PD IV Exam I Study Guide
As a student you can put experience in, but not put
"proficient in" until you're a PA
Besides federal law, what else does a HIPAA violation violate?
- AAPA Code of Ethics - MCPA Technical Standards - NCCPA Code of Conduct - MSBML Rules & Regulations
When do you change gloves and perform hand hygiene?
- During use if torn and when heavily soiled - After use on each patient - When moving from a dirty task to a clean task - YOU HAVE TO WASH WITH SOAP AND WATER FOR C. DIFF
Groups that Advocate for Patients
- Government Advocacy (i.e. NIH, CDC, FDA) - Nonprofit Advocacy Groups (i.e. American Diabetes Assoc., Alzheimer's Association) - For-Profit Advocacy Groups (sometimes trustworthy if paid for by employer or patient) - Patient Advocates in Hospitals - Individual Patient Advocates (often synonymous with case managers or care coordinators)
When Using Protective Gloves
- Inspect for defects before use - Remove gloves and wash hands if gloves have become contaminated - Do not snap gloves when removing them - Grasp gloves at the wrist and pull off, inside out - Discard in biohazard waste container - Always wash hands after removing gloves - Never reuse disposable gloves
Latex allergy protections
- Latex is ubiquitous in the health care system. Peaked in 80s/90s due to HIV. Increased Use = Increased Allergic RXN - Coated in cornstarch as dry lubricant. Latex proteins aerosolize when removed - 0.5 - 24% allergy prevalence >> IF you have a latex sensitivity or allergy, carry a medical alert bracelet that can identify your allergy for HC providers >> Avoid latex gloves/products, and notify your supervisor or preceptor on your condition >> If you reaction is severe, keep an Epi pen ready for emergency
Disposal of Personal Protective Equipment
- Remove all personal protective equipment immediately after contamination or leaving the work area - Place all personal protective equipment in an appropriately designated area or container for storing, washing, decontaminating, or discarding - Replace disposable, gloves as soon as possible when contaminated or if torn, punctured, or barrier function is compromised - Do not reuse disposable gloves
Preparation for international travel
- developing countries, get prophylactic vaccinations - participate fully in the planning of your trip (rotation assignment) - check with your medical insurance company to determine if you are covered for emergency care while abroad (evacuation back to US can be $10,000+) >>>> if not covered, purchase a policy that provide medical coverage and evacuation if necessary US Dept of State (http://www.state.gov/travel)
Goggles
- protect eyes - should fit snugly over and around eyes - personal glasses not a substitute for goggles
Face Shields
- protect face, nose, mouth, and eyes - should cover forehead, extend below chin and wrap around side of face
Masks
- protect nose and mouth - should FULLY cover nose and mouth and prevent fluid penetration
I am looking for my first job. How can I "pad" by resume?
-Recent graduates should include individual clinical rotations along with brief summaries of the most relevant ones. Additionally, previous clinical experience, research, honors and other projects that demonstrate a solid work ethic should be emphasized. Beyond that, only include information that adds to your appeal for the position. Including additional "filler" just for the sake of making your resume longer is frequently counterproductive. -**short and concise and easy to read is wayyy better than fluffing with BS
Donning Sequence of PPE
1. Gown 2. Mask or Respirator 3. Goggles or Face Shield 4. Gloves (extend to cover wrist of isolation gown)
Doffing Sequence of PPE
1. Gown and Gloves (front and sleeves are contaminated, so pull away from body and roll into bundle. peel off your gloves at the same time, only touching the inside of the gloves and gown with your bare hands. immediately wash hands) 2. Goggles or Face Shield (outside are contaminated. remove from the back by lifting head band and without touching the front of the goggles or face shield.) 3. Mask or Respirator (front is contaminated, so again do not touch. grasp bottom ties or elastics, then the ones at the top, and remove) 4. Wash hands or use an alcohol-based hand sanitizer immediately after removing all PPE (OR) Perform hand hygiene between steps if hands become contaminated and immediately after removing all PPE.
7 Patient Rights Regarding Privacy of PHI
1.Receive notice of an agency's privacy practices. 2.Know that an agency will use its PHI ONLY for treatment, payment, operations (TPO), certain other permitted uses and uses as required by law. 3.Consent to and control of the use and disclosure of their PHI. 4.Access their protected health information (PHI), except for psychotherapy notes (they might be charged for copies). 5.Request amendment or addendum to their PHI (not always granted). -He had off label use for SSRI for migraines -His Dr. did a click and pick to get it approved; Dr. Martin didn't want "major depressive episode" on his medical record 6.Receive accountings of disclosures. 7.File privacy complaints to agency officer.
Who will make recommendations for immediate evaluation and care in the event of a potential bloodborne pathogen exposure?
A member of the medical staff.
Sharps Container
A puncture-proof container designed specifically to safely dispose of needles, scalpels, and other sharp disposable medical instruments if the contaminated item must be re-used: store and process, still puncture and leak proof
Who gets appropriate access?
Access is limited to individuals who need such info to carry out job responsibilities
What is Appropriate Access?
Access to confidential info is based on a "need to know/right to know" basis - sometimes in EHR, you have to "break the glass"
You are the student caring for Mr. Sanchez. His physician has called in several consultants to assist with his care. One of the physicians, Dr. Han, a neurologist, calls to get some information about Mr. Sanchez. Can you release information to her?
After obtaining sufficient info to know that it is Dr. Han, you can share the requested information.
Modes of Transmission for Bloodborne Pathogens
Any form of broken skin, which includes: •Abrasions •Blisters •Burns •Cuts •Eyes, nose, mouth (mucosal surface) •Punctures from sharp objects Bloodborne Pathogens are not passed through the air like cold and flu germs.
Are all institutions the same regarding viewing your chart?
At some institutions, you aren't even allowed to view your own chart in the EMR (Baptist has this policy) other than through a designated pt portal, but that may vary by state or institution ***rotation 1 you are allowed to give/do __________, but on rotation 2 you are NOT allowed to give/do _____________. (changes institution to institution)
Prior to using a respirator, the user must: - ON EXAM
Be medically screened Be fit tested Be trained on respirator use Perform a fit check on the respirator OSHA considers four types of qualitative testing methods acceptable: Bitrex (leaves a bitter taste in the mouth) Irritant smoke (can cause coughing) Isoamyl acetate (smells like bananas) Saccharin (leaves a sweet taste in the mouth) *spray spray spray* "can you taste anything?" Quantitative Ambient aerosol condensation nuclei counter Controlled negative pressure Generated aerosol Modified ambient aerosol condensation nuclei counter for full- and half-facepiece elastomeric respirators Modified ambient aerosol CNC for filtering facepiece respirators
What should you not do with contaminated needles?
Bend, recap, or remove them unless required by medical procedures or employer.
HIPPA DON'Ts
DO NOT discuss info in front of family or visitors w/o pt permission (make a note when you do ask them and their answer about permission) DO NOT discuss in public (cafe, elevator, etc.) DO NOT be loud DO NOT take photo and post (no FB status, no XR of weird injury) DO NOT use temporary baskets or boxes for paper info DO NOT text a photo to a co-worker with pt or PHI in background (tiktok lady) DO NOT text info to co worker unless team member DO NOT use public printer DO NOT photoduplicate, e-mail, text or fax patient documents
What should you do as soon as work is complete?
Disinfect the area.
What should be done with items that come in contact with biohazard materials?
Disinfected or discarded appropriately.
glove DO NOTs
Don't touch your face or adjust PPE with contaminated gloves Don't touch environmental surfaces except as necessary during patient care
Where does HIPPA apply?
EVERYWHERE school, home, bus, work
What should you not do in areas of potential bloodborne pathogen exposure?
Eat, drink, apply cosmetics, or handle contact lenses.
Most current
FIRST
Why HIPPA?
Genetic - risk of people getting denied insurance b/c genetic predisposition to disease Marketing - prevent marketing of unsolicited products/services (Names of patients on antihypertensive drugs cannot be released to a company marketing nutritional products to lower blood pressure.) Tech - info moves quickly and loosely, so you want to prevent interception (accidental or intentional) Control - give pt control over their own health info
Contact or Special Enteric Contact Precautions
Gown and gloves for contact with the patient or his environment (equipment, surfaces)
What is required for Standard and Expanded Precautions?
Hand hygiene.
HIPAA
Health Insurance Portability and Accountability Act of 1996, as amended Federal guidelines to safeguard patient identifiable information (known as Protected Health Information or PHI) Contains penalties for both intentional and unintentional violations by individuals and healthcare facility/organization
Education Resource Library
Health literacy training
Examples of student mistreatment and sexual harassment
IS mistreatment: no one really speaks to you or engages with you during or after rounds. The few times you offer to help with a procedure or presentation of a patient, the resident and attending NP both question whether or not you are actually capable of doing said procedure. You tell them you are trained and they say "as if we would ever let you handle that. you are just a stupid student. you don't deserve to be on rotations with us and you don't deserve to be in healthcare" Is NOT mistreatment: no one really speaks to you or engages with you during or after rounds. The few times you offer to help with a procedure or presentation of a patient, the resident and attending NP both question whether or not you are actually capable of doing said procedure, and they don't seem to know anything about your training. This persists for the full 5 weeks of your rotation. IS sexual harassment: Jenny states that Dr. Creep was constantly making sexual jokes around her, and he made several unwanted comments about her attire and her appearance, all of which were sexual in nature. Despite being extremely uncomfortable about it, she decided against reporting it to her clinical director or to the hospital for fear of retaliation from her preceptor. He was constantly talking about how well connected he was in Mississippi, and how he could keep students from getting jobs if they made him mad. Is NOT sexual harassment: You're on rotations and Dr. Nice says, "Oh! I love your scrubs. They look so nice on you, where did you get them." ORRRR (goebel example) - You are on surgical rotation and while in the OR the surgeon comments that your sutures are "too tight". The first assist in the room says "lol that what she said"
Emergency Needlestick Information
If you experience a needlestick or sharps injury or are exposed to the blood or other body fluid of a patient during the course of your work, immediately follow these steps: 1. Wash needlesticks and cuts with soap and water 2. Flush splashes to the nose, mouth, or skin with water 3. Irrigate eyes with clean water, saline, or sterile irrigants 4. Report the incident to your supervisor and contact the Director of Clinical Education (we have a form to fill out) 5. Immediately seek medical treatment Medical Providers Please Note: If you have questions about appropriate medical treatment for occupational exposures, 24 hour assistance is available from the Clinicians' Post Exposure Prophylaxis Hotline (PEPline) at 1-888-448-4911.
Where should you not store food or drink?
In refrigerators or on shelves where blood or potentially infectious materials are present.
What should a student do if initial care is provided outside the student health system?
Inform the provider that the PA Program follows CDC guidelines for post-exposure HIV prophylaxis.
HIPAA Consequences
Legal consequences - Civil or criminal penalties - Fines plus imprisonment Professional consequences: - Disciplinary action by the MSBML Academic consequences: - Reprimands - Loss of points toward grade or failure of course - Dismissal from MCPA
What information should a student obtain in the event of a potential bloodborne pathogen exposure?
Name of source patient, medical record #, room number, and diagnosis.
Title IX
No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving Federal financial assistance.Aug 20, 2021 The Office for Civil Rights (OCR) enforces Title IX by investigating complaints, conducting compliance reviews, and providing technical assistance. An institution found to violate Title IX (or any of the regulations enforced by OCR) has the opportunity to remedy the violation voluntarily. The person coming forward can be cross investigated over the allegations**
Airborne Precautions
Particulate respirator- N95 mask or PAPR
PPE
Personal Protective Equipment - specialized clothing or equipment worn for protection against dangerous or infectious materials why? - prevents contact with an infectious agent by creating a barrier between the potentially infectious material and the healthcare worker. Gloves - protect hands Gowns/Aprons - protect skin and/or clothing Masks and Respirators - protect mouth/nose (respirators protect the respiratory tract from airborne infectious agents) Face Shields - protect face, mouth, nose and eyes
#1 Method of Control
Personal protective equipment must be used throughout the duration of bloodborne pathogen exposure It is essential to have a barrier between you and the potentially infectious material. Protective barriers are intended to prevent blood or other potentially infectious materials from passing through to worker's clothing, skin, or mucous membranes. Equipment includes: •Latex, rubber or vinyl gloves •Gowns •Laboratory coats •Face shields or masks •Eye protection
What should you use instead of glass when available?
Plastic.
PHI
Protected Health Information as any information that may be used to identify a patient, including: -Pt name, address, SSN, DOB -Employer info -Relatives (names and other info) -Medical record number (MRN) -Health Plan Number or account numbers -License plate numbers -Device identifier and serial numbers -Fingerprints -Photographic images -Email or URL addresses -Any unique physical characteristic that could be used to identify the patient, such as a tattoo
What type of relationship is required?
Providers need physician-patient treatment/diagnostic relationship in order to view patient info Accessing records of family members, relatives, or friends out of concern or curiosity is a HIPAA violation
Respiratory Protection
Purpose - protect from inhalation of infectious aerosols (e.g. Mycobacterium Tuberculosis, viruses such as COVID-19 or MERS Co-V) Respirator types: Particulate respirators (N95 masks) Powered air purifying respirators (PAPR)
Resume vs. Curriculum vitae
RESUME • Length - SHORT • Content - all-inclusive summary of skills, experiences, and education • Purpose - get employment (or interview) CURRICULUM VITAE • Length - As long as it needs to be • Content - area-specific listing of education and academic background • Purpose - detail background and qualifications
While assessing Mrs. Johnson after her admission, she tells you that she would like to remove her name from the patient data that the volunteers have at the reception desk. Is this a reasonable request? What would you do with this request?
Reasonable; report it to the head nurse or the floor/agency privacy officer.
You work on the neuro unit at the hospital. You were able to convince your best friend to move to Jackson and work with you. In the cafeteria, she begins telling you about this handsome guy that was just admitted to her unit after a bad car wreck. She continues to tell you some of the gory details including 'driving while intoxicated' (DWI). What should you do?
Remind her of HIPAA and tell her that you shouldn't discuss this type of information.
What is the responsibility of the student in case of potential exposure to bloodborne pathogens?
Report immediately to supervisor and PA program.
While working a 3-11 shift in the city/county health clinic, you see some patient data in the trash can. What should you do?
Report it to your instructor or preceptor.
Hand Hygiene
Required for Standard and Transmission-based Precautions Perform hand hygiene: - Before donning PPE - Immediately after removing PPE - Between patients - When moving from dirty to clean tasks while caring for the same patient - Wash hands thoroughly with soap and water or use alcohol-based hand sanitizer
Which section actually needs a description
Research is the only one that should need a description NOT professional experience (unless the position is unclear)
Helping people choose the right health insurance plan/coverage
Selecting the right type and amount of insurance is based on your specific situation, such as children, age, lifestyle, and employment benefits. types of insurance that most financial experts recommend include life, health, and long-term disability.
Why is time important in managing bloodborne pathogen exposures?
Some treatments must be started within 2 hours.
What happens if the student contracts a communicable disease that poses a risk to patients or co-workers?
Steps will be taken to prevent dissemination. Student Health, Public Health and/or CDC protocols.
Droplet Precautions
Surgical/isolation masks within 6 feet of patient
Where can resources for post-exposure prophylaxis be found?
The National Clinicians' Post-Exposure Prophylaxis Hotline or http://www.nccc.ucsf.edu/.
Accounting of Disclosure (AOD)
The patient has the right to have an AODs for his PHI or PMI.
Standard Precautions (Universal Precautions)
The single most important measure to prevent transmission of HBV and HIV is to treat all human blood and other potentially infectious materials AS IF THEY ARE infected with HBV and HIV. *Includes use of Gloves, Gowns, and Face masks/shields
How to choose which PPE to use?
The type of PPE used will vary based on the level of precautions required, such as standard and contact, droplet or airborne infection isolation precautions. COVID-19 requires contact, droplet, and a face shield or goggles.
Release/Disclosure
These are terms used in describing the release of PHI to other CEs for TPO, treatment, payment, or health care operations.
Directory
This is CE's census or list of patients used by volunteers and operators to direct visitors.
Work from "clean to dirty"-
This is a basic principle of infection control. In this instance it refers to touching clean body sites or surfaces before you touch dirty or contaminated areas surgery lab - you have to let water drip from your hands to your elbows
What should you do if there is exposure to the eye?
Use an eye wash immediately.
What should you do as soon as gloves are removed?
Wash hands to prevent contact with blood or other infectious materials.
When should the student notify the PA program in case of an exposure incident?
Within 24 hours of the exposure.
Are certain communicable diseases required to be reported to county or state health authorities?
Yes, as required by law.
Covered Entity (CE)
a health plan, a health care clearinghouse, or a health care provider that transmits any health information in electronic form in connection with a HIPAA transaction
Remove all PPE before exiting the patient room except
a respirator, if worn. Remove the respirator after leaving the patient room and closing the door.
Needle Stick Stats
about 385,000 needlestick and other sharps-related injuries occur each year in hospital-based situations Health care students are at especially high risk because of their relative inexperience; exposure rates have been reported as between 11% and 50% of students One PA program found that 22% of its students had some type of exposure, 60% of which were percutaneous injuries
student mistreatment and sexual harassment
abuse in belittlement, ethnic insensitivity, and sexual harassment Types of sexual harassment: > Offensive body language > Flirtation > Unwelcome comments on students' dress/appearance > Outright sexual invitations > Propositions > Sexual contact > Sexual bribery > Sexual assault > Exclusion from educational opportunities based solely on gender > Discriminatory grading abused children = similar changes to abused students
Bloodborne Pathogens
are classified as anything that contains human blood, blood products, or blood components
HIPPA DOs
confirm you're giving the right discharge info to the right pt before handing get pt's signed authorization to release their info (to family or referring dr/pa) use strong passwords log off shared workstations shred all paper documents treat phone like wallet or purse, keep it on you at all times, and keep a passcode on it as few individuals as possible, and as little info as possible (the nursing assistant gets "needs to know" facts, not whole chart) identify the patient/client by initials only protect screen (don't be in a position where a ton of people behind you can see) use the agencies' security procedures to transmit PHI.
Case Management Assistance
coordinating home health or hospice for example
Clean up of blood spills should be done by _______________ only.
custodians
Privacy Officer (PO)
each facility has an employee who is responsible for implementing and enforcing this law.
What do you do if you are the first to learn about a violation?
immediately contact his/her manager and/or the entity's Privacy & Security Officer or HIPAA Officer
Financial Aid Funds & Co-pay Relief Programs
people can apply for grants can be general or for specific diseases
Hostile Environment
persistent, severe, or pervasive unwelcome sexual conduct that limits a student's ability to participate in or benefit from school or activities or that creates a hostile or abusive educational environment
PDA
personal digital assistant ex. a palm pilot
patient advocacy
regards any activity which ultimately benefits a patient • caring for a patient • policy (for the hospital) and legislation (for the state or larger) creation • Would I use that scalpel, drug, etc. on me? No? then you shouldn't use it on them
allegiance bias
retention by or affiliation with a party in a legal proceeding may create bias that influences the expert's thoughts, feelings, and behavior in favor of the retaining or affiliated party • how they are compensated for the work they do, and therefore how trustworthy they are - power point advocacy groups can help, but may have alt motives or different core values ($$$, not getting sued, lobbying by pharm and other companies)
Procedures that are likely to generate aerosols
should be performed in a negative pressure room and healthcare personnel should wear an N95 mask or PAPR. *Aerosol generating procedures include: aerosolized or nebulized medication administration (albuterol), sputum induction, nasopharyngeal and oropharyngeal specimen collection, bronchoscopy, airway suctioning, endotracheal intubation (covid/TB intubation), positive pressure ventilation, tracheostomy care.
Quid pro quo
something given in exchange or return for something else Occurs when an employee of the school (or preceptor) explicitly or implicitly applies conditions to a student's participation in school or activities on the basis that the student submits to unwelcome sexual advances, requests for sexual favors, or verbal, nonverbal, or physical contact of a sexual nature
What is required to obtain a patient's records?
written authorization signed by the patient and presented to the Medical Records department is required to obtain a copy of a patient's medical record. OR sometimes in can be requested through patient portals in some EHRs (e.g. MyChart in Epic)
Key Points About PPE
• Don before contact with the patient, generally before entering the room • Use carefully - don't spread contamination • Remove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside room • Immediately perform hand hygiene
General Set-Up Features
• Full name on every page • Number pages • Regular single-sided paper (white) is fine • Same font throughout (may vary sizing some) • Use bolding and CAPS to have things stand out • Margins - 1" • No graphics all around • Font size - 12 point • Font - Times New Roman Clear, Concise, Complete, Consistent, Current
Hepatitis B
• In 2007, there were an estimated 43,000 new Hepatitis B virus infections in the United States. However, the official number of reported Hepatitis B cases is much lower. • Rates of acute Hepatitis B in the United States have declined by approximately 82% since 1990. At that time, routine Hepatitis B vaccination of children was implemented and has dramatically decreased the rates of the disease in the United States, particularly among children. • In the United States, an estimated 850,000 to 2.2 million persons are living with chronic Hepatitis B virus infection. • Globally, chronic Hepatitis B affects approximately 350 million people and contributes to an estimated 620,000 deaths worldwide each year. • Vaccination is available • Biggest concern w/ accidental needle stick Hep B is up to 100x more infectious than HIV/AIDS
Hepatitis C
• Infected individuals usually show no symptoms. • In 2007, there were an estimated 17,000 new Hepatitis C virus infections in the United States. However, the official number of reported Hepatitis C cases is much lower. • An estimated 3.2 million persons in the United States have chronic Hepatitis C virus infection. Most people do not know they are infected because they don't look or feel sick. • Approximately 75%-85% of people who become infected with Hepatitis C virus develop chronic infection. • Chronic infection usually results in chronic liver disease. With about 15,000 deaths per year from Hepatitis C related liver disease. • It is treatable if detected early. • There is no vaccination available.
Curriculum Vitae (or "CV")
• Origin is Latin - "course of one's life" • Note "vitae" (vee-tie or vee-te) is the plural form; "vita" (vee-tuh) is singular
Potentially Infectious Human Body Fluids Include:
• Saliva in dental procedures • Semen and vaginal secretions • Cerebrospinal, synovial, pleural, pericardial, peritoneal, and amniotic fluids • Body fluids visibly contaminated with blood • HIV-containing cell or tissue cultures and HIV or HBV-containing culture mediums or other solutions
HIV/Acquired Immune Deficiency Syndrome
•Over 1.2 million Americans have HIV/AIDS •The individual's immune system is depleted •If infected, he or she may not have symptoms for years •There is no cure or vaccination but there are treatment options available to prolong an individual's life PEP available
Know basic elements and order of the CV
Contact (full name, mailing addy, email, phone #) Education (always first on the CV, so your MSM) - master of science in medicine - TEST QUESTION, specific distinction not w/honors) Honors and Awards (back to undergrad but not before, most recent first, only academic/prof., scholarships count) Professional Experience (employment, only if relevant to academic/medical career - you can put desk or other job if it is to show you worked during undergrad, no description unless position unclear) Extracurricular and Volunteer Experience (better to have long-term/relevant items short list > long list of EVERYTHING) Interests (4 of them, creativity counts, take or leave this portion) OPTIONAL (as needed) -Objective - not typical -Demographics -Certifications and Licensure (only current, item + expiration date, do not add pending) -Professional Affiliations (only current, alphabetical order, AAPA, Donald Fischer, MAPPA) -Professional Activities (only relevant, include role if in position) -Research (ONLY list if you can remember it, brief description on CV) - Publications and Presentations (last, capstone project in your clinical year, bold your name in authorship, may include pending, make copies) -Added Qualifications (verifiable, language - fluent vs conversational)
Transmission-based (isolation) precautions include:
Contact precautions - special enteric contact precautions Droplet precautions Airborne precautions contact precautions (for diseases spread by direct or indirect contact), droplet precautions (for diseases spread by large particles in the air), and airborne precautions (for diseases spread by small particles in the air). Precaution types may be used in combination. In COVID-19 contact, droplet and eye protection are used.
What should a student do in the event of a potential bloodborne pathogen exposure?
Contact preceptor or site administrator immediately.
