Everything you need to begin booking jobs on the Medely Platform.

Please note, it is your responsibility to become familiar with and follow each facility's policies and procedures.


Table of Contents -1

Welcome -3

Community Guidelines- 3

Recommended Practices for Safety and Health- 4

Life Safety (Fire) Management -5

Environmental Safety - 6

Personal Property- 6

“Security-Sensitive” areas -6

EMERGENCY PREPAREDNESS/DISASTER SAFETY- 7

Earthquake/Disaster Preparedness- 7

Electrical Safety - 8

Chemical Safety/Hazardous Communications- 9

Health Hazards- 9

Acute and Chronic Exposure- 10

Routes of Entry- 10

Your responsibilities when handling hazardous materials -10

Blood or Body Fluids- 10

Wear PPE 10

There are three ways that a chemical substance may harm you 10

Appropriate PPE for toxic fumes may include 11

Having physical contact with the chemical 11

Swallowing the chemical 11

Report a serious incident or injury 11

Joint Commission 12

Error 12

Sentinel Event 13

Hazardous Condition 13

Annual National Patient Safety Goals 14

Do-not-use List 15

Infection Control 15

Nosocomial Infections 16

The Spread of Germs 16

General Prevention 16 1.


CDC Hand Hygiene Guidelines 17

Standard Precautions 17

Bloodborne Pathogens 18

Hepatitis 18

Human Immunodeficiency Virus (HIV) 18

Tuberculosis 18

Medication Safety 19

What are medication errors? 19

Avoiding Medication Errors 19

Continuing Education 20

Skills Checklist and Age Specific Self-Assessment 20

Reporting Illegal Behavior 20

Medely takes Illegal behavior very seriously. As a healthcare provider, you are required to identify and report any aberrant or illegal behavior witnessed to professional boards and law enforcement agencies. 20

Abuse and Neglect 20

Basic Definitions 21

Abuse Warning Signs 22

Abuse Reporting 22

The Hipaa Privacy Rule 23

What is HIPAA? 23

What information is protected? 23

What types of information is protected? 23

What are examples of PHI? 24

Releasing Patient Health Information (PHI) 24

Who are the Records Custodians? 24

What are the Authorization Requirements? 24

How is Protected Health Information handled for Minors? 25

Emancipated Minors 25

Minors Who Are Not Emancipated 25

Body Mechanics 25

Lifting 25

Sitting 26

Standing 26

Back Care and Points for Prevention 26 2.


Welcome

Welcome to Medely. Here is everything you need to start Posting or Booking Jobs on the Medely Platform.

Please note that it is your responsibility to become familiar with and follow each facility's policies and procedures.

The Medely office, located in Santa Monica, CA is open Monday through Friday from the hours of 9:00am – 6:00pm Pacific Standard Time. Our local telephone number is (888) 858-7660. You can also reach us via live chat between the hours of 4a-6p Pacific Standard Time. Outside of normal business hours and in the event of an emergency, please email us at [email protected] and/or send a chat message in app (Chat is monitored for emergencies only from 6p-4a Pacific Standard Time).


Community Guidelines

We want Medely to be enjoyable and safe for everyone. These guidelines are designed to ensure that facilities and Medely professionals have an exceptional experience when using Medely’s platform. Please take a moment to review these guidelines.

Required Credentials and Documentation:

Professionals are responsible for keeping all required documentation up to date. The Medely platform will not allow you to book jobs if your documentation is expired. If a required document expires during an assignment the professional is responsible to renew that document within 30 days of expiration.

Respect each other:

Treat everyone you encounter as you would like to be treated yourself: with respect. Most important of all, remember that you may meet people who may look different or think differently from you. Please respect those differences.

Be on time:

Always try to be on time for your assignment because facility staff and patients may be waiting on you.We recommend arriving 15 minutes before the start of the assignment so that you can familiarize yourself with the facility and change into facility issued attire if necessary.If you are running late, please let the facility know as soon as possible.We also understand that unforeseen circumstances do occur, so communicate with the facility as early as possible so they can plan patient coverage accordingly.

Unit Orientation:

When arriving at a new facility you should receive a brief orientation to acclimate yourself to the unit. This orientation includes but is not limited to work station/ area, supplies, charting materials and any facility specific policies and procedures. It is your responsibility to ask for any specific details that are necessary to complete your job and provide excellent patient care.

Be professional on the job:

Providing quality healthcare is a very serious matter and it is very important to abide by the policies and procedures of the particular facility.Also, as a medical professional, you are expected to conduct yourself in accordance with state laws and regulations governing acceptable conduct.

Safety first:

Everyone wants a safe environment at work. It is your responsibility to follow your professional scope of standard of practice and maintain proper safety techniques. If you see anything that does not seem right or you do not have the technical skills or feel qualified to perform, please inform the facility contact immediately. Additionally, patient safety can be improved by following JCAHO’s National Patient Safety Goals. The goals focus on problems in health care safety and how to solve them. Click on this link to read the 2020 National Patient Safety Goals® (NPSGs). https://www.jointcommission.org/standards/national-patient-safety-goals/ 3.


Floating:

Professionals are only notified and can book jobs that match the position for which they are activated for. If a Professional is asked to float to another department with the customer, the department should be a similar department or unit. Professionals should only be floated to areas of comparable clinical diagnoses and acuities.

Confidentiality:

Professional agrees that patient records and charts shall at all time remains the property of the Healthcare Facility. Professional should maintain the confidentiality of all information related to patient records, charges, expenses, quality assurance, risk management or other programs derived from, through, or provided by Healthcare Facility in accordance to HIPPA Standards.

Cancellations or no-show

When you book an available job, you are agreeing to complete the job. We understand that unforeseen issues may arise after you've booked a job, so you do have the right to cancel jobs you've accepted.

However, cancelling jobs can result in poor experiences for other Medely Professionals, Healthcare Facilities, and Patients as well as disrupt the platform.

No Show

If you need to cancel a job less than 24 hours before the start of the job, your account will be paused from accepting jobs for a period of time so that you can address the issue you are experiencing. Once the pause is over, you’ll be able to go back online and book new jobs. If this happens two times within a six month period, your account may be suspended in order to ensure the platform continues to function efficiently.

Frequent Cancellations

Frequent job cancellation impairs the effective operation of Medely's platform and is inconsistent with the professional terms of service. For this reason, your access to the platform may be suspended if many of your booked jobs end in cancellations. As a general reminder, our highest rated Medely Professionals tell us that they only accept jobs they can complete.

Identification

State law requires all Medely healthcare partners to wear, while working, an identification badge (also referred to as trade dress) stating their name and license while working. You should always have your driver's license with you at all times to verify your identity. If you didn't receive your trade dress you can request one by email [email protected]. Healthcare facilities should confirm that the drivers license displayed in your app matches the actual drivers license for the professional. 4.


Healthcare workers face a number of serious safety and health hazards. They include bloodborne pathogens and biological hazards, potential chemical and drug exposures, waste anesthetic gas exposures, respiratory hazards, ergonomic hazards from lifting and repetitive tasks, laser hazards, workplace violence, hazards associated with laboratories, and radioactive material and x-ray hazards. Some of the potential chemical exposures include formaldehyde, used for preservation of specimens for pathology; ethylene oxide, glutaraldehyde, and peracetic acid used for sterilization; and numerous other chemicals used in healthcare laboratories. Click here for additional information OSHA workplace safety: https://www.osha.gov/SLTC/healthcarefacilities/index.html

Life Safety (Fire) Management

When fire strikes, the action taken during the first few minutes make the difference between containment and catastrophe. It is with the training of personnel that proper action can be taken during these very important first few minutes and disaster averted. https://www.osha.gov/SLTC/etools/facility/hazards/fire/fire.html

Important locations you need to know

  • Fire extinguisher in your department

  • Closest fire-alarm pull

  • Evacuation route

  • Fire doors and walls

  • Next safe fire zone (smoke compartments

Important facility conditions to maintain

  • Keep emergency exits, firefighting equipment and fire-alarm pull stations clear at all times

  • Never put door wedges under doors that prevent doors from closing.

  • Keep doors closed unless they are controlled by an electromagnetic system.

  • Keep all corridors and exits clear of all unnecessary traffic and/or obstruction.

  • Keep telephone lines clear for fire control.

Creation of fire

A fire requires that the following three elements (known as the fire triangle) are present at the same time to burn:

The following steps should be followed when responding to incipient stage fire https://www.osha.gov/SLTC/etools/evacuation/portable_use.html:

  • Sound the fire alarm and call the fire department, if appropriate.

  • Identify a safe evacuation path before approaching the fire. Do not allow the fire, heat, or smoke to come between you and your evacuation path.

  • Select the appropriate type of fire extinguisher.

  • Discharge the extinguisher within its effective range using the P.A.S.S. technique (pull, aim, squeeze, sweep).

  • Back away from an extinguished fire in case it flames up again.

  • Evacuate immediately if the extinguisher is empty and the fire is not out.

  • Evacuate immediately if the fire progresses beyond the incipient stage.

Rescue

Immediately stop what you are doing and remove anyone in immediate danger from the fire to a safe area. Ambulatory persons should be instructed to leave under their own power and report to the Emergency Assembly Point. Persons that require assistance with ambulation should be assisted to the Emergency Assembly Point (identified in the Evacuations section of this manual). Get out as safely and quickly as possible. The less time you and others are exposed to poisonous gases, heat, or flames, the safer everyone will be. Assist/ensure evacuation per instructions from the Disaster Leader and according to the Evacuations section of this manual.

5.


Alarm

Activate the nearest fire alarm pull stations (if applicable). Call 911 and/or the front desk (if applicable) to report the location and current extent of the fire. The front desk is notified so that the entire disaster response team can be quickly notified.

Contain

Close all doors and windows that you can safety reach to contain the fire.

During evacuation close the doors behind you.

Extinguish

Only attempt to extinguish the fire if it is safe for you to do so. Retrieve the nearest fire extinguisher and follow the “P.A.S.S.” procedure:

P = Pull the pin breaking the plastic seal;

A = Aim at the base of the fire;

S = Squeeze the handles together; and

S = Sweep from side to side.

Environmental Safety

In every facility, it is important to follow security protocols for each facility. It is recommended that you familiarize yourself with each facility's safety and security protocols prior to starting your job. Some of these protocols may include:

Personal Property

There are a number of security precautions that you can take at your facility to help protect your own personal property:

  1. Lock car doors.

  2. Secure all valuables.

  3. Keep purses and wallets in a locked area or locker.

“Security-Sensitive” areas

Some areas in a facility may be restricted or "security-sensitive." This means that only people who need to be in these areas should be there.

Security-sensitive areas may include the following:

  • Pharmacy

  • Operating rooms

  • Obstetrics (especially the Nursery)

  • Pediatrics

  • Medical Information Systems

  • Medical Records

  • Billing

If you work in a security-sensitive area, follow facility policies and procedures to keep them secure. Procedures that should be followed all the time, especially in security-sensitive areas may include:

  1. Wearing your ID badge

  2. Keeping doors locked

  3. Reporting missing or damaged equipment. 6.


You should wear your ID badge according to facility policy. If you lose your badge, you should report it and have it replaced immediately. It is important for you to be properly identified. It is also important to insure no-one else uses your badge.

In addition to wearing your own ID badge, you should be suspicious of people who are not wearing proper identification. Remember, wearing a lab coat or scrubs does not mean someone works at the healthcare facility.

You should also be sure to keep doors to security-sensitive areas locked. Do not prop doors open that are supposed to be secure. If you do see someone acting suspiciously, report it to the security personnel.

There are good reasons that some areas need to be secure. For example, the pharmacy must restrict access to drugs. In Obstetrics (particularly the Nursery), it is important to guard against infant abduction. Medical Records contain sensitive personal information. By following procedures, you can help keep these areas secure.

EMERGENCY PREPAREDNESS/DISASTER SAFETY

Emergencies or disasters can be classified as either "internal" or "external."

An internal emergency is one that directly involves the facility and is a threat to the staff and patients, such as an in-house fire, a toxic chemical spill, or a natural disaster such as a tornado, earthquake, or hurricane that causes damage to the facility.

An external emergency is one that occurs outside of the facility and does not directly threaten the staff, patients and others inside the building(s). The indirect effect on the facility is the possibility of large numbers of casualties arriving for treatment. External disasters include such things as:

  • Accidents involving buses, trains, airplanes or multiple vehicles

  • Explosions

  • Chemical spills

  • Large fires

  • Violent incidents involving a large group of people

  • Natural disasters occurring outside the facility such as tornadoes or floods.

By law all organizations must have an emergency management plan or disaster plan so that patient care can continue if a disaster occurs.

facility disaster/emergency management plans must:

  • Address both external and internal disasters

  • Include general activities that will occur no matter what the emergency situation

  • Allow specific responses to the types of disasters the facility might face

  • Include a plan for evacuation of the facility if all or part of the facility is damaged or non-functional.

When there is an emergency situation that could affect many workers, a facility wide-notification system will be activated to let you know what is going on and the location. The notification will direct you to take action according to the type of emergency. Professionals should follow the healthcare facility evacuation and emergency removal plan of patients.

Earthquake/Disaster Preparedness

For additional information on OSHA Earthquake Preparedness and Response click here https://www.osha.gov/dts/earthquakes/preparedness.html 7.


  1. Attempt to familiarize yourself with the facility/unit earthquake preparedness plan. You can reduce injuries to co- workers and patients and lessen the possibility of panic after the disaster has occurred by planning for all eventualities.

  2. At least 2 persons in each unit or on each floor should assume leadership roles after the disaster has occurred it is the facility’s responsibility to be sure they are properly trained.

  3. Understand how to protect yourself (and patients if possible) during an earthquake: Get under a desk or table or stand in a doorway away from the glass. Do not leave the building during the quake.

  4. Attempt to locate and have available for immediate use, the telephone numbers and alternative means of communication with public safety agencies. When given the chance, participate in drills; take advantage of the opportunity to prepare for possible disasters.

  5. In medication rooms, patient rooms, clean and dirty utility rooms be aware of high or top-heavy shelves, cabinets, machinery or any other equipment that could fall during a tremor. Heavy objects should not be on top shelves, but stored in lower places.

  6. Be aware of possible necessity to shut off lights, gas and water.

  7. Attempt to locate several alternate routes of evacuation in the various parts of the unit and or facility, should you need to leave your work area because it is unsafe.

  8. Consider the possibility that you may not be able to leave the premises and attempt to locate supplies on hand that may be needed.

  9. Provide assistance for physically compromised patients and co-workers who are unable to leave the building without the aid of another person.

  10. Attempt to locate areas of the facility that may be suitable as shelter areas should patients be required to stay there after the disaster.

  11. Be sure the fire extinguishers are kept in good working order and that you know how to use them.

  12. If your building is windowless, consider alternative means of ventilation and lighting if the power is off.

  13. Attempt to locate contingency plans for continued operation of the facility based on total and/or partial shutdowns due to building/utility/communication/transportation failures. Try to identify key personnel, communication systems, utilities and other support needs for 24 hours, 72 hours, one week and one month, if available.

  14. Organize Interdisciplinary Team and patients for whom they are responsible and determine what steps are to be taken in accordance with the facility’s earthquake plans.

  15. Immediately check for injuries among fellow workers and render first aid as needed. Seriously injured persons should not be moved unless they are in danger of further injury. Be sure your entire area is checked for injured.

  16. In the event of fatalities, cover bodies and notify the coroner. They should not be moved.

  17. Check for fires and fire hazards, especially for gas leaks and damaged electrical wiring.

  18. See that these are turned off at main valves and switches if required. Check for building damage and move patients to safe areas.

  19. Do not use elevators or to run into the street.

  20. Flashlights should be used if power is off, since sparks from a match or light switch could ignite leaking gas.

  21. Immediately clean up dangerous materials that may have spilled.

  22. Limit use “landline” and mobile telephones for outside calls except in genuine emergencies. Use battery-powered radios for damage reports and information from public safety agencies.

  23. Check closets and storage areas very carefully, watching for falling objects.

  24. After a major earthquake prepare for aftershocks which will be occurring and may cause more damage.

  25. Check that all telephones are correctly “on hook” so the system does not indicate “busy” to incoming or internal calls.

Electrical Safety

Much of the work to support patient care depends on electrical devices. A few basic reminders will help you to maintain a safe workplace. https://www.osha.gov/SLTC/etools/facility/hazards/electrical/electrical.html

  1. All outlets are “grounded” outlets, accepting three-prong plugs. Never try to introduce another kind of plug into the outlets.

8


2. Water and electricity a bad mix. Never try to plug something in, or run an appliance, if water is in the area. Clean up the water first. Electricity passes easily through water and can cause serious harm to you and others around.

3. If you notice an electrical hazard, contact your facility representative immediately.

Chemical Safety/Hazardous Communications

A variety of chemicals are used to support patient care, including things as simple as cleaning agents or complicated medications such as chemotherapy drugs. It is your legally protected right to know about these chemicals. https://www.osha.gov/Publications/osha3084.html

Understanding the Material Safety Data Sheet (MSDS)

The Hazard Communication Standard is also known as the Workers’ Right-to-Know standard. You have the right to know about the chemical hazards in your workplace. The MSDS and manufacturer’s product label(s) are a fast and easy way to obtain information about how to work safely with a specific product.

A hazardous substance is one, which causes physical or related health hazards, may be found on Lists issued by the State of California such as: “List of Regulated Substances,” “Pesticide 200 Ingredients” and/or “The Safe Drinking Water and Toxic Enforcement Act of 1986” also popularly known as “Proposition 65.”

Information within the MSDS

  1. Identification of product: You will find the product name, manufacturer’s name, address, telephone and emergency number.

  2. Hazardous ingredients: Lists of all the ingredients in the product.

  3. Physical data: Provides information on how to work with the chemical and describes the physical characteristics.

  4. Fire and Explosion Hazard data: Specifies if the material may present a fire or explosive hazard and under what conditions the hazard exists.

  5. Health hazard data: Identifies the symptoms related to overexposure (nausea, vomiting, and dizziness).

  6. Reactivity Data: Describes what materials will react with the chemical you’re using.

  7. Spill/leak procedures: Addresses how to respond to an accident spill or leak.

  8. Control measures and special precautions: Specifies the type of PPE that you should wear when handling the product.

  9. Handling and storage precautions: Describes how to safely store and handle materials.

The following are examples of some important information one may find on an MSDS. Physical Hazards

The coverage of physical properties associated with the specific material may include the following information:

  1. Compressed gas: such as high-pressure oxygen and nitrous oxide cylinders.

  2. Explosive: substance that can explode under certain conditions of release.

  3. Flammable or combustible: substance that burns easily such as alcohol.

  4. Organic peroxide: derivative of hydrogen peroxide.

  5. Pyrophoric: ignites spontaneously in air under certain conditions.

  6. Unstable: reactive substance.

  7. Water reactive: such as strong acids and bases when mixed with water. 9.


Health Hazards

Disseminated as hazardous to your health are chemical substances https://www.osha.gov/SLTC/hazardoustoxicsubstances/. Both liquids and solids may be identified on a MSDS and are indicated as:

  1. Carcinogens: these cause cancer, reproductive toxicity in males or females, reproductive toxins can result in fetus damage.

  2. Toxic: a substance that acts as a poison.

  3. Irritants: these may cause irritation to any body part.

  4. Corrosives: these can cause damage to body tissue.

  5. Sensitive: these can cause allergic reaction.

  6. Hepatoxin: this is a liver poison.

  7. Nephrotoxin: this is a kidney poison.

  8. Neurotoxin: this is a nerve poison.

  9. Hematopoietic System: Act on the system resulting in blood poisoning.

  10. Substance compounds: damaging to lungs, skin, eyes or mucous membranes upon contact.

Acute and Chronic Exposure

An acute exposure is a short-term exposure to a substance and can cause dermatitis, headaches, or rashes.

A chronic exposure is a long-term exposure and can cause cancer or permanently damage a biological system.

Routes of Entry

  1. Through inhalation (painting, stripping floors, anesthesia gas waste).

  2. Through absorption (handling formaldehyde and glutaraldehyde).

  3. Through ingestion (this can occur if you handle poisonous chemicals and do not wash your hands before eating, smoking or applying cosmetics. This can also occur if containers are not properly handled, labeled, sealed).

  4. Injection (accidental needle sticks).

Your responsibilities when handling hazardous materials

OSHA https://www.osha.gov/SLTC/poweredindustrialtrucks/hazmat.html

  1. Read the label and MSDS of new chemicals you are working with.

  2. Follow warnings and precautions

  3. Use appropriate PPE

  4. Learn emergency procedures for the chemicals with which you work.

  5. Act in a sensible manner, be a safe and responsible worker.

  6. Never use hazardous material substances you’re not trained to use

  7. Never place a chemical substance into an unlabeled container.

  8. Never mix substances without asking your facility representative first.

  9. Always ask your facility representative if you have a question about any substance.

Blood or Body Fluids

Minimize your risk by containing, removing, and disinfecting all blood or body fluid spills as quickly and effectively as possible. 10.


Wear PPE

PPE stands for "Personal Protective Equipment." A PPE is an item you use for safety when working with chemicals. Some examples of PPE are Utility gloves, Safety glasses, Goggles, Gowns, Ventilators and Masks PPE is listed on the MSDS (Material Safety Data Sheet) for all the chemicals you work with. The PPE necessary for each substance are determined by the ways the substance can harm you. https://www.osha.gov/SLTC/personalprotectiveequipment/

There are three ways that a chemical substance may harm you

  1. Breathing the chemical

  2. Having physical contact with the chemical

  3. Swallowing the chemical Breathing the chemical

The chemical may have toxic fumes that can injure your lungs if you breathe them. For example, cleaning materials, especially bleach, are toxic when inhaled.

Appropriate PPE for toxic fumes may include

  1. Special mask

  2. Ventilator

In addition, OSHA states that you should always use these products in a well-ventilated area. If you begin to feel dizzy or weak or have difficulty breathing when using a product, you need to leave the area immediately.

Having physical contact with the chemical

The chemical may injure any part of the body that comes in contact with it. Your eyes are in danger from liquid splashing into them. Any exposed skin is also at risk.

Appropriate PPE to prevent physical contact may include:

  1. Goggles, safety glasses, or other eye protection

  2. Gown

  3. Gloves

  4. Mask

In addition, flushing with water is usually the most immediate treatment for any accidental splashing of solutions in your eyes or on your skin.

Swallowing the chemical

Some chemicals are dangerous if swallowed. To prevent swallowing a solution that may have splashed on your fingers, always wash your hands thoroughly after coming in contact with anything that should not be swallowed. Appropriate PPE to prevent swallowing may include:

  1. Mask (that covers your nose and mouth to prevent the solution from being splashed onto your lips)

  2. Gloves (to protect against hand to mouth transfer). 11.


In addition, if you should accidentally swallow a harmful chemical, go to the Emergency Department.

Report a serious incident or injury

We are committed to the safety of everyone using Medely. If you have been involved in an accident, please follow these steps:

  1. Professionals should Notify a facility representative.

  2. If injured the professional should go to the emergency room.

  3. Professionals and Facilities can Contact us to report an injury or incident..

If you wish to report a serious incident, please let us know by using this link at the bottom of this page and sharing some info. If you were a witness to an incident, please reach out. We are here to help.

REPORT INCIDENT

Medely enforces strict safety guidelines to keep professionals and facilities safe and comfortable. Unprofessional behavior, like inappropriate physical contact or verbal aggression, is not tolerated.

Data is collected and tracked once an irregular occurrence report is received. Irregular occurrence reports are reviewed by Medely and we will implement any changes as deemed necessary.

Joint Commission

In order for a healthcare organization to participate in and receive federal payment from Medicare or Medicaid programs, one of the requirements is that a healthcare organization meet the government requirements for program participation, including a certification of compliance with the health and safety requirements called Conditions of Participation (CoPs) or Conditions for Coverage (CfCs), which are set forth in federal regulations. The certification is achieved based on either a survey conducted by a state agency on behalf of the federal government, such as the Centers for Medicare & Medicaid Services (CMS), or by a national accrediting organization, such as The Joint Commission, that has been approved by CMS as having standards and a survey process that meets or exceeds Medicare’s requirements. Health care organizations that achieve accreditation through a Joint Commission “deemed status” survey are determined to meet or exceed Medicare and Medicaid requirements.

The Joint Commission emphasizes prevention - identifying problems and correcting them before anything happens. The organization has definitions that you need to know for the following terms:

  1. Error

  2. Sentinel Event

  3. Near Miss

  4. Hazardous Condition

Error

An Error is an unintended act of either omission or commission, or an act that does not achieve its intended outcome. In other words, an Error is:

  1. Something done by accident

  2. Something that should have been done but was not

  3. Something that was done that did not have the expected result. 12.


An example of an Error is a patient's blood pressure not being measured when it should have been.

Sentinel Event

A Sentinel Event is an unexpected occurrence which actually happened and which either resulted in death or serious physical or psychological injury, or carried a significant risk thereof. Serious injury specifically includes loss of limb or function. https://www.jointcommission.org/sentinel_event_policy_and_procedures/

An example of a Sentinel Event is the wrong dose of medication being given to an infant, causing death.

Certain types of events are reported to The Joint Commission under their Sentinel Event policy, whether they actually or potentially resulted in death or serious injury. These events are:

  1. Rape

  2. Patient suicide

  3. Infant abduction or discharge to the wrong family

  4. Hemolytic transfusion reaction involving administration of blood or blood products

  5. Errors (example: Surgery on the wrong patient or wrong body part)

  6. Safety Hazards

  7. Injuries

  8. Property Damage

  9. Security Incidents

Any irregular occurrence involving a professional or facility while on assignment (regardless of adverse patient outcome) should be reported via the appropriate form available at all times in Medely’s help section. Medely's Customer Success Manager will contact the responsible parties upon receipt of your written description. Medely analyzes staff-reported incidents to identify opportunities for reducing safety risks to patients and staff.

Near Miss

This term is used to describe any process variation which could have led to a Sentinel Event, but the Sentinel Event did not actually happen because of some kind of intervention. A recurrence of the process variation carries a significant chance of a serious adverse outcome.

Here is an example of a Near Miss. By mistake, a patient is handed a medication to which she is allergic, and which could lead to death or serious illness. Fortunately, she recognizes the medication is different from what she is usually given, questions staff about it, and ultimately receives the correct medication, instead. In this case, the process variation is that the patient is not wearing a wrist band listing her allergies, and that the information about her allergies is not available to staff anywhere else.

Hazardous Condition

This refers to any set of circumstances (other than the disease or condition for which the patient is being treated) which significantly increases the likelihood of a serious adverse outcome.

In other words, a Hazardous Condition is:

  1. Something that could cause the patient harm

  2. Something other than the patient's disease or condition. 13.


An example of a Hazardous Condition is a power outage and simultaneous failure of the back-up generator that shuts down life-support systems for some patients, meaning staff must manually ventilate affected patients until power is restored.

All facilities must have a plan to identify risks to patient safety. They must also have policies for reporting and investigating sentinel events, near misses, and hazardous conditions.

Annual National Patient Safety Goals

The National Patient Safety Goals are derived primarily from informal recommendations made in the Joint Commission’s safety newsletter, Sentinel Event Alert. The Sentinel Event database, which contains de-identified aggregate information on sentinel events reported to the Joint Commission, is the primary, but not the sole, source of information from which the Alerts, as well as the National Patient Safety Goals, are derived.

https://www.jointcommission.org/standards_information/jcfaq.aspx

https://www.jointcommission.org/standards/national-patient-safety-goals/

You don't need to memorize this .. just know what it refers to

  1. Identify Patients Correctly- Use at least two ways to identify patients. For example, use the patient’s name and date of birth. This is done to make sure that each patient gets the correct medicine and treatment.

  2. Improve Staff Communication

  3. Use Medicines Safely

  4. Use Alarms Safely

  5. Prevent Infection

  6. Identify Patient Safety Risks

  7. Prevent mistakes in surgery 14.


Do-not-use List

The Joint Commission has created a list of abbreviations, acronyms, symbols, and dose designations that are not to be used throughout the organization. The Do-Not-Use list applies to all orders and medication-related documentation and information that is handwritten or computer entered as free text

Do Not Use

Why

Use Instead

U (unit)

Mistaken for “0” (zero), the number “4” (four) or “cc”

Write “unit”

IU (International Unit)

Mistaken for IV (intravenous) or the number 10 (ten)

Write “International Unit”

Q.D., QD, q.d., qd (daily)

Mistaken for each other. Period after the Q mistaken for “I” and the “O” mistaken for “I”

Write “daily”

D.O.D., QOD, q.o.d., qod (every other day)

Write “every other day”

Trailing zero (X.0 mg)*

Lack of leading zero (.X mg)

Decimal point is missed

Write X mg

Write 0.X mg

MS

MSO4 and MgSO4

Can mean morphine sulfate or magnesium sulfate. Confused for one another.

Write “morphine sulfate”

Write “magnesium sulfate”

Infection Control

Several OSHA standards and directives are directly applicable to protecting workers against transmission of infectious agents. These include OSHA's Bloodborne Pathogens standard (29 CFR 1910.1030) which provides protection of workers from exposures to blood and body fluids that may contain bloodborne infectious agents; OSHA's Personal Protective Equipment standard (29 CFR 1910.132) and Respiratory Protection standard (29 CFR 1910.134) which provide protection for workers when exposed to contact, droplet and airborne transmissible infectious agents; and OSHA's TB compliance directive which protects workers against exposure to TB through enforcement of existing applicable OSHA standards and the General Duty Clause of the OSH Act.

CDC Guidelines

Below is an abbreviated list of CDC resources available to assist HCWs in assessing and reducing their risks for occupational exposure to infectious diseases.

  • Hand Hygiene in Healthcare Settings. This web page provides HCWs and patients with a variety of resources including guidelines for providers, patient empowerment materials, the latest technological advances in hand hygiene adherence measurement, frequently asked questions, and links to promotional and educational tools published by the World Health Organization (WHO), universities, and health departments.

  • Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care. This document is a summary guide of infection prevention recommendations for outpatient (ambulatory care) settings.

  • Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. This document presents evidence-based recommendations on the preferred methods for cleaning, disinfection and sterilization of patient-care medical devices and for cleaning and disinfecting the healthcare environment. This document supersedes the relevant sections contained in the 1985 Centers for Disease Control and Prevention (CDC) Guideline for Handwashing and Environmental Control. 15.


Nosocomial Infections

Nosocomial infections are infections which are a result of treatment in a facility or a healthcare service unit, but secondary to the patient's original condition. Infections are considered nosocomial if they first appear 48 hours or more after facility admission or within 30 days after discharge. This type of infection is also known as a facility-acquired infection.

Nosocomial infections are even more alarming in the 21st century as antibiotic resistance spreads. Reasons why nosocomial infections are so common include:

  1. Facilities house large numbers of people who are sick and whose immune systems are often in a weakened state.

  2. Increased use of outpatient treatment means that people who are in the facility are sicker on average;

  3. Medical staff move from patient to patient, providing a way for pathogens to spread;

  4. Many medical procedures bypass the body's natural protective barriers;

  5. Routine use of antimicrobial agents in facilities creates selection pressure for the emergence of resistant strains

The Spread of Germs

Germs can be spread through 4 different modes of transmission. https://www.cdc.gov/infectioncontrol/spread/index.html

  1. Airborne transmission: Occurs by dissemination of either airborne droplet nuclei (small-particle residue of evaporated droplets containing microorganisms that remain suspended in the air for long periods of time) or dust particles containing the infectious agent. Microorganisms transmitted by airborne transmission include Mycobacterium tuberculosis and the rubeola and varicella viruses.

  2. Droplet transmission: Contact of the mucous membrane of the nose, mouth or eye with infectious articles can be produced by coughing, sneezing, talking or procedures such as bronchoscopy or suctioning. Droplet transmission requires close contact between the source and the susceptible person because particles remain airborne briefly and can travel. Microorganisms transmitted by droplet transmission include the common cold and flu. 16.


  1. Blood borne transmission: Germs can live in the bloodstream and in other body fluids that contain blood components. A person's skin prevents germs from entering into the body, but if the skin is broken because of a cut, it is possible for infected blood of another individual to enter. Mucous membranes, found in the mouth, vagina, or rectum may also allow germs to spread through contact with blood and/or secretions containing blood. Unprotected sexual contact can lead to this method of transmission.

  2. Direct Contact Method: Infectious agents can spread directly or indirectly from one infected person to another, often on contaminated hands. The best protection is proper hand washing (Please see Centers for Disease Control and Prevention Hand Hygiene Guideline for more information on proper hand washing).

General Prevention

The CDC reccoments these general steps to follow to prevent the spread of germs are https://www.cdc.gov/infectioncontrol/basics/transmission-based-precautions.html :

  1. Following the Infection Control policies of your facility

  2. Identifying the people, patients, and staff, who are most at risk

  3. Washing your hands

  4. Staying healthy by getting plenty of rest, eating properly, and exercising

  5. Getting vaccinated against flu and hepatitis B

  6. Washing your hands

  7. Following the standard recommended precautions with everyone

  8. NOT coming to work if you are sick.

CDC Hand Hygiene Guidelines

Improved adherence to proper hand hygiene has been shown to terminate outbreaks in health care facilities, to reduce transmission of antimicrobial resistant organisms and reduce overall infection rates. https://www.cdc.gov/handhygiene/providers/guideline.html

The Centers for Disease Control (CDC) has released the following guidelines to improve adherence to hand hygiene in health care settings.

The six steps in routine hand washing are:

  1. Wet hands thoroughly under running water. Warm or hot water is best.

  2. Lather with soap from a dispenser

  3. Wash hands thoroughly, for 15 seconds, using friction. Be sure to include the backs, palms, wrists, between fingers, and under fingernails.

  4. Rinse hands thoroughly under running water.

  5. Leave the water running and use a paper towel or an air dryer to dry hands thoroughly.

The four steps to round alcohol hand rubs are:

  1. Pour the alcohol hand rub in the palm of one hand

  2. Rub both hands together

  3. Rub all parts of the wrist, hand, and fingers

  4. Rub until completely dry

Standard Precautions

Standard Precautions are used for all patient care. They’re based on a risk assessment and make use of common sense practices and personal protective equipment use to protect healthcare providers from infection and prevent the spread of infection from patient to patient. https://www.cdc.gov/infectioncontrol/basics/standard-precautions.html 17.


Bloodborne Pathogens

The Occupational Safety and Health Administration (OSHA) has a Standard which was developed to protect the healthcare worker. The Bloodborne Pathogen Standard addresses the potential exposure of healthcare workers to blood and body fluids in the work environment. Bloodborne pathogens are Hepatitis B, C and Human Immunodeficiency Virus (HIV).

Hepatitis

Hepatitis is a serious disease of the liver, an organ necessary for life. Hepatitis B and C, the two most serious kinds of hepatitis, are similar kinds of liver infection that are caused by different viruses. https://www.cdc.gov/hepatitis/index.htm

Methods of blood-borne transmission of both Hepatitis B and C include:

  • Blood splashes from minor cuts and nosebleeds

  • Procedures that involve blood (especially in health care)

  • Hemodialysis (using kidney machines)

  • Sharing personal items like nail clippers, razors, and toothbrushes

  • Sharing needles for intravenous drug use In order to prevent the spread of Hepatitis:

  • Follow Standard Precautions.

  • Receive the Hepatitis B vaccine at no cost, if you are not already immune to the virus.

  • Maintain good personal hygiene habits.

Human Immunodeficiency Virus (HIV)

HIV is the virus that causes AIDS, A. condition in which the immune system begins to fail, leading to life-threatening opportunistic infections. Once this virus enters and infects the body, the person is said to be "HIV Positive." However, the person may be infected with the virus for up to 10 years or more before developing AIDS. https://www.cdc.gov/hiv/

The routes of transmission for HIV are:

  • Sexual route: Acquired through unprotected sexual relations, wherein infected sexual secretions of one partner come into contact with the genital, oral or rectal mucous membranes of another

  • Blood/blood product route: Accounts for infections in intravenous drug users, hemophiliacs and recipients of blood transfusions and other blood products.

  • Mother-to-child: Occurs in utero during pregnancy and intrapartum at childbirth.

In order to prevent the spread of HIV

  • Follow Standard Precautions

  • Wear protective equipment

  • Abstain from sex or sex-related activities when the HIV status of your partner is doubtful or not known.

  • If you are HIV infected and pregnant, take appropriate medication to reduce the chances of passing the virus to your unborn child.

  • If you are HIV infected, DO NOT breastfeed.

  • NEVER share needles, including needles used for tattoos, body piercing, or injecting steroids.

Tuberculosis

Tuberculosis is a common and deadly infectious disease caused mainly BY Mycobacterium tuberculosis. Tuberculosis most commonly attacks the lungs (but can also affect the central nervous system, the lymphatic system, the circulatory system, the genitourinary system, bones, joints and even the skin. Tuberculosis is curable, but it involves taking medication for a very long time. TB is caused by airborne bacteria and spreads through coughing, sneezing, talking, laughing, and breathing. https://www.cdc.gov/tb/default.htm 18.


Healthcare professionals and persons exposed to TB need to have a Purified Protein Derivative (PPD) skin test or a chest X-ray. Positive test results indicate the person is infected with TB but may not have TB disease. He or she may be given preventive therapy to kill germs that are not doing any damage now, but could break out later.

To protect yourself and others from contracting tuberculosis, follow your facility's recommended Special Precautions in addition to Standard Precautions.

Special Precautions for the treatment of TB patients:

  • Place TB patients in private rooms.

  • Ventilate rooms directly to the outside if possible, to prevent the circulation of TB germs to other areas of the facility.

  • Wear a special "fit-tested" mask (and receive training in how to wear it correctly) when entering the room and while in the room.

  • Explain to patients and visitors how to use special masks.

  • Keep patients in their rooms as much as possible.

  • Encourage patients to cough or sneeze directly into tissues and to dispose of them.

  • Have patients wear masks when being transported to other areas of the facility

Medication Safety

What are medication errors?

Medication errors are errors involving drugs that cause, or could cause, harm to a patient. They may be errors in prescribing, dispensing or administering, and they include both errors that reach the patient as well as those errors that do not reach the patient. They can occur in any patient care area or in the pharmacy.

https://www.nursingcenter.com/ncblog/may-2011/8-rights-of-medication-administration

https://www.americannursetoday.com/medication-errors-best-practices/

Avoiding Medication Errors

How can you safeguard your practice from medication errors? For starters, be conscientious about performing the “eight rights” of medication administration every time.

1. Right patient

  • Check the name on the order and the patient.

  • Use 2 identifiers.

  • Ask patient to identify himself/herself.

  • When available, use technology (for example, bar-code system).

2. Right medication

  • Check the medication label.

  • Check the order.

3. Right dose

  • Check the order.

  • Confirm appropriateness of the dose using a current drug reference.

  • If necessary, calculate the dose and have another nurse calculate the dose as well. 19.


4. Right route

  • Again, check the order and appropriateness of the route ordered.

  • Confirm that the patient can take or receive the medication by the ordered route.


5. Right time

  • Check the frequency of the ordered medication.

  • Double-check that you are giving the ordered dose at the correct time.

  • Confirm when the last dose was given.

6. Right documentation

  • Document administration AFTER giving the ordered medication.

  • Chart the time, route, and any other specific information as necessary. For example, the site of an injection or any laboratory value or vital sign that needed to be checked before giving the drug.

7. Right reason

  • Confirm the rationale for the ordered medication. What is the patient’s history? Why is he/she taking this medication?

  • Revisit the reasons for long-term medication use.

8. Right response

  • Make sure that the drug led to the desired effect. If an antihypertensive was given, has his/her blood pressure improved? Does the patient verbalize improvement in depression while on an antidepressant?

  • Be sure to document your monitoring of the patient and any other nursing interventions that are applicable.

Continuing Education

Ongoing continuing education is the responsibility of the healthcare professional to maintain current knowledge and practice base for your trade. Medely maintains information on available resources for BLS, ACLS, PALS, etc. The following resources are suggested for healthcare professionals however this is not an inclusive list of all resources: www.nursetesting.com, www.nursingspectrum.com, and www.lww.com.

Registered nurses are required by law to complete continuing education according to your state's Board of Registered Nursing, in addition to paying the renewal fee, to maintain an active license. Continuing education courses must have been completed during the preceding renewal period (when renewing), or during the preceding two years (when renewing a delinquent or lapsed license, or going from an inactive to active license). Courses must be taken through a continuing education provider recognized by the Board of Registered Nursing. You can upload copies of your continuing education certificates on the platform.

Skills Checklist and Age Specific Self-Assessment

Healthcare professionals on the Medely platform are required to provide an annual update on the nursing/professional skills learned, improved, or mastered during the previous year as well as a self-assessment regarding their understanding of age specific concepts.

The most effective way of completing these requirements is by signing into your personal profile on the Medely website (www.Medely.com). After signing in, you can update your file with new credentials and skills. 20.


Reporting Illegal Behavior

Medely takes Illegal behavior very seriously. As a healthcare provider, you are required to identify and report any aberrant or illegal behavior witnessed to professional boards and law enforcement agencies.

Report the situation to the facility and Medely immediately. Then, contact the appropriate state BON (or state licensing authority) and file a complaint. If unsure whether a professional has done something that should be reported, contact the local police department or state BON for assistance.

Abuse and Neglect

Elder and Child abuse and neglect are a growing problem that occurs all too common in our society. Abuse is a problem that affects everyone—individuals from all racial, ethnic, and socioeconomic groups. Abuse can occur with seniors who are full of life and independent as well as those who or physically or mentally frail. Abuse can be caused by family members, caregivers, and even strangers. Family members are the most common abusers when the victim lives outside of a healthcare facility. Abuse and neglect often arise from misunderstanding or ignorance. https://www.adoc.us/ADOC-en-us/assets/File/MandatedReportingRequirementsMRR_Mandated-Reporting-Requirement.pdf

Domestic violence, also known as domestic abuse, spousal abuse, child abuse or intimate partner violence (IPV), can be broadly defined as a pattern of abusive behaviors by one or both partners in an intimate relationship such as marriage, dating, family, friends or cohabitation. Domestic violence has many forms including physical aggression (hitting, kicking, biting, shoving, restraining, slapping, throwing objects), or threats thereof; sexual abuse; emotional abuse; controlling or dominating; intimidation; stalking; passive/covert abuse (e.g., neglect); and economic deprivation. Domestic violence may or may not constitute a crime, depending on local statutes, severity, and duration of specific acts, and other variables. Alcohol consumption and mental illness can be comorbid with abuse, and present additional challenges when present alongside patterns of abuse.

The American Medical Association defines elder abuse or neglect as "an act or omission, which results in harm or threatened harm to the health or welfare of an elderly person." Elder abuse is associated with a higher mortality and increased health care costs due to a higher frequency of office and facility/Surgery Center visits.

Child abuse and neglect are defined by Federal and State laws. The Child Abuse Prevention and Treatment Act (CAPTA) is the Federal legislation that provides the following definition of child abuse and neglect; “Any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse, or exploitation, or an act or failure to act which presents an imminent risk of serious harm”

Basic Definitions

  • Physical Abuse (non-accidental injury)

  • Slapping, hitting, bruising, beating or any other intentional act that causes someone physical pain, injury or suffering.

  • Also includes excessive forms of restraint used to confine someone against their will (i.e., tying, chaining, or locking someone in a room).

  1. Emotional Abuse

  2. Threatening, intimidating or humiliating an individual and causing them emotional pain, distress or anguish.

  3. Emotional abuse can be verbal or non-verbal; it includes insults, yelling and threats of harm or isolation.

  4. Sexual Abuse/Exploitation

  5. Any sexual activity to which the older or dependent adult does not consent or is incapable of consenting. Non-consensual sexual activity includes everything from exhibitionism to sexual intercourse. 21.

  6. The employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct; or

  7. The rape, and in cases of caretaker or interfamilial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children"

  8. Financial or Material Exploitation

  9. Misuse, mishandling, or exploitation of the individual’s property, possessions, or financial assets.

  10. Neglect

  11. Intentional or unintentional failure of a caregiver to support the physical, emotional, and social needs.

  12. Neglect can include denying food, shelter, clothing, medication, health services, or contact with friends and family. Neglect is the most common form of elderly mistreatment in domestic settings. Failure to educate is also considered a definition of neglect with children.

  13. Isolation

  14. Acts intentionally committed for the purpose of preventing, and that do serve to prevent, an individual from receiving his or her mail or telephone calls.

  15. Elderly: Telling a caller or prospective visitor that an elder or dependent adult is not present, or does not wish to talk with the caller, or does not wish to meet with the visitor where the statement is false, is contrary to the express wishes of the elder or the dependent adult, whether he or she is competent or not, and is made for the purpose of preventing the elder or dependent adult from having contact with family, friends, or concerned persons.

  16. Physical restraint of an individual for the purpose of preventing the individual from meeting with visitors or responsible parties.

  17. Abandonment

  18. A caregiver deserts the elderly or dependent person

  19. A parent or caregiver deserts the child.

  20. Self-Neglect (elderly)

  21. An elderly or dependent adult fail to meet their own physical, psychological, or social needs or they threaten their own health or safety in any way.

Abuse Warning Signs

As a healthcare professional, it is important that you become aware of the warning signs of abuse and neglect. You should report suspected abuse to the designated person at the facility where you are working and/or to the appropriate government agency. In many states, you are required by law to report observed or suspected elder and child abuse.

The following indicators by themselves do not necessarily signify abuse or neglect. The may be helpful clues however, in the assessment of abuse.

Possible Indicators of Physical Abuse

  • Cuts, lacerations, puncture wounds

  • Bruises, welts, discoloration of the skin

  • Any injury incompatible with the individual’s history

  • Any injury which has not been properly cared for

  • Poor skin condition or poor skin hygiene

  • Dehydration and/or malnourishment

  • Loss of weight

  • Burns

  • Soiled clothing or bedding

  • Withdrawal of the individual from social situations

Possible Indicators of Financial Abuse

  • Unusual or inappropriate activity in bank accounts

  • Recent changes to will when the person is incapable of making such decision

  • Unusual concern by caregiver or family member that an excessive amount of money is being 22.


  • expended on the care of the individual

  • Numerous unpaid bills and/or forged checks

  • Placement in a residential care facility which is not commensurate with the size of the older person’s estate

  • Lack of amenities, such as TV, clothing, grooming items, etc. that the estate can afford

  • Missing belongings

  • Caregivers or relatives who are dependent on the individual for money or housing

Abuse Reporting

All healthcare practitioners are mandated reporters. Social workers are not on site 24 hours/day, so practitioners need to know appropriate procedures to take when abuse is suspected. Failure to report child, spousal or elder abuse or neglect is a misdemeanor punishable by up to six months in jail and a $1000 fine. The law requires that the suspected abuse be reported immediately by telephone and followed up with a written report within 26 hours. In order to recognize these situations, it is important to know signs and symptoms of abuse.

Suspected abuse, neglect and/or exploitation should be reported directly to the Nurse Manager/Nurse Director/Charge Nurse and should include:

  1. A description of the incident

  2. To whom the incident happened

  3. When the incident occurred

  4. Where the incident occurred

  5. Who was responsible for the neglect/abuse?

The Hipaa Privacy Rule

A patient's right of privacy and confidentiality is protected by law. No one, including spouses, friends, or attorneys, is permitted to review the patient's medical record without prior written authorization, except as required by law (court order or subpoena) or other regulation. https://www.hhs.gov/hipaa/for-professionals/index.html

  • Only information that is pertinent to a patient's treatment may be disclosed to other practitioners. Only authorized facility personnel have access to medical records. All requests for medical information must be referred to the Health Information Management department.

  • All professionals are required to sign a confidentiality statement.

  • To decrease the risk of uninvolved persons overhearing or seeing confidential patient information:

  • Confine discussion of patient care information to the patient care areas

  • Keep computer ID/passwords confidential. Unauthorized use of ID/passwords may be subject to disciplinary action.

  • Exit computer programs and log off before leaving the work station.

What is HIPAA?

The HIPAA Privacy Rule is a Federal Law that went into effect on April 14, 2003. The law protects the confidentiality of our patients’ protected health information, or PHI. Protection of patient privacy and confidentiality is also required by the Center for Medicaid Services (Trusted Health) and the Joint Commission.

Healthcare has a tradition of privacy. People have kept patient information private as far back as the fourth century BC with the Hippocratic Oath. However, with the advanced communications technologies in use today, safeguarding the privacy of patient information is more of a challenge. The HIPAA Privacy Rule reflects these new concerns. 23.


The HIPAA law is complex. Protecting patients’ healthcare information involves two considerations: Privacy and Security. There are differences between the two that you should know.

“Privacy” is concerned with the disclosure of information about a patient to the patient directly, or to those to whom we reasonably believe the information can be disclosed if it is consistent with good health care professional practices. (See HIPAA Privacy.)

“Security” is concerned with the processes, procedures, and technologies that we use to make sure that the people viewing or changing the information are really the ones who are authorized to do so. (See HIPAA Security.)

What information is protected?

All patients (including celebrities) have the right to privacy, and this extends to their personal health information, referred to in the HIPAA Privacy Rule as "Protected Health Information," or PHI.

What types of information is protected?

  • Paper records

  • Computerized information

  • Oral communication

What are examples of PHI?

  • Face sheets

  • Results of exam/evaluation

  • Test results

  • Treatment and appointment information

  • Patient bills

  • Photographs

  • Paper records

  • Computerized patient records and information

Releasing Patient Health Information (PHI)

As a general rule, Medical Records can only be released to outside parties with the patient's approval, or if there is a law requiring release. (See following section, below.) Again, as a general rule, this information can be released to outside parties only by the Health Information Management Department (Medical Records), or in some cases, the Records Custodian of each department.

Who are the Records Custodians?

Each department or unit that maintains PHI has a "records custodian" to approve access to PHI, for purposes other than routine treatment, payment or operations purposes. Records Custodians may include department leaders and facility representatives, unit secretaries, or other persons designated by department leaders 24.


What are the Authorization Requirements?

A written authorization, signed by the patient or legal representative, must be obtained for any release of information except when the release is required by law, or when the information is used for the routine purpose of treatment, payment, or operations. For example, we are permitted to share our patients' PHI with other providers such as physicians to treat the patient, or we may submit PHI to insurance companies to obtain payment, all without patient authorization.

What about releasing Patient's Protected Health Information (PHI) verbally in discussions with friends and family?

When the patient is present and has the capacity to make his or her decisions, we may disclose PHI to friends and families, if one of the following conditions is met:

  • We obtain the oral agreement of the patient or legal representative;

  • We provide the patient with an opportunity to object to the disclosure, and the patient does not object;

  • We infer from the circumstances that the patient does not object to the disclosure. For example, when a friend has brought the patient to the emergency room for treatment.

When the patient is not present, or when the patient is incapacitated due to an emergency, it's okay to make the disclosure if our decision is consistent with good health care professional practices. For example, when a patient is brought to the emergency room, we may inform relatives and others involved in the patient's care that the patient has suffered a heart attack and we may provide updates on the patient's progress and prognosis when the patient is unable to make decisions about such disclosures.

Whatever information we disclose to the patient's friends or families should be directly relevant to that person's involvement. For example, a neighbor picking up a patient can be told that the patient is unsteady on his feet; however, the neighbor should not be told that a tumor was removed.

How is Protected Health Information handled for Minors?

If a patient is a minor (under 18 years of age), the patient's parents or guardian may receive or direct use and disclosure of PHI on behalf of the patient, except for "Emancipated Minors.”

Emancipated Minors

are children who have been released from the control of parents or guardians, and may control their own PHI, in the same manner as an adult:

  • Anyone who is not yet 18 years old but is legally married or who is a parent.

  • Anyone who is not yet 18 years old, but has been legally married and is now divorced, or a widow or widower.

  • Anyone who is not yet 18 years old but is maintaining his or her own residence and is self-supporting. A reasonable effort to contact parents must be made.

  • Anyone who is not yet 18 years old, and is pregnant.

Minors Who Are Not Emancipated

Any minor (under 18 years of age) may without parents' consent, approval, or notification have the right, in the same manner as an adult, to protect their health information for the voluntary treatment of:

  • Alcohol or drug abuse

  • Testing and treatment for sexually transmitted disease 25.


Body Mechanics

With the use of proper body mechanics and ergonomics (the undersigning of the workplace to fit the worker), most injuries are preventable. OSHA study on workplace ergonomics https://www.osha.gov/Publications/osha3125.pdf

Lifting

  • Assess the situation and plan how to accomplish it before beginning.

  • Use the muscles of the legs, hips and arms – the strongest in the body. Keep a neutral spine.

  • Bend knees and hips avoid bending at the waist, and lift with your legs, not you back

  • Keep feet at shoulder width to provide a broad base of support.

  • Make sure the object is close to you, do not-overreach, and carry the load close to you.

  • Avoid lifting higher than your waist.

  • Push and don’t pull.

  • Ask for help.

Sitting

  • Use chairs that provide support to the back, particularly the lower back.

  • Both feet should be able to rest flat on the floor.

  • Avoid slouching, walk around and stretch occasionally, or change position often to avoid strain.

  • Avoid twisting and overreaching

  • Position yourself directly in front of your work and make sure your work is at eye-level to avoid neck strain.

Standing

  • Stand close to your work area with your back erect, chin in, pelvis tucked under and knees slightly flexed.

  • Maintain a broad base with your feet and ensure even weight bearing.

  • Avoid prolonged positions and slouching – stretch occasionally.

Back Care and Points for Prevention

  • Use good posture at all times and proper body mechanics.

  • Change position frequently.

  • Exercise regularly and eat a well balanced diet to control your weight.

  • Ensure enough rest at night.

  • Practices stress reduction techniques, such as yoga and relaxation.

  • Ask for help in lifting or moving heavy objects.

  • Keep work area safe – clean up spills, wet floor signs; ensure no loose equipment, boxes or flooring, no loose power cables, close drawers. Notify appropriate personnel immediately, such as maintenance. 26.


  • Wear shoes with non-skid soles.

  • Walk and don’t run.

  • Report any accidents to staff patients or visitors to facility representative immediately.

  • Monitor safety of patients closely.

  • Ensure brakes are applied to wheelchair or bed when moving patients.

  • Adjust height of bed or table waist / mid-to-upper thigh level when moving patient.

  • Maintain ergonomics at all times. 27.

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