Orientation for Students and Faculty Welcome to the Texas Children’s Hospital p

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