Welcome to the Texas Children’s Hospital p Orientation for Students and Faculty Texas Children’s Hospital ® Who We Are Texas Children's Hospital is an integrated delivery system that includes a full range of services for i f t children infants, hild and d teenagers t throughout th h t Houston H t and around the world. As one of the nation’s largest, free standing pediatric health care institutions, institutions Texas Children’s is committed to redefining children’s health care through patient care care, education education, and research research. Texas Children’s Hospital ® 6 Guiding Principles At the heart of Texas Children’s vision and mission is a set of core values that guide us individually and collectively as an organization. These are Texas Children’s 6 Guiding Principles and they are part of all of our interactions interactions. They are the following: 1. Commitment to Excellence 2. Customer Center Service • We sustain and nurture a culture that supports our mission, vision and d values. l • We are proud of who we are and have the passion to make a dail daily difference. difference • Above all, we deliver the finest possible work, care, and service with personal and professional excellence and are committed to continuous improvement. • We show consideration, compassion and support for all people. • We have exceptionally high standards for individual, team and organizational performance. • We provide the expertise, innovation and visionary thinking that will continue to advance pediatric health care, education and research. • We carefully consider the impact our decisions have on others. • We find innovative solutions to support the needs of those we serve. • We work together to create the best possible customer outcomes. 3. Integrity & Ethical Behavior • We are honest and trustworthy. We hold h ld ourselves l to hi high h •W standards of moral, ethical, and legal conduct. • We keep our promises and commitments. • We have the character to do what is right, not what is easy. • We exhibit the highest levels of professionalism in all situations. Texas Children’s Hospital ® 6 Guiding Principles – cont. 4. Valuing Individuals 5. Communication & Interaction 6. Accountability • We treat all people with courtesy, respect and dignity. • We choose to interact in the spirit of collaboration. • We own our words, actions and outcomes. • We constantly strive to create an environment of mutual respect, teamwork and commitment. • We are honest and forthright in our relationships with others. • We set high performance expectations and work together to achieve the organization's mission, vision, values and business objectives. • We support diverse perspectives, ideas, backgrounds and cultures and find value in our differences. • We recognize and value the contributions of others. • We actively seek, share, hear and value information and feedback. • We lead byy example. • We engage others in dialogue, planning and decisions that involve them. • We align our work with organizational priorities. Diversity At Texas Children’s Hospital Texas Children's creates and fosters a work environment that attracts, welcomes, supports and develops a diverse organization. A critical part of this culture is for every individual to feel valued for his or her contribution to the mission and vision of Texas Children's. All of us are responsible for embracing and nurturing a culture of inclusiveness in our own work areas. p things g to remember when dealing g with patients, p , families and employees: p y Important • Always be respectful in both words and actions • Display an overall positive body language • Whenever possible, offer assistance • Maintain confidentiality • Use the resources available to assist in resolving conflicts • Always create an environment that is respectful of differences • Be mindful of the seen and unseen Dimensions of Diversity and be respectful in word and action based on the Guiding Principles, especially the principle of Valuing Individuals. By understanding the Dimensions of Diversity, every employee can: • Truly understand what is unique and special about others • Better serve our patients, their families and other customers • Find value and richness interacting with co-workers co workers and maximize their contributions to Texas Children's Children s ongoing success Family-centered care Family-centered care is a philosophy of care that is based on the belief that: Parents (caretakers) are experts when it comes to dealing with their own children and want what is best for them. Parents need adequate information and support in order to care for their children in the best possible way. p y A child is not merely a patient, but a part of a family, and the family is a partner in the child's health care. A family-centered care approach to pediatric health care is one that: • Recognizes R i th thatt th the ffamily il iis th the constant t t iin a child's hild' life, lif while hil the th health h lth care service i system t and d the th personnell within ithi the system may fluctuate. • Facilitates family/staff collaboration on all levels of heath care • Consistently demonstrates a caring attitude towards patients and families, honoring their racial, ethnic, cultural and socioeconomic diversity. • Recognizes and respects the strengths, values, concerns and choices of families. • Identifies family needs and collaborates with families to determine actions needed to meet those needs. • Understands and incorporates the developmental needs of infants, children and adolescents and their families into a health care plan plan. Family-centered care LANGUAGE SERVICES A child is not merely y a patient, p , but a part p of a family, y, and the familyy is a partner p in the child's health care. A family-centered care approach to pediatric health care is one that: • Recognizes R i th thatt th the ffamily il iis th the constant t t iin a child's hild' life, lif while hil the th health h lth care service i system t and d the th personnell within ithi the system may fluctuate. Disaster Codes CARLA At Texas Children’s, there is a plan in place so that all staff know how to respond in the event of a natural disaster or emergency. During the past several years, Texas Children’s has worked closely with federal, state and local agencies to prepare for domestic situations in the event of a nuclear, biological or chemical disaster. The word that describes emergency preparedness and response at Texas Children’s is CARLA and preparation for the emergency begins long before the event itself is imminent. For the purposes of your orientation, it is important to be familiar with 3 terms: CARLA Alert An emergency event is imminent. Some examples include: external emergencies either natural or manmade, mass casualties, internal disasters, or severe weather like a storm or hurricane. CARLA This is the highest level of emergency response. CARLA activates the hospital’s emergency response teams of preparation, ride-out and relief. Examples of CARLA may include: hurricane landfall, freezing or icing conditions, community wide emergencies requiring a coordinated response and patient relocation and d evacuation. ti CARLA Clear Hospital returns to normal operations with continued care for casualties. Disaster Codes Call *9999 in the hospital to report any of the following: Code RED - A cardiac or respiratory arrest in any Texas Children’s Hospital building • If you are in a patient's room, press the Emergency Call button and dial *9999 on the phone. • If you are in another area of the hospital dial *9999. • Begin CPR only if you are certified to do so. If you are not certified, wait for qualified code response team members to arrive. Code Pink – A patient under the age of 18 is missing from the unit or has been abducted • The hospital will then be in lock down and everyone must remain in current location until the Code Pink is cleared. Dr. Pyro STAT – Fire Emergency - A fire has been reported in the hospital • Follow the procedures in place for your unit. Know your unit's evacuation plan, fire exits and fire extinguisher location. Never shout "FIRE" If you are working at any off-campus location including a Health center, Nabisco Building, TCPA Practice or Meyer Building, the number to dial for emergencies is 9-1-1. Emergency / Safety Situations Fire Safety - Protection To be well prepared in the event of a fire, all Texas Children's staff including Baylor staff, Volunteer Services students, Services, students faculty and anyone who works in a Texas Children location should know the following: • Locations of fire alarms and pull stations on your floor or area • Locations of fire extinguishers, specific types and procedures for using them • Locations of fire doors • Locations of exits, stairwells and proper routes to safety that you are to use • Specific number you call in your work location in order to contact the fire department, emergency medical system and/or the appropriately trained employee response teams • Locations of smoke compartments on your floor or area Only the FIRE DEPARTMENT or Nursing Administrative Coordinator (NAC) can authorize evacuation down the stairs and out of the building. If you are trying to extinguish a fire: • Discontinue the use of oxygen or gas and disconnect electrical appliances in the immediate area. • Always stand between the fire and the way out to safety. • Crouch low to avoid the smoke and heat from the fire. Avoid inhaling the smoke or fire gases. If you are working at any off-campus location including a Health Center, Nabisco Building, TCPA Practice or Meyer Building, the number to dial for emergencies is 9-1-1. Emergency / Safety Situations Extinguishing a fire - cont. If you are trying to extinguish a small fire by using a fire extinguisher, first choose the appropriate fire g and then remember the letters P A S S. extinguisher P - Pull the pin A - Aim at the base of the flames S - Squeeze the handle S - Sweep form side to side RACE The acronym R.A.C.E. is used throughout Texas Children’s main campus to help staff to remember what steps to take in th eventt off a fi the fire emergency. Th The letters l tt stand t d for: f R - Rescue The safety of the patient comes first. If a patient in in immediate danger, remove the patient to safety before doing anything else. A - Alert Activate fire alarm system by pulling the closest fire alarm pull station. Report the fire to the hospital operator at Ext. *9999 C - Confine Confine the fire to prevent it from spreading by closing doors and windows. E - Extinguish Try to control the fire by using the proper fire extinguisher only if your safety can be assured. Safety Waste Control Red Bag Waste: Any item which is visibly contaminated with blood or blood-tinged body fluids, or contains or has contained visible blood or blood-tinged body fluids is considered special waste and will be placed in a cardboard bio hazardous waste (Red Bag Waste) container marked with the bio bio-hazardous biohazardous label. The red bio-hazardous waste bag is enclosed or placed in a cardboard box to ensure proper disposal. Blue Bag Waste: All linens are to be placed in the labeled linen (blue bag lined) containers. No other items are placed in the linen containers. Safety Policy References: SAF 103 Hazardous Chemicals & waste management SAF 104 Smoking and Tobacco Use SAF 302 Balloons Material Safety Data Sheet - Hazardous Materials Hazardous materials are handled everyday in the hospital environment. Precautions need to be taken when handling these materials. Hazardous materials can be identified by the product label and warning symbols or by the proper Material Data Safety Sheet (MSDS) (MSDS). The MSDS provides the user with physical hazards, route of entry, precautions for safe handling, control measures, and emergency first aid. The MSDS sheets for chemicals at Texas Children's can be accessed through Connect (Texas Children’s intranet) on the Office of Safety Management Web page. S ki Smoking It is Texas Children's Hospital policy to be a smoke-free institution and to extend that policy to all hospital premises include parking garages. There are designated smoking areas around each building. Balloon Policy Latex/rubber balloons and similar products create safety hazards for small children (i.e., choking). Therefore, it is the policy of Texas Children’s to ban the sale, use or display of latex/rubber balloons, which includes surgical gloves when being used as a toy in any Texas Children’s building or Hospital sponsored function. Policy References: SAF303 Use of Devices Emitting electromagnetic Interferences Safety Devices Emitting Electro-Magnetic Interferences Devices emitting radio frequencies such as cellular phones, citizen band radios and other personal communication devices or games operated by radio remote control are not permitted unless approved by the Biomedical Engineering Department Department. An approved appro ed cellular cell lar phone list is a available ailable on Connect under nder the Biomedical Engineering Department web site under "Services". Areas where devices are allowed include all general floors, patient rooms, corridors and lobbies. Cell p phones may y NOT be used in the Intensive Care Units ((ICU)) or within a p proximity y of three feet or less from patient care equipment. Restricted Areas All devices must stay in their off position while in restricted areas where life support equipment may be in use. Restricted areas include: OR ands all ICU areas Cath Lab PICU CV-ICU Neonatal ICU Dialysis Infection Control Policy References: SAF 207 Standard Precautions PC120-01 on Fingernails Standard Precautions "Standard Precautions" provide a method of effective infection control that considers all patients p y to be potentially: • Infected with a bloodborne pathogen • Infected with a microorganism capable of spreading communicable diseases St d d Precautions Standard P ti should h ld be b utilized tili d for f allll body b d fluids. fl id T Treatt allll bl blood d and d potentially t ti ll iinfectious f ti materials as infectious. Fingernail g Policy y All health care workers, including volunteers who care for patients directly, must have short, clean and natural fingernails. No artificial nails, tips, jeweled insets or overlays should be worn by direct patient care providers. All health care workers who prepare medications or serve food must have short, clean and natural fingernails. No artificial nails, tips, jeweled insets or overlays should be worn by these health care workers. Infection Control Can I get a HY5? Only if those hands are clean! Hand Washing • Wash hands thoroughly with soap and water for 10 seconds when hands are visibly soiled soiled. • Use gel or foam for cleansing hands when they are not visibly soiled and rub over all surfaces of hands and fingers. Remember, gloves are not a substitute for hand hygiene! H d hygiene Hand h i should h ld be b performed: f d • BEFORE and AFTER each patient contact • Between different types of patient care on the same patient • After removing protective gloves • Before preparing or administering medications or food • After touching inanimate sources that are likely to be contaminated with microorganisms • Before performing any invasive procedure such as starting an IV, suctioning or inserting a Foley catheter • Before and after eating and drinking • After using the restroom Infection Control Policy References: SAF 200 Infection Control Plan Series SAF 206A OSHA Bloodborne Pathogen Standard Selecting Personal Protective Equipment (PPE) PPE may include gloves, gowns, disposable lab coats, face shields or masks, eye protection, pocket masks and other protective gear. The Personal Protective Equipment (PPE) must be “readily available” in the workplace and in appropriate sizes. If employees/students/faculty anticipate that they will have contact with blood and/or other potentially infectious materials or contaminated surfaces, they must wear gloves. Please remember: Single use gloves cannot be washed or decontaminated for reuse. Utility gloves may be decontaminated, if they aren't damaged or otherwise unable to protect the wearer. Gloves should be replaced if they show signs of cracking, peeling, tearing, puncturing or deteriorating. Single use gowns are recommended during patient care to prevent soiling of clothing with secretion/excretion, such as rocking a baby with diarrhea. • Masks are recommended to prevent transmission of infectious agents through the air. Masks protect the wearer from inhaling: -Large Large particle aerosols (droplets) that are transmitted by close contact and generally travel only short distances (about 3 feet) -Small-particle aerosols (droplet nuclei) that remain suspended in the air and thus travel longer distances. • Wearing gloves, gowns, masks and other eye protection can significantly reduce health care worker risks for p to blood and other p potentially y infectious materials. exposure • All PPE must be disposed of in the proper isolation reciprocal after each use. • • • • Infection Control Policy References: SAF 200 Infection Control Plan Series SAF 206A OSHA Bloodborne Pathogen Standard Tuberculosis Tuberculosis (TB) is an airborne disease that affects the lungs or other organs where the lymph system may be involved. TB maybe transmitted by inhalation of respiratory secretions from infected individuals. Generally, very young children cannot transmit TB since they cannot cough forcefully enough to generate sputum. Signs and symptoms of active TB include: • • • • • Fever Malaise Night Sweats Cough U Unexplained l i dW Weight i h L Loss • Blood in the sputum Evaluation Criteria Pediatric patients with suspected or confirmed TB are evaluated for infection using the same evaluation criteria as adults. These children must be placed in airborne isolation. Because family members are usually the source of infection, parents and other caregivers should do the following: • Be evaluated for TB as soon as possible. Call the Infection Control Department to assist in arranging chest xrays for two caregivers who will be staying with the patient. • Wear W surgical i l masks k when h iin th the h hospital it l setting tti until til an evaluation l ti is i complete. l t A surgical i l mask k iis nott necessary for a family member if the family member is in the negative pressure room with the patient. Infection Control Policy References: SAF 200 Infection Control Plan Series SAF 206A OSHA Bloodborne Pathogen Standard Tuberculosis – Engineering (Physical) Controls There are two (2) types of engineering controls that are used to keep TB bacteria from spreading. These include: 1. Isolation rooms with special ventilation called “negative pressure airflow.” P ti t suspected Patients t d or known k to t have h active ti TB should h ld b be placed l d iin th these rooms and d th the d doors tto these rooms are kept closed. Facilities Operations ensures that a room is under “negative pressure.” Call Facilities Operations to verify that the room is operating properly. An N-95 mask should be worn by all healthcare workers when entering these isolation rooms. 2. Airborne isolation procedures should be maintained until the patient is no longer contagious, as determined by Infection Control. Before ruling out TB and discontinuing airborne isolation, clinical staff must first contact the Infection Control Department Department. Infection Control Isolation Signs at Texas Children’s Infection Control Isolation Signs at Texas Children’s – cont. Infection Control Policy References: SAF 200 Infection Control Plan Series SAF 206A OSHA Bloodborne Pathogen Standard Bloodborne Pathogens Bloodborne pathogens are communicable diseases that are transmitted by blood or other body fluids, including but not limited to semen and vaginal secretions. All body fluids visibly contaminated with blood should be considered as potentially infectious for: HBV – the virus that causes Hepatitis B HCV – the virus that causes Hepatitis C HIV – the h virus i that h causes AIDS What is Hepatitis B (HBV) Hepatitis B (HBV) is a liver disease that is caused by a virus and can alter liver function. The liver, when f functioning ti i normally, ll stops t bl bleeding, di stores t energy and d removes d drugs and d ttoxins i ffrom th the bl blood. d How is HBV spread? HBV is spread by contact with an infected person's blood, semen, or other bodily fluids. Anyone with occupational exposure to blood is at risk of contracting HBV. What are the signs and symptoms of HBV? HBV can make you feel like you have the flu. You might experience fatigue, nausea, diarrhea, fever or loss of appetite. Some people who are infected with HBV produce dark yellow urine and/or light colored stools. They also may have yellowish eyes and skin. Infection Control Policy References: SAF 200 Infection Control Plan Series SAF 206A OSHA Bloodborne Pathogen Standard Bloodborne Pathogens - Cont. What is Hepatitis C (HCV) Hepatitis p C ((HCV)) is an infection of the liver caused by y a virus. It is less common than Hepatitis p A or Hepatitis p B. How is Hepatitis C spread? Hepatitis C is spread by contact with an infected person’s blood. In rare cases, a person could get Hepatitis C from sexual contact with an infected person. Some blood transfusions or organ transplants conducted before 1992 have resulted in exposure to the virus. Prior to that time, health care facilities did not test to detect Hepatitis C antibodies. What are the signs and symptoms of Hepatitis C? Hepatitis C infections typically have no symptoms for a period of years. Most cases of Hepatitis C are identified when people have liver tests or Hepatitis C antibody tests done before donating blood. Some people eventually experience flulike symptoms with fatigue, nausea, diarrhea and loss of appetite. They may have dark yellow urine, light colored stools or yellowish skin or eyes eyes. How can health care workers protect themselves from HCV? Currently, no vaccine exists to prevent Hepatitis C. Studies have found that health care workers exposed to the Hepatitis C virus through a needle stick or other injuries that enter t the th skin ki have h b become iinfected f t d att an average off 1.8% 1 8% per iinjury. j Those at risk should use appropriate Personal Protective Equipment (PPE) and appropriate safety devices to protect themselves from Hepatitis C. There is a vaccine to protect against Hepatitis B; however, there is no vaccine to protect against Hepatitis C. Infection Control Policy References: SAF 200 Infection Control Plan Series SAF 206A OSHA Bloodborne Pathogen Standard Blood-borne Pathogens – cont. What is the Human Immunodeficiency Virus (HIV)? HIV is the virus that causes AIDS. The virus is passed from one person to another through direct blood to blood contact. HIV kills an important kind of blood cell – the CD4 T lymphocyte or T cell cell. As the T cells die off off, the body becomes more and more vulnerable to other diseases called "opportunistic infections." When persons with HIV get these infections or if their CD4 T cell levels become too low, they may contract AIDS. Who is at risk for contracting HIV? Health care workers whose job duties involve potential contact with a patient's patient s blood or other hazardous body fluids in a health care setting are at risk. How can exposures to HIV occur? Exposures can occur through contact with blood or other hazardous body fluids. Exposures can occur through needle sticks,, cuts,, lacerations and contact with non-intact skin or mucous membranes. Protection Against Exposures To protect against exposure to blood-borne pathogens, health care workers should use Standard Precautions. Complying with these precautions will help to maintain a safe work environment for everyone. Some examples of Standard Precautions are: • Properly using Personal Protective Equipment (PPE) such as respirators, goggles, gloves, gowns, masks and properly disposing of safety sharps sharps. • Removing all contaminated or dirty gloves promptly. • Disposing of closed, locked sharps containers in designated red bag waste containers immediately after use and when the sharps containers are 2/3 full. Infection Control Protect Yourself 1. Never overfill the sharps container 2 Ch 2. Change th the container t i out when it is 2/3 full Don’t put yourself at risk for a needle stick injury. Please visit the Infection Control Webpage on the Texas Children’s Hospital Intranet “Connect” for further information & resources Ethical Issues Policy Reference: CCP101, CCP 101-01: Code of Ethical Behavior PS 100, PS 100-01, PS 100-01a, PS-01b: Patient Rights & Responsibilities PC118-01: Guidelines on Institutional Policies on the Determination of Medically Inappropriate Interventions What is an ethical issue? Patient care providers may be faced with ethical issues in their work environment. When forced to consider two different,, but morallyy defensible alternatives to the same problem, p , an individual mayy experience p conflicting loyalties to their profession, colleagues, patients and families, institution and society. The following information may be helpful to students, faculty, and new employees at Texas Children's Hospital. Definitions: Ethical: pertaining to ethics or morality: conforming to moral standards Issue: A matter that is in dispute between two parties What are some examples of ethical issues? S Some examples l off ethical thi l iissues may b be: • • • • Prolonged life support - medically futile procedures Withdrawal of life support Administration of blood or blood products Abortion What resources are available to me? Should an ethical issue arise, resources are available to staff at Texas Children's Hospital, including: • • • • • Policy & Procedures Leadership team Human Resources Department Chaplain Services Bioethics Committee Ethical Issues Policy Reference: CCP101, CCP 101-01: Code of Ethical Behavior PS 100, PS 100-01, PS 100-01a, PS-01b: Patient Rights & Responsibilities PC118-01: Guidelines on Institutional Policies on the Determination of Medically Inappropriate Interventions Corporate Compliance Program What is your role? • Follow the Texas Children Children's s Code of Ethical Behavior Behavior. • Understand your job responsibilities. • Ask questions if you don't fully understand your responsibilities or are able to identify a potential issue. • Report potential issues. What is the Code of Ethical Behavior? At Texas Children's, the Code of Ethical Behavior means that we are committed to: • Following the laws • Following ethical business practices • Following the Mission, Vision, Values and Guiding Principles of Texas Children's • Avoiding conflicts of interest • Adhering to Texas Children's policies and procedures • Reporting inappropriate or unethical conduct or activity • Maintaining confidentiality • Keeping accurate and complete records • "Doing what is right, not what is easy" Ethical Issues Compliance Texas Children's and related personnel are required to comply with all laws, regulations and policies including p g the following: g • Fraud and abuse laws such as the Federal False Claims Act • Medicare and Medicaid coding and billing regulations • Employment and labor laws • Texas Children's policies How To Report Suspected Ethics and Compliance Violations Please report all suspected ethics and compliance violations to any of the following: • Your unit leader • Any other Texas Children's leader • The Compliance Office at 832-824-2085 • Texas Children's Confidential Hotline at 1-866-478-9070 Ethical Issues Policy Reference: IM 100: Corporate Information Security Policy IM 105: Use and Disclosure of Protected Health Information IM 106-01: “No Information” Patient Status IM 201-201A: Patient Access to Protected Health Information Information Management & Privacy 1. Never discuss any private information about patients with anyone except other health care workers who are providing care. 2. Password protect or logoff the computer if you leave the area. 3. Do not share your password with anyone. 4. If a patient is identified as "no information” status, do not give out ANY information. 5. Place "hardback" charts in the appropriate place. 6 O 6. Only l obtain bt i iinformation f ti about b t a patient ti t or a patient's ti t' family f il that th t is i necessary to t workk in i your role. l This Thi means you may not look up information about you friend’s ro co-worker’s child or your own child just because you have access to the information. 7. All students and p professionals entering g Texas Children's Hospital p will be required q to p provide completed p HIPPA & Patient Confidentiality forms prior to coming into the Texas Children’s Hospital facility. 8. If you suspect any illegal or unethical activity, you must report this to one of the following: • Privacy office • Security Services • Texas Children’s Hospital Confidential Hotline 1-866-478-9070 You have now completed p the Texas Children’s Hospital p Orientation for Students and Faculty
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