Environment of Care

Environment of Care Training

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Environment of Care Training for

Residents and Medical Students Academic Year 06/07

·  This is the South Texas Veterans Health Care System (STVHC) Environment of Care (EC) Training for residents and medical students (RMs).

·  This training is required for all individuals rotating through the VA system. This training integrates the safety disciplines together to ensure the safest possible environment for our veteran patients, employees and visitors.

ENVIRONMENT OF CARE (EC) OVERVIEW

·  The Environment of Care (EC) is a Joint Commission on Accreditation of Healthcare Organizations (JCAHO) set of eight standards. JCAHO standards evaluate the hospital’s performance level in patient rights, patient treatment, occupational health, safety, fire, environmental protection, infection control and activities that affect the safety and quality of patient care.

·  Environment of Care contains eight management programs intended to reduce/eliminate injuries/occupational illnesses, and to maintain a safety and healthy work environment for employees, visitors and patients in the healthcare environment.

Key elements that apply to all heathcare settings:

o  Reduce and control environments hazards and risks

o  Prevent accidents and injuries

o  Maintain safe conditions for patients, and staff

o  Maintain an environment that is sensitive to patient needs for comfort, social interaction, and positive distraction

o  Maintain an environment that minimizes environmental stresses for patients, and staff

Ask yourself? Would I want to place a family member at the VA?

How can I make a difference?

Who do I contact to report safety hazards?

You can report EC safety hazards to the STVHCS Safety Occupational Health Environment and Fire Protection Section (basement 034) Telephone (210) 617-5300 extension 14039. The Chief of the Safety Section is Ms. Joan Ahrens, MSPH. Her email address is

·  The SAFETY MANAGEMENT Program promotes a safe and healthy physical environment free of hazards.

·  What is my responsibility?

·  You are encouraged to report unsafe and unhealthy working conditions/acts. Correction of unsafe or unhealthful conditions are given the highest priority.

·  You are responsible to help prevent and report all accidents and injuries.

·  What if I am injured? What do I do?

·  Let your supervisor know immediately!

·  This includes residents and medical students. If you are injured at the STVHCS you will be provided first aid treatment at Urgent Care or Employee Health.

·  Most injuries/accidents to residents and medical students involve sutures, sharps; hollow bore needle sticks or splashes. In FY05, residents and medical student reported 20 blood borne pathogen exposures. Compared to the 24 exposures reported by residents and medical Students in FY04:

·  7 (FY04: 2) were exposed to blood or bodily splashes

·  5 (FY04: 6 were injured using sutures

·  5 (FY04: 6) were injured using sharps (surgical blade or scalpel)

·  3 (FY04: 10) were injured during the use of hollowbore devices

·  If you are injured at the VA, you will receive first aid treatment. BUT remember to report your incident to your employer (University Hospital or UTHSCSA).

·  Residents and Medical Students are involved in many decisions and activities within the clinical setting. For example, a prominent New York Hospital was fined for needle-stick-safety violations. OSHA cited that medical center for numerous unsafe practices that exposed interns, residents and other healthcare workers to sharps injuries. The citations and fines came in response to a complaint filed by medical residents.

The VA wants to hear your complaints and comments to improve patient care including your safety.

·  The EMERGENCY MANAGEMENT Program implements emergency procedures in the event of a community or internal event and/or disaster to continue providing patient care to veteran patients and provide minor emergency medical treatment for casualties.

·  What is your role?

·  All Residents and Medical Students are involved. Safety of humankind has first priority!

·  You need to:

·  Understand your role in an emergency even if it is to "stand by and await further instructions from your supervisor".

·  Know that the system used is the Hospital Emergency Incident Command System (HEICS), which links us to other hospitals in the San Antonio area. This is the standard for healthcare emergency management. HEICS is an organizational method that allows flexible response to specific emergencies. HEICS allows the STVHCS to expand or contract the response depending on the need.

·  The Chief of Staff is the Incident Commander (person in charge) during an emergency. The ICC is located in J114 at Audie during emergencies, and in the Chief Medical Officer’s Office at KD.

·  An Internal Emergency (Disaster) is one that occurs within the STVHCS!

Loss of electricity

·  What is considered an External Emergency (Disaster)?

·  An external emergency is an incident that occurs within the community (outside the STVHCS), which may require expansion of services for receiving patients. Examples include:

·  Fire/Explosion

·  Aircraft/vehicle accidents

·  Chemical Spills

·  Release of toxic gases

·  Tornadoes, floods, ice storms or other natural disasters

·  Food and/or chemical poisoning

·  Any form of terrorism

·  Every one needs to know that the STVHCS has the following emergency plans Note: Utilities, medical equipment and emergency management have numerous overlapping aspects:

·  Emergency Electrical Plan

·  Emergency Heating Ventilation and Air Conditioning Plan

·  Emergency Sewage Plan

·  Emergency Elevator Shut Down Plan

·  Emergency Communication Plan

·  Emergency Medical Gas Cessation Plan

·  Fire Response Plan

·  During an Oxygen Fire:

·  The Nurse Manager, Organizer and/or person in charge in each area are responsible for ensuring that Oxygen is shut off in a fire or threat in their area.

·  Bomb Threats, hostage situations and demonstration issues are detailed in attachments to the Emergency Management Plan as well as in Police Service policies.

·  Each service will also have individual plans for computer failure and emergency communication that all employees working in the service must know.

·  The MEDICAL EQUIPMENT MANAGEMENT PROGRAM is designed to assess, monitor and control the clinical and physical risks of equipment used for the diagnosis, treatment, monitoring and care of patients. Equipment is rated either life support or non-life support equipment.

·  What Do I Need to Know?

·  Which equipment is in the medical equipment management program

·  How to check and operate equipment, including response in an emergency

·  How to report Biomedical equipment failures

·  Preventive Maintenance (PM) inspection is regularly done at intervals not to exceed one year.

·  How equipment is reported, documented and removed from service

·  Safety recalls, hazard alerts and incident reviews are acted upon appropriately and have high priority.

·  That in event of a utility failure, which electrical outlets (red plugs) are supported by the Emergency Generator(s)

·  Users of clinical equipment need to know how to tell the last day each piece of equipment may be used (from the inspection sticker).

·  Engineering Service must inspect all patient care equipment and all electrically non-patient equipment, regardless of ownership, prior to initial use. Personal equipment can be used only if patients have received written authorization from their physicians.

·  The HAZARDOUS MATERIALS AND WASTE MANAGEMENT Program involves the safe handling and disposal of chemicals, hazardous materials and wastes.

·  What is it?

·  This includes the Hazard Communication Program, the Hazardous Materials and Waste Management Program as well as the safe obtaining, handling and disposing of all chemicals (including radioactive materials, asbestos, hazardous energy, chemotherapy, and other pharmaceuticals).

·  What Do I Need to Know:

·  The Hazard Communication Program (OSHA 29CFR1910.1200), or "Right to Know Law" states that everyone has both a need and a right to know the hazards and identities of the chemicals they are exposed to in the workplace.

·  Material Safety Data Sheets (MSDS’s) are readily accessible (not locked up) for each hazardous chemical in each workplace. MSDS can be located on “Resource” link on the VA intranet page.

·  Given a large enough quantity any chemical can be a hazard.

·  When to Seek Medical Attention:

·  If you repeatedly experience any symptoms typical of an exposure.

·  When a hazardous chemical or body fluid is splashed into the eyes or in/on the skin (after you have first flushed with water).

·  If any dangerous substance is inhaled or ingested.

·  The UTILITY MANAGEMENT TRAINING Program assures failures to the plumbing, HVAC (heating, ventilation and air conditioning system), electrical, etc., do not disrupt patient care environment.

·  What is it?

·  The Utility Management Program ensures the operational response to failures of utility systems that support the patient care environment. This includes periodic inspection of utility related equipment and systems (preventive maintenance), as well as emergency utilities.

·  Many more people die annually from hospital-acquired infections than from fires. Infection Control works with Safety personnel to minimize the release of fibers, dust, transmission of pathogens and airborne hazards during utility operations and constructions.

·  What Do I Need to Know?

·  All utility systems include a primary (such as CPS for electrical power) and a secondary (back-up), such as the emergency generators should city power fail.

·  What’s on the Emergency Generator:

·  All alarm systems

·  Computer mainframe and network hubs

·  Emergency Lighting System

·  Medical Air and Vacuum Systems

·  Emergency Water Distribution System (pumps)

·  Pager and Communication Systems

·  Red plugs for Patient Life Support

·  One elevator in each bank at ALMD and KD

·  Nurse Call Systems

·  Code Blue Systems

·  What you need to know about the generator system:

·  Availability of emergency power in your work area, including every third light in the hallways.

·  Engineering Service conducts electrical inspections. Failures can be addressed to Engineering Service
Maintenance and Operation Section (AD 15025, KD 2559). After hours report to the Engineering Energy Control at ALMD (15724), and the boiler plant at KD (2234). Police Service or the operator can connect you.

·  Medical Gas Systems (oxygen, nitrogen, medical air, etc):

·  Need to know the location of outlets, zones, pressure alarms and shut off valves and who is authorized to use the oxygen shut-ff valve.

·  Oxygen is supplied by large white bulk storage tanks by warehouse

·  Compressed gas cylinders for short-term outages of the oxygen are available from SPD. This is the back up for this utility.

·  Heating, Ventilation and Air Conditioning System (HVAC):

·  Certain areas have recirculated and fresh air

·  Crucial areas have 100% fresh air (Operating Rooms and ICU)

·  Only areas required to have humidity control are OR’s.

·  Isolation rooms are on negative pressure draw air (suck) from under the door, whereas positive pressure rooms push (blow) air through a filter. Doors must be kept closed.

·  Communication Systems:

·  Are on the emergency power generators at both hospital divisions

·  If there is a loss of power a portion of the Emergency Management Plan may be implemented.

·  Vertical Transport System (Elevators):

·  There is a policy to be followed in the event that an elevator is non-functioning and has passengers on board

·  All have intercoms or telephones

·  All contain an emergency buzzer

·  All have emergency lighting

·  Selected elevators will continue to operate if there is a loss of power from City Public Service (CPS).

·  The LIFE (Fire) SAFETY MANAGEMENT Program provides instructions on how to react to a fire (life safety) emergency to prevent personal injury, impairment of health, and/or property damage (also known as fire safety).

·  What Do I Need to Know?

·  Be alert using all of your senses (smell, sounds, sight, etc)

·  Take time to investigate suspicious smells or smoke immediately

·  Close all doors. If you smell smoke behind a door feel the door with the back of your hand first.

·  If the door is too hot too touch don’t open it, otherwise, open door slowly.

·  Fire Response Plan - Things You Must Know to doe in case of a fire

·  Dial 15555 (ALMD) or 2911 KD)

·  The acronym RACE (Rescue, Alarm, Confine and Extinguish)

·  Firewalls and smoke partition walls are in place to prevent the spread of fire/smoke.

·  The hospital divisions are fully sprinkled. Sprinklers go off at 165 degrees by melting (heat) a link.

Smoke Detectors:

·  Installed 30 feet apart in all corridors

Fire Alarm Bells:

The Fire Bell System has been replaced by audio notification and visual

alarms at both hospital systems.

Fire Alarm Pull Station Locations:

At/in every stairwell

·  By every exit

·  In every Nurses Station at hospital divisions

·  Other areas not to exceed 200 feet

·  Types of Fire Extinguishers:

·  Class ABC - Dry Chemical is used on paper, flammable liquids and electrical equipment, "All Purpose". DO NOT USE ON METALS

·  When would you use a Fire Extinguisher?

·  Use to fight small fire (nothing larger than a trash can size)

·  To operate a fire extinguisher:

·  P ull the safety pin

·  A im the nozzle at the base of the fire

·  S queeze the handle

·  S weep at the base of the flame

·  You need to know:

·  Where your two nearest fire exits are?

·  Where your two nearest fire alarm pull stations are?

·  Where your two nearest fire extinguishers are?

·  The location of smokes barriers and firewalls closest to your work area?

Interesting Fact: More patients in the hospitals die from nosocmial diseases than from inadequate fire protection.

·  INTERIM LIFE SAFETY MEASURES

·  What is this?

·  The purpose of Interim Life (Fire) Safety Measures (ILSM) is to establish polices and procedures for ensuring that an adequate degree of life safety is maintained in and around areas of construction in facilities in the STVHCS

·  The SECURITY MANAGEMENT Program identifies and implements instructions on how to react to a fire (life safety) emergency to prevent personal injury, impairment of health, and/or property damage.