Feelings of hopelessness are found to be more predictive of suicide risk than a diagnosis of depression

per se. o The socially isolated are generally found to be at high risk of suicide.

To evaluate for suicide risk, ask the person directly if he or she (1) is having suicidal thoughts/ideas, (2) has a plan to do so, and (3) has access to lethal means: o “Are you thinking about killing yourself?” o “Have you ever tried to hurt yourself before?” o “Do you think you might try to hurt yourself today?” o “Have you thought of ways that you might hurt yourself?” o “Do you have pills/weapons in the house?”

Please note that asking these questions will not increase the person's suicidal thoughts. It will give you information that indicates how strongly the person has thought about killing him or herself. Take seriously all suicide threats and all suicide attempts. A past history of suicide attempts is one of the strongest risk factors for death by suicide. There is no evidence that "no-suicide contracts" prevent suicide.

Listen and look for red flags for suicidal behavior, such as:

Ideation — thoughts of hurting or killing him/herself Substance abuse — excessive or increased Purposeless — no reasons for living Anxiety — agitation/insomnia Trapped — feeling there is no way out

Hopelessness –lacking enthusiasm and optimism about life Withdrawing — from friends, family, society, self-isolating Anger (uncontrolled) — rage, seeking revenge Recklessness — risky acts, unthinking Mood changes (dramatic)—goes from perky to sad, to angry, to quiet, etc. for no obvious reasons

If you suspect that someone is at risk for suicidal behavior, TELL SOMEONE—your manager, the house supervisor, a doctor, or anyone you can think of who can intervene to determine

if action is needed. Article expert: Michelle Fox

Spirituality Article Kaiser Permanente Downey Medical Center is committed to helping our members meet spiritual needs in any denomination. Staff members should try to learn about patient’s spiritual beliefs and try to make appropriate responses in a respectful conversation. Spiritual Care services provided include: Healing prayers – Spiritual counseling – Crisis intervention and supportive presence. Upon the request of patients or family members, Rev. John Korszyk, our Chaplain at Downey Medical Center, can assist in contacting religious leaders to provide ministration/rites or prayers from any denomination during the patient’s hospitalization. To contact the Chaplain phone 562-657-8939 Tie line 8-327-8939 Pager (310) 609-0662. Please indicate the type of spiritual care services you are seeking, the religion and language Phone 562-657-8939 Tie line 8-327-8939 Pager (310) 609-0662 for assistance, as your health care practitioner. Article expert: Rev. John Korszky, Chaplain

EMTALA The Emergency Medical Treatment and Active Labor Act is a federal law which governs when and how a patient may receive emergency care or care for active labor. EMTALA rules apply to hospitals that receive payment from Medicare, like KFH, Downey. However, it covers all patients, not just those enrolled in Medicare. The law was established to prevent hospitals from turning away patients, refusing to treat them, or transferring them to other hospitals because they are unable to pay. EMTALA applies to patients in a “Dedicated Emergency Department” (DED). For the Downey Medical Center, that includes the Emergency Department and the Labor and Delivery unit. Anyone who comes to the Emergency Department requesting care must be provided with an appropriate medical screening examination to determine if an emergency medical condition exists. The screening exam must be done by a physician, Physician Assistant, Nurse Practitioner, or Nurse Midwife. If there is a medical emergency, the hospital is obligated to provide treatment until the patient is stabilized. If treatment is required that our hospital cannot provide, the patient may be transferred to another hospital. A pregnant woman in labor must receive a medical screening exam. If in active labor, the patient must be admitted and treated until the delivery is completed, unless a safe transfer is appropriate for the patient’s care. Emergency medical screenings are provided without regard to the person’s health insurance or their ability to pay. No questions about a person’s insurance or finances can be asked until the patient has received the medical screening examination. A person does not have to be a Kaiser member or have health insurance to receive the medical screening and treatment in our ED. Any person requesting emergency care must be evaluated. A hospital is obligated to comply with the EMTALA requirements when a person requests an exam or treatment for a medical condition, someone asks that the person receives medical treatment, or any prudent layperson observer would believe that the person needs an exam or treatment. If a person asks for emergency care, direct them to the Emergency Department. EMTALA does not apply to non-emergency appointments in physician offices. EMTALA does not apply to:

• Urgent Care services • Occupational Health services • Medical Offices including the Garden and Orchard MOB’s • Patients who have been admitted for inpatient services • Outpatients who have begun to receive services • A person who presents to any off-campus department • An person who is not on hospital property

Article expert: Nancy Keiser

Americans with Disabilities Act (ADA)

Kaiser Permanente is committed to providing the highest quality of care to our increasingly diverse membership. Ensuring that a patient's cultural needs are considered and respected at every point of contact is essential. This commitment is aligned with Kaiser Permanent's mission to provide personalized care and to improve the overall health of the communities we serve.

Our goal in gathering the resources for Kaiser's health care workers is to provide an overview of the cultural differences that characterize members with disabilities. Our intention is in no means to suggest that we stereotype our members or patients by groups, but to interact more effectively with our members with disabilities through increased staff awareness. The following is equipment that is available to meet the needs of our members or patient groups:

• Wheelchair scales - Standing scale to weigh members in wheelchairs, 660 lbs capacity • Hi-lo exam tables - Height adjustable tables 18-37 inches, 400lbs capacity (for members in

wheelchair) • Patient lift equipment - Assist members to move from a wheelchair to a bed

(or other areas).

TTY/TDD - (Teletypewriter / Telecommunications Device for the Deaf) is an electronic device for text communication via a telephone line, used when one or more of the parties has hearing or speech difficulties. Other names for TDD include TTY (telephone typewriter or teletypewriter, although TTY is also a term used for teletypes in general).

Service Animals – It is the policy of Kaiser Permanente to make its facilities and services fully accessible to individuals with disabilities; and to provide access, wherever feasible, to service animal users, in compliance with the Americans With Disabilities Act of 1990 (ADA). Service Animals are defined as any dog that is individually trained to do work or perform tasks for a person with a disability. Animal species other than dogs do not quality as service animals. An individual who uses a dog for assistance with hearing, seeing, mobility, or other tasks may have that animal accompany them into a health care setting. Service animals are working animals and not pets.

Motorized Wheelchair – Now available for bariatric patients going to Garden and Orchard Medical offices. They are currently stored at the securities office and must be checked out to be used by staff.

The motorized wheelchair has a the weight capacity of 750lbs, accommodates an IV Pole and O2 tank, features a 180 degree swivel seat for easy on/off access, and an adjustable speed control.

Assistive Listening Systems (Pocket Talker) – Allows an individual to communicate with a person who is hard of hearing. A small microphone picks up speech, which is amplified and sent to a hearing aid-compatible earphone. It amplifies sounds and voices in your immediate environment when you direct the microphone toward the sounds you

wish to hear. Pocket Talker can be used by individuals who have hearing impairments to communicate with other individuals or for listening to TV, radio, etc.

Alternative Format Solutions

Effective communication revolves around the exchange of information. Many of us are accustomed to traditional forms of print medium to communicate. Printed materials, such as flyers, newsletters, instructional information, or health information, are great for persons who are able to read them. However, some individuals with cognitive disabilities or visual limitations may not be able to process written text. For individuals unable to process information in traditional ways, we offer large print, electronic formats, audio solutions and Braille. For more info and to see a list of vendors for alternative formats, go to http://kpnet.kp.org/ada/newADAsite/CAS_Resources/alt_format.html

The Hearing Impaired

Pocket Talkers / Language Line / Wireless Language Line - A device for the hearing impaired that amplifies sound, i.e. a person's voice. Ask manager for location in your area and how to use.

UbiDuo - is a communication device that enables deaf/hard of hearing people to communicate instantly with anyone face to face without a third party. “Instant-on” technology makes the UbiDuo ready for split screen chat within three seconds.

Weighing in at only six pounds, the UbiDuo is lightweight enough to carry anywhere within the department. With its patented hinge technology, allows the two halves to be quickly separated for use in a variety of settings with a wireless range of 500 feet, using its own broadcasted wireless network. Through instantaneous typing one can start a conversation right away instead using paper and a pen, or waiting for an interpreter to arrive. Request from Communication Dept. Tie-line 8-327-9000.

TTY/TDD — A Teletypewriter (TTY), also known as a Telecommunications Device for the Deaf (TDD), is an electronic device for text communication via a telephone line, used when one or more of the parties have hearing or speech impairment. Request from Communication Dept. Tie-line 8-327-9000

CA Relay Service — From your standard telephone dial 9-711 to reach specially-trained Communication Assistants to relay conversations between deaf, hard of hearing, or speech-loss individuals.

The Visually Impaired

Large Print A document in large print improves communication with members who have low vision. This can be achieved by enlarging a document on a copier or by enlarging fonts on electronic files. Located in Member Health Education – Imperial Satellite and Member Services, Bellflower MOB .

Audio Solutions Text-to-Audio creates audio information from electronic text using “text-to-speech” technology. The audio files can then be used to create audio CDs for the individual to listen to the information. This format is usable by individuals with low vision, blind or cognitive limitations. There are

departments at your medical center with this technology, which include Health Education, Member Services and Emergency. Located in Member Health Education – Imperial Satellite and Member Services, Bellflower MOB

Signage Located in Member Health Education – Imperial Satellite and Member Services, Bellflower MOB

Braille Documents in Braille are available upon request. This format is utilized by members who are blind or deaf/blind and tends to be more popular with older members. If you get requests for Braille documents, you will need to have the document in an electronic format.

Regarding Braille Request:

First, let the member know that it may take a long time to convert, offer other alternatives suchas audio or electronic files. If it is not readily available electronically, it may be scanned with theHealth Education computers.

Requests for local or Health Education materials are the responsibility of the medical center to convert for members. (Cost will vary depending on the complexity of the document. Vendors work by the hour ~$50/hr.)

If members are requesting Regional Health Plan Materials such as Healthwise Handbook, Evidence of Coverage, or Guidebooks, they may contact the Member Service Call Center at 1-800-464-4000 or 1-800-777-1370 (TTY for the hearing/speech impaired).

If the cost is too great for the department to handle, please be sure to contact Theresa Tang at theresa.tang@kp.org.

Note: Every staff member is responsible to know how to locate, obtain, and use the above devices - see your Manager.

Other Health Plan Materials Members may also call the Member Service Call Center at 1-800-464-4000 or 1-800-777-1370 (TTY for the hearing/speech impaired) to request Health Plan related materials in an alternative format.

Article expert: Ben Cherian

Culturally Responsive Care At Kaiser Permanente, it is important that our members receive Culturally and Linguistically (C&L) appropriate care which includes (but is not limited to) providing language assistance services at all times at no cost and C&L appropriate referrals to community-based organization as applicable.

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.

Minor children should not be used as interpreters except in extraordinary situations such as medical emergencies where any delay could result in harm to a member/patient, and only until a qualified interpreter is available. Use of a minor child for interpretation under these circumstances should be documented in the medical record.

KP provides oral language assistance through the following:

Face-To-Face - Interpretation Services Qualified Bilingual Staff (QBS) are KP employees qualified, through testing and training, to provide verbal language assistance.

QBS Level 1 - use language skills in non-clinical situations that require only basic conversationallanguage.

QBS Level 2 – requires greater level of fluency including medical terminology in order to function inmost business and/or clinical settings.

Non-QBS staff - All KP employees may greet and assist members/patients with getting to theirdestination in the member’s target language (e.g., Spanish), even if the employee does not have aQBS designation. If the conversation goes into the scope of a QBS Level 1 or Level 2, then the non-QBS employee is asked to transition the patient/member to a QBS employee to further assist in thepatient’s target language.

QBS badge - QBS staff must wear appropriate QBS badge identifying their level of qualification.

Always try to obtain QBS as the first choice for interpretation. 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” linkunder Comprehensive Linguistic Program and Qualified Bilingual Staff Program

Approved In-Person Interpreter Vendors – KP has contracts with outside vendors that provide quality spoken and sign language interpretation services.

When requesting services, please provide: • Billing Cost Center (GL String/NCOA): Business Unit

(Region/Entity), Location, and Department Codes • Interpreter Expense Code = 78615 • FDA Approver’s NUID (Person who will be receiving and paying

service invoice) • Requester’s Name and Number • Language/Service Needed • Patient’s Information, as requested • Sign and Verify the Verification of Services Form. Make copy for department records

Interpreters Unlimited (800) 726-9891 Both Sign Language and Spoken Languages

Accomodating Ideas (800) 257-1783 Sign Language

LifeSigns (888) 930-7776 After Hours (800) 633-8883 Sign Language

CTS LanguageLink (800) 535-7993 Spoken Languages Continental Interpreting Services (800) 201-7121 Spoken Languages

Over-The-Phone- Interpretation Services

LANGUAGE LINE (800) 523-1786 Spoken Languages Only

Language Select (855) 701-8100 Spoken Languages Only When requesting services, please provide your: • Language the member speaks • Medical Center’s Client ID: 201111

(Note: To call a Deaf or Hearing Impaired member using a standard phone, dial a voice relay operator from the CA Relay Service at:1-866-461-4288 (English) or 1-

866-288-1677 (Spanish)

For additional information on approved interpreter vendors: Go to My HR > KP & ME tab, select “Diversity” go to “Interpreter Services” link under Language Services. Language Concordance Program – promotes language concordance between patients and physicians. Language concordance exists when a physician speaks the patient’s preferred language. Physicians if you have questions about the program check the SCPMG Physicians’ Portal or email your questions to Language.Concordance@kp.org

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.

Qualified Bilingual Staff are NOT qualified to perform written translations.

Documents not immediately available in a target language can be sight translated (Oral/Spoken conversion of written text from one language into another language) by a QBS employee.

For a list of approved vendors and information on how to request translation services visit: https://wiki.kp.org/wiki/display/translationservices DOCUMENTATION - CULTURAL AND LINGUISTIC

The following must be documented in the patient’s medical record:

• Language preferences (written, spoken and interpreter need) for obtaining healthcare/medical services

• The use or refusal of interpreter services at each encounter • The vendor’s name and interpreter ID number, QBS’ name and NUID, and/or the

family/friend’s name/association and non-minor status when providing interpreter services

• Language preferences (written, spoken and interpreter need), as applicable, or the patient’s caregiver, guardian or legal decision maker.

• Race and ethnicity (as self-identified by the patient) Every staff member is responsible to know how to locate/obtain all language services options and know where and how to correctly document the use and/or refusal of such services.

C&L APPROPRIATE REFERRALS

Kaiser Permanente must provide culturally and linguistically appropriate community referrals. See your Manager or contact the Social Services Department (562) 657-8590 for additional information

For any questions regarding C&L appropriate services/care contact the local CRC Designee Mario Aparicio (562) 622-4153/8-324. Article expert: Mario Aparicio

SECURITY:

Security Phone Numbers:

Medical Center Campus 562-657-9000 Garden, Orchard & Imperial Satellite 562-657-7799 Medical Center Emergency Line Ext. 79999 Bellflower 562-461-6007 Norwalk (pager) 310-609-0434 Cudahy (pager) 310-609-0067 Whittier Putnam (pager) 310-609-4642 Lynwood (Spectra Link) 310-604-5735

Identification Badges All employees are required to wear Kaiser Permanente photo identification (ID) badges at all times. Badges are to be worn above the waist, with photo and ID facing outward. Replacement badges are obtained from Security, hours for replacement badges are Monday – Friday 0800-1600. Call first at (562) 657-7799.

The goal of Security is to protect YOU, patients and visitors as well as our property and assets. Security assists with threat management, conducts security patrols and investigations, operates cameras, and manages access to "sensitive areas". Security sensitive areas are those departments that may require additional security measures like cameras, keyed or pass-code entry, or inconspicuous silent alarms.

ALL VENDORS MUST REPORT TO SECURITY!

Security

“Help” buttons

Identified sensitive areas include areas where infants are cared for (e.g., NICU and nurseries), areas where there are money transactions (e.g., gift shops, pharmacies) and the Emergency Department.

Suspicious Persons/Activity

Reporting strange or suspicious activity can help security personnel be proactive in investigating and protecting company assets, and ensuring the safety of our members and you. If it's suspicious, contact Security immediately!

Code Secure

Safeguarding infants and children is everyone's responsibility. An infant abductor often poses as an employee or volunteer. All of us need to be aware of any suspicious activity in our own work areas, even if infants and children are not routinely cared for there.

An actual or attempted infant abduction is paged overhead three times as “Code Secure”. Security will initiate their protocol; you are asked to assist by responding to your areas of responsibility (if applicable) and/or by being vigilant until additional support comes from outside agencies. It is in the first few minutes after hearing “Code Secure” that the chances for recovering an abducted infant remain high.

If you suspect an abduction is occurring, attempt to direct the suspicious person back to the unit and note willingness to comply with directions. Do not attempt to detain, but notify security immediately of physical description of the suspected abductor, location and general direction of exit route.

In the event of a “Code Secure”, all bags/containers large enough to conceal an infant will be checked by security department personnel.

Are you as safe as you can be?

The following list provides important tips and principles of personal protection and crime prevention.

• Always wear your photo ID badge in plain sight. Politely challenge those in "sensitive" areas who are not wearing a badge or call security.

• Report any suspicious looking or unfamiliar package, container, parcel or letter. • Immediately report workplace threats of any kind, including inappropriate advances

and behaviors, sexual harassment, threats of violence. • Lock your office/work area (if possible) when you leave. • Refrain from bringing costly personal belongings or articles with high personal value

to work. • After hours, walk to your car in a group or call your security department to request an escort. Always

have your keys in hand, ready to go. Be aware of your surroundings. • Don't make it easy for a thief. Lock your car and keep the windows rolled up. Consider

protecting your car with an alarm device, electronic tracking system or steering wheel securing apparatus. Parking a vehicle on Kaiser Permanente properties is done at your own risk. KP is not responsible for theft of (or from) vehicles or damage which may be incurred.

Threat Management

Workplace violence, aggressive behavior, threats and harassment can occur anywhere, anytime and in any department. At Downey Medical Center, we are committed to preventing workplace violence.

Our medical center has a Security team available 24 hours a day, 7 days a week. If you feel that you have been threatened or are in a threatening situation, contact the Security Department right away – ext. 79999. (Medical Center Campus)

If you feel you have a life threatening issue call 911.

You deserve and have a right to a safe, secure work environment free from the threat of violence. You can help by doing your part.

Article expert: Oziel Barajas

Advance Directive Adult patients have the right to make decisions about their end-of –life care. Those decisions can include whether the patient wants to be resuscitated or placed on a ventilator. An Advance Directive is a legal document that lists the patient’s wishes so that physicians and family members will know what health care decisions the patient wants. An Advance Directive allows a person to name someone to make those decisions for them regarding medical care and life support if the patient is not able to act for himself due to illness or diminished mental capacity. That designated person is referred to as the agent. An Advance Directive only covers healthcare decisions. Similar documents used in the past are Living Wills and Durable Power of Attorney for Health Care documents. Once an Advance Directive is completed, it does not expire, but a person has the right to revoke their Advance Directive. The POLST order sheet is an adjunct to the Advance Directive. POLST (Physician Orders for Life Sustaining Treatment) is a special physician order form in California that addresses a person’s wishes regarding life-sustaining treatment and resuscitation. The POLST policy (MCW # 1389.00) and the Advance Directive policy (MCW 1305) can be found in Docushare.

Members should be informed about Advance Directives and encouraged to complete the form before they face an end-of-life event. Advance Directive forms are available to members in a variety of locations such as Health Education, Member Services, Social Services, Continuing Care, Home Health, and Hospice. If a member needs counseling or advice about completing an Advance Directive, Social Workers can help them. This complies with the federal Patient Self Determination Act. The purpose of the act is to protect adult patients’ rights to participate in their healthcare decisions. A patient’s doctor or other member of the patient’s healthcare team cannot be named as the agent for the patient unless they are related to the patient. A Kaiser employee or volunteer cannot act as a witness.

All patients 18 years old and older must be asked if they have an Advance Directive when they

are admitted to the hospital’s inpatient or outpatient areas. If they have not completed an Advance Directive, information can be provided. Information about whether or not the patient has an Advance Directive should be documented in the patient’s medical record. Advance Directives can be scanned into KP HealthConnect. If the patient did not bring a copy of their Advance Directive with them, family members should be asked to bring a copy to the hospital.

Article expert: Allison Kassorla

If patient appears to be having an acute stroke, notify physician immediately to evaluate patient.

ED - Alert ED Physician

Inpatient - Activate Stroke Alert at ext. 79999

Outpatient - Call 911

STROKE is an

EMERGENCY ACT F A S T AND SAVE LIVES!

Face Facial droop, uneven smile

Speech Slurred speech, difficulty speaking Time Time to get help. Note last known well time

Stroke Risk Factors HIGH BLOOD PRESSURE HEART DISEASE HIGH CHOLESTEROL DIABETES HEAVY ALCOHOL USE SMOKING PHYSICAL INACTIVITY &

OBESITY FAMILY HISTORY OF STROKE ATRIAL FIBRILLATION

(IRREGULAR HEARTBEAT)

Questions Contact: Stroke Coordinator Extension 7-7155 Pager# 562-272-5108

Stroke Info Flyer 1.30.13 Internal—martha.e.burke@kp.org

Downey Medical

Ethics Services Have you ever asked yourself: "Are we really doing the right thing for this patient?" Or perhaps the question was: "Are we really doing the right thing for grandma?" If you have asked such questions, you have a healthy moral compass! There are circumstances when all partners of the shared decision-making process may be wondering what course of treatment would be the most appropriate for a designated patient in a specific situation. Pondering such questions is probably your cue to call the Medical Bioethics Director. Downey now has a full time ethicist who covers the inpatient as well as outpatient needs in the Downey area, his name is Alain P. Durocher, PhD. Ethics consultations are designed to address ethical dilemmas related to the care of a patient. An ethics consultation becomes especially necessary when ethics principles seem to conflict with one another in a particular situation. For example, patient autonomy does not always meet the physician's obligation to provide treatment that will bring more benefit than burden. However, ethics consultations are only one of three areas of interest for a medical ethicist. Education and policy reviews are also part of the responsibilities of a medical ethicist. Workshops or seminars with physicians, nurses, social workers, etc., are also part of the ethicist's job description. Finally, ethicists have to develop or review policies that have a strong ethical component such as an Advance Directive Policy, or a policy about Informed Consent. The Medical Bioethics Director though does not work alone! Downey has a vibrant Bioethics Committee under the leadership of Dr. Tim Hickey, MD. The Committee meets once a month to make sure that ethics consultations are addressed in a timely manner, that policies are periodically reviewed, and that education is provided on a continuous basis. For more information or to require the services of our very own Downey medical Bioethics Director, please see the contact information below.

Alain P. Durocher, PhD Office: 562-657-6956. [tie line: 327] Pager: 562-272-5997 alain.p.durocher@kp.org