Orientation Manual
Reporting for Work

When reporting for work assignments you must report to the Nursing Supervisor and or the Staffing Coordinator’s office. You must be able to present your nursing license, CPR, ACLS, Driver License, name badge or other official picture identification.

The importance of reporting to work on time cannot be stressed enough. You should be prepared to arrive 15 minutes before your scheduled shift.

We realize that on occasion regardless of your best effort and due to circumstances beyond your control, you may be subject to arriving late. Should you find yourself in this situation, we simply ask that you call us as soon as possible, so that we may notify the facility with your expected time of arrival.

Tardiness will be documented and should a pattern develop, you will be subject to administrative review for continued employment.

Dress Code

Scrubs are acceptable for most work areas. The proper dress code will be established by the

contracting facility for which you will be assigned on a given shift.

Other Appearance Requirements

Hair should be neat and clean

Avoid strong odors-fragrances and body odor

Shoes should be clean

Wear lab coats and sweaters with complimentary color schemes or patterns Avoid large, distracting earrings, and hair and or body ornaments

Nails should be natural, no overlays, gel or artificial nails and no longer that % inch past the end of the finger

Assignments

Always clarify your assignment with the person in charge. Communication and understanding is essential to the success of an agency professional. Ensure that you communicate any data about your patients with the appropriate charge nurse or supervisor.

Charting

Make sure that your chart appropriately and medication administration records are legible and complete. Sign your name in full to each entry. Should your documents contain gaps or incomplete information, you may be immediately required to return to the facility to make corrections. Should you experience such an occurrence, we will not accept responsibility for your oversight and you will be required to correct the oversight on your own time and expense. Therefore, please make sure your documentation is accurate, thorough, and complete even if it means having to remain a few extra minutes after your shift has ended, to ensure quality medical legal reports.

Narcotics Accountability

While most facilities have computerized narcotic administration methods, some may not or have devices that require reconciliation at the end of your shift. Always notify the charge nurse or nursing

supervisor that you are leaving and inquire if the narcotic count is complete and correct. If at any time during your shift you feel that there has been an unauthorized or mishandling of narcotics, be sure you

notify the charge nurse/nursing supervisor and Cure Healthcare Staffing.

Universal Precautions

Remember to practice universal precautions during patient care. All isolation precautions will be covered as part of your orientation and you are expected to follow these guidelines as per facility and CDC guidelines.

Occurrence Reporting

Occurrences include medication errors, staffing problems, confrontations, patient injuries, nurse injuries or falls and needle sticks. Any must be reported to the Charge Nurse and or House Supervisor and Cure Healthcare Staffing, as well as a written narrative report may be required of you and anyone else involved in the incident.

On the Job Injuries, Getting sick, Testing for Virus, Positive Tests of Virus & Quarantine

All on job injuries including exposures must be reported immediately to the Charge Nurse or House Supervisor and Cure Healthcare Staffing You will be advised of precautionary procedures to ensure your safety and patient confidentiality. On the job injuries will require that you consent and submit to a urine drug screen. While on assignment, you are covered by Cure Staffings Workers Compensation Policy. If you fall ill, and feel it is a result of a virus, Cure Staffing has been instructed by its workers compensation carrier that it will get involved and all claims must be reported with 24 hours of occurrence. Cure Staffing’s Workers Compensation Insurance Carrier makes all determinations of claims and how to proceed or not to proceed. All claims must go through the standard filing procedures.

Communication

Communication is essential during the tenure of an agency professional. Whether in a hospital setting or communicating with the agency clarity, courtesy, and assertiveness, should guide your communications. Always remember that we are guests in their hospital and we should not voice opinions about internal policies, management, or procedures. Also, do not become involved in internal politics of the facility. Should you have a concern, please contact Cure Healthcare Staffing.

Facility Orientation

Each facility will have orientation guidelines that you are obligated to follow. Cure Healthcare Staffing will assume full cost for any customer facility orientation that is necessary, in order to assist you in meeting a contracting facilities requirement. Your orientation pay will be paid in full to you after you have completed 36 worked hours at that facility.

Time Keeping and Submission

Accurate record keeping is essential. Cure Healthcare Staffing provides and prefers electronic time keeping using our automated systems. However, on occasion client facilities may request a paper time sheet. If you need assistance to learn more about our electronic time sheets, please contact our office and one of our staffing professional can assists you. ALL TIME SHEETS MUST BE SUBMITTED BY CLOSE OF DAY EVERY S IN ORDER FOR YOU TO RECEIVE A CHECK ON FRIDAY.

Payroll

Payroll will be processed on a weekly basis via direct deposit or check card on Fridays. Deductions will be made from your earnings as per the current W4 form on file.

*Pay period begins at 0700 on Sunday and ends at 0700 on Saturday, Weekend differential begins at 1500 on Friday and ends at 0700 on Monday. Time and a half will be paid for any time worked over 40 hours in a week (unless CA assignement).

Time and a half will be paid for the Big 6 Holidays: New Years Day, Memorial Day, Fourth of July, Labor Day, Thanksgiving and Christmas

Before a check can be issued we request the time slips be present in our system. Every effort will be made to ensure you receive your paycheck in a manner and time frame that is convenient to you.

Staffing Options

PRN STAFFING

The contracting facility will notify Cure Healthcare Staffing of the need for staffing at least two hours prior to the start of the shift. The facility has the option of canceling the shift within two (2) hours the time a nurse is to report for duty. If for any reason the facility cancels a nurse during a shift Cure Healthcare Staffing will pay for the actual hours worked, or the minimum of four(4) whichever is greater.

PRE-BOOKING

While working at a facility you may be given the opportunity to pre-book yourself with either the

Charge Nurse or the Nurse Supervisor. In such an event, we ask that you notify us of the shifts to

which you have committed, in case the facility subsequently cancels or changes your schedule. If you pre-book at a facility, remember that it is your obligation and responsibility to fill the shift. We do not pay extra for pre-booking as we consider this to be a privilege of continued work at an agreed upon contracting facility. Pre-booking is highly recommended however, please be sure to notify us immediately so that we do not also schedule you to work elsewhere.

CONTRACTS

Cure Healthcare Staffing offers facilities the option of contracting for a specified time span. Contracts

can run from 4 to 13 weeks contingent upon the need of the contracting facility.

If you choose to end/quit your assignment early, no matter the reason, Cure Staffing will not be liable to pay your travel stipend to get you home. You assume all risk and responsibility with your decision.
Ending Assignment If you end your assignment early, or cancel the assignment, the contract becomes void at that time and you are allowed only payment for the days you have completed.

AVAILABILITY

We ask that you notify us of your availability as far in advance as possible. Doing so will allow us the option of pre-booking you with our facilities. Remember that good communications are the essence of agency work and many shifts are booked on a “first call” basis. Our state of the art, staffing system will allow you to enter availability and notify you of available shifts via phone call, text or email.

Please note it is your responsibility to keep your contact information current so that we may reach you in a timely manner.

CANCELLATIONS

Should you need to cancel a shift, please notify Cure Healthcare Staffing ASAP! The minimum cancellation notification requirement is four (4) hours. This will allow us to make adjustments and fill he shift with someone else. Repeated cancellations may result in possible termination.

Time card Process (IMPORTANT)

All timecards are due to Cure Staffing each EVERY SUNDAY for the previous work
If your timecard is not received on Monday by Noon CST, this will result in you not being paid on time and you will have to wait for the following week to be paid. You accept this responsibility by taking the assignment with Cure
Timecards must be emailed to Payroll@CurestaffingCorp.com or faxed to 800-201-8653
Facility Time System. If the Facility uses KRONOS, print ou your hours worked for the week and send it to Cure including Punch Times. If the facility does not use KRONOS, email Payroll@curestaffingcorp.com for a Cure Time Sheet. Cure timesheets need to be signed by you and the Supervisor.
If you choose to end/quit your assignment early, no matter the reason, Cure Staffing will not be liable to pay your own travel stipend/needs to get you home. You assume all risk and responsibility with your decision.
Incorrect/Mispunched Timesheets. If we receive a timesheet, or notification that you failed to clock-in on Facility timeclock, did not enter a time correctly or mis-punched your timesheet, you will not receive payroll payment until you have taken all steps necessary to correct this problem. Cure Staffing will need you to provide all proof and acceptance from the Facility that these corrective measures have been You are responsible for your correct time sheet.
Time recording / Breaks / Overtime: Hours worked shall be paid by the minute and reflected on your Unless otherwise specified on your timecards, you are expected to take a unpaid 30 minute lunch break. If you do not notate that you were asked to work through your lunch break, you will not be paid for this time. You will also need to take any other rest breaks as required by law.
Guaranteed Hours. Your agreement may state that you have guaranteed hours, this does not mean they will be allowable and paid if your assignment ends early. You agree and understand that the Client Facilities agreement will ultimately override your assignment agreement with Cure Staffing. Guaranteed Hours are only guaranteed while your assignment is active and will not be paid if you or the facility cancel/end the assignment early. By accepting this assignment, you understand that it can be cancelled with or without notice and Cure Staffing, & Cure Staffing’s client facilities reserve right to amend, change, alter or cancel your assignment at any time without

Cure Healthcare Staffing Standards of Professionalism

While on assignment, you are an employee of Cure Staffing, LLC and a representative of Cure. Your performance is vital to the facility’s future use of the healthcare staff within Cure. In recognition of this responsibility, employees are expected to act in a professional manner throughout the course of assignment.

It is the employee’s responsibility to adhere to the rules, policies and procedures set for by the facility. This includes any required competency, drug screening or other testing they require. As the employee, you are responsible for all information presented during your onboarding process and employment with Cure Staffing, LLC. Allegations or commissions of the following acts will be grounds for immediate termination:

Negligence
Malpractice
Tardiness
Unauthorized Absence
Substance Abuse
Insubordination
Violation of Company & Facility rules
Unprofessional Conduct
Breach or Neglect of Duty
No Call No Show for assignment

In the event of misconduct, wages for hours worked prior to termination will be paid, less any deduction for housing (including lease termination costs if applicable) and benefit charges. Upon termination, Cure Staffing, LLC has no further financial obligation to the employee and employee will hold Cure Staffing, LLC harmless from any and all claims past, present or future.

Ethics

As a Cure employee, you will:

Provide services to patients regardless of race, creed, color, age or sexual
Respect the patient’s right to confidentiality, privacy and
Maintain professional integrity by neither seeking nor receiving personal compensation from purveyor of services in return for the referral of patient or patients to such
Be responsible for informing the patient (or his/her representative) and the necessarymedical and administrative personnel when a continuity of care plan is judged
Maintain complete records and appropriately document the continuity of care process including
Promote interdisciplinary practice and interagency collaborations to achieve continuity of
Communicate an accurate assessment of patient care needs to service
Accurately represent any known limitations of
Assure quality of practice through an ongoing evaluation process and participation in continuing

Reporting for Work

The importance of reporting to work on time cannot be stressed enough. You should be prepared to arrive 15 minutes before your scheduled shift.

We realize that on occasion regardless of your best effort and due to circumstances beyond your control, you may be subject to arriving late. Should you find yourself in this situation, we simply ask that you call us as soon as possible, so that we may notify the facility with your expected time of arrival. The receptionist at the Facility is not a point of contact and should never be treated as such.

Tardiness will be documented and should a pattern develop, you will be subject to administrative review for continued employment.

Dress Code

Scrubs are acceptable for most work areas. The proper dress code will be established by the contracting facility for which you will be assigned on a given shift.

Other Appearance Requirements

Hair should be neat and clean

Avoid strong odors-fragrances and body odor
Shoes should be clean
Wear lab coats and sweaters with complimentary color schemes or patterns
Avoid large, distracting earrings, and hair and or body ornaments
Nails should be natural, no overlays, gel or artificial nails and no longer that ¼ inch past the end of the finger

Assignments

Charting

Narcotics Accountability

While most facilities have computerized narcotic administration methods, some may not or have devices that require reconciliation at the end of your shift. Always notify the charge nurse or nursing supervisor that you are leaving and inquire if the narcotic count is complete and correct. If at any time during your shift you feel that there has been an unauthorized or mishandling of narcotics, be sure you notify the charge nurse/nursing supervisor and Cure Healthcare Staffing.

Universal Precautions

Occurrence Reporting

On the Job Injuries

Communication

Facility Orientation

Each facility will have orientation guidelines that you are obligated to follow. Cure Healthcare Staffing will assume full cost for any customer facility orientation that is necessary, in order to assist you in meeting a contracting facilities requirement. Your Orientation pay will be paid in full to you after you have completed 36 worked hours at that facility.

Cure Staffing, LLC Credentialing Requirements

Cure Staffing, LLC maintains Joint Commission Certification

The Joint Commission on Accreditation of Healthcare Organizations has awarded Cure Staffing the Healthcare Staffing Services Certification. Cure has met national standards which ensure that competent staff is provided to healthcare facilities.

The Joint Commission seeks to continuously improve the safety and quality of care provided to the public. This is done through establishing standards that support performance improvement in healthcare organizations.

The Joint Commission evaluates, accredits and/or certifies more than 15,000 healthcare organizations and programs in the United States. It is the nation’s oldest and largest standards- setting and accreditation body in healthcare.

Client facilities of Cure recognize that Joint Commission certified healthcare staffing companies employ only those professionals who meet well established standards and provide quality patient care. Certification is an important factor in creating more opportunities for our employees.

“Health care organizations that contract with Cure Healthcare Staffing in Austin, Texas can look to Joint Commission certification as an assurance that Cure Staffing demonstrates a commitment to providing and continuously improving quality services,” says Michele Sacco, M.S., executive director, Health Care Staffing Services Certification, The Joint Commission.

Certification

All nurses must maintain a current certification for Basic Life Support (BLS). For assignments in certain clinical areas, a certificate in Advanced Life Support (ACLS), Neonatal Resuscitation Program (NRP) and/or Pediatric Life Support (PALS) is required. A copy of current certifications must be submitted for inclusion in Cure’s files. Employees must bring original certificate(s) when reporting to the assignment so that the facility may inspect and copy the documentation. All certificates must be current prior to the beginning of the assignment.

Medication Administration & Basic Nursing Skills Testing (RN’s only)

Nurses will be required to achieve 80% or better on a computer-offered medication administration and basic nursing skills test provided by Cure. Employees may also be required to pass a medication administration test given by the assigned facility. Some facilities may also require a nurse to pass a specialty-specific exam.

OSHA Testing

The Federal Government requires all employers of healthcare workers to provide education in blood borne pathogens, fire safety and fall prevention. Cure maintains information directly related to these topics in the Employee handbook you received. Employees will be required tocomplete generalized testing related to these areas. Employees must also complete in-service sessions addressing facility specific OSHA topics conducted by the facility.

Drug Screening

Prior to the first assignment and then annually employees will be required to pass a 10-panel drug screen. Employees may be required to submit a drug/alcohol screen more frequently if required by the facility. Some facilities may request a drug screen that tests for alcohol and nicotine as well.

Tuberculosis Screening

Employees must submit documentation of a negative TST administered within a year of the initial assignment. If the TST shows a positive for the first time, the employee will be required to present a statement from a physician, PA or nurse practitioner confirming that there is no threat of infecting others with TB. If the employee has shown a positive PPD in the past, the employee must submit documentation showing negative chest x-rays within the past 5 years and complete a form stating that there are no signs or symptoms of TB.

Drug & Alcohol Use

Cure works to maintain and provide a drug-free, safe and healthy work environment. To promote the goal, employees are required to report to work in appropriate mental and physical condition to perform jobs in satisfactory manner. Cure retains the right to test current employees at any time in response to reasonable suspicion on part of management. No employee may use, possess, distribute, sell, or be under the influence of alcohol or illegal drugs will on Cure premises, at Client facilities or conducting any other business-related activities.

The legal use of prescription drugs is permitted on the job as long as it does not impair the employee’s ability to perform the essential functions of the job. This must be done in a safe manner that does not endanger others in the workplace. Violations to this policy may lead to disciplinary actions, immediate termination of employment, and/or required participation in a substance abuse program. Such violations may also have legal consequences.

Physicians Statement

A statement by a physician, PA or nurse practitioner ascertaining that the employee is physically and mentally able to work must be on file with CURE. The appropriate form is provided with

the New Hire paperwork. There must be an updated physical and physician’s statement each year. Some facilities will perform physical examinations at the beginning of an assignment. Recruiters will help ensure that employees are prepared to comply with all facilities.

Immunizations and Titers

Documentation of immunity to measles (rubeola), German measles (rubella), mumps, varicella (chicken pox), and hepatitis B must be submitted to CURE before the first assignment.

Immunity can be shown through documented titers. Attestation of having the disease is not considered sufficient proof of immunity.

Identification/Work Eligibility Documents

On each assignment, employees must bring original documents that establish both the

employee’s identity and employment eligibility. A Social Security card and a driver’s license are the most common documents used to complete the Employment Eligibility Verification for (I-9) for CURE and the facility. For questions regarding other acceptable documents, call CURE or the facility well in advance of departure for the assignment.

Licensure

All states require that employees hold a current license valid to practice in the state in which they are assigned. It is important that employees plan enough time to achieve the legal ability to practice in the state of assignment. Each state has its own requirements for licensure. RNs can find state licensing board information and multi-state compact licensing information. Licensure

is the employee’s responsibility. Employees are accountable for the timely submission of completed, accurate applications and for following all prescribed procedures related to paying fees, obtaining verifications, filing fingerprints and documenting education. Before starting an assignment, each employee must submit to CURE a copy of his/her temporary or permanent license for the state in which he/she is assigned. It is also the employee’s responsibility to

follow-up on the status of permanent licensure if they are issued a temporary license. Employees should carry any required professional license and/or certification from their home state and assignment state during all working hours of the assignment. It is the employee’s responsibility to present documentation of all required licensure and certification(s) if asked by supervisors.

Neither CURE nor its clients will pay for any work performed by employees who are not licensed or who do not have the legal right to practice in the state in which services were provided. CURE employs only those healthcare professionals who hold a current, unencumbered, active license to practice their professions.

To Obtain Reimbursement for Licensure

CURE can reimburse for some or all of the expenses related to achieving licensure once the employee starts the assignment. License-related expenses include fees for verifications and mailing. This does not include food or lodging. A copy of the employee’s license and receipts proving expenses must be submitted to CURE in order to process licensure reimbursements. In the event of assignment cancellation, licensure reimbursement may be withheld from any compensation owed to the employee.

Other Requirements

Healthcare professionals may need to meet additional requirements if mandated by a specific healthcare facility. These may include, but are not limited to, mask fit-testing, color blind testing, a 12-panel drug screen, and additional references.

Work Injuries/Incidents

It is critical that employees notify Cure about any significant incident that occurs while on assignment. Any on-the-job injuries, exposures to disease, illnesses that may be attributable to the workplace or any other significant incidents must be reported to the supervisor at the facility. The Cure recruiter must be informed immediately after the event, as well. If an employee ever experiences a work injury, the employee should always seek first aid or other medical attention as soon as possible. If the employee is not able to first talk with his0her recruiter or worker’s compensation officer, check with the on-site supervisor. Then, go to the facility’s emergency room, outpatient area of clinic to receive treatment. As long as a work injury is properly documented, reasonable necessary follow-up medical attention will be paid for by the

appropriate worker’s compensation insurance. This will continue even after the assignment has ended. If the employee anticipates further treatment may be required, be sure to check with the Cure worker’s compensation officer. The officer will provide the name, address and policy number for the employee to give future medical providers. Most insurance carriers need to hear from the employee before seeking follow-up treatment in order to give prior approval for payment or physician selection.

Worker’s Compensation Insurance (Cure Payroll)

A worker’s compensation insurance policy is maintained for all assignments in which Cure issues employee’s paychecks. This provides employees with comprehensive coverage in the event of an on-the-job injury or work-related illness. If an employee is injured on such an assignment and notifies Cure, our worker’s compensation officer promptly files a report with the appropriate insurance carrier to ensure that any associated medical bills will be paid.

In case of National Crisis/Pandemic responses. If you are subject to quarantine, you will still need to follow Workers Compensation Procedures. All Quarantine related claims are subject to the discretion & final approval of valid claim by CURE’s Workers Compensation Carrier.

In Case of Injury:

Get the facts about the
Secure appropriate medical
Fill out the Worker’s Compensation Accident Form and email it to hr@curestaffingcorp.com attention: Worker’s Compensation Officer

Worker’s Compensation Insurance (Facility Payroll)

For assignments in which employees are paid by the facility, worker’s compensation is generally handled by the facility’s risk management or personnel office. Again, the appropriate facility representative must promptly report the injury in order to guarantee that it will be covered by insurance.

For life-threatening injuries, call 911 immediately. Then report the claim following the steps above.

Occupational Exposure to Disease

If the employee is in a situation with a likelihood of exposure to a contagious disease (e.g. tuberculosis) or a blood borne pathogen (e.g. hepatitis B or HIV, immediately report this to the facility supervisor. Follow up with a report to the worker’s compensation representative. Before the employee starts an assignment, he/she will need to provide documentation of the hepatitis B vaccination series or a waiver of vaccination. While on assignment, any required vaccinations for hepatitis B will be provided to the employee through reimbursement of expense by Cure. If this is not already completed, employees are strongly encouraged to take this significant preventative step. There has been an increased emphasis on educating health professionals on occupational exposure to disease, particularly those illnesses that are communicable by blood borne pathogens. Cure is committed to fulfilling an obligation to reduce the risk of exposure through vaccination, education and follow-up of any incident. If an employee becomes ill and has reason to believe the illness is work-related, it is important that the employee notifies the facility supervisor, Cure recruiter or worker’s compensation officer immediately in the same manner that he/she would in the event of injury.

Other Work Place Incidents

If an employee is involved in an incident in which there may be an allegation of negligence or violation of rules or procedures, it is essential that the employee notifies the facility supervisor and Cure recruiter immediately. A delay in reporting the matter could result in an insurance company’s rejection of any claim that may result.

As with work injuries, reporting involvement in a potential professional liability situation necessitates the collection of information. Before the employee calls the recruiter, record, in writing, as many of the following questions as possible:

What was the date and time of the incident? Where, in the facility, did the incident occur?

What was the employee doing at the time of the incident? How did it occur? Who were the witnesses to the incident (patients, doctors, etc)?

What was the nature of the incident? Did the incident result in injury?

Have there been any threats of legal action? By whom?

It is important that the employee refrains from discussing the incident with anyone other than a representative of Cure or facility management until an initial investigation can be conducted.

Contact Corporate Compliance at hr@curestaffingcorp.com if you have any questions.

I have read and accept all procedures and requirements outlined in the Orientation Manual.

Cure Staffing, LLC

EMPLOYEE HANDBOOK

WELCOME 3

MISSION STATEMENT 3

ADMINISTRATIVE BASICS 3

CODE OF BUSINESS ETHICS 6

STANDARDS OF CONDUCT 7

CURE STAFFING, LLC DNR POLICY 8

LIFE SAFETY (FIRE) MANAGEMENT 10

ENVIRONMENTAL SAFETY 11

EMERGENCY PREPAREDNESS/DISASTER SAFETY 13

ELECTRICAL SAFETY 16

CHEMICAL SAFETY/HAZARDOUS COMMUNICATIONS 16

JOINT COMMISSION EDUCATION 19

NATIONAL PATIENT SAFETY GOALS 20

Do‐Not‐Use List 21

CDC HAND HYGIENE GUIDELINES 23

STANDARD PRECAUTIONS 24

BLOODBORNE PATHOGENS 25

MEDICATION SAFETY AND DOCUMENTATION 26

SUSPECTED ABUSE: IDENTIFICATION, TREATMENT AND REPORTING 29

EMPLOYEE ESSENTIALS 31

RESTRAINTS 31

END OF LIFE CARE 34

EMERGENCY CODES 34

AGE SPECIFIC EDUCATION 35

EMERGENCY TREATMENT OF PATIENTS (EMTALA) 36

THE HIPPA PRIVACY RULE 37

BODY MECHANICS 39

UNDERSTANDING CULTURAL DIVERSITY 39

DISCHARGE PLANNING 42

PATIENT RIGHTS AND RESPONSIBILITIES 43

UTILITY MANAGEMENT 45

PATIENT EDUCATION 46

MEDICAL EQUIPMENT MANAGEMENT 47

PAIN MANAGEMENT 48

RADIATION SAFETY 51

FALL PREVENTION 51

COMPLAINT RESOLUTION (STAFF AND CUSTOMER) 53

HUMAN RESOURCES: EMPLOYMENT APPLICATION PROCESS 53

PERFORMANCE IMPROVEMENT AND EDUCATION PROGRAM 57

REPORTING ANY ISSUES 58

CLINICAL INCIDENTS AND SENTINEL EVENTS 60

WELCOME

Welcome to the CURE STAFFING, LLC team! We look forward to working with you and assisting you in achieving exciting and rewarding assignment opportunities with CURE STAFFING, LLC! This handbook will serve as your point of reference for any standards, policies and procedures that CURE STAFFING, LLC employees are expected to follow.

It is required that you review and return the acknowledgement form that accompanies this handbook. This acknowledgement form will be kept on file for our records.

Your association is at will and this handbook is in no way, shape or form a contract. You, the employee and CURE STAFFING, LLC have the right to terminate your association with CURE STAFFING, LLC with or without notice or cause at any time.

MISSION STATEMENT

Our mission is to develop long lasting relationships built on trust, kindness and respect with the professionals who dedicate their lives to caring for other people.

ADMINISTRATIVE BASICS

Availability of CURE STAFFING, LLC Office Staff

The CURE STAFFING, LLC corporate office located in Austin, Texas and is open Monday through Friday, from the hours of 8:30AM – 5:00PM. Our local telephone number is (512) 364-1964 and the toll free number is (800) 590- 1690. Outside of normal business hours and in the event of an emergency, please contact us at either (281) 630- 0044 or (800) 590-1690 option 1. CURE STAFFING, LLC’ staff will return your call as soon as possible.

Our goal is to always provide you with a consistent level of service. If for any reason, you are dissatisfied with our service or the service provided by one of our healthcare professionals, we encourage you to contact the local manager to discuss the issue. CURE STAFFING, LLC has processes in place to resolve complaints in an effective and efficient manner. If the resolution does not meet your expectation, we encourage you to call CURE STAFFING, LLC and ask to speak with the manager. We will work with you to resolve your concern. Any individual or organization that has a concern about the quality and safety of patient care delivered by CURE STAFFING, LLC healthcare employees, which has not been addressed by CURE STAFFING, LLC management, is encouraged to contact the Joint Commission at www.jointcommission.org. CURE STAFFING, LLC demonstrates this commitment by taking no retaliatory or disciplinary action against employees when they do report safety or quality of care concerns to the Joint Commission.

In the event of an emergency, natural disaster or other uncontrollable event, CURE STAFFING, LLC will continue to provide service to you through our network from a location where phones and computers are functional. CURE STAFFING, LLC will do everything possible to support you in meeting your needs during crisis situation(s). A copy of our Emergency Management Plan is available upon request.

Orientation

A CURE STAFFING, LLC internal employee will gather the necessary assignment protocol information for each employee prior to the start of assignment and the internal employee will discuss the assignment details directly with each employee. This information will include but is not limited scheduling, timesheet submittal, client facility arrival instructions and whom the employee reports to. This information will be kept on file at CURE STAFFING, LLC and the conversation duly recorded.

Clinical Supervision

The President/CEO provides clinical staff supervision for CURE STAFFING, LLC employees. The President/CEO has an understanding of the scope of services provided by the healthcare professionals supervised. The President/CEO utilizes the appropriate practice acts, the professional licensing and certification boards and professional associations as clinical resources, as needed. It is the President/CEO’s responsibility to identify and report aberrant or illegal behavior to professional boards and law enforcement agencies.

Reassignment Policy

CURE STAFFING, LLC employees may only be placed in assignments that match the job description for which CURE STAFFING, LLC assigns them. If an employee is asked to provide services to another client facility, the client facility must be a like department or unit and the employee must have demonstrated previous competency and have the appropriate certifications, credentials for that department/unit. Employees should only be reassigned to areas of comparable clinical diagnoses and acuities.

The following procedures should be followed by employees when assigned to an area in which they do not feel competent:

The employee will immediately notify CURE STAFFING, LLC and ask for the compliance
The CURE STAFFING, LLC employee is obligated to inform the hospital of his/her

professional limitations based upon the State Boards and Professional Associations standards and upon CURE STAFFING, LLC’ client contract specifications as they relate to the assignment.

The President/CEO at CURE STAFFING, LLC will work within the bounds of each discipline’s Professional Association or State Governing Body and the client agreement to resolve the
CURE STAFFING, LLC or client facility will pay a employee for hours worked up until the end of his/her

Joint Commission Policy Statement

CURE STAFFING, LLC is committed to providing a higher standard of service and to the delivery of safe, quality patient care. CURE STAFFING, LLC complies with the Joint Commission’s Standards for Healthcare Staffing Services. You can have confidence that through the processes within CURE STAFFING, LLC health care professionals working in your organization have met the requirements established by the Joint Commission. To assure compliance with the Joint Commission Standards for healthcare staffing services, CURE STAFFING, LLC provides the contracted client a written description of the following service features.

Competency Review

It is the responsibility of CURE STAFFING, LLC to conduct and finalize the pre-employment assessment of the health care professional’s competency based on the techniques, procedures, technology and skills needed to provide care, treatment and services to the populations served by the client upon completion of CURE STAFFING, LLC’ orientation.

It shall be the responsibility of the client to cooperate in a review or evaluation of each Assigned Employee, relative to the employee’s ability to perform specific job functions upon completion of employee’s assignment or shift. CURE STAFFING, LLC relies on the client’s feedback in order to accurately assess and re-assess the competency of the Assigned Employee on an ongoing basis based on the client’s report of clinical performance.

Subcontractors

CURE STAFFING, LLC will not engage subcontractors to provide Assigned Employee unless agreed to in advance by the client. CURE STAFFING, LLC will conduct and finalize the pre-employment assessment regardless of subcontractor’s assessment of Assigned Employee.

Orientation of Clients

CURE STAFFING, LLC will provide all new clients with an orientation to the company’s policies and procedures. It shall be the responsibility of the client to orient assigned employee to the facility and its rules and regulations and to acquaint them with the facility’s policies and procedures, including dress code, physical layout and equipment and to validate competency and ability of assigned employee to properly use equipment.

Client and Independent Contractors

CURE STAFFING, LLC will be the agency/registry of assigned employee to client. At its sole discretion, CURE STAFFING, LLC reserves the right to utilize independent contractors in addition to specifications of direct hires, to assist in the provision of all agreed upon healthcare staffing services.

Incident, Error, Tracking System

Upon notification of Incidents and or Errors, CURE STAFFING, LLC shall document and track all unexpected incidents, including errors, sentinel events and other events, such as injuries and safety hazards related to the care and services provided, utilizing its data gathering tools. Information gathered tracked and analyzed is to be shared and reported appropriately to clients, regulatory bodies and the Joint Commission as required.

Communicating Occupational Safety Hazards/Events

It shall be the responsibility of the client to notify CURE STAFFING, LLC within 24 hours of the event; any competency issues, incidents, and/or complaints related to the assigned employee and/or CURE STAFFING, LLC Client agrees to initiate communication with CURE STAFFING, LLC whenever an incident/injury report related to the assigned employee is completed

Requirements for Staff Specified

The requirements of employees sent to the client by CURE STAFFING, LLC are to be determined by the client as part of the written agreement between the two parties. It is CURE STAFFING, LLC’ obligation to comply with the requirements of the client by supplying staff and/or independent contractors who have the documented competencies, credentials, health screening and experience to satisfy the requirements specified by the client in order to deliver safe care to the population being served.

Staff Matching Requirements

CURE STAFFING, LLC shall verify the assigned employee’s licensure, certification, education and work experience to assure employee is competent and possess the skills and experience that match requirements for the assignment. Matching the assigned employee’s licensure, certification, education and work experience to assure employee is competent and possesses the skills and experience matching the specified requirements of the assignment may include the use of new grad employees upon the request or approval of the client.

Reassignment

Assigned employee may only be placed in assignments that match the job description for which CURE STAFFING, LLC assigns him or her; if an assigned employee is asked or requests to be reassigned to

another facility with the client, the department must be a like department or unit, and the employee must have demonstrated previous competency and have the appropriate certifications and credentials for that department/unit. Assigned employees should only be resubmitted to areas of comparable clinical diagnoses and acuities as well as other suitably matched assignments of CURE STAFFING, LLC’ various clients.

Information

The CURE STAFFING, LLC office, located in Austin, Texas is open Monday through Friday from the hours of 8:30AM – 5:00PM. Our telephone number is (800) 590-1690 and can also be used outside of normal business hours in the event of an emergency.

In the event of an emergency, natural disaster or other uncontrollable event, CURE STAFFING, LLC will continue to provide service to you through our corporate network from a location where phones and computers are functional. CURE STAFFING, LLC will do everything possible to support you in meeting your needs during crisis situation(s). A copy of our Emergency Management Plan is available upon request.

Our goal is to always provide you with a consistent level of service. If for any reason you are dissatisfied with our service or the service provided by one of our healthcare professionals, we encourage you to contact the local manager to discuss the issue. CURE STAFFING, LLC has processes in place to resolve complaints in an effective and efficient manner. If the resolution does not meet your expectation, we encourage you to call the CURE STAFFING, LLC corporate office at (800) 590-1690. A corporate representative will work with you to resolve your concern. Any individual or organization that has a concern about the quality and safety of patient care delivered by CURE STAFFING, LLC’ healthcare professionals, which has not been addressed by CURE STAFFING, LLC management, is encouraged to contact the Joint Commission at www.jointcommission.org. CURE STAFFING, LLC demonstrates this commitment by taking no retaliatory or disciplinary action against clients when they do report safety or quality of care concerns to the Joint Commission.

CODE OF BUSINESS ETHICS

The first element of the Code of Business Ethics is putting the interests of the client facilities and ultimately the patient above our personal and individual interests. It is in the best interest of CURE STAFFING, LLC to avoid conflicts of interest between the client hospital, employees and staff.

CURE STAFFING, LLC has developed corporate compliance guidelines to supplement and reinforce our client facilities’ existing policies and procedures. It is also meant to assist CURE STAFFING, LLC’ efforts to comply with all applicable laws, rules and regulations.

All employees are responsible for conducting their jobs in a manner reflecting standards of ethics that are consistent with accepted criteria for personal integrity.

Preserving CURE STAFFING, LLC’ reputation for integrity and professionalism is an important objective. The manner in which employees carry out their responsibilities is as important as the results they achieve. All activities are to be conducted in compliance with both the letter of the law and spirit of the law, regulations and judicial decrees.

No employee should, at any time take any action on behalf of CURE STAFFING, LLC, which is known or should be known to violate any law or regulation.

Information about an employee’s medical condition and history is required during the hiring process. CURE STAFFING, LLC recognizes this health information and electronic information must be held securely and in confidence. It is the policy of CURE STAFFING, LLC that employees’ specific information is not to be released to anyone outside of CURE STAFFING, LLC without a court order, subpoena of applicable statute.

Marketing materials, regardless of medium, shall accurately describe the services, facilities and resources of CURE STAFFING, LLC

To maintain high standards of performance, CURE STAFFING, LLC employs only those individuals it believes are most qualified without regard to race, color, religion, sex, age, national origin, handicap or disability in compliance with all federal and state laws regarding discrimination.

CURE STAFFING, LLC is committed to maintaining a work place environment in which employees are free from sexual harassment.

CURE STAFFING, LLC will not tolerate violence or threats of violence, including but not limited to abusive language, threats, intimidation, inappropriate gestures and/or physical fighting by any employee. These actions are strictly prohibited and may lead to severe disciplinary action up to and including termination of contract.

CURE STAFFING, LLC recognizes that its employees and internal employees are its most valuable assets and is committed to protecting their safety and welfare. Employees are required to report accidents and unsafe practices or conditions to their supervisors or other management staff. Timely action will be taken to correct unsafe conditions.

Employees that are licensed or certified in any profession shall follow all applicable rules and professional codes of conduct pertaining to that profession, in addition to the rules stated herein.

CURE STAFFING, LLC prohibits the use or possession of illegal drugs and alcohol abuse on CURE STAFFING, LLC property or while engaged in company activities.

CURE STAFFING, LLC is committed to providing initial and ongoing information for all employees regarding their responsibilities to uphold the code of business ethics and this set of CURE STAFFING, LLC Corporate Compliance guidelines.

CURE STAFFING, LLC prohibits internal employees to discuss bill rates of hospitals or special rates of CURE STAFFING, LLC with other healthcare employees.

CURE STAFFING, LLC prohibits internal employees from discussing personal or business affairs of any employee (or internal employee) with any individual not directly involved with the said personal or business affair.

CURE STAFFING, LLC is committed to protecting the privacy, confidentiality and security of the personal (education, employment and health) information of its employees. This policy is designed to assure compliance with applicable state and federal laws and regulations.

CURE STAFFING, LLC is committed to protecting its own and its clients’ trade secrets, proprietary information and other internal information.

It is CURE STAFFING, LLC’ desire to provide only authorized third parties with information whenever requested while committing to our responsibility to control the release of information to protect the privacy and confidentiality of the employee and/or corporate information.

Employees are not authorized to issue any statement, written or oral, to any news media representative or grant any public interview pertaining to the company’s operations or financial matters.

Any employee that becomes aware of any ethical issues or unethical practices must immediately report it to their supervisor. If the supervisor is unavailable or you believe it would be inappropriate to contact that person because of their involvement in the situation, you should immediately contact the CURE STAFFING, LLC corporate office or any other member of management. Any employee can raise concerns and make reports without fear of reprisal or retaliation.

All reports and inquiries are handled confidentially to the greatest extent possible under the circumstances. You may choose to remain anonymous, though in some cases that can make it more difficult to follow up and ensure resolution to the situation.

CURE STAFFING, LLC wants every employee to report violations of our ethical or other principles whenever you see them or learn about them. In fact, it is a requirement of your contract. If you do not know whether something is a problem, please ask a member of management.

STANDARDS OF CONDUCT

It is the responsibility of members of CURE STAFFING, LLC’ internal employees to exercise appropriate judgment, and conduct themselves in a manner that reflects the highest standards of professional and personal ethics and behavior.

CURE STAFFING, LLC Employee Responsibilities

A CURE STAFFING, LLC employee is and shall be duly licensed to practice his/her profession in any state where the CURE STAFFING, LLC employee is assigned and shall maintain current professional standing at all times during the assignment. Evidence of such licensing shall be submitted to CURE STAFFING, LLC prior to commencing the assignment. A CURE STAFFING, LLC employee agrees to give immediate notice to CURE STAFFING, LLC in the case of suspension or revocation of his/her license, initiation of any proceeding that could result in suspension or revocation of such licensing, or upon the receipt of any notice or any other matter that may challenge or threaten such licensing.

A CURE STAFFING, LLC employee agrees to submit to CURE STAFFING, LLC before commencing any assignment, all requested documentation that is necessary to comply with Joint Commission, the client and CURE STAFFING, LLC expectations 10 days prior to assignment start date in assignment detail.

A CURE STAFFING, LLC employee agrees to and shall observe and comply with the applicable policies, procedures, rules and regulations established by the client.

A CURE STAFFING, LLC employee agrees to work all scheduled shifts as directed by the client (including weekends and holidays).

A CURE STAFFING, LLC employee agrees to adhere fully with all quality assurance, peer review, risk management program or other programs that may be established by the client to promote appropriate professional standards of medical care. A CURE STAFFING, LLC employee agrees to accept both clinical and operational supervision from his/her immediate supervisor.

A CURE STAFFING, LLC employee agrees that patient records and charts shall at all times remain the property of the client. A CURE STAFFING, LLC employee agrees to 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 clients and all information related to this agreement.

A CURE STAFFING, LLC employee agrees to immediately provide written notice to CURE STAFFING, LLC as to any legal proceeding instituted or threatened, or any claim or demand, made against the CURE STAFFING, LLC employee or CURE STAFFING, LLC with respect to the CURE STAFFING, LLC employee’s rendering of services under this agreement.

A CURE STAFFING, LLC employee agrees to notify client and CURE STAFFING, LLC of any unscheduled absence at least two (2) hours prior to beginning a shift.

A CURE STAFFING, LLC employee agrees not to disclose any CURE STAFFING, LLC trade secrets or any confidential or proprietary information of CURE STAFFING, LLC employees, clients, or patients of clients. Employee agrees to refer client facility to CURE STAFFING, LLC for any future arrangements for temporary or permanent coverage that may be requested of employee by client facility, including without limitation any hospital, clinic, office, organization, individual, or group directly or indirectly owned by, operated by, or affiliated with client facility for a period of two (2) years from the last day of service.

CURE STAFFING, LLC Contract Termination Policy

Do Not Return (DNR) Policy

The following point system is used to determine termination of contract between clinical professionals / professionals and CURE STAFFING, LLC as a result of unsatisfactory services, referred to as Do Not Return. The contract Employee will be notified and counseled if a Do Not Send is documented. A Contractor who receives 5 points will be considered for termination of contract with CURE STAFFING, LLC. Any employee involved in illegal activity will result in contract being terminated immediately.

1 Point

Points

Points

Unprofessional communication / lack of professionalism

Clinical incompetence – poor clinical performance Poor time management

Medication Error

Documentation Deficiencies/Facility Reported Charting Error Danger to patient.

Departing facility before end of shift without prior approval from facility.

5 Points

Illegal Behavior (includes false identity; falsified documentation, use of or distribution of controlled substances etc.)

Error resulting in patient death or permanent physical or mental damage Self-terminating assignment without proper notice to facility or CURE STAFFING, LLC

No Call – No Show

Other Points

If any of the following are found to be no longer acceptable once an employee has begun working, an assessment of the severity of the situation will be made by CURE STAFFING, LLC Clinical Consultant and Do Not Return Points will be applied accordingly.

Background Check, AMA, or other report is found to have previously undisclosed negative information.

Job Appropriate Credentials are found to have lapsed. CURE STAFFING, LLC will routinely notify the employee that credentials are set to expire with the intent of reminding them to prevent lapse in licensure. If an employee fails to keep current all necessary licensure or other requirements, he or she will be immediately removed from their current assignment (as they will no longer be qualified) and if possible, once licensure is brought up to date, returned to the position.

SAFETY MANAGEMENT

LIFE SAFETY (FIRE) MANAGEMENT

GENERAL RULES

When fire strikes, the actions 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.

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:

If the sides of the triangle are not allowed to meet – if the triangle does not form, there will be no fire. In the event of a fire, follow the below action plan:

When using a fire extinguisher, follow the below action plan:

ENVIRONMENTAL SAFETY

In every client facility, it is important to follow security procedures. By taking simple security precautions, you can help to:

Protect personal, patient, and institutional property Maintain a safe environment.

Personal Property

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

Lock car
Secure all
Keep purses and wallets in a locked area or

Patient Property

Patients should be encouraged to leave their valuables at home. If patients choose to bring their valuables into the client facility with them, you can help to keep them safe by:

Securing patient
Educating patients about

Follow your client facility policy for securing patient valuables. For example, valuables may be placed in the client facility safe according to policy. You can educate patients by explaining the visitor policy, including who can visit, visiting hours, and any restrictions. You should also explain how patients can identify staff.

Institutional Property

There are also things you can do to protect institutional property:

Keep restricted areas
Report missing or damaged equipment.

“Security-sensitive” Areas

Some areas in your client facility may be restricted or “security-sensitive.” These are areas with limited or restricted access. Your client facility may have policies restricting access to these areas. There may also be security devices, such as alarms and video cameras. Restricted access to security areas applies to everyone, even staff. This means that only people who need to be in these areas should be there.

Security-sensitive areas may include the following:

Pharmacy, because of access to drugs Operating rooms

Obstetrics (especially the nursery, because of the risk of child abduction) Pediatrics

Medical Information Systems

Medical Records, because of access to confidential information Billing

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

Wearing your ID badge
Keeping doors locked
Reporting missing or damaged equipment

You should wear your ID badge according to client 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 is a employee or staff member.

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 your 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 contains sensitive personal information. By following procedures, you can help keep these areas secure.

In addition to protecting personal, patient, and institutional property, it is important to ensure your personal safety. Take the following simple precautions:

Do not walk alone to your car at night or any time you feel uncomfortable. Follow your client facility procedure to get an
Park in well-lit areas and do not keep valuables in your car, especially in plain sight. If you do have valuables in your car, lock them in the
Report any potential security hazards. This includes such things as burned out lights in a stairwell or If you feel someone is acting suspiciously, notify security personnel immediately.

EMERGENCY PREPAREDNESS/DISASTER SAFETY

Emergencies or disasters can be classified as either “internal” or “external.”

An internal emergency is one that directly involves the client 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 client facility and does not directly threaten the staff, patients and others inside the building(s). The indirect effect on the client 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.

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

Client 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 client facility might face

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

When there is an emergency situation that could affect many workers, a client facility’s 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.

EVACUATION

Client facility evacuation is an entirely different process than is recommended for schools and factories. Leaving the client facility is the very last resort, while in other establishments the objective is to clear the building as quickly as possible.

Familiarity with several types of evacuations is a necessity in any client facility. There are four types of evacuations. Each may be separate and complete operation, or all four may have to be used in successive stages if circumstances so require.

Partial Evacuation: This is removing one or more patients from a dangerous room or When the patients are removed, an attempt must be made to subdue the fire with the extinguisher and hose line. If this is impossible the door must be closed and the threshold sealed with a wet towel or blanket. If the fire continues to grow, then the next step is to proceed with the horizontal or vertical evacuation.
Horizontal Evacuation: This type of evacuation takes place when fire or heavy smoke from a single room or ward threatens to spread to the adjoining All patients should be moved laterally by bed, cart, wheelchair, gurney, blanket or other conveyance to the nearest and safest protected area. Patients in immediate danger should be moved first, including those who might be separated from safety if the fire enters the corridor. Next

to move (and contrary to some opinion) should be the ambulatory patient. Panic is never caused by helpless people. Those who are ambulatory should be pre-instructed to line up outside their rooms, form a chain by holding hands and follow a lead person into the safe area. The rooms should be checked for stragglers and all windows and doors closed. When horizontal evacuation is ordered, the personnel in the receiving area should assist in the removal of the patients if needed.

Vertical Evacuation: This is the downward movement of patients to a safe area. This may be one or two floors below, or it may be down and out of the building. If the movement is out of the building, it should be an area far enough from the building to be safe and also to be out of the way of the fire In most cases, a horizontal movement to a safe stairwell will precede this movement. The priority for movement is the same for a horizontal movement.
Total Evacuation: This means vacating all floors to a place of safety. Cause would be possible conflagration or an enemy air attack warning, or dense smoke and fumes. A place of safety might mean the basement, or even leaving the building, or even leaving the city. It would be necessary to use all stairways and safe elevators. It would require the help of everyone available. This action must be undertaken floor by floor with enough trained help above and below to keep traffic moving quickly and properly by stair and elevator.

Untrained or unassigned personnel would report to the manpower pool under the direction of personnel. Remember that more good work could be accomplished and less panic created by the work of two-dozen competent people than by 300 anxious but untrained volunteers.

There should be carrying teams to get the patients downstairs and fire escapes. These practically trained people should be called loaders, movers and carriers. It would certainly be a much more orderly arrangement than for a single team to tackle all three phases.

EMERGENCY REMOVAL

In a client facility fire, the first duty of the personnel is to remove the patient(s) who are in immediate danger. This may require moving one person or many. If eight out of twenty-five are helpless as acknowledged, then it seems sensible to assume that the proper time to learn removal techniques would be before rather than during the fire.

Three considerations may be dominant factors in emergency patient handling:

The nature of the emergency
The weight and condition of the patient
The strength and adaptability of the rescuer

Of all the possible equipment for evacuation, the BLANKET is more important than any other. It can be used to smother fire, drag a patient from the room, made into a stretcher with or without poles, used for carrying in halls, on stairs, or fire escapes. Eight or ten infants can be carried easily and safely in a blanket.

There should be no uncertainty in bed fires. The rule is to get the patient on the floor. In an oxygen tent fire: SHUT OFF THE OXYGEN, THEN GET THE PATIENT ON THE FLOOR. In both situations, if you throw a blanket on the floor, you can use it to smother fire or as a drag. The fear of handling people who are on fire is undeserved. Bodies do not burn, they cook. So really all you have to contend with is the night clothing and the hair, once you free the patient from the bed.

Personnel working in orthopedics should carry a small sharp pocketknife. Do not depend on the pair of scissors in the desk; someone else may need them, too. Remove the small pair in your pocket because they may severely injure you or the patient you are moving. If there is any question of responsibility in removing someone from traction, just remember that there is always a chance of recovering from an aggravated fracture, but never from cremation or asphyxiation.

In case of fire, do not be surprised to find the patient on the floor. He/she will get out of the bed if he/she can. If the patient is supposed to be in the room and you cannot see or feel him or her, look under the bed, or in the closets or elsewhere.

Earthquake/Disaster Preparedness

Attempt to familiarize yourself with the client facility/unit earthquake preparedness 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.
At least 2 persons in each unit or on each floor should assume leadership roles after the disaster has occurred. It is the client facility’s responsibility to be sure they are properly
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 Do not leave the building during the quake.
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.
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.
Be aware of the possible necessity to shut off lights, gas and

Attempt to locate several alternate routes of evacuation in the various parts of the unit and or client facility, should you need to leave your work area because it is
Consider the possibility that you may not be able to leave the premises and attempt to locate supplies on hand that may be
Provide assistance for physically compromised patients and co-workers who are unable to leave the building without the aid of another
Attempt to locate areas of the client facility that may be suitable as shelter areas should employees and patients be required to stay there after the
Be sure the fire extinguishers are kept in good working order and that you know how to use

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

Attempt to locate contingency plans for continued operation of the hospital based on total and/or partial shut downs due to building/utility/communication/transportation Try to identify key personnel, communication systems, utilities and other support needs for 24 hours, 72 hours, one week and one month, if available.
Organize Interdisciplinary Team and patients for whom they are responsible and determine what steps are to be taken in accordance with the hospital’s earthquake plans.
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 Be sure your entire area is checked forinjured.
In the event of fatalities, cover bodies and notify the They should not be moved.

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

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

Do not use elevators or to run into the

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

Immediately clean up dangerous materials that may have

Limit use of “land line” and mobile telephones for outside calls except in genuine emergencies. Use battery- powered radios for damage reports and information from public safety
Check closets and storage areas very carefully, watching for falling

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

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

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 work place.

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

Water and electricity are 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.

If you notice an electrical hazard, contact your supervisor 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.

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, that 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

Identification of product: You will find the product name, manufacturer’s name, address, telephone and emergency
Hazardous ingredients: Lists of all the ingredients in the
Physical data: Provides information on how to work with the chemical and describes the physical
Fire and Explosion Hazard data: Specifies if the material may present a fire or explosive hazard and under what conditions the hazard
Health hazard data: Identifies the symptoms related to overexposure (nausea, vomiting, and dizziness).
Reactivity Data: Describes what materials will react with the chemical you’re

Spill/leak procedures: Addresses how to respond to an accident spill or
Control measures and special precautions: Specifies the type of PPE that you should wear when handling the
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:

Compressed gas: such as high-pressure oxygen and nitrous oxide cylinders.
Explosive: substance that can explode under certain conditions of
Flammable or combustible: substance that burns easily such as
Organic peroxide: derivative of hydrogen
Pyrophoric: ignites spontaneously in air under certain
Unstable: reactive
Water reactive: such as strong acids and bases when mixed with

Health Hazards

Disseminated as hazardous to your health are chemical substances. Both liquids and solids may be identified on a MSDS and are indicated as:

Carcinogens: these cause cancer; reproductive toxicity in males or females, reproductive toxins can result in fetus
Toxic: a substance that acts as a
Irritants: these may cause irritation to any body
Corrosives: these can cause damage to body
Sensitive: these can cause allergic
Hepatoxin: this is a liver
Nephrotoxin: this is a kidney
Neurotoxin: this is a nerve poison.
Hematopoietic System: act on the system resulting in blood
Substance compounds: damaging to lungs, skin, eyes or mucous membranes upon

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

Through inhalation (painting, stripping floors, anesthesia gas waste).
Through absorption (handling formaldehyde and glutaraldehyde).
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).
Injection (accidental needle sticks).

Your responsibilities when handling hazardous materials

Read the label and MSDS of new chemicals you are working
Follow warnings and
Use appropriate
Learn emergency procedures for the chemicals with which you
Act in a sensible manner, be a safe and responsible
Never use hazardous material substances you’re not trained to use

Never place a chemical substance into an unlabeled
Never mix substances without asking your supervisor
Always ask your supervisor if you have a question about any

HANDLING HAZARDOUS MATERIALS

Infectious waste: Separate infectious waste from other waste as soon as the material becomes a waste.

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

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.

There are three ways that a chemical substance may harm you: Breathing the chemical

Having physical contact with the

chemical 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:

Special mask Ventilator

In addition, always use these products in a well-ventilated area. If you begin to feel dizzy or weak or havedifficulty 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: Goggles, safety glasses, or other eye protection Gown

Gloves 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:

Mask (that covers your nose and mouth to prevent the solution from being splashed onto your lips) Gloves (to protect against hand to mouth transfer).

In addition, if you should accidentally swallow a harmful chemical, tell your supervisor immediately. You will probably be sent to the Health Nurse or to your Emergency Department.

JOINT COMMISSION EDUCATION

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:

Error

Sentinel Event Near Miss

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:

Something done by accident

Something that should have been done but was not

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

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.

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:

Rape

Patient suicide

Infant abduction or discharge to the wrong family

Hemolytic transfusion reaction involving administration of blood or blood products Surgery on the wrong patient or wrong body part.

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 wristband 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) that significantly increases the likelihood of a serious adverse outcome.

In other words, a Hazardous Condition is:

Something that could cause the patient harm Something other than the patient’s disease or condition.

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 hospitals 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.

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.

Improve the accuracy of patient identification

Use at least two patient identifiers (neither to be the patient’s room number) whenever administering medications or blood products, taking blood samples and other specimens for clinical testing, or providing any other treatments or procedures. For example, use the patient’s name and date of birth.

Improve the effectiveness of communication among caregivers

For verbal or telephone orders or for reporting critical test results over the telephone, verify the complete order or test result by having the person receiving the order or test result “read-back” the complete order or test result.

Standardize a list of abbreviations, acronyms and symbols that are not to be used throughout the organization. Measure, assess and, if appropriate, take action to improve the timeliness of reporting, and the timeliness of receipt by the responsible licensed caregiver, of critical test results and values.

Implement a standardized approach to “hand off” communications, including an opportunity to ask and respond to questions.

Improve the effectiveness of communication among caregivers

Have on hand a small supply of the medicines that are used in the hospital.

Create a list of medicines with names that look alike or sound alike and update the list every year. This will prevent errors involving the interchange of these drugs.

Label all medications, medication containers (e.g., syringes, medicine cups, basins), or other solutions on and off the sterile field in preoperative and other procedural settings.

Take extra care with patients who take medicines to thin their blood.

Prevent infection

Comply with current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines. Report death or injury to patients from infections that happen in the hospital.

Check patient medicines

Find out what medicines each patient is taking. Make sure that it is OK for the patient to take any medicines with their current medicines.

Give a list of the patient’s medicines to the patient’s next caregiver. Give this same list to the patient before they leave the hospital.

Prevent patients from falling

Find out which patients are most likely to fall. For example, is the patient taking any medicines that might make them weak, dizzy or sleepy? Take action to prevent falls for these patients.

Help patients to be involved in their care

Tell each patient and their family how to report their complaints about safety.

Identify patient safety risks

Find out which patients are most likely to try to kill themselves.

Watch patients closely for changes in their health and respond quickly if they need help

Create ways to get help from specially trained staff when a patient’s health appears to get worse.

Prevent errors in surgery

Create steps for staff to follow so that all documents needed for surgery are on hand before surgery starts. Mark the part of the body where the surgery will be done. Involve the patient in doing this.

Do-Not-Use List

Joint Commission has created a list of abbreviations, acronyms, symbols, and dose designations that are not to be used throughout 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)

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

Mistaken for each other. Period

after the Q mistaken for “I” and the “O” mistaken for “I”

Write “daily”

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

MSO4 and MgSO4

Can mean morphine sulfate or

magnesium sulfate. Confused for

one another.

Write “morphine sulfate”

Write “magnesium sulfate”

INFECTION CONTROL: UNIVERSAL PRECAUTIONS AND BLOODBORNE PATHOGENS

CURE STAFFING, LLC strives to educate employees on nosocomial infections and their method of transmission and to provide education on work practices; engineering control and personal protective equipment prevent the spread of nosocomial infections.

NOSOCOMIAL INFECTIONS

THE SPREAD OF GERMS

Germs can be spread through 4 different modes of transmission

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 Microorganisms transmitted by airborne transmission include Mycobacterium tuberculosis and the rubeola and varicella viruses.
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 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.

Blood borne transmission: Germs can live in the bloodstream and in other body fluids that contain blood 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.
Direct Contact Method: Infectious agents can spread directly or indirectly from one infected person to another, often on contaminated 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

General steps to follow to prevent the spread of germs are:

Following the Infection Control policies of your client facility Identifying the people, patients, and staff, who are most at risk Washing your hands

Staying healthy by getting plenty of rest, eating properly and exercising Getting vaccinated against flu and hepatitis B

Following the standard recommended precautions with everyone 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.

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:

Wet hands thoroughly under running Warm or hot water is best.
Lather with soap from a
Wash hands thoroughly for 15 seconds, using Be sure to include the backs, palms, wrists, between fingers, and under fingernails.
Rinse hands thoroughly under running
Leave the water running and use a paper towel or an air dryer to dry hands

The four steps to round alcohol hand rubs are:

Pour the alcohol hand rub in the palm of one hand
Rub both hands together
Rub all parts of the wrist, hand, and fingers
Rub until completely dry

STANDARD PRECAUTIONS

Standard Precautions combine the major elements of Universal Precautions and Body Substance Isolation. Standard Precautions call for the use of gloves and other personal protective equipment to guard against anticipated or accidental contact with any body fluid, secretion or excretion.

Personal Protective equipment is to be utilized when there is a break in the skin or when working around mucous membranes. All employees shall follow Standard Precautions in order to minimize and/or eliminate exposure to blood borne pathogens and communicable diseases. All body substances shall be treated, as a potential source of infection and all facilities shall provide an adequate supply of Personal Protective Equipment in appropriate sizes to ensure all personnel have access when required.

At a minimum, all employees should follow these basic practices:

Hand protection

Protect your hands by wearing latex/hypoallergenic gloves (the correct size) when: Emptying a Foley catheter

Emptying a bedpan Starting an IV

Dealing with trauma in the emergency room Pricking the finger for blood glucose

Handling blood specimens

Drawing arterial or venous blood Cleaning biomedical equipment.

Body protection

Wear gown, mask and goggles to cover any part of your body that could be splashed or sprayed (or otherwise come in contact with) the blood and/or body fluids of another person (for example, when caring for a trauma patient in the Emergency Department or when assisting in a procedure where exposure is possible).

General protection

Dispose of all materials containing blood in the proper waste containers.

Use a barrier device instead of performing direct mouth-to-mouth ventilations during CPR. Avoid contact with blood from needles by using safety devices provided by your facility. Never recap a needle (if you miss, you could jab your finger).

Dispose of all sharps (needles, blades, IV catheters) in the proper disposal box. Wash your hands after removing gloves.

Do not eat, drink and/or apply make-up or contact lenses in areas where exposure to body fluids is possible.

POST EXPOSURE EVALUATION AND FOLLOW UP PLAN

An exposure incident to blood borne pathogens involves specific eye, mouth, mucous membrane, or parenteral contact with blood or other potentially infectious materials that result from the performance of a employee’s duties. All employees involved in direct patient care should be familiar with appropriate decontamination procedures. CURE STAFFING, LLC shall make immediately available a confidential medical evaluation and post-exposure follow-up with the exposed individual. Post-exposure follow-up shall be:

Made available at no cost to the employee.

Performed by or under the supervision of a licensed healthcare professional whom has a copy of all relevant information related to the incident.

Made available at a reasonable time and place.

CURE STAFFING, LLC post-exposure and follow-up, shall include the following:

Documentation of the route(s) of exposure, and the circumstances under which an exposure incident occurred Identification and documentation of the source individual

Collection and testing of blood for HIV and HBV serological status

Post-exposure prophylaxis, as recommended by the U.S. Public Health Service Counseling

Evaluation of reported illness

CURE STAFFING, LLC maintains confidential medical records for each employee with occupational exposure. Records are kept for the duration of employment plus thirty (30) years. Each record shall contain the employee’s name, social security number, hepatitis B vaccine history, and a record of all post-exposure follow-ups.

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 infections that are caused by different viruses. 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. 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.

Employees 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 hospital

MEDICATION SAFETY AND DOCUMENTATION

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.

What are common sources of medication errors?

Lack of knowledge about drugs: with so many new drugs being developed each year, it’s never been more important to understand what each drug can do and how to use it
Lack of patient information: Ensuring medication safety means it’s important to know key information about each patient, including his/her age, weight, clinical status, known drug allergies and use of other medications (herbs, supplement, vitamins, other holistic remedies) and the potential for

Poor communication: Problems can result from things such as:
- Not using standardized abbreviations
- Handwriting that’s hard to read
- Verbal miscues (for example, mispronouncing a drug’s name)
- Unclear decimal points
Storage and stocking of drugs: For example, the risk of someone picking up the wrong drug is higher when the two drugs are similarly packaged (but are very different).
Equipment used to administer drugs: Variations in the design of IVs and infusion pumps can cause confusion. Poor maintenance and not understanding how to program automated equipment also increases the risk of medication
Patient identifications: A good system to identify patients, such as armbands, may be in place. However, the system must be utilized (i.e. the armbands must be checked) in order for it to work
Distractions: Ringing telephones, too much conversation, and interruptions can cause even the most careful healthcare worker to lose

How can medication errors be prevented?

Contrary to popular belief, most medication errors are not due to a careless individual act, but are related more directly to some type of system failure or inefficiency. Medication errors can be prevented if everyone in the organization:

Works together across departments, including physicians, pharmacists, nurses, support staff and
Focuses on systems, which means improving procedures to help prevent
Takes blame away from employees and looks at the process (es) that led to the
Helps patients understand their medications, follow their treatment plans, and take an active role in their care at every step along the
Uses benchmarks to compare challenges and successes of other health care organizations with their
Reports errors voluntarily so that a root cause analysis can be A root cause analysis is a step-by-step method to understand what went wrong and why. It allows us to make improvements in a system and monitor changes to see how well they are working.

Medication Administration and safety

Administered by a licensed nurse upon a written order by a staff
Pour medications immediately before No pre-pouring!
Always check patient ID band and Medication Two forms of identification must be used.
Patients must take all medications in the presence of the administering
Medications can be given ½ hour before or ½ hour after the scheduled
Double-check all insulin, chemotherapy agents, anticoagulants and PCA narcotics with another licensed nurse.

Anesthestetic Documentation

Document the time the anesthetic was
Include injection site for all injectables or sub queue

Narcotics

Per client facility documentation, administration and wastage of narcotics must be handled following state and client facility policy and

Medication Labeling

Labeling and drawing of medications must be done per Joint Commission

Why is clinical documentation so important?

Communication
Quality of care issues
Compliance: reimbursement verification
Fulfills federal, state, regulatory and accreditation requirements
Supports if Standard of Care was met
Memories fade, aids in defense in lawsuits when present
May be used as teaching tools

Basic charting tips

Use a pen, black ink is preferred
Print legibly
Date, time and sign all entries
Don’t use white out or obliterate entries
Use approved abbreviations
Record objective information – be clear and concise

Good Documentation Habits

Use language patient understands for discharge instructions and patient education material Documentation of actions, conversations with the patient, family members, physicians Documentation of safety precautions reviewed with the patient and/or family

Description of unusual incidents Documentation of contacts with the employee Contemporaneous, chronological Do not editorialize, criticize, add ‘hearsay’ Avoid blaming another person or department Complete all boxes / forms accurately

Do not leave open lines on records between documentation entries Verification that informed consent was obtained

Instructions given to patient/verbalization of understanding Do not alter entries

Alteration of Records

Medical records should never be ‘edited’ after the fact Never document in anticipation of an event

Never chart for someone else

– Exceptions

* Code situations

You may be personally assessed for penalties related to falsification of documentation Alterations in a record can make the case indefensible

Late Entries

Late entries are placing additional information in the medical record when pertinent information was missed or not written in a timely manner.

A general guideline of when late entries can be added is within 7 days. Consult your Supervisor or Risk Manager for guidance if necessary.

Should not be used if there has been adverse outcome to patient or there is known litigation. Must also include a reference point. This should specify the date and time. See below.

Example:

8/20/15 1600: Late Entry for 8/19/15 at 0800:

Patient also complained of pain at base of neck and bleeding from nose. Dr. Thomas notified, CT of head ordered along with CBC & diff, INR.

Corrections

Draw single line through entry, initial, write the correct information. Review your hospital’s policy for corrections. Sign and date the entry.

Example:

8/19/15 0800: Pt found on floor in LN hallway; BP:165/66 VS: 36.8-136-20

Dr. Thomas notified. Orders for MRI obtained

SUSPECTED ABUSE: IDENTIFICATION, TREATMENT AND REPORTING

ELDER/ADULT ABUSE

As applied to an elderly person (65 years of age or older) or a disabled adult (18 years of age or older), abuse means the willful infliction of injury, unreasonable confinement, intimidation, cruel punishment resulting in physical harm, pain or mental anguish or the willful deprivation by a caretaker or oneself of goods or services which are necessary to avoid physical harm, mental anguish or mental illness.

SIGNS AND SYMPTOMS OF ELDER/ADULT ABUSE

Patient or family member states that abuse is happening in the home
Explanation for injuries is inconsistent with the injury
Family or caregiver attempts to conceal injury
Indications that someone is exploiting patient’s finances or property
Delay in seeking treatment
Multiple bruises or injuries in various stages of healing
Human bite marks
Burns especially on back or buttocks
Bruises in the shape of a hand or fingers
Patient’s behavior changes in the presence of the family or caregiver

CHILD ABUSE

With a child (under 18 years of age), abuse includes:

Mental or emotional injury that results in an observable and material impairment in the child’s growth, development, or psychological functioning.
Causing or permitting the child to be in a situation in which the child sustains a mental or emotional injury that results an observable and material impairment.
Physical injury that results in substantial harm to the child or the genuine threat of substantial harm from physical injury to the
Failure to make a reasonable effort to prevent an action by another person that results in substantial harm to the
Sexual contact, sexual intercourse or sexual
Failure to make a reasonable effort to prevent sexual contact, sexual intercourse or sexual

SIGNS AND SYMPTOMS OF CHILD ABUSE

Burns on the soles of the feet (from forced standing in hot places)
Burns on buttocks, thighs, hands or feet (from submersion in hot water)
Explanation for injury does not match developmental stage (for example, caregiver explains a broken leg by saying the patient fell down, but the patient is too young to stand up)
Evidence of sexually transmitted disease
Bruising or tearing around the genital area

NEGLECT

With an adult, neglect means failure to provide the goods or services, which are necessary to avoid physical harm, mental anguish or mental illness.

With a child, neglect includes leaving the child in a situation where the child would be exposed to a substantial risk of harm, i.e. failure to seek or follow through with medical care, failure to provide food, clothing or shelter.

SIGNS AND SYMPTOMS OF ELDER/ADULT NEGLECT, INCLUDING SELF-NEGLECT

Malnutrition
Dirty, unkempt
Unattended medical conditions
Alcohol or substance abuse by caretakers

SIGNS AND SYMPTOMS OF CHILD NEGLECT

Chronic truancy (caregivers do not send child to school)
Failure to thrive (unexplained weight loss)
Unexplained delay in development
Accidental injuries that suggest poor supervision

SPOUSAL PARTNER/VIOLENCE

Spousal/partner violence involves the situation where a victim has been involved in an intimate, romantic or spousal relationship with the perpetrator. It encompasses violence against both men and women and includes violence in same- sex relationships. It consists of a pattern of behaviors that establish power over another adult.

SIGNS AND SYMPTOMS OF SPOUSAL PARTNER/VIOLENCE

Signs and symptoms of spousal/partner violence can include the usual signs and symptoms of abuse and neglect. Violence in a relationship may not result in physical evidence. For example, the abuser may deny the victim the ability to communicate with friends or relatives. The abuser may abandon the victim in a dangerous place, refuse help when sick or injured or prohibit access to money or other basic necessities.

EXPLOITATION

The illegal, improper act or process of a caretaker using the resources of an elderly or disabled personfor monetary or personal benefit, profit or gain.

The treatment team may identify possible history of abuse, neglect or
Any employee and/or staff member suspecting child and/or adult abuse and/or neglect is required to report suspicions according to local law and the rules and regulations of the state’s Department of Human Services (DHS) or appropriate agency. If clarification is necessary concerning the criteria for reporting, an Adult Protective Supervisor will be contacted for clarification without disclosing the identity of the patient and/or
The report to DHS may be made orally or in It shall include:
1. The name, age and address of the person
2. The name and address of the person responsible for care
3. The nature and extent of the person’s condition
4. The basis of the reporter’s knowledge
5. Any other relevant information
6. Documentation shall occur in the appropriate section of the patient record

If circumstances allow, the reporting procedure will be discussed with the patient and/or family involved prior to the report being made. Consent will be obtained if deemed appropriate by the treatment
Outside agency personnel requesting information about the family should be referred to the patient’s physician or other appropriate
Any act of omission is A reportable suspicion that includes a child victim of abuse shall be documented in the appropriate section of the medical record.
The patient’s treatment team will address symptoms resulting from
Documentation of physical marking should include photographic documentation (with appropriate patient identification) and be included in the appropriate portion of the patient’s medical
Any other evidentiary material of abuse released by the patient will be included in the appropriate portion of the patient’s medical record.
Adult patients shall be given information regarding legal
Physical injuries requiring medical attention will be treated as deemed necessary by the patient’s

ABUSE REPORTING

All healthcare employees are mandated reporters. Social workers are not on site 24 hours/day so employees 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 $1,000 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:

A description of the incident
To whom the incident happened
When the incident occurred
Where the incident occurred
Who was responsible for the neglect/abuse

EMPLOYEE ESSENTIALS

RESTRAINTS

It is the policy of CURE STAFFING, LLC that the patient has the right to be free from any physical or chemical restraints unless it is necessary for patient’s safety or safety of others. Restrictive devices/restraints will be applied when the safety of the patient and/or the employee is in jeopardy. Restrictive devices/restraints will be applied only after less restrictive measures have proved inadequate. Restraints shall not be used in a manner that causes undue distress or increases a risk for injury.

BEHAVIOR MODIFICATION RESTRAINT: Behavior modification restraint means the use of a physical or mechanical devise to involuntarily restrain the movement of the whole or a portion of a patient’s body for the reason of controlling his/her physical activities in order to protect him/her and others from injury (such as the use of 5-point restraints to keep a patient from injury or soft ties to keep a confused patient from self-injury). The following are not behavior modification restraints: 1) Safety Restraint; 2) The use of side rails or, in the case of infants, the use of a safety net to keep patients from falling out of bed; 3) handcuffs applied by peace officers; 4) isolation for control of communicable disease.

Behavior modification restraints shall only be used when alternative methods are not sufficient to protect the patient or prevent injury.

There are two types of behavior modification restraint: psychiatric behavior modification restraint (“psychiatric restraint” used hereunder) and medical restraint. A psychiatric restraint is used for patients with signs of acute mental illness who appear to be a danger to themselves or others. A medical restraint is used for patients whose primary diagnosis is medical and for whom psychiatric hospitalization is not indicated.

At the time of the patient assessment the clinical staff member shall comment on the patient’s clinical condition, circulation, condition of limbs and attentions that should be given to the patient’s needs including hydration, elimination and nutrition. A report of the clinical assessment shall be recorded in the medical record. All restraints shall be released at least every two hours.

MEDICAL RESTRAINT WITH CONSENT OF PATIENT OR FAMILY

When other forms of medical restraint are to be imposed (for example, to restrain a confused patient from pulling at a nasogastric tube or intravenous line) a separate consent should be obtained when possible. In the case of a minor, consent should be obtained from the parents or guardian. In the case of a confused or comatose adult, consent may be obtained from the immediate family or conservator.

Steps to follow:

A physician’s order is
In addition to usual nursing evaluation and care, the patient’s needs including hygiene, elimination and nutrition shall be assessed at least every two
Supports shall be released at least every two

MEDICAL RESTRAINT WITHOUT CONSENT

It is not always possible to get the consent of the patient, family or conservator for the imposition of medical restraint. In such cases, the following procedures should be used:

Steps to follow:

An assessment of the patient, either by physician or a registered nurse, is required prior to instituting medical The assessment shall consider the use of less restrictive means to protect the patient and shall be documented in the medical record.
Medical restraint shall be imposed upon the order of a licensed independent employee. In an emergency, a registered nurse may initiate the use of a medical restraint (without consent). The emergency implementation shall continue beyond one hour only with a physician’s Verbal orders may be accepted.
All physician orders for medical restraint shall be time limited. PRN orders shall not be given or accepted. Upon expiration of the time-limited order, a physician must review and renew the
Devices to be used may include soft ties, posey vests, mittens, etc. Hard leather restraints shall not be used for medical
Any patient in medical restraint (without consent) shall be observed at intervals not greater than fifteen minutes. The exact time interval of observation may be more frequent and shall be determined by the clinical condition of the patient. Staff shall document these observations in the medical record at the end of each shift or more frequently as the condition of the patient or findings of the observation
An appropriate clinical staff member shall assess each patient in restraint at least every two At the time of the patient assessment the clinical staff member shall comment on the patient’s clinical condition, circulation, condition of limbs and attention should be given to the patient’s needs including hydration, elimination and nutrition. A report of the clinical assessment shall be recorded in the medical record.

SAFETY RESTRAINT

There are two types of safety restraint: adaptive support and patient protection.

Adaptive Support: Adaptive support is the use of mechanisms or devices intended to permit a patient to achieve maximum normative bodily functioning (such as the use of orthopedic appliances, braces, splints to prevent contracture or devices intended to give postural support).

Patient Protection: In the context of the policy, “patient protection” means the use of mechanisms intended to compensate for a specific physical deficit or prevent safety incidents not related to cognitive dysfunction (such as the use of bedrail with safety net to keep the patient from falling out of bed during sleep). [NOTE: The use of side rails alone is not considered This is a protective measure taken to keep all hospital patients from falling out of bed].

Steps to follow:

A physician’s order is PRN orders may be used.
In addition to usual nursing evaluation and care, the patient’s needs, including hygiene, elimination and nutrition, shall be assessed at least two
Supports shall be released at least every two

ROUTINE TREATMENT IMMOBILIZATION

Routine treatment immobilization means the use of mechanisms employed during medical, diagnostic or surgical procedures that are considered a regular part of such procedures (such as body restraint during general anesthesia, board immobilization of the site of intravenous therapy, immobilization during magnetic resonance imaging, etc). The patient’s consent for the procedure includes consent for necessary positioning and support. No separate order is required for such immobilization. Documentation of the immobilization is part of the documentation of the procedure itself.

GENERAL RESTRAINT GUIDELINES

Restraints shall not be ordered on a PRN

Restraints shall be only employed on the written order of a physician after personal evaluation of the patient’s physical and mental status. When the physician is not immediately available to assist the patient and make a determination regarding his/her need to be restrained the decision can be made by a registered nurse (RN), after careful assessment of the patient. All registered nurses shall be authorized to initiate or terminate the use of restraints as permitted by individual facility policy.

Evaluation of Patient

All patients using restraints shall be evaluated ongoing for continued use and need of restraints and shall be closely monitored, with the maximum time between observations being two hours.

Responsibilities of the Physician

The physician shall assess the patient to ascertain whether the restraint is justified. After consideration of the alternatives to restraint, an order for restraints must be written on the order sheet and should include:

Type of restraint; b) the starting and ending times; c) indications for use; and d) level/frequency of Verbal orders must be signed within 24 hours of implementation.

Responsibilities of Nursing

Documentation in the medical record shall include:

Time and type of restraint applied, noting skin condition and color
Reason for application of restraints
Time restraint are released/removed
Needs of the patient are addressed: ADLs, hygiene, fluids, and elimination
Prior alternatives considered and lack of effectiveness
Functional assessment

Monitoring of Patients in Restraints

All patients in restraints of any kind shall be closely monitored, with the maximum time between observations being two hours. Monitoring shall include condition of skin, observations that support adequate circulation, and observation for bruises, abrasions and lacerations.

Application of Restraints

Restraints must be carefully selected to be of appropriate size for the patient. Restraints are to be secured to the bed frame if the patient is in bed, never to the side rails. Use of restraints will be discontinued as soon as feasible.

When using wrist and ankle restraints, a finger’s width of space must be maintained between the skin of the wrist/ankle and the restraining device.

Vest Restraints are to be applied with the crossing ties in the back, as per the manufacturer’s directions. The patient must be able to maximally expand their chest wall without hindrance.

Soft leather restraints shall be used only for severely combative individuals.

Mittens are placed on the hand with the palm on the smooth side of the mitt. Mittens shall be removed every two hours to prevent contracture and to assess circulation.

END OF LIFE CARE

As with all patient care, end of life care must emphasize comfort, relief of pain and distress, with provision of physical and emotional support. The patient and family as desired must be included in making decisions based on their personal beliefs and values. Many people do not consider their personal definitions regarding the meaning and purpose of life until crisis, illness, and/or suffering force the awareness of life as a finite experience. Staff will act with awareness of the psychological and spiritual aspects of support and care, participating in an interdisciplinary team that “affirms life and regards dying as a normal process,” allowing the patient to die with dignity, while supporting the family during the final illness and their bereavement.

EMERGENCY CODES

In all cases, you should know what your department-specific responsibilities are. Each hospital has a disaster plan designed to direct how to carry out patient care during an internal and external disaster. Always be prepared to respond to the following situations:

Actual colors associated with specific emergency situations may vary from one client facility to another.

Code Red: Fire

Code Blue: Life Threatening situation

Code White: Life threatening situation for pediatrics Code Pink: Infant abduction

Code Purple: Child Abduction

Code Orange: Hazardous Materials Spill

Code Gray: Potential or real violence occurring in the facility Code Yellow: Bomb threat

Code Silver: Person with weapon or hostage situation

What is my role in a disaster?

If you are on duty when a disaster strikes, you have certain duties to perform:

Contact your Supervisor to find out where to report, or if you should continue your work assignment. Use pay phones if personal calls are necessary.

Wear your photo identification badge at all times. Your photo ID will get you through Police roadblocks.

Communication

The backup communication system includes: use of pay phones, use of fax machines, the distribution of 2-way radios to all patient care areas, and the use of runners in a disaster.

Supplies and Equipment

Backup supplies and equipment are available for disasters.

AGE SPECIFIC EDUCATION

As people age, they continue to experience physical and emotional changes. These changes are the result of many experiences and influences, including the genes we inherit and the lifestyles we choose. This review will outline the common changes that occur with age. It will provide some tips for helping you to remain sensitive to your patients.

Early Older Adulthood (60-75 years)

The average American lives to be 77.2 years old. Most adults will live well into early older adulthood. People in early older adulthood usually have at least one chronic disease. High blood pressure, arthritis, heart disease and cancer are the most common. Most people in this age group will need eyeglasses to read. Many will suffer from the loss of hearing associated with old age. Most women have gone through menopause. Many in this group require daily medications.

People in this age group are beginning to lose friends and loved ones to the inevitable process of death and dying. Hospitalization may cause fear as patients confront their mortality. Other concerns relate to limited income, since many have retired. Fear of permanent disability may be a worry for hospitalized patients in early older adulthood. Arthritis is common in this age group. Older adults often experience both chronic and acute pain. Consistent use of the pain scale will help older adults evaluate their pain.

You can help to create an environment that is friendly to aging patients. Adjust lighting to help patients better navigate the hospital environment. Provide extra time for learning to help older adults retain the information presented. Use verbal as well as written instruction to help them learn. Make sure the telephone is within reach, the call light is close by and that the room is clutter-free to promote safety and independence.

Middle Older Adulthood (75-85 years)

The average 75 year old has three chronic conditions and takes about 5 medications a day. Many in this group feel their body is “wearing out.” Almost all need glasses to see. Most have reduced hearing. Hospitalization can be frightening in particular ways for this group. Many have been struggling to live independently and most do not want

to be placed in a nursing home. As a result of these fears, patients may make health decisions that are not in their best interest, like ignoring signs of disease, because they are afraid of the consequences.

People in this group are vulnerable to depression, which may not be obvious to you. Assessment should include an evaluation of coping skills. Providing spiritual and social services can be especially helpful for this age group, since it can take time to get someone to open up about these issues.

Many patients in this group, like those in the previous group, live with arthritis pain. They may not talk about this pain unless you specifically ask about joint or muscle aches. Good pain management will help them participate in physical activities like walking and physical therapy.

Late Older Adulthood (85 plus years)

With age the number and severity of disabilities increases. Chronic diseases progressively get more severe and many patients are diagnosed with new illnesses. Most in this group are frail and increasingly dependent on other people to assist them with their daily tasks. Older adults fear changes to their routine, so a hospitalization can be particularly stressful.

Care for adults at this stage in life should focus on improving or maintaining function. Allow the patient to express needs and then tailor the care environment to meet those needs. Maintaining a user-friendly environment will promote independence.

Some older adults may not report pain due to fear of losing independence. Others have been living with arthritis and other pain so long that they no longer express their discomfort verbally. Look for nonverbal signs of pain including confusion, inability to ambulate, grimacing and decreased range of motion. Adults in this age group have decreased cough ability and decreased swallowing skills. Aspiration precautions should be used with all frail older adults. In this age group, skin becomes thin, patients become at risk for skin tears and pressure ulcers.

People of any age can become confused while hospitalized, but the likelihood is greater for older patients. Memory loss is not necessarily a part of the aging process so if you speak with someone who seems to be losing memory, that patient should probably be evaluated for underlying illness. In many cases, we can find a cause and a solution. Confusion that is normal at admission may develop into delirium. This condition may indicate an underlying illness, such as infection, that needs to be treated. Frequent reminders about time, date, season and weather may help older adults regain a sense of security and confidence.

Patients who have lived this long have experienced many losses. Life review is common in this group. Many will enjoy telling you about “how it used to be.” Reviewing the past can help people achieve closure. Pastoral care and social work can provide assistance to patients beginning this profound and affecting final journey.

EMERGENCY TREATMENT OF PATIENTS (EMTALA)

Federal law requires that a facility take care of any patients who need emergency care, regardless of their ability to pay for care. Unless the patient is pregnant and in labor, a facility can transfer the patient to a more appropriate hospital once the patient has been stabilized and once the facility has verified that the next facility has room.

CURE STAFFING, LLC provides special education with regards to this legislation. You should be aware that if someone asks you about getting emergency treatment for any condition, you should refer that person to the Emergency Department or call the house supervisor. It is against the law to send a patient away who seeks treatment for an emergency condition.

If you will be working in the ER, please make sure you receive and complete CURE STAFFING, LLC education module on EMTALA.

THE HIPPA PRIVACY RULE

A patient’s right of privacy and confidentiality is protected by law. No one, including spouses, friends, or attorneys, are permitted to review the patient’s medical record without prior written authorization, except as required by law (court order or subpoena) or other regulation.

Only information that is pertinent to a patient’s treatment may be disclosed to other employees. Only authorized hospital personnel have access to medical All requests for medical information must be referred to the Health Information Management department.
All Employees are required to sign a confidentiality statement upon

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

Confine discussion of patient care information to the patient care
Keep computer ID/passwords Unauthorized use of ID/passwords may be subject to disciplinary action.
Exit computer programs and log off before leaving the

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 (CLINICAL RESOURCES, LLC) 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.

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 and our own employees) 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’S PROTECTED HEALTH INFORMATION (PHI)

What information can be released only with the patient’s approval?

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 supervisors, unit secretaries, or other persons designated by department leaders.

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 employees 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 a 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
We provide the patient with an opportunity to object to the disclosure, and the patient does not
We infer from the circumstances that the patient does not object to the 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
Anyone who is not yet 18 years old, but has been legally married and is now divorced, or a widow or
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
Anyone who is not yet 18 years old, and is

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

BODY MECHANICS

With the use of proper body mechanics and ergonomics (the undersigning of the work place to fit the worker), most injuries are preventable. The following prevention points, when adhered to, will promote safety.

Lifting

Assess the situation and plan how to accomplish it before
Use the muscles of the legs, hips and arms – the strongest in the Keep a neutral spine.
Bend knees and hips avoid bending at the waist and lift with your legs, not your
Keep feet at shoulder width to provide a broad base of support.
Make sure the object is close to you, do not over reach, and carry the load close to
Avoid lifting higher than your
Push and don’t
Ask for

Sitting

Use chairs that provide support to the back, particularly the lower
Both feet should be able to rest flat on the
Avoid slouching, walk around and stretch occasionally, or change position often to avoid
Avoid twisting and over-reaching
Position yourself directly in front of your work and make sure your work is at eye-level to avoid neck

Standing

Stand close to your work area with your back erect, chin in, pelvis tucked under and knees slightly
Maintain a broad base with your feet and ensure even weight
Avoid prolonged positions and slouching – stretch

Back Care and Points for Prevention

Use good posture at all times and proper body
Change position
Exercise regularly and eat a well balanced diet to control your
Ensure enough rest at
Practice stress reduction techniques, such as yoga and
Ask for help in lifting or moving heavy

Keep work area safe – clean up spills, use wet floor signs, ensure no loose equipment, boxes or flooring, no loose power cables, close Notify appropriate personnel immediately, such as maintenance.
Wear shoes with non-skid
Walk and don’t
Report any accidents to staff, patients or visitors to supervisor
Monitor safety of patients
Ensure breaks are applied to wheelchair or bed when moving patients.
Adjust height of bed or table to waist/mid-to-upper thigh level when moving
Maintain ergonomics at all

UNDERSTANDING CULTURAL DIVERSITY

Ineffective culturally diverse relations can lead to prejudice, discrimination and racism. All three are due to a combination of factors.

Lack of understanding of culturally diverse groups other than one’s own.

Stereotyping of members of culturally diverse groups without consideration of individuals within the group. Judgment of culturally diverse groups according to standards/values of one’s own group.

Assignment of negative attributes to the members of other culturally diverse groups.

View of the quality and experience of other groups as inferior to those of one’s own group.

ETHNOCENTRISM

Because culture influences people so strongly including the way they feel, think, act and judge the world, it is typical for people to subconsciously restrict their view of the world to the point of inability to accept other cultures. This is called ethnocentrism.

Ethnocentrism can prevent one from accepting others and can lead to clash of values, shaky interpersonal relationships and poor communication.

APPROACHES TO MINIMIZE CULTURAL CONFLICTS IN THE MEDICAL SETTING

Deliver patient care that emphasizes the interrelationships among persons, cultures, health and medicine.

Facilitate the employees/clients relationship through the development of special resources such as translators and multicultural workforce.

Establish norms allowing family involvement in the healing process.

Identify and increase knowledge about non-traditional community resources such as local herbalist or specialty stores.

Explain community health practices to clients and assess their level of acceptance.

Include cultural diversity concepts in the education of medical personnel and the orientation of hospital employees.

CROSS CULTURAL COMMUNICATION FOR HEALTHCARE EMPLOYERS

In the business of healthcare, 90% of activities involve communication. Achieving effective communication is a challenge to managers even when the workforce is culturally homogenous. Communication is the exchange of meaning. Communication includes any behavior that another human being perceives and interprets. The meaning interpreted by the receiver may be different from the information being conveyed by the communicator. When translating meanings and behaviors, keep in mind that meaning is based on a person’s cultural background and is not

the same for each person. The greater the differences in backgrounds between the sender and the receiver the greater the difference in meaning attached to particular words and behaviors. Cross-cultural communication occurs when a person from one culture sends a message to a person from another culture.

There are ways to increase the chances of accurately understanding people who speak a different language.

VERBAL BEHAVIOR

Speak clearly and slowly. Repeat each important idea. Use simple sentences.

Use active verbs.

NON-VERBAL BEHAVIOR

Visual restatements (use pictures, graphs, etc.). Gestures (use facial and hand gestures).

Demonstration: Act out the themes. Pause more frequently.

ATTRIBUTION

SILENCE: When there is silence, wait. Do not jump to fill in the silence. The other person is probably thinking.

INTELLIGENCE: Do not equate poor grammar and mispronunciation with lack of intelligence. It is a sign of second language use.

DIFFERENCES: If unsure, assume differences rather than similarities.

COMPREHENSION

UNDERSTANDING: Do not assume that they understand. Assume that they do not. CHECK: Have the people repeat their understanding.

BREAKS: Take more breaks, second language comprehension is exhausting.

MOTIVATION

ENCOURAGEMENT: Verbally and non-verbally encourage and reinforce. REINFORCEMENT: Do not embarrass speakers.

STRATEGIES TO COMMUNICATE EFFECTIVELY

Strategies to overcome our natural parochial tendencies do exist. With care, the default option can be avoided. We can learn to understand and control our own cultural conditioning. In facing foreign cultures, we can emphasize description rather than interpretation or evaluation and thus minimize self-fulfilling stereotypes and premature closure. We can recognize and use our stereotypes as guides rather than rejecting them as simplification. Effective cross-cultural communication pre-supposes the interplay or alternative realities. It rejects the actual or potential domination of one reality over another.

Miscommunication is a frequent problem in healthcare organizations. The most obvious case is when the patient and the hospital personnel do not speak the same language. Also patients and staff may operate on different beliefs, values and/or clocks causing confusion and resentment for all parties.

TIME

When is the right time? People of different cultural background may give different answers to this question. Some people count time by a watch. They see time as money saved, spent, squandered. Others see only the rhythm or cycles of growth of people or things.

Make allowances for the fact that differences about time can be legitimate cultural differences. Do not jump to conclusions that others are irresponsible. Do not assume that you are stupid or insensitive because you don’t manage time the way they do.

If you cannot adapt to the other person’s sense of time, negotiate something that will work for both of you.

Remember that culture runs deep. It is one thing to make an agreement and another to create a habit. Changes here will take patience and persistence with others and yourself.

PERSONAL SPACE

How large space is depends on your background and culture. Getting too close may make another think you are intrusive, aggressive or pushy. Staying too far may give them the impression that you are cold, impersonal, afraid or disinterested.

Learn to be flexible

Know that others my feel differently about space. Stay put and let the other people adjust to where they feel comfortable with you.

TOUCHING

When people touch physically it means different things.

– I have power Hello/Goodbye

I want you to understand I like you

I want to congratulate

COMMUNICATE

When you communicate, be aware of:

Tone of voice Body posture Breathing rate Distance

Timing and pacing of speech patterns

DISCHARGE PLANNING

This fact sheet discusses a hospital’s responsibilities to assist with nursing home placement and right to challenge hospital discharge decisions. All of the information applies only to persons on Medicare, although there are similar rights under other health insurance programs.

WHAT IS HOSPITAL DISCHARGE PLANNING?

Hospital discharge planning is a service to assist patients in arranging the care needed following a hospital stay. Discharge planners help arrange services including home care, nursing home care, rehabilitative care, out-patient medical treatment and other help. Hospital discharge planning is usually handled by the hospital’s Social Services Department.

If a patient needs help arranging nursing home care, ask the nurse to contact the Social Work Department. If a hospital discharge planner does not contact the patient within a short time, contact the Social Work Department directly for assistance.

Discharge planning services in Medicare certified hospitals must meet the following standards: Hospitals must identify and evaluate persons who may need discharge planning assistance.

The evaluation must be done on a timely basis and must determine the need for services after the hospital stay

and the availability of these services.

The results of the evaluation must be discussed with the patient or patient’s representative.

If requested by the patient’s physician, the hospital must help develop and implement a discharge plan for the patient.

Discharge planning must be provided or supervised by a social worker, registered nurse or other appropriately qualified person.

If a patient needs nursing home care, the hospital’s discharge planner should provide information about local nursing homes and should help identify homes that have vacancies.

The hospital cannot force a patient to go to any particular nursing home or discharge a patient to a nursing home without the consent of the patient’s legal representative. If the hospital believes that a patient no longer needs hospital care and is refusing appropriate discharge, it must issue notice to the patient of its determination. This notice can cause the patient to become responsible for payment of continuing hospitalization, subject to the patient’s right to appeal. The notice and appeals rights are discussed below.

PATIENT RIGHTS AND RESPONSIBILITIES

CURE STAFFING, LLC employees must uphold their role as advocates and recognize the consumer/patients’ right to dignity, individual value systems, access to medical care and confidentiality. As advocates, nurses should be able to speak up to protect the health and safety of patients in their care without fear of retaliation.

THE PATIENTS’ BILL OF RIGHTS

The U.S. Advisory Commission on Consumer Protection and Quality in the Health Care Industry conceived the Patients’ Bill of Rights in 1998. Its purpose is to promote healthcare quality and support the public as they navigate through the healthcare system. The seven areas of rights and responsibilities are:

Information Disclosure: Patients have the right to accurate and easily understood information about theirhealth plan, healthcare professionals and healthcare facilities. If a patient speaks another language, has a physical or mental disability, or just doesn’t understand something, assistance must be provided so that the patient can make informed healthcare decisions.
Choice of Employees and Plans: Patients have the right to a choice of healthcare employees who can provide high-quality healthcare when
Access to Emergency Services: Patients who have severe pain, an injury, or sudden illness that convinces them that they are in serious danger have the right to be screened and stabilized using emergency services. These services should be provided whenever and wherever needed, without the need to wait for authorization and without any financial
Participation in Treatment Decisions: Patients have the right to know their treatment options and to take part in decisions about their care. Parents, guardians, family members, orothers that a patient selects can represent them if they cannot make their own
Respect and Non-discrimination: Patients have a right to considerate, respectful care from doctors, healthplan representatives, and other health care employees without
Confidentiality of Health Information: Patients have the right to talk privately with health care employees andto have their health care information protected. Patients also have the right to read and copy their own medical Patients have the right to ask that a doctor change their record if it is not accurate, relevant, or complete.

Complaints and Appeals: Patients have the right to a fair, fast, and objective reviewof any complaint they have against their health plan, doctors, hospitals or other healthcare personnel. This includes complaints about waiting times, operating hours, the actions of healthcare personnel and the adequacy of healthcare

THE SIX ETHICAL PRINCIPLES OF THE PATIENT’S BILL OF RIGHTS

The Patients’ Bill of Rights supports six basic principles of ethics:

Autonomy: Independence, self-direction, and freedom of When patients choose a healthcare employee, a healthcare facility or make decisions about treatment they are exercising autonomy. The Patients’ Bill of Rights supports autonomy by supporting the patients’ right to the choice of plan and healthcare employees that ensures access to appropriate healthcare. The healthcare professional’s duty is to support patients’ autonomy by ensuring that patients understand their treatment options.
Beneficence: Acts of charity or kindness. As a principle of ethical care, it means that treatment provided is for the good of the patient. The principle of beneficence means that patients should receive considerate and respectful care and have the opportunity to let healthcare workers know when they are not receiving the quality or value of care necessary. The employee should assist patients to voice their concerns through a complaint The principle of beneficence indicates that healthcare employees must provide competent care so the patient is safe and is treated with respect.
Confidentiality: Private or As a principle of ethical care, it means that information about patients and their care is protected and shared only with those who have the right or the need to know. The patient also has a right to know how others will use information about him/her, and who will receive that information. The principle respects that patients have the right to know about their treatment and to review their own records.
Fidelity: Faithfulness, as in a pledge or duty. As a principle of ethics, it means healthcare workers have a duty to be patients’ advocates and to protect patients’ rights. Fidelity is demonstrated by upholding the Patients’ Bill of
Veracity: As a principle of ethics, it means supporting both information disclosure and the right to make treatment decisions as described in the Patients’ Bill of Rights. Correct and truthful information helps patients to make informed choices.
Justice: Impartiality or fairness. As a principle of ethics, it means that all patients and their families are treated the same, without favoritism or discrimination based on race, color, gender, economic status, social status or any other personal All people have the right to fair and unbiased treatment.

INFORMED CONSENT

Informed consent is a process in which consent is obtained for a treatment or healthcare service when the patient knows about and understands the treatment, including its implications, benefits, risks and the alternatives. The patient must know they have the right to accept or refuse the treatment or service.

Before undergoing treatment, patients must give consent. Some patients may not be capable of giving consent because of age, mental competence or other possible factors. As such, a designated guardian (such as a parent, relative, friend or caregiver) represents that patient. Healthcare employees must ensure that the consent is “informed” and signed by either the patient or the guardian.

ADVANCE DIRECTIVES

Advance Directives: Documents written in advance of serious illness or injury, which states choices for medical treatment or names someone to make treatment decisions on behalf of that individual should he/she become unable to make or communicate such decisions. Advance directives promote an individual’s control over his/her own healthcare decisions. All patients entering the healthcare system must be given the opportunity to complete an advance directive document which will define the patients’ preferences in end-of-life decisions or at any time that they are unable to convey their own wishes regarding healthcare. Advance directives are voluntary and are

supported by the Patient’s Bill of Rights dependent upon state law. There may be two or more types of advance directives: the living will and the durable state of attorney/healthcare surrogate, as examples.

Living Will: A “Living Will” is a document that gives direction about the medical care, and limitations of medical care, desired by the patient when he or she is either in a permanent vegetative state with no hope of recovery or has an imminently terminal condition AND is unable to make his or her needs known.

Healthcare Surrogates/Durable State of Attorney: A document, which names someone to make medical care dictions for another, should that person become unable to make them for themselves. This document may include instructions about treatments the individual may or may not want, should he/she become seriously ill or injured.

Guidelines

Written information regarding advance directives may be available to anyone and most often is administered through the admission department, Social Work department, Pastoral Care department, or Medical Records department. It is the responsibility of the registered nurse to assure this documentation is available in the medical record.

Any competent patient may sign a living will or durable power of attorney for healthcare. Witnesses to a living will may not be:

Related to the patient by blood or marriage

The patient’s physician or nurse of the physician

A patient care employee working on behalf of the hospital if the employee is providing direct care to the patient or is involved in the hospital’s financial affairs

Be a patient of the hospital

Have a claim against the hospital

Witnesses to a durable power of attorney for healthcare may not be: The person appointed as agent in the document

A employee of health or residential care The operator of a community care facility

A employee or operator of a healthcare facility

Each adult (or their representative) who registers as an inpatient should be asked if they have a living will and/or durable power of attorney for healthcare. If the patient has a living will and/or durable power of attorney for healthcare, it shall be noted on the appropriate form and be made part of the medical record.

If a patient decides to revoke a written advance directive, the patient’s physician should notify the appropriate department or staff nurse. Said department shall explicitly mark the advance directive as being revoked and should clearly document the date of the revocation. A patient may revoke an advance directive at any time, regardless of the patient’s mental state of competency.

UTILITY MANAGEMENT

Utilities are basic building services. They include:

Electricity: Emergency Electrical Service is supplied from a hospital’s emergency powerhouse generators. When normal service fails, the generators support essential building systems, fire safety systems and pre- designated medical equipment. Most hospitals have an Uninterruptible Power Supply (UPS) System. It permits power sensitive equipment to function normally during transitions in power supply.

Water: Water is needed for drinking, cooking, bathing, cleaning, flushing the toilet, steam production, heating and cooling systems and cooling some clinical equipment.

Sewer: The Sewer Service allows for waste disposal from the facility.

Natural gas: Hospitals use natural gas as the primary fuel for the boilers to make steam and hot water. Natural gas also supports food service and lab processes. The hospital may have a backup diesel fuel supply to fire the boilers if the natural gas supply fails.

Piped Medical Gases: Medical gases include oxygen, nitrogen, nitrous oxide and carbon dioxide. They are supplied from the hospital medical gas storage systems. Medical Gases are distributed to specific outlets throughout the hospital. Medical air is also distributed via special outlets throughout the hospital.

Heating, Ventilation and Air Conditioning Systems (HVAC): The functions of HVAC include heating to support room comfort, ventilation to support air quality and infection control and cooling to support human comfort and in some locations, equipment function.

Fire Protection System: Fire protection systems are operated and maintained by the Hospital’s Physical Plant and Maintenance Departments. Smoke detection systems are designated to operate at all times. Fire sprinklers turn on when a defined temperature is reached. Fire alarms are triggered by either the smoke detection of fire sprinkler systems. They produce audible alarms and visual strobe signals.

Pneumatic tube systems Telephones

Computers

Code White: Utility Failure

The purpose of a Code White is to alert employees to a hospital-wide failure of one or more of the above utility systems. All departments and units have Utility Failure Plans that identify what action you need to take in the event of one or more utility failures. Make sure you know the location of the Utility Failure Plan and contact the hospital Safety Management, Department Manager or Safety Coordinator if you have any questions.

PATIENT EDUCATION

Patient/family teaching has been recognized as an essential activity fundamental to every nursing, medical and allied specialty. The growing awareness that individuals can be more responsible and participate in their own health is prompting the employees, policy makers, regulatory agencies and payers to strengthen patient and family education in every phase of patient care.

Patient and family education is interactive and appropriate to the patient’s age and length of stay. It includes, but is not limited to:

Helping the patient adopt or function more independently. Information about access to additional resources.

When and how to obtain further treatment.

Safe and effective use of medication and medical equipment. Potential drug – food interaction.

Nutrition information/counseling on modified diets as appropriate. Rehabilitative techniques, including activity and assistive devices.

Maintenance of good standards for personal hygiene and grooming, including brushing teeth, bathing, caring for hair and nails, and using the toilet.

Information on patient/family responsibilities for the patient’s healthcare need (e.g. self-care, signs and symptoms to report, etc.) including the knowledge and skills to carry out these responsibilities.

How is Patient/Family Education Implemented?

Patient teaching is based on assessed learning needs.

Assessment includes consideration of cultural and religious practices. Barriers to learning are identified.

Age-appropriate teaching is matched with developmental stage.

Education is provided by the appropriate healthcare professionals (Pharm D, MD, RN, LCSW, RD, RCP, RT, OT, SLP and other disciplines involved with the patients care).

Educational materials (video and print) utilized are medically current, instructionally correct, cost effective and developmentally coordinated through the Patient Education Committee.

The Employees Role in Patient Education

Asses/re-assess patient including cultural and religious beliefs Identifies learning barriers

Identifies learning need Provides necessary information

Discusses plan of care for patient with patient/family and explains roles of interdisciplinary team Explains treatment plan, verifies patient’s knowledge about procedures

Explains medication in collaboration with clinical pharmacist as necessary or upon request Provides discharge instructions such as:

Follow up appointment with physician
Danger signals and symptoms to report
Medications, food-drug interactions Provides patient with education materials Discusses appropriate pain management

Discusses return to work and driving

MEDICAL EQUIPMENT MANAGEMENT

The Safe Medical Devices Act, in an effort to monitor incidents involving equipment, requires all healthcare personnel to follow up on problems or incidents involving equipment promptly. If a piece of equipment does not function properly:

Take it out of service and generate a work order for its repair.
If the item has been involved in an incident causing serious illness or injury to anyone at the client facility, the equipment should be isolated and saved for Risk Management to
Fill out an incident
Report the incident immediately to Risk Risk Management staff will evaluate the incident for reporting to the FDA and manufacturer.

In order to provide quality patient care with the least amount of risk possible, all facilities have developed an Equipment Management Program. All equipment (clinical or non-clinical) must be inspected by the facilities’ Management Department prior to its initial use. “Equipment” is defined as all equipment, fixed or portable, that is used for the diagnosis, treatment, monitoring or care of patients, which could pose a physical and/or clinical risk to a patient and/or operator during use.

All employees who operate, monitor or maintain clinical equipment must be trained to do so safely.
Employees are required to be familiar with the clinical equipment inspection stickers affixed to each piece of
All equipment should have the facility’s inspection sticker on it that indicates the equipment was inspected, the equipment passed the electrical safety test and how frequently the equipment is

CLINICAL EQUIPMENT

In order to provide quality patient care with the least amount of risk possible, the facilities management department has developed a Clinical Equipment Management Program.

Clinical equipment is defined as all equipment, fixed or portable, that is used for the diagnosis, treatment, monitoring or care of patients, and which could pose a physical and/or clinical risk to a patient and/or operator during use.

All equipment (clinical or non-clinical) must be inspected by the facility’s management department prior to its initial use.

Many different types of clinical equipment are used to help treat patients in your facility. Some of these are:

Ventilators

IV (Intravenous) pumps Glucose-testing monitors Cardiac monitors

Enteral pumps Radiant warmers Hypothermia blankets

EKG (Electrocardiograph) machines Electric beds

Clinical equipment can be an important part of a patient’s treatment, but there are things that can go wrong. There are three types of risk factors or potential problems that can arise in the use of clinical equipment:

Malfunction
Improper use
Damage to equipment

It is important that you do not use any equipment that you have not been trained to use. You need to know the following information about any equipment you use:

How to operate it
The purpose of the equipment and the intended results
Monitoring and observation activities – what to observe, frequency precautions, and adverse reactions
Contraindications – warning signs
Troubleshooting – including how to respond to alarms
Care and maintenance
Backup procedures and equipment

In addition to proper training, there are other things you can do to help ensure that equipment functions properly and safely:

Teach patients and their families about any equipment, including how it works, its purpose, safety precautions, signs of problems, what to do if problems arise and when to notify staff.
At the first sign of a malfunction, take equipment out of Label it so that others do not use it, and follow the policy of the client facility for repair.
If equipment has a battery backup, keep it plugged in whenever possible so that it stays fully
Remove equipment from rooms when it is no longer needed to prevent it from being damaged and to make it available for others to use. Follow the policy of the client facility to prepare the equipment for use with another patient, including disinfecting, cleaning, re-inspecting and recalibrating where
If any equipment is dropped, take it out of service Even though it may seem intact, there might have been damage to some components that could pose a safety hazard.
Cellular phones have been found to interfere with some electrical equipment. The client facility may have a policy that bans cell phones in the facility or within certain

PAIN MANAGEMENT

Pain management is a complex, subjective and highly unpleasant sensory or emotional experience caused by a physical, neurological or emotional response to noxious stimuli. Pain can be acute or chronic in nature. No two

people experience or express their pain alike. The most reliable indication of the existence and intensity of pain is the patient’s testimony, and its measurement is considered the fifth vital sign. Many factors can influence the severity of pain including the personal meaning of pain, additional anxiety, tension, depression, fatigue and sleeplessness. Chronic pain is the most frequent cause of reduced quality of life. Untreated acute pain in hospitalized patients can cause longer hospital stays, delayed healing and increased fear and anxiety.

When you are providing care, moving, lifting a patient or performing procedures, ask the patient if they are having pain. Do not assume a patient is not in pain just because he or she doesn’t speak up. Often, careful moving or re- positioning may help.

Patient pain level will be assessed using ETRMC’s Universal Pain Assessment 10-point scale. Pain management includes main assessment, planning, intervention, reassessment of patient responses to pain management measures, and education of patient and family regarding pain management. Patient assessment, reassessment and education must be documented on the medical record.

Pain control measures fall into two categories:

Pharmacological interventions
Non-pharmacological interventions

Pharmacological interventions are pain control methods that use medications. These include:

Opiates, such as morphine and
Non-opiates, such as
Adjuvants, a variety of drug types that are usually used to supplement opiates or non-opiates.

Non -pharmacological interventions are alternative measures that do not use drugs. The methods that are selected will depend on the needs of the patient. Non-pharmacological pain management methods include:

Relaxation and distraction
Physical

Relaxation and distraction techniques

These techniques work best if they are practiced before they are needed for pain relief. They include: Deep breathing (with focus on breathing techniques)

Listening to music Guided imagery Biofeedback

Hypnosis

Physical Interventions

Physical interventions that can help in the treatment of pain include: Massage

Exercise (especially for chronic pain)

Application of heat or cold (not longer than 20 minutes; be careful of extremes of heat or cold that could damage tissue)

Acupuncture Position change

TENS unit (trans-electrical nerve stimulation therapy)

A TENS unit controls pain by stimulating the nerves at the pain location and helping to block pain signals.

When using drugs to control pain, the best strategy is to use the least strong drug which still gives adequate pain relief. If the intervention does not relieve the pain, it may require:

An increase in dosage An increase in frequency

An increase to the next level of drug

Usually, pain control measures begin with non-opiates (non-narcotic) drugs. Non-opiates, such as acetaminophen (Tylenol) are generally available in both over-the-counter and prescription strengths. Non-opiates are usually taken orally or by suppository. The most common side effect of acetaminophen is hepatotoxicity (liver involvement). This is most common with an overdose.

Non-opiates also include NSAIDS (non-steroidal anti -inflammatory), such as Advil and Motrin. These may also be used in combination with opiates. The most common side effects of NSAIDS are:

Gastric irritation Prolonged bleeding time.

The name, opiates, refers to drugs that are based on opium. They can be either natural or synthetic. Opiates are used for moderate to severe pain.

Pure agonists

One class of opiates, known as “pure agonists,” which refers to their specific mechanism for pain relief, includes:

Morphine

Hydromorphone (Dilaudid) Fentanyl

Codeine

Increased dosage of pure agonists provides increased analgesia (pain relief) and side effects. Side effects include: Euphoria

Sedation Constipation Nausea Vomiting Itching

Urinary retention Hypotension

Respiratory distress

Over time, patients may develop a tolerance for opiates, meaning they require higher dosages to achieve the same pain relief. However, the usual reason for increasing dose is because of disease progression. Patients who have received opiates for a long period of time may experience withdrawal when the drug is stopped. This means that patients should not be taken off the drug suddenly but should gradually decrease the drug level over several days.

There are two important things to remember about opiates and other pain drugs:

Drug-seeking behavior is NOT a sign of
Drug-seeking behavior IS a sign of inadequate pain

Other opiates

Other types of opiates such as nalbuphine (Nubain) and butorphanol (Stadol) provide less analgesia, but also fewer side effects. There is also a limit to their effectiveness. After a point, higher doses do not increase analgesia. These drugs are sometimes used to reverse analgesia and side effects caused by pure agonists.

Administration of opiates

Opiates can be given orally. As pain levels increase, they are administered in other ways, which deliver a higher level of pain relief:

Sublingually (under the tongue)

Bucally (placed in the cheek area if patient unable to swallow) Dermal patch (for continuous release)

Intravenous (IV) by continuous infusion or intermittent dosage Patient-controlled analgesia (PCA) using intravenous delivery Intramuscular or subcutaneous injection

Suppository

Adjuvants

Other drugs that may help in pain control are called adjuvants. These include:

Corticosteriods Antidepressants Local anesthetics Anticonvulsants.

These drugs are used to:

Enhance the effectiveness of a primary analgesic
Limit the side effects of a primary analgesic (usually an opiate)
Treat concurrent symptoms that increase pain
Provide analgesia for certain types of pain that are not relieved by opiates

RADIATION SAFETY

Time, distance and shielding prevent unnecessary exposure to radiation. Spend only the needed time in the radiation area, keep your distance from the source of radiation and use proper shielding when radiation equipment is being used. To do this, routine testing and evaluation of equipment, procedures, personnel monitoring and continuing education are critical. Those involved with radiation need to attend an annual refresher course on radiation safety. The classes are listed in the Memorial Academy catalog.

Always observe radiation-warning signs.

Enter areas employing radioactive sources only for authorized and necessary purposes.

Do not attempt to clean up spills on floors and counter tops labeled “Caution: Radioactive Materials.” These may be radioactive and require special clean-up procedures.

FALL PREVENTION

Most facilities have developed a Fall Prevention Program to identify those patients who are at highest risk to fall, with the intent of reducing injuries.

A patient fall may also result in: Longer hospital stays

Permanent injury

Disability Death

There are things you can do to help prevent patient falls:

Orient patients to their surroundings.

Show them how to use the call light and explain how and when to get assistance. Ensure good lighting in rooms and bathrooms.

Keep beds at a low height.

Make sure path to bathroom is clear.

You can also learn to recognize patients who are at risk for falls. These include: Infants and young children.

Older adults.

Sedated patients.

Infants and young children

These patients are immature, and they often do not understand what they should or should not do. Their motor skills are still developing, so they can fall easily. They are also full of curiosity.

Older adults

The majority of falls occur in patients over 65 with the highest number in the 80-89 age group. These patients may be unsteady on their feet. They may also have problems with hearing and eyesight.

Sedated patients

Patients who are sedated may not be able to understand instructions. They often cannot recognize dangers and may become confused.

Patient education can also help prevent falls. Teach patients and their families about:

The hospital environment.

Potential hazards.

Equipment being used.

In addition to patient falls, there are other types of injuries. These include injuries from misuse of equipment and burns from hot liquids. These injuries are less frequent than falls, but all have one thing in common:

Most injuries can be prevented!

There are several things you can do to help prevent injuries:

Identify and correct safety
Take care in using
Follow the standard of care when doing procedures and

Identify and correct safety hazards

Slips, such as water on the floor, should be cleaned up. Trips, or obstacles, should be removed.

Sharps, such as needles or glassware, should be properly disposed of.

COMPLAINT RESOLUTION (EMPLOYEE AND CLIENT FACILITY)

A Service Complaint is any complaint and/or concern from one of our valued employees and clients regarding a situation or incident that results in dissatisfaction of that employee or client. The purpose of our complaint policy is:

To have a positive impact in improving service and satisfaction.

To understand the causes that underlie a complaint and to focus on making changes to systems and processes to reduce the probability of a similar complaint in the future.

To prevent potentially compensable events and to protect corporate financial resources potentially jeopardized by customer dissatisfaction.

To analyze and trend data to identify opportunities for improvements in organizational performance.

All CURE STAFFING, LLC employees and internal office staff are entitled to full and equal accommodations, advantages, facilities, privileges and services provided by the company.

CURE STAFFING, LLC accepts complaints from persons who believe that they have experienced a violation of their rights. The following guidelines shall be followed in resolving complaints.

Complaints must be filed within 30 days of the alleged act.

The complaint is the written document that describes the occurrence and why the person filing the complaint believes the action or incident was in violation of his/her rights.

An individual seeking to file a complaint needs to contact CURE STAFFING, LLC management. An intake interview or phone interview will be conducted with the complaining party.

After a careful screening process, the complaint is investigated to determine if there is sufficient evidence to support the allegation. The complaint documentation must contain a claim, which constitutes a violation of the complaining person’s rights.

A complaint may be settled at any time after it is filed. Opportunities will be given to all parties involved to ask questions, provide information, and suggest witnesses in order to resolve the complaint.

As the investigation proceeds, individuals will be interviewed and pertinent records and documents will be reviewed.

The person filing the complaint must cooperate fully by providing accurate information and by supplying documents to support the allegations.

All information gathered in the course of an investigation is subject to disclosure unless otherwise protected by the individual’s right to privacy (e.g. medical records).

If the complaint is substantiated, a reconciliation conference to settle the complaint will be scheduled. Settlement terms may require:

Restoration of previously denied
Compensation of any out-of-pocket losses incurred by person filing complaint
Correction of other harm(s) resulting from the violation(s).
Modification of practices that adversely affect persons protected under law
Other actions to eliminate the effects of violation of

Our goal is to always provide you with a consistent level of service. If for any reason you are dissatisfied with our service, we encourage you to contact the CURE STAFFING, LLC management to discuss the issue. CURE STAFFING, LLC has processes in place to resolve complaints in an effective and efficient manner. If the resolution does not meet your expectation, we encourage you to call the CURE STAFFING, LLC corporate office at (800) 590- 1690. A corporate representative will work with you to resolve your concern. Any individual that has a concern about the quality and safety of patient care delivered by A CURE STAFFING, LLC employee, who has not been addressed by CURE STAFFING, LLC management, is encouraged to contact the Joint Commission.

CURE STAFFING, LLC demonstrates this commitment by taking no retaliatory or disciplinary action against employees when they do report safety or quality of care concerns to the Joint Commission.

HUMAN RESOURCES: APPLICATION PROCESS

In keeping with our standard of excellence, CURE STAFFING, LLC’ initial application process and ongoing quality assurance initiatives are designed with the primary goal being to provide the highest quality of professionals possible. Our objectives include:

To recruit professionals who are dedicated to quality care with proven skill histories.

To provide an orientation for each physician so that he/she may perform his/her work in a safe and effective manner.

To provide consistent opportunities for staff education via our website that has been equipped with educational links.

To monitor the quality of performance through regular assignment evaluations.

To work closely with clients while modifying our service concepts to meet their needs.

Each applicant undergoes a stringent screening process to verify skills and commitment to professional excellence.

BACKGROUND CHECKS:

CURE STAFFING, LLC performs criminal background checks on applicants, which includes at a minimum a felony and misdemeanor search in their state of current residence, and may also include states and counties of residence/employment for the previous 7 years. Criminal background checks can also be conducted during post assignment based upon a reasonable suspicion of criminal activity. In addition, CURE STAFFING, LLC verifies that applicants are not included in the Office of Inspector General’s (OIG).

LICENSE/CERTIFICATION/EDUCATION VERIFICATION

At a minimum, applicants are required to provide copies of professional licenses to practice their profession in the state of the assignment and any other professional certifications required for the practice of their specialty. CURE STAFFING, LLC conducts primary source verification of all professional licenses in all relevant states with the appropriate licensing bodies to verify issue date, expiration date, active status of license and to determine if a license has ever been suspended, revoked, restricted, reprimanded, sanctioned or disciplined. Any disciplinary action on a professional license can be terms for ineligibility to work with CURE STAFFING, LLC and falsification of any documentation will render applicant completely ineligible for placement with CURE STAFFING, LLC

Positions that require a specific educational requirement and/or certification must have verification of such. Where education and licensure are required, but the license may not be obtained without meeting the education requirements, it is not necessary to confirm education, but only to verify the license. (A specific example would be an RN where state licensure is required and completion of an approved nursing program or completion of a certain number of continuing education units. In this case, the individual may not obtain state licensure or renewal without completion of an approved program or continuing education units, therefore only license verification would be required. If the position requires state licensure as an RN and a Master’s degree, then both the licensure and the education would need to be verified). It is the employee’s responsibility to maintain a current valid license. Failure of the employee to maintain a current valid license will result in removal from duties and progressive discipline. Employees are required to immediately notify CURE STAFFING, LLC if a license/certification is suspended or revoked or if a malpractice case is pending or been settled against the employee.

It is the employee’s responsibility to maintain a current valid license. Failure to do so will result in removal from duties and progressive discipline. Employees are required to immediately notify CURE STAFFING, LLC if a license/certification is suspended or revoked prior to education.

REFERENCE CHECKING

CURE STAFFING, LLC verifies at least one reference from previous employers or from clinical peers that may provide information related to the applicant’s knowledge and applied job skill proficiency or confirm dates of employment

PRE-EMPLOYMENT SKILLS ASSESSMENT/COMPETENCY EXAMINATIONS

To ensure that work is performed safely and efficiently in the hospital setting, all applicants are required to complete a competency self-assessment. All competency assessment tools are maintained in their personnel file.

CURE STAFFING, LLC’ placement department shall assess applicant competency through review of all competency self-assessments, competency examination, references and in-person or telephone interview. A position description that specifies job duties, expectations, qualifications and special requirements commensurate with the position are reviewed with each applicant as well.

ADDITIONAL QUALIFICATIONS OF PROVIDER PERSONNEL

Applicants must be a graduate of an accredited medical school, nursing school, or appropriate certification
All applicants must possess at least one year’s full-time experience within the last three years in an Acute General Care Hospital, which experience shall be documented by reference in personnel file
All applicants must be ACLS/BLS certified
Applicants working in ER, PEDS and PACU must be PALS certified
Applicants working in NICU and Nursery must be NALS/NRP certified
Applicants working in L&D must be NALS/NRP certified and also be certified for Advanced Fetal Monitoring
Applicants working in Post-Partum or any OB/GYN area must be NALS/NRP certified

HEALTH SCREENING

Applicants may need to go through a screening process when specified in the written agreement between CURE STAFFING, LLC and its clients, to demonstrate that they are free from communicable disease and are free from any health impairment that is of potential risk to the patient, caregiver, other employees, or that may interfere with the performance of duties. All applicants may need to provide:

Clearance for Work: are only required when specified in the written agreement between CURE STAFFING, LLC and its clients. If required the applicant will Submit a written clearance for work conducted within the last twelve months prior to hire date. The Clearance for Work shall include whatever specifications are in the written agreement between CURE STAFFING, LLC and its clients, which may or may not include a medical history, physical examination, laboratory work as indicated, and a written report to indicate that the employee is physically and medically qualified to perform the duties to be assigned. In addition, annual physicals are required thereafter Tuberculosis Test: are only required when specified in the written agreement between CURE STAFFING, LLC and its clients. TB tests if required may need to be conducted within the last twelve months prior to hire date. The TB test may show a negative result. Applicants who test positive as a tuberculin reactor are required to submit documentation of a negative chest x-ray showing no abnormalities and/or provide proof of prophylactic antibiotic therapy. One clear chest x-ray is required for individuals following a positive skin test or documented history of positive skin test, repeat chest X rays thereafter are not required for those who present positive skin results, repeat chest x rays are only required when specified in the written agreement between CURE STAFFING, LLC and its clients. Applicants with positive TB results must also complete a TB questionnaire upon hire and annually thereafter.

Vaccinations: are only required when specified in the written agreement between CURE STAFFING, LLC and its clients. If required the applicant will Submit proof of exposure to or immunization to Rubella, Rubeola, mumps, and Varicella zoster.

Drug Test: are only required when specified in the written agreement between CURE STAFFING, LLC and its clients. If required the applicant will Submit 10 panel drug screen for amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, meperidine, Methadone, Opiates, Phencyclidine, Propoxphene Hepatitis B: are only required when specified in the written agreement between CURE STAFFING, LLC and its clients. Must provide proof of vaccination to Hepatitis B or sign waiver/declination. The Hepatitis B vaccine and vaccination series shall be made available at no cost to all employees. Employees shall not receive the vaccination if they have previously received the Hepatitis B vaccination series or have antibody resting which reveals the employee is immune or for whom the vaccine is contraindicated for medical reasons.

for medical reasons.

*** Please note that random drug screening and drug screening for cause may occur at any time.

INTERVIEW AND EDUCATION

The CURE STAFFING, LLC recruiters screen the applicants. Screening is designed to determine if the applicant’s knowledge, competence and skills in specified areas of expertise match what is requested by client facility. Screening is based on actual detailed requests solicited by the account manager from each client facility.

Applicants are also provided with current information on a variety of topics, including, but not limited to: Medication: administration, safety and prevention of errors

Abuse: Child, elder and reporting, SCAN Sexual and domestic violence, assault, rape Drugs in the workplace, workplace violence

Safety: electrical, fire, environmental, safety signals Hazardous materials

Infection control and CDC Hand Guidelines OSHA and bloodborne pathogens

Dress code and fingernail policy

JCAHO education, National Patient Safety Goals, List of Abbreviations/Do-not-use Patient rights/advance directives

Emergency preparedness End-of-life care

Code situation policies

Sentinel event policies and procedures Restraints

Age-specific education HIPAA

Pain Management Body Mechanics

Documentation: of patient care, transcribing of physician orders Conscious Sedation

Patient safety and education Fall prevention

CURE STAFFING, LLC requires the review of the above information when applicable. The completion of the review is verified and documented upon the applicant signing the Employee Handbook Acknowledgement Form. The Employee Handbook Acknowledgement Form will be retained in the employee’s personnel record.

Maintaining Personnel Files

All personnel files are maintained by CURE STAFFING, LLC, which monitors relevant requirements and expirations of any requirements. Requirements are kept current through daily alerts of soon-to-expire or expired requirements.

Orientation

CURE STAFFING, LLC will provide all new employees with an orientation to the company’s policies and procedures. Each Employee will receive a Employee Handbook.

Some facilities require some form of orientation. The amount of time required by each facility varies. Some facilities require computer training classes and orientation prior to the first shift worked. The account manager will explain required orientation to all employees prior to scheduling their first shift with a facility. Orientation time worked at the facility may be paid or unpaid at the rate specified by the client facility.

Some facilities require that the prospective employee at CURE STAFFING, LLC complete their specific pre- employment orientation “packets” before the first shift is worked, and there is no pay for this required activity.

The first time you visit a facility the following guidelines should be followed:

Report on time for orientation (it may vary for each facility).
Carry photo ID for evidence of identity when reporting for assignment
Take your nursing license and certifications with you
Report to the appropriate supervisor
It is expected that the healthcare employee locate and comply with the facility policy and procedures manual, locate fire pulls, crash cart, room, linen cart, and appropriate exits before your shift starts.
Always dress in proper attire when working at the Orientation is only paid if approved by the client facility and when facility staff has properly verified the time.

Occasionally, A CURE STAFFING, LLC employee may show up early as directed for orientation shift and no one is available for orientation. Please take it upon yourself to utilize this time to become familiar with the floor layout and the location of vital items you may need in order to function effectively on your shift. It will be to your advantage to have knowledge of the location of the policy and procedures manual, fire pulls, crash cart, med. room, linen cart, and appropriate exits prior to the onset of your shift.

CURE STAFFING, LLC attempts to provide a comprehensive and thorough pre-employment orientation and in service training that reflects current compliance and promotes safe healthcare delivery. The program includes, but is not limited to the following:

Age Specific

Disaster Preparedness Cultural Diversity Environmental Safety Hazardous Chemicals HIPAA

Infection Control/Bloodborne Pathogens Abuse

Domestic Violence Ethics For Healthcare

2008 National Patient Safety Goals Pain Awareness

Patient Restraints Patient Rights

Workplace Violence

PERFORMANCE IMPROVEMENT AND EDUCATION PROGRAM

The purpose of performance management is to enhance the knowledge, skills and behaviors of all employees. This is accomplished by providing a means to measure a employee’s effectiveness on the job; identifying areas of development where employees are in need of training, growth, improvement and/or additional resources; maintaining a high level of motivation through feedback with management and establishing individual performance goals.

INITIAL ASSESSMENT

Upon initial contact, CURE STAFFING, LLC will have an specialist contact a new applicant to inform him or her of the competencies that must be met. For the initial assessment, the competency self-assessments will serve as the baseline assessment.

ON-THE-JOB ASSESSMENTS

CURE STAFFING, LLC has implemented a continuous, systematic and coordinated approach to measure and assess client feedback on all agency personnel being utilized. The following assessments are utilized to ensure employee performance and customer satisfaction:

Initial Shift: The chief of staff or hospital designee at the completion of the first shift assesses employees. Assessment focuses on professionalism, safety, patient care, compliance, assessment, planning and documentation.

Random: The chief of staff or hospital designee assesses employees at random. Assessment focuses on professionalism, safety, patient care, compliance, assessment, planning and documentation.

Any unsatisfactory scores will be reviewed and discussed with each employee and CURE STAFFING, LLC President/CEO will recommend methods for improvement. For more information on CURE STAFFING, LLC Progressive Discipline Program, please see Progressive Discipline Program.

PERIODIC ASSESSMENTS

CURE STAFFING, LLC conducts ninety-day and annual assessments of all employees. The CEO evaluates employee job performance based on the functions and standards as outlined in the assignment requirements. Together, the CEO and employee will identify strengths, accomplishments and areas for improvement and development.

EMPLOYEE PERFORMANCE REVIEW

Every provider on assignment with CURE STAFFING, LLC or who has worked in the last year, will have an annual performance evaluation carried out by the account manager or designee on or around your anniversary date.

CURE STAFFING, LLC will attempt to obtain feedback from client representatives regarding clinical staff competence and ongoing performance of professional provider. Unfortunately, some clients will not cooperate with CURE STAFFING, LLC in this regard, so CURE STAFFING, LLC follows a competence by exception philosophy. In the absence of client feedback, unless there is evidence of a performance issue, we assume that our providers are meeting performance expectations.

Feedback from our clients regarding clinical and/or professional performance is addressed with our providers immediately. Follow-up with our clients is completed within an appropriate time frame.

Every provider associated with CURE STAFFING, LLC will complete annual skills checklists, which apply to his/her specialty area of work.

When training needs are identified, an opportunity to complete the training will be provided at the earliest possible occasion.

The company assesses aspects of the provider’s competence during initial contact, at performance evaluation and as needed or required by state licensing agencies, to ensure that providers have the skills or can develop the skills to perform and continue to perform their duties.

President/CEO is responsible to ensure that any areas of development are identified and addressed.

EDUCATION

Ongoing continuing education is the responsibility of CURE STAFFING, LLC employees to ensure that all clinical staff has a current knowledge and practice base. CURE STAFFING, LLC maintains information on available resources for BLS, ACLS, PALS, etc. The following online education programs are also available for continuing education; however this is not an inclusive list of available resources: www.americanheart.org. Evidence of continuing education is part of the ongoing competency assessment program and will be maintained in your personnel file. Please provide CURE STAFFING, LLC with copies of your continuing education certificates.

CONSEQUENCES OF POOR PERFORMANCE

CURE STAFFING, LLC has established workplace standards of performance and conduct as a means of maintaining a productive and cohesive working environment. A positive, progressive approach is taken to solve discipline problems, which appeals to a provider’s self respect, rather than create the fear of losing work. Our system emphasizes correction of the offensive behavior. If correction of the problem and sustained improvement does not occur, professional disassociation with CURE STAFFING, LLC may result.

The following may be grounds for disciplinary action, up to and including termination: Accepting an assignment and not reporting to work or not notifying CURE STAFFING, LLC

Unauthorized possession, use, or removal of property belonging to CURE STAFFING, LLC or any client

of CURE STAFFING, LLC

Failure to comply with all safety rules and regulations, including the failure to wear safety equipment when instructed.

Reporting to work under the influence of alcohol, illegal drugs, or being in possession of either item on company premises or work sites of client facilities.

Lewd, unacceptable behavior, possession of weapons or explosives and provoking, instigating or participating in a fight is prohibited at CURE STAFFING, LLC and/or at its clients’ facilities.

Violation of the harassment policy.

Insubordination of any kind is grounds for immediate termination. (For example, refusal to carry out your supervisor’s reasonable works request).

Leaving an assignment without notice i.e. patient or assignment abandonment.

Falsifying records, including but not limited to time records or claims pertaining to injuries occurring on company premises or work sites of client companies or personnel records.

Disclosing confidential information without authorization. Disregard for established policies and procedures.

Excessive cancellations or tardiness. Discourtesy to clients or fellow employees.

REPORTING ANY ISSUES

ASSIGNMENT ISSUES:

Issues may arise while a employee is on assignment for CURE STAFFING, LLC As a representative of CURE STAFFING, LLC and as a responsible and mature medical professional, it is important that professionalism and integrity are maintained throughout the conflict resolution process and that above all patient safety is the priority.

Common issues that may arise are:

Conflict with hospital staff

Conflict with patient and/or patient family members Unfair patient assignments, or “dumping”

Assignment to a unit for which you are incapable of safely performing your duties

In the event of any of the above events:

Contact the nursing supervisor for
If escalation is required, contact CURE STAFFING, LLC for
Complete an incident report at the (if required)
Complete an incident report at CURE STAFFING, LLC (if required)

BLOOD BORNE EXPOSURE

In the event of exposure to any bloodborne pathogens:

Adhere to appropriate decontamination procedures
Contact the medical supervisor
Inform your workers comp carrier and CURE STAFFING, LLC immediately of exposure

CLINICAL INCIDENTS AND SENTINEL EVENTS

As a healthcare employee, it is your duty and responsibility to promptly report any unsafe condition, sentinel event or unusual event that can result in a sentinel event. Everyone is expected to participate in maintaining a safe environment for patients, visitors, physicians and their coworkers. This means taking an active role in reporting any and all unsafe conditions, unusual or sentinel events. All such events should always be reported immediately to your supervisor and CURE STAFFING, LLC

As a healthcare employee, you must recognize the importance of following effective procedures and are encouraged to speak up if something has compromised or might compromise patient safety and quality.

A clinical incident is any event or series of events that results in or has the potential to result in an adverse patient outcome. Healthcare employees should notify CURE STAFFING, LLC of any clinical incidents that occur while on assignment, regardless of any adverse outcomes.

A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase “or the risk thereof” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.

Such events are called “sentinel” because they signal the need for immediate investigation and response.

EXAMPLES OF CLINICAL EVENTS

Omission of treatment Deviation from policy Medication errors Improper equipment usage IV or Blood complications Patient fall

Inaccurate clinical assessment Patient or physician complaint

EXAMPLES OF SENTINEL EVENTS

Any patient death, paralysis, coma or other major permanent loss of function associated with a medication error. A patient commits suicide within 72 hours of being discharged from a hospital setting that provides staffed around-the-clock care.

Any elopement, that in unauthorized departure, of a patient from an around-the-clock care setting resulting in a temporally related death (suicide, accidental death, or homicide) or major loss of function.

A hospital operates on the wrong side of the patient’s body. Any intrapartum (related to the birth process) maternal death.

Any perinatal death related to a congenital condition in an infant having a birth weight greater than 2500 grams. A patient is abducted from the hospital where he or she receives care, treatment or services.

Assault, homicide, or other crime resulting in patient death or major permanent loss of function.

A patient fall that results in death or major permanent loss of function as a direct result of the injuries sustained in the fall.

Hemolytic transfusion reaction involving major blood group incompatibilities.

A foreign body, such as a sponge or forceps that was left in a patient after surgery.

JOINT COMMISSION’S SENTINEL EVENT POLICY

The Joint Commission has defined a sentinel event policy that you should be aware of. This policy has four goals:

To have a positive impact in improving patient care, treatment and services and preventing sentinel
To focus the attention of an organization that has experienced a sentinel event on understanding the root causes that underlie the event, and on changing the organization’s systems and processes to reduce the probability of such an event in the
To increase the general knowledge about sentinel events, their causes, and strategies for
To maintain the confidence of the public and accredited organizations in the accreditation

In the event of deviation of practice according to the professional practice act, fraudulent behaviors, narcotic abuse or deviation and/or other aberrant or illegal behavior, each event is documented and a report is made, which includes information from the customer. The President/CEO reports each situation according to the guidelines of the appropriate professional association.

I have read and understand the employee handbook provided to me and will abide by all terms.

Name

Signature

Date

Cure Staffing, LLC Payroll Information

Cure Staffing, LLC pays weekly via direct deposit only every Friday. Pay periods begin on Sunday and end on Saturday (unless altered by facility). In order to process payroll, your time sheet must be received every Sunday for pay on Friday.

In the event that a time sheet is not turned in by 12:00 p.m. Noon Central Time on Monday, your pay may be delayed until the following week’s pay period.

Deductions will be made from your earnings as per the current W4 form on file. Updates and changes may be made for withholdings by completing a new W4 form online. Pay period begins at 0700 on Sunday and ends at 0700 on Saturday. Weekend differential begins at 1500 on Friday and ends at 0700 on Monday. Time and a half will be paid for any time worked over 40 hours in a week.

Time Sheets

Time sheets are provided by Cure or the facility to which you are assigned, but it is your responsibility to have a paper copy of the time sheet for your shift. Calculate hours based on 15 minute increments. Each employee is responsible for properly documenting the verifiable worked hours on the time sheet, getting the supervisor on duty’s signature at the end of the shift and submitting to Cure before the cutoff. We highly recommend you send it to Cure at the end of your shift.

In addition, if the facility has the employee complete a log for billing purposes, the hours in the log must match those recorded on the time sheet. Any discrepancy which results in overpayment in hours to the employee will be corrected with a future payroll deduction.

It is important that an employee account for all hours that he/she is scheduled to work and that the explanation for any time off is included. Note all schedule changes (ex: sick time, requested time off, or exchanging hours on a time sheet). If there is a missed shift due to facility scheduling, illness or any other reason please contact Cure as soon as possible.

If a facility requests you to use their time sheet, please inform Cure immediately and also recommend to the facility to use Cure’s as well.

Payroll related inquires & TimeSheets can be sent to: payroll@curestaffingcorp.com

Holiday Pay

Cure does not pay wages for holidays not worked. Employees will only be paid for the actual hours worked during pay periods in which holidays fall. Cure allows traveler holiday schedule of the facility in which the current assignment is being conducted. If an employee works on one of the holidays predetermined by the facility, employee will be paid at a rate of 1.5 times the hourly rate.

Time and a half will be paid for the following Holidays unless otherwise noted by facility agreement. Please direct all questions to hr@curestaffingcorp.com

New Year’s Day	0700 and 1500
Memorial Day	0700 and 1500
July 4	0700 and 1500
Labor Day	0700 and 1500
Thanksgiving	0700 and 1500
Christmas Day	0700 and 1500

Overtime

Cure follows all federal wage, state wage and hour laws for payment of overtime worked. Overtime is considered any regular hours worked over 40 hours per week (some state laws may be different). Some facilities do not authorize overtime work for travelers. Therefore, all overtime hours worked must be pre-approved by the on-site supervisor and notified to Cure immediately. Cure will require the supervisor to validate the overtime on the employee time sheet.

On Call/Call Back

In some instances, the employee may be required to be on-call. In these circumstances, the employee will be paid a predetermined rate. Please indicate the hours in & out. In the event the employee is on-call and gets “called back” to work, the employee will be paid at a rate of 1.5 times the hourly rate as specified in the service agreement. Please notify the payroll department of any “on-call hours” needing to be reported.

Pay Corrections

Cure takes pride in making sure all employees are paid correctly and on-time. Cure takes all the responsible steps to ensure that employees receive the correct pay on each paycheck. In the unlikely event that there is an error in the amount of pay, the employee should immediately bring the discrepancy to the attention of the payroll department payroll@curestaffingcorp.com so that corrections can be made immediately. All corrections will be made on the next pay period.

Confidential Payroll lnformation

Compensation data is confidential and must not be shared to anyone. Discussing confidential information or compensation to coworkers or anyone outside of Cure may result in termination without previous counseling.

Work Schedule & Time off

Cure recommends that the employee review with the facility and his/her recruiting team all anticipated work schedules during assignment. This includes weekends and overtime policies. Any absence from scheduled work must be approved by the facility, as well as Cure. Missed hours should be made up throughout the duration of the assignment.

While at work on a Cure assignment, schedule is determined by the facility. Employees may not perform scheduled work for another employer during an assignment without advanced approval from both Cure and the facility.

I have read and understand all above information related to payroll processing.

Name

Signature

Date

Orientation / Safety Manual Acknowledgement

In compliance with THE JOINT COMMISSION standards, OSHA requirements, and Cure Staffing policies, I acknowledge that I have received and reviewed the information included in the following sections of the safety manual:

Safety Training including:

First Aid Procedures
Accident Reporting/Sentinel Events
Body Mechanics/Environment Safety
Disaster/Emergency Preparedness
Electrical Safety/Fire Safety
Medical Equipment Management
Labeling & Handling of Chemicals/Hazardous Materials
Infection Control: Blood borne Pathogens, TB prevention
Preventing Workplace Violence
Personal Protective Equipment
Patient Rights
Employee Right-to-Know Company Policies:
Timecards and Payroll Procedures
Drug Policy
Dress Code
Sexual Harassment
Proof of Identity
Complaint/Grievance Policy
Code of Business Ethics
Emergency Management Plan

In-Service Training including:

HIPAA & Confidentiality
Advance Directives / End of Life Decisions
Age-Specific Competency
CDC Hand Hygiene Guidelines
Cultural Competency
Elder & Dependent Abuse
Fingernail Policy
Pain Management
Use of Restraints
Joint Commission 2021 National Patient Safety Goals
Joint Commission Banned Abbreviations
Management of Aggressive Behavior (M.O.A.B.)
Medical Error Prevention
Domestic Violence
Patient /Family Education
Ethical Care and Patient Rights
Incident Reporting
Personal Security

I also acknowledge that:

I have reviewed my job description in the Healthcare Safety and Orientation Manual, as the Joint Commission I am capable of performing my job duties, and I fully understand all of my job responsibilities and expectations.
The company has a strict “No Drug Policy”, and this document serves as my consent to submit to drug testing as per company
If for some unexpected reason, I am unable to make it to work to perform my assigned duties I will notify my employer representative as soon as Failure to do so could lead to disciplinary action or possible termination.
If I have an accident or sustain an injury while on the job that requires medical attention, I agree to notify my employer representative immediately. A company representative will coordinate proper procedures for handling of my
I have been informed of the procedures which are required of me in the event I am involved in an accident or am There procedures are necessary in providing me with timely medical attention and investigation as to the cause of the accident so that it might be avoided in the future.
I understand and agree to comply with all safety policies, rules, regulations, and hazard communication programs which Company has outlined in this safety manual. My signature below indicates that I have read and acknowledge all of the rules in this
I understand that if I am involved in an accident, or injured on the job and that injury is work related, I will submit to a drug and / or alcohol testing as per company policy and in conjunction with state and local laws. Failure to submit to this testing could lead to disciplinary action, including my
I understand that my signed time card is a statement which indicates that I have not witnessed or incurred any accidents / injuries while on the job during the period covered on that time
I have read and fully understand the above statements regarding Company policies and procedures and agree to comply with them. I agree that my failure to comply with these policies and procedures could result in my termination and could jeopardize any insurance benefits that I may have been otherwise
I, by my signature below, acknowledge that a representative of Company has thoroughly answered all of my questions in regards to the above policies and
By signing below, I acknowledge that the confidentiality of patient health care information (“Confidential Patient Information”) that I may receive or have access to in the course of providing patient care services at participating

hospitals at which I am assigned by Company. I shall maintain the confidentiality of Confidential Patient Information, and in doing so, shall comply with all applicable state and federal laws and regulations, including, without limitation, that privacy provisions under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and the policies and procedures of each participating hospital where I amassigned. My agreement

to maintain the confidentiality of Confidential Patient Information shall survive the termination of my employment with Company and the conclusion of any assignment at Company client.

Print or Type Name Signature Date

STATEMENT AND POLICY

Cure Staffing, LLC is committed to a work environment in which all individuals are treated with respect and dignity. Each individual has the right to work in a professional atmosphere that promotes equal employment opportunities and prohibits unlawful discriminatory practices, including harassment. Therefore, Cure Staffing, LLC expects that all relationships among persons in the office will be business-like and free of bias, prejudice and harassment.

Cure Staffing, LLC has developed this policy to ensure that all its employees can work in an environment free from unlawful harassment, discrimination and retaliation. Cure Staffing, LLC will make every reasonable effort to ensure that all concerned are familiar with these policies and are aware that any complaint in violation of such policies will be investigated and resolved appropriately.

Any employee who has questions or concerns about these policies should talk with the director of human resources or a member of the personnel practices committee.

These policies should not, and may not, be used as a basis for excluding or separating individuals of a particular gender, or any other protected characteristic, from participating in business or work-related social activities or discussions. In other words, no one should make the mistake of engaging in discrimination or exclusion to avoid allegations of harassment. The law and the policies of Cure Staffing, LLC prohibit disparate treatment on the basis of sex or any other protected characteristic, with regard to terms, conditions, privileges and perquisites of employment. The prohibitions against harassment, discrimination and retaliation are intended to complement and further those policies, not to form the basis of an exception to them.

Equal employment opportunity

It is the policy of Cure Staffing, LLC to ensure equal employment opportunity without discrimination or harassment on the basis of race, color, religion, sex, sexual orientation, gender identity or expression, age, disability, marital status, citizenship, genetic information, or any other characteristic protected by law. Cure Staffing, LLC prohibits any such discrimination or harassment.

Retaliation

Cure Staffing, LLC encourages reporting of all perceived incidents of discrimination or harassment. It is the policy of Cure Staffing, LLC to promptly and thoroughly investigate such reports. Cure Staffing, LLC prohibits retaliation against any individual who reports discrimination or harassment or participates in an investigation of such reports.

Sexual harassment

Sexual harassment constitutes discrimination and is illegal under federal, state and local laws. For the purposes of this policy, “sexual harassment” is defined, as in the Equal Employment Opportunity Commission Guidelines, as unwelcome sexual advances, requests for sexual favors and other verbal or physical conduct of a sexual nature when, for example: a) submission to such conduct is made either explicitly or implicitly a term or condition of an individual’s employment, b) submission to or rejection of such conduct by an individual is used as the basis for employment decisions affecting such individual, or c) such conduct has the purpose or effect of unreasonably interfering with an individual’s work performance or creating an intimidating, hostile or offensive working environment.

Title VII of the Civil Rights Act of 1964 recognizes two types of sexual harassment: a) quid pro quo and b) hostile work environment. Sexual harassment may include a range of subtle and not-so-subtle behaviors and may involve individuals of the same or different gender. Depending on the circumstances, these behaviors may include unwanted sexual advances or requests for sexual favors; sexual jokes and innuendo; verbal abuse of a sexual nature; commentary about an individual’s body, sexual prowess or sexual deficiencies; leering, whistling or touching; insulting or obscene comments or gestures; display in the workplace of sexually suggestive objects or pictures; and other physical, verbal or visual conduct of a sexual nature.

Harassment

Harassment on the basis of any other protected characteristic is also strictly prohibited. Under this policy, harassment is verbal, written or physical conduct that denigrates or shows hostility or aversion toward an individual because of his or her race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, marital status, citizenship, genetic information, or any other

characteristic protected by law, or that of his or her relatives, friends or associates, and that: a) has the purpose or effect of creating an intimidating, hostile or offensive work environment, b) has the purpose or effect of unreasonably interfering with an individual’s work performance, or c) otherwise adversely affects an

individual’s employment opportunities.

Harassing conduct includes epithets, slurs or negative stereotyping; threatening, intimidating or hostile acts; denigrating jokes; and written or graphic material that denigrates or shows hostility or aversion toward an

individual or group that is placed on walls or elsewhere on the employer’s premises or circulated in the workplace, on company time or using company equipment by e-mail, phone (including voice messages), text messages, social networking sites or other means.

Individuals and Conduct Covered

These policies apply to all applicants and employees, whether related to conduct engaged in by fellow employees or by someone not directly connected to Cure Staffing, LLC (e.g., an outside vendor, consultant or customer).

Conduct prohibited by these policies is unacceptable in the workplace and in any work-related setting outside the workplace, such as during business trips, business meetings and business-related social events.

Reporting an Incident of Harassment, Discrimination or Retaliation

Cure Staffing, LLC encourages reporting of all perceived incidents of discrimination, harassment or retaliation, regardless of the offender’s identity or position. Individuals who believe that they have been the victim of such conduct should discuss their concerns with their immediate supervisor, any member of the personnel practices committee, human resources or any ombudsman. See the complaint procedure described below.

In addition, Cure Staffing, LLC encourages individuals who believe they are being subjected to such conduct to promptly advise the offender that his or her behavior is unwelcome and to request that it be discontinued. Often this action alone will resolve the problem. Cure Staffing, LLC recognizes, however, that an individual may prefer to pursue the matter through complaint procedures.

Complaint Procedure

Individuals who believe they have been the victims of conduct prohibited by this policy or believe they have witnessed such conduct should discuss their concerns with their immediate supervisor, human resources, any member of the personnel practices committee or any ombudsman.

Cure Staffing, LLC encourages the prompt reporting of complaints or concerns so that rapid and constructive action can be taken before relationships become irreparably strained. Therefore, while no fixed reporting period has been established, early reporting and intervention have proven to be the most effective method of resolving actual or perceived incidents of harassment.

Any reported allegations of harassment, discrimination or retaliation will be investigated promptly. The investigation may include individual interviews with the parties involved and, where necessary, with individuals who may have observed the alleged conduct or may have other relevant knowledge.

Confidentiality will be maintained throughout the investigatory process to the extent consistent with adequate investigation and appropriate corrective action.

Retaliation against an individual for reporting harassment or discrimination or for participating in an investigation of a claim of harassment or discrimination is a serious violation of this policy and, like harassment or discrimination itself, will be subject to disciplinary action. Acts of retaliation should be reported immediately and will be promptly investigated and addressed.

Misconduct constituting harassment, discrimination or retaliation will be dealt with appropriately. Responsive action may include, for example, training, referral to counseling or disciplinary action such as a warning, reprimand, withholding of a promotion or pay increase, reassignment, temporary suspension without pay, or termination, as Cure Staffing, LLC believes appropriate under the circumstances.

If a party to a complaint does not agree with its resolution, that party may appeal Cure Staffing, LLC’s executive director or the chief operating officer.

False and malicious complaints of harassment, discrimination or retaliation (as opposed to complaints that, even if erroneous, are made in good faith) may be the subject of appropriate disciplinary action.

Notification and Authorization to Release Criminal Information for Employment Purposes

Notification

The position for which I am being considered requires me to consent to a background check as a condition of employment. This check includes the following: Criminal history reference searches for felony and misdemeanor convictions at the county and federal levels of every jurisdiction where I currently reside or where I have resided during the past 7 years; and sex offender registry searches at the county and federal levels in every jurisdiction where I currently reside or where I have resided.

Authorization

I hereby authorize Cure Staffing, LLC and all applicable company relationships, such as 3^rd party services and/or companies to conduct the criminal background check described above. In connection with this, I also authorize the use of law enforcement agencies and/or private background check organizations to assist Cure Staffing, LLC in collecting this information.

Universal Background has been secured as a third party vendor (consumer reporting agency) to assist Cure Staffing, LLC in collecting and verifying information.

I also am aware that records of arrests on pending charges and/or convictions are not an absolute bar to employment. Such information will be used to determine whether the results of the background check reasonably bear on my trustworthiness or my ability to perform the duties of my position in a manner which is safe for Cure Staffing, LLC and its contractual relationships that I may perform services.

To the best of my knowledge, the information provided in this Notice and Authorization and any attachments thereto is true and complete. I understand that any falsification or omission of information may disqualify me for this position and/or may serve as grounds for the severance of my employment with Cure Staffing, LLC. By signing below I hereby provide my authorization to Cure Staffing, LLC to conduct a criminal background check and I acknowledge that I have been provided with a summary of my rights under the Fair Credit Reporting Act.

Printed Name

Signature Date

Handbook

Assignments

Charting

Universal Precautions

On the Job Injuries, Getting sick, Testing for Virus, Positive Tests of Virus & Quarantine

Communication

Staffing Options

PRE-BOOKING

While working at a facility you may be given the opportunity to pre-book yourself with either the

CONTRACTS

AVAILABILITY

Cure Healthcare Staffing Standards of Professionalism

Ethics

Reporting for Work

Other Appearance Requirements

Assignments

Charting

Narcotics Accountability

Occurrence Reporting

On the Job Injuries

Communication

Facility Orientation

Cure Staffing, LLC Credentialing Requirements

Certification

Medication Administration & Basic Nursing Skills Testing (RN’s only)

OSHA Testing

Drug Screening

Tuberculosis Screening

Drug & Alcohol Use

Physicians Statement

Immunizations and Titers

Licensure

To Obtain Reimbursement for Licensure

Other Requirements

Work Injuries/Incidents

Worker’s Compensation Insurance (Cure Payroll)

In Case of Injury:

Worker’s Compensation Insurance (Facility Payroll)

For life-threatening injuries, call 911 immediately. Then report the claim following the steps above.

Other Work Place Incidents

TABLE OF CONTENTS

WELCOME

MISSION STATEMENT

ADMINISTRATIVE BASICS

Joint Commission Policy Statement

CODE OF BUSINESS ETHICS

STANDARDS OF CONDUCT

CURE STAFFING, LLC Contract Termination Policy

SAFETY MANAGEMENT

LIFE SAFETY (FIRE) MANAGEMENT

ENVIRONMENTAL SAFETY

EMERGENCY PREPAREDNESS/DISASTER SAFETY

ELECTRICAL SAFETY

CHEMICAL SAFETY/HAZARDOUS COMMUNICATIONS

JOINT COMMISSION EDUCATION

NATIONAL PATIENT SAFETY GOALS

Do-Not-Use List

INFECTION CONTROL: UNIVERSAL PRECAUTIONS AND BLOODBORNE PATHOGENS

GENERAL PREVENTION

CDC HAND HYGIENE GUIDELINES

STANDARD PRECAUTIONS

BLOODBORNE PATHOGENS

MEDICATION SAFETY AND DOCUMENTATION

SUSPECTED ABUSE: IDENTIFICATION, TREATMENT AND REPORTING

EMPLOYEE ESSENTIALS

RESTRAINTS

END OF LIFE CARE

EMERGENCY CODES

AGE SPECIFIC EDUCATION

EMERGENCY TREATMENT OF PATIENTS (EMTALA)

THE HIPPA PRIVACY RULE

BODY MECHANICS

UNDERSTANDING CULTURAL DIVERSITY

DISCHARGE PLANNING

PATIENT RIGHTS AND RESPONSIBILITIES

UTILITY MANAGEMENT

PATIENT EDUCATION

MEDICAL EQUIPMENT MANAGEMENT

PAIN MANAGEMENT

RADIATION SAFETY