DNV Etiquette
You must obtain a patient's __________ prior to allowing a surveyor to enter their room
What is Permission?
In the halls, you can't park carts, or computers in front of these.
What are Electrical panels, fire extinguishers or medical gas?
Mission of Sentara
What is "We improve health every day"?
Database used to store Hospital Policies.
What is Compliance 360?
All Sentara divisions/locations are required to ask the patient and their companion if they have any_________?
What is special communication needs?
The DNV surveys hospitals on an ___________ basis.
What is ANNUAL?
Linen carts must be ___________ at all times.
What is covered?
1) Improve Customer Satisfaction
2) Provide a Consistent product or service
3) Continual Improvement of the organization
What are the 3 c's of ISO (International Organization for Standardization). ISO standards are international standards that describes the best way of doing something. We must be compliant with ISO 9001.
ISO Made Easy:
1) document what you do
2) Do what you document
3) Prove it and improve it
Quarterly email from Professional Practice co-chairs, and updated P&P notebook in LD/PP/NSY.
What is how FBP communicates policy changes and assures we are using the most updated policies.
A witnessed, written document, voluntarily executed by the patient in advance of any injury or illness that allows them to write their wishes for the type of medical treatments they would or would not want, appoint a healthcare agent to speak for them, acknowledge an anatomical give or organ donation designation.
What is an Advanced Care Plan. Sentara is required to ask all patients if they have one.
We don't know when the survey will happen because the DNV is required to make them ______________.
What is unannounced?
RACE and PASS
What is the steps you would complete if there was a fire in your area
Rescue, Alarm, Contain, Extinguish/Evacuate
Pull Pin, Aim, Squeeze, Sweep
Surveyor identifies staff/providers are not following policies.
What is survey citation?
Multidisciplinary simulations, Fetal Monitoring tracing reviews, NRP, & PPH/HTN education.
Emergency and Disaster Preparedness, Fire Safety, Hazardous Material and Waste, Abuse and Neglect, Advance Care Plans, Illness or Impairment of Licensed Independent Practitioners, Basic Restraints and Seclusion, & Infection Prevention
What is Sentara’s and FBP's Annual Mandatory and Regulatory training?
Drinks at computers, at a nursing station or in an empty room that can be used for a procedure
What is an Infection Prevention citation? OSHA regulation.
Also Food!!!
The most important participant in the Annual DNV Survey
Who is all of us?
Your role in the Emergency Management Plan.
Being aware of the code names and RACE & PASS?
How often we review Policies, Procedures, and job aids.
What is every 3 years?
The form of identification you are required to wear at all times while in the hospital?
What is your badge?
If I share patient information with someone who does not need to know, I have violated _______________.
What is a HIPAA (Health Insurance Portability and Accountability Act) ?
The system used by the surveyors to follow individual patients through their hospitalization, evaluating multiple care units, departments, and services rendered to the patient.
What is the Tracer Methodology?
1. Using proper patient ID.
2. 5 rights for medication
3. Fall prevention
4. Time outs for procedures
5. Proper cleaning of patient rooms & equipment.
What is patient safety?
-Always keep you safe.
-Always treat you with dignity, respect, and compassion.
-Always listen and respond to you.
-Always keep you informed and involved.
-Always work together as a team to provide you quality healthcare.
What is the 5 Sentara Commitments?
To be the healthcare choice of the community we serve
What is the Sentara Vision?
1) Patient identification (verify and match using at least 2 identifiers before acting)
2) Critical Value (appropriate checks & notifications)
3) Double checks (perform a 2-person double check before administering medication identified on the High Risk Drug Matrix and before administering blood and blood products)
What are examples of FBP red rules?