Oconee Regional Medical Center

Clinical Student

Clinical Student Orientation

Clinical Student Orientation

Clinical Student Orientation

Welcome to Oconee Regional Medical Center’s Clinical Student orientation page. In order to prepare you for your experience, you are required to complete the orientation module and test prior to your first visit at the hospital. Begin by printing the following forms. After reading the entire module, complete the post-test and other forms.  You can either fax the forms to 478-454-3555 OR deliver the forms to Shantee Henry.

  1. ORMC Orientation Checklist
  2. Student Application
  3. Certification and Agreement of Compliance form (sign after reading the Code of Conduct section)
  4. Confidentiality and Security Agreement
  5. Post-test

You may pick up a temporary ORMC badge from me at the time you turn in your paperwork. It is imperative that you turn the badge in to me on your last day of clinicals.

We welcome you to Oconee Regional Medical Center (ORMC) and wish you a worthwhile experience on campus. Please feel to call me at 478-454-3709 or email me at shenry@ormcinc.org.

Orientation Module

Orientation Module

ORMC Mission Statement
The MISSION of Oconee Regional Medical Center is to provide high quality, safe, compassionate and patient-focused healthcare.

 

General guidelines for student responsibility

~A student will never assume total responsibility for a patient.
~All planned student activities pertinent to care of a patient will be shared with the designated Instructor, Department Manager, or Preceptor.
~A student, who has not attained competency in a skill or procedure, is required to have the Instructor, Department Manager or Preceptor present if the student is to participate in that procedure.
~A student must comply with the school dress code.  Their school badges or nametags and ORMC temporary ID must be visible.
~A student must report any incident/accident to the Instructor, Department Manager or Preceptor.

Part 1

Orientation Module
Pillars of Our Culture
PillarsStellar Service

Foundations of Stellar Service

  • Exceed Expectations (Go the Extra mile)
  • Make the customer feel special
  • Create positive defining moments
  • Remember the business, human and hidden dimensions of each defining moment
  • Be friendly and courteous: Smile, Greet, Own and Thank
  • Fix it fast when there is a service breakdown

 

AIDET

ORMC has partnered with Studer Group to employ tactics proven to move patient experience and quality outcomes. One of those tactics AIDET, an acronym that stands for Acknowledge, Introduce, Duration, Explanation, and Thank You. AIDET is a communication framework that:

  • Improves patient and customer perception of their care or the service they receive
  • Helps reduce their anxiety (thus improving outcomes)
  • Builds customer loyalty
  • Ensures that all service providers are delivering consistent measures of empathy, concern, and appreciation

Acknowledge

Introduce

Duration

Explanation

Thank you

 

 

 

Cultural Diversity

We all differ from one another. As students in the health care industry, our differences can become more important due to the extremely personal nature of the service we provide.  As we work with employees and patients/families, and maintain an environment that is respectful of all people.

No one can know and understand all the ways we differ from one another.  However, we can create an environment that is respectful of differences. To do this, you must be aware of your own feelings about differences and consistently use behaviors that communicate respect.

Learn to recognize, respect and work with patient’s different cultures, values, beliefs, practices and rituals.  If you need to access translation services, including sign language, promptly call the Patient Representative or the Overhouse Supervisor after hours.

You have a big role to play when it comes to embracing cultural difference and sensitivity toward other cultures.  It is the policy of ORMC to respect the cultural and ethnic needs and desires of the patients that we serve if at all possible.

This may include:

  • Respect the patient’s beliefs regarding the origin of illness
  • Provide kosher or vegetarian meals/respecting dietary restrictions
  • Providing alternatives such as electric candles for rituals since actual candles cannot be used within the hospitals
  • Provide an interpreter so that the patient can participate in decisions regarding care.

Population Specific or Age Specific Considerations for Assessment

The goal of patient assessment is to develop and implement an individualized interdisciplinary plan of care for the patients and the families.  In the creation and implementation of this plan of care, it is imperative that the appropriate age-related or population specific considerations be addressed. These considerations for care must address the chronological age of an individual and be amended to conform to the individual’s level of cognitive development.  The following information outlines age categories and age appropriate considerations for assessment and treatment and can be readily utilized for plans of care.

 

Newborn (0-1)

Newborns quickly develop during their first month of life. They are growing rapidly and require tremendous amounts of attention to meet their developmental needs. As a nurse, you are responsible for helping to meet a newborn’s health needs and you are also tasked with preparing new parents through effective communication and education. As the child develops during that first year, care plans must follow their growth patterns to keep their safety and health in check.

Toddler (1-3)

Toddlers start gaining a sense of independence when entering this developmental stage. You will witness a drastic change in height and weight during these years, and toddlers will begin to understand their own movements such as balance, climbing, running and jumping. They will also gain control of their bodily functions, including those of the bowel and bladder. Communication is key in providing healthcare to this age group, as they are still relatively unaware of right and wrong but are cognizant of directions. You must thoroughly explain treatment plans in a tone that is easily understood by this age group.

Preschool (3-5)

This development stage is marked by extreme activity and discovery, with the significant development of motor skills and personality. Children in this age group are exploring their world, including their physical and emotional state. They are more prone to accidents, as their motor skills try to keep pace with their imagination. You must be adept in communicating with young patients and recognizing age-appropriate treatment plans. Parental involvement in patient treatment is still key at this development stage, so you must be willing and able to communicate with both the patient and their guardians.

School age (6-12)

This is a broad age group that will experience a tremendous amount of development, including an average weight gain of three to five pounds and a height increase of one to two inches every year. And, while they are shooting up the charts physically, they are also making leaps and bounds in their mental development by learning to read, write and do complicated calculations. It is within this age group that patients begin to fully understand their personal health and wellness, including hygiene, physicality and more. You should address a child’s needs on the full wellness spectrum.

Adolescence (13-18)

Adolescence is a time of tremendous growth, including bodily changes, which can have both a physical and mental effect on this age group. Peer pressure is also at its height during this development stage, and this age group may encounter many challenges to their principles that could affect their health. Adolescent patients are fully aware of the cause and effect of their decisions on their health and wellness. You should openly communicate with these patients as well as their parents while also keeping a relative sense of privacy for the child.

Adult (19-65)

This is a vital developmental age group that spans several decades. During this time, patients will experience many life changes that could affect their health and well-being both positively and negatively. Most body functions are at their prime during the early years in this developmental stage; however, after the age of 45, patients can expect to experience changes in their muscular strength, endurance and mobility as well as vision, hearing and joint activity. You must consider a patient’s lifestyle and age when devising a treatment plan, and most patients prefer open communication.

Older Adult (over 65)

The end of life doesn’t have to mean the end of quality healthcare. This age group often places tremendous patient demand on nurses; however, understanding how to communicate and treat elderly patients can ease your job. Many body functions of the patient will continue to deteriorate, and many patients will require serious healthcare.

Understanding the development and communicative needs of your patients is essential to quality patient care.

 

Suspected Abuse, Neglect, Violence and Exploitation Assessment

Population specific considerations should also be utilized for patients when there is suspected abuse or neglect. ORMC policy ADM-CL-565 supports licensed health care providers in directing them to “disclose PHI about an individual whom ORMC reasonably believes has been a victim of abuse, neglect, or domestic violence to a government authority, including a social service or protective service agency, authorized by law to receive reports of such abuse, neglect, or domestic violence”. ORMC policy ADM-CL-563 addresses the reporting of suspected child abuse or neglect.

Part 2

Orientation Module

Health Insurance Portability and Accountability Act (HIPAA)
Definition of HIPAA
The Health Insurance Portability and Accountability Act of 1996 is a multifaceted piece of legislation covering three areas:
a. Insurance Portability:
Portability ensures that individuals moving from one health plan to another will have continuity of coverage and will not be denied coverage.
b. Fraud enforcement (accountability):
Significantly increases the federal government’s fraud enforcement authority in many different areas.
c. Administrative simplification:
Ensures system-wide, technical and policy changes, in healthcare organizations in order to protect patient’s privacy and the confidentiality of identifiable protected health information.
Patient Confidentiality
Patient confidentiality is a conscious effort by every healthcare worker to keep private all personal information revealed by patients and their families and/or medical records during a hospital visit. You may have access to confidential information about patients and their families. You must never discuss, disclose or review any information about a patient’s medical condition with any other person unless they have proper authorization.

Every student must read the Code of Conduct booklet and sign the Confidentiality Form.

Identifiable Protected Health Information

Protected health information (PHI), under the US Health Insurance Portability and Accountability Act (HIPAA), is any information about health status, provision of health care, or payment for health care that can be linked to a specific individual. Consider everything inside a patient’s chart (paper or electronic) as identifiable protected health information. Assure that patient confidentiality and privacy are not compromised.

  • Privacy is a patient’s right. Medical information must be shared only with those who need to know.
  • Patient privacy can be violated when protected health information and patient names are left on voicemail messages or telephone answering machines.
  • In a semi-private area, pull the curtain around the patient’s bed, and lower your voice before speaking about medical information.
  • Computer printouts, and other paper records containing patient information, must be kept in a secure place and shredded when not longer needed. Never throw in a regular trash can.
  • Never leave any patient information, including computer screens, charts and operating room schedules unattended. Never discuss patient information or hospital business in public areas.
  • Shred confidential information. Knock before entering a patient room and always identify yourself by your name, your position and your reason for being there.
  • Provide a second gown or extra blanket when a patient is ambulating, in a wheelchair or being transported.
  • Use the most private space available when discussing patient information with a patient or family members.

Part 3

Orientation Module
EMTALA

The Emergency Medical Treatment and Active Labor Act ensures that anyone presenting on hospital property asking for medical treatment must be taken to the Emergency Department and given a medical screening exam (MSE). An emergency condition must be treated regardless of ability to pay.

EMTALA also requires:

  • Stabilization of a patient before transfer if tertiary care is required
  • Benefits must outweigh risks of transfer
  • There must be an accepting physician and hospital before transfer, and medical records of treatment here must be sent with the patient.

Environment of Care

Emergency Preparedness

This section prepares you to safely respond to an emergency situation at work as well as at home. This section will help you learn how to respond to unexpected events and emergencies, as your actions could have an impact on patients, parents and coworkers. Following these procedures may ensure safety for you, our patients and their families.

Code Red = Fire

  • Reassure the patients or visitors you are responsible for.
  • Close all doors
  • Clear the hall ways

Code Red means there is a fire somewhere at the hospital.

RACE is a national acronym used to help you remember what you must do in case of a fire.

If there is a fire, remember the term “RACE”:
R – Rescue: Your first priority is to remove patients from immediate danger.
A – Alarm: Pull the nearest red fire alarm box.
C – Contain: Close all doors.
E – Evacuate/Extinguish: Know the location of all fire exits should evacuation become necessary.

Evacuate horizontally following your unit’s evacuation plan. Do not use elevators, use only stairs. Remember to CLOSE ALL DOORS.
Use the proper fire extinguisher to extinguish or control a fire, only if trained to do so. ORMC’s safety plan outlines specific personnel that will respond should a code red be called.

Code Blue = Adult Cardiopulmonary Arrest

Code Blue means cardiac arrest or respiratory arrest.

If a patient, visitor or employee has cardiac or respiratory arrest, call for help by dialing 3999 on any in-house phone. Most patient rooms have a “Code Blue” button.  It is preferable to use this if available.  Give the number of the patient’s room or area where the victim is located. The switchboard operator will page “Code Blue” on the Overhouse page. Begin CPR if you are certified to do so.

Code Pink = Infant/Child Cardiopulmonary Arrest
Follow the same procedure above.

Code Black = Tornado sighted in the area
Close blinds and curtains in patient rooms and remove any items from the window sills. Inform patients and visitors that it may be necessary to move to a n inner corridor. Make sure hallways are free of obstruction.

 Code Adam = Infant/Child abduction
Immediately proceed to the nearest exterior exit. If that exit is already manned by a hospital staff member or security guard, proceed to the nearest exit until Code Adam is “all clear”. If someone attempts to exit the building, state that “due to an emergency, Administration has directed that no one exit the building at this time”.

 Code Triage = an event that significantly disrupts the environment of care and/or the care and treatment of patients

 Code Silver = Active Shooter
An “active shooter” is an individual who is engaged in killing or attempting to kill people in a confined and populated area; in most cases, active shooters use firearms and there is no pattern or method to their selection of victims.

You have 3 options:

RUN:

  • Have an escape route and plan in mind
  • Leave your belongings behind
  • Evacuate regardless of whether others agree to follow
  • Help others escape, if possible
  • Do not attempt to move the wounded
  • Prevent others from entering an area where the active shooter may be
  • Keep your hands visible
  • Call 911 when you are safe

HIDE:

  • Hide in an area out of the shooter’s view
  • Lock door or block entry to your hiding place
  • Silence your cell phone (including vibrate mode) and remain quiet

FIGHT:

  • Fight as a last resort and only when your life is in imminent danger
  • Attempt to incapacitate the shooter
  • Act with as much physical aggression as possible
  • Improvise weapons or throw items at the active shooter
  • Commit to your actions….your life depends on it

When law enforcement arrives:

  • Remain calm and follow instructions
  • Drop items in your hands (e.g., bags, jackets)
  • Raise hands and spread fingers
  • Keep hands visible at all times
  • Avoid quick movements toward officers, such as holding on to them for safety
  • Avoid pointing, screaming or yelling
  • Do not ask questions when evacuating

Information to provide to 911 operations:

  • Location of the active shooter
  • Number of shooters
  • Physical description of shooters
  • Number and type of weapons shooter has
  • Number of potential victims at location

Code Green = behavior health patient in the ED
Any patient presenting to the ED for psychiatric or behavioral health interventions and therapies, with complaints such as severe drug or alcohol abuse, severe depression, a self-injury, past or present suicide attempt, or a clear statement of suicidal intent will have a suicide risk assessment done. During the assessment, if it is identified that the patient has a previous history or is currently severely depressed, exhibits drug or alcohol abuse or has made a past or present suicide attempt, the suicidal risk assessment will be performed to assist in determining the plan of care/safety plan.

These may include:

  1. Assignment to a room in close proximity to the nurses’ station and away from elevators, stairwells whenever possible.
  2. Asking for the patient to undress, and change into a hospital gown/paper scrubs. If the patient refuses, staff will attempt to negotiate to get their shoes, belt, and contents of pockets, purse, and any bags and place them in a secured location. Patient belongings are inventoried and logged in by Security and Security will place them in a locked cabinet outside the treatment room.
  3. Apply a green armband and initiate a Code Green.
  4. As soon as possible, staff will search clothing and property (pockets, jackets, shoes, suitcases, socks, backpacks, purses and bags) for contraband (weapons, glass, sharp objects, matches, plastic bags, etc.). This is to be done by two (2) staff members.
  5. Patients who are at risk for harm to themselves or others will be wanded by security. In the event a weapon is found in the patient’s possessions, the patient will be asked to relinquish the weapon. The contraband will be logged into a secure location by security.
  6. Should the patient refuse to relinquish the weapon, staff will request assistance from local law enforcement immediately and have Security clear the area of all personnel and patients.  Notify the Administrator on Call ASAP.

Code Brain = suspected stroke patient transferring into the ED or in the hospital
Best practice for suspected stroke includes rapid CT evaluation. If a hemorrhagic stroke is identified, arrangements are made to transfer the patient to a facility capable of neuro surgery. If anischemic stroke is identified, the patient is screened to receive thrombolytic therapy. When a Code Brain is called, the CT area prepares to receive the patient very shortly after their arrival to the ED. Upon arrival to the ED, the ambulance personnel will transport the patient to the nurses’ station for a brief assessment, and then proceed to the Radiology Department for the CT scan.

Electrical Safety
Electrical safety is very important for preventing fires and shock.

  • Do not use cords with insulation that is cracked, torn or rubbed off.
  • Do not use any cord or plug that appears damaged or heats up when used.
  • Get safety instructions before using, cleaning and maintaining electrical power equipment.
  • Do not use any electrical equipment that appears to be damaged or in poor repair. TAG, TAKE OUT OF SERVICE AND NOTIFY BIOMED.
  • Do not use any device that blows a fuse or gives a shock. Report all shocks-even small tingles immediately. TAG, TAKE OUT OF SERVICE AND NOTIFY BIOMED
  • Be aware of tags indicating equipment is not working properly. Equipment that is tagged should not be used to perform patient care, until the Biomedical Department has repaired it.

Patient incidents involving medical equipment or products must be reported to Risk Management (3552) and Biomed (3799) in accordance with the Safe Medical Devices Act (SMDA).

Personal Safety Tips

You can help us make the hospital a safer place by taking steps to protect yourself.

  • Do not leave your purse or wallet unattended. Keep them out of view.
  • Report any suspicious person or unauthorized persons to Security immediately.
  • Watch drug containers and packages for signs of tampering.

Security
Security officers are to be contacted through the hospital switchboard at extension 3505.

Hazardous Materials

Hazardous materials are chemical products that can harm yours eyes, lungs or skin. Be sure to protect yourself when handling chemical products. Use Personal Protective Equipment including gloves, mask, gown, and protective eyewear.

Waste Disposal: There are several types of hospital waste. Each type of waste has its own type of waste container.

Biohazard Waste is any type of waste that is contaminated by blood or other body fluids contaminated with blood. All items contaminated with more than a small amount of blood, drainage, or infectious secretions are discarded in red bags for incineration. These containers have the Biohazard symbol. Note: always wear Personal Protective Equipment (PPE) when handling Biohazardous Waste.

Sharps are substances that can poke or cut your skin, such as needles, broken ampules and/or lancets. Sharps are disposed of into a hard, plastic Sharps Box. Sharps may be contaminated; therefore, you must always wear PPE when handling sharps.

Part 4

Orientation Module

Infection Control

ORMC students/volunteers need to follow a basic level of caution during their work activities. They include:

  • Comply with hospital and unit specific dress code regulations
    • Clean uniform or scrubs daily
    • Long hair should be restrained or tied back in some fashion to reduce risk of hair contamination of patient food, supplies, and/or environment, and to reduce the risk of personnel hair contamination from splashes or contact with soiled hands
  • Avoid touching eyes or mouth during patient contact activities
  • No eating or drinking in areas where patient contact activities or contact with contaminated equipment or surfaces could occur.
  • Routine hand washing BEFORE and AFTER patient care.
  • Compliance with hospital guidelines for Universal Precautions and Safety.
  • Recognition of types of isolation precautions used for specific communicable disease.
  • Artificial nails are NOT permitted to be worn by employees or student with direct patient care responsibilities. Artificial nails include: acrylic nails, nail extenders, nail wraps, silk wraps, sculptured nails, press-on nails, and nail jewelry.

Universal Precautions
Universal or Standard Precautions are a set of standardized precautions to be used for all patients, regardless of illness or medical condition for the prevention of blood-borne pathogens.

Hand washing is required before and after patient contact as it is the single most important action in preventing the transmission of disease.

Personal Protective Equipment (PPE) is worn to protect against blood/body fluid exposures. Staff should know location of PPE in each patient care area and be familiar with them when barriers are indicated and used as required.

*Gloves for hand protection
*Gowns to protect clothing
*Protective eyewear to reduce risk of splashes, use goggles or masks with shield
*Masks to reduce risk of respiratory exposure

Avoid touching face or eyes during patient care activities. Many respiratory viruses are readily transmitted through the mucus membranes of the eyes, nose, and mouth.

Avoid eating, drinking, or applying lipstick or lip balm in patient care areas. Enteric viruses such as Rotavirus may survive for up to 5 days on environmental surfaces.

Staff should know the location of eye wash stations in patient care areas and use to immediately cleanse eye if contamination with blood, body fluid or hazardous chemicals should occur.

Injuries with contaminated sharps present a significant risk to healthcare workers. Blood borne pathogens, which have been documented to be transmitted by percutaneous exposure, include: Hepatitis B, Hepatitis C, and Human Immune-deficiency Virus (HIV). Hepatitis B is best prevented by administration of Hepatitis B vaccine. Post exposure prophylaxis for HIV requires administration of anti-retroviral medications. There is currently no prophylaxis for Hepatitis C.

Handling Sharps Safely
*Never recap used needles by hand. If needles must be recapped, use on handed scoop method or recapping device (activate protective covering).
*Do not bend or break needles.
*Keep used sharps separate from other items such as gauze and alcohol wipes.
*Always point a used sharp away from your body.
*If assisting with a procedure always be aware of where the sharp is being placed.
*Never clean up broken glass by hand.
*Do not overfill a sharps container. If it appears to be over 2/3 full, notify Environmental Services at 3100.
*Do not open, reach into, empty, or clean a sharps container.
*When using sharps remember to activate protective covering.

Reporting a Blood/Body Fluid Exposure

If you are injured by a contaminated sharp, the incident must be reported immediately.

  • Notify immediate supervisor or nurse manager
  • Notify your clinical instructor
  • Complete a hospital incident report
  • Obtain medical evaluation in the Emergency Department

Part 5

Orientation Module

Patient Safety Goals
Improve the accuracy of patient identification
ORMC requires the use of two identifiers whenever administering medications or blood products, taking blood samples and other specimens for clinical testing, or providing any other treatment or procedures. These two identifiers are specifically the Name and Birth date. All patients must have an ID bracelet.
Improve the effectiveness of communication among caregivers
ORMC has a standardized list of abbreviations and also a list of “Do Not Use Abbreviations” posted on each clinical unit. Reporting of critical results of tests and diagnostic procedures in a timely manner is defined in policy ADM-PC-060. Specific times are defined for Radiology, Cardiopulmonary, and Laboratory results.
Improve the safety of using medications
All medications, medication containers (ex. Syringes, medicine cups, basin), or other solutions on and off the sterile field must be labeled with the name of the medication, amount, dilution, date, and initials. ORMC has a standardized Heparin drip and protocol.
Reduce the risk of healthcare-associated infections
ORMC complies with CDC hand hygiene guidelines and implements evidence-based practices to prevent health care associated infections due to multiple drug-resistant organisms. Nasal swabs are done for certain populations and isolation procedures. There is a central line check sheet for guidelines to prevent central line-associated bloodstream infections. There are surgical guidelines for antibiotic administration and discontinuation.
Accurately and completely reconcile medications across the continuum of care
ORMC has a written process for reconciling medications on admission, at discharge, and throughout the hospital stay.
Identifies safety risks inherent in its patient population
ORMC identifies patients at risk for suicide using a suicide screen. The policy is HW-PC-210 on the Intranet. Nurses screen all patients for the risk of falls and institute the fall protocol if indicated.
Universal Protocol for preventing wrong site, wrong procedure, wrong person surgery
*ORMC conducts a pre-procedure verification of the correct person, procedure, and site regardless of being elective or emergent.
*Site marking is done for all procedures involving incision or percutaneous puncture or insertion. The site is marked initially before the patient is moved to the location of the procedure and takes place with the patient involved, awake and aware. The physician will mark the site with a permanent marker.
*A time-out is conducted immediately prior to starting the procedure. The time-out addresses the following: correct patient identity, confirmation that the correct side and site are marked, an accurate procedure form, agreement on the procedure to be done, correct patient position, relevant images and results are properly labeled and appropriately displayed, the need to administer the antibiotics, and safety precautions based on patient history or medication use.
Patient Education

ORMC’s primary patient education systems are Krames and Micromedex. Both of these web-based software programs allow the hospital staff to access and print out patient information about illnesses or medications. The health sheets are available in English and Spanish, with many available in more languages than this. The content is written on a 6th through 8th grade reading level and is updated on a regular basis by the respective editorial boards. They are located on the hospital’s Intranet under “User Applications”. Any of our staff will be happy to assist you with accessing these.

Pain Management
At ORMC, the patient’s self-report of pain is the single most valuable indicator of pain. The patient and their caregiver can expect that pain will be evaluated using an appropriate pain scale. The pain scales include: 0-10 pain scale, FLACC pain scale, or the Wong-Baker Faces pain scale. Patients will be taught that the goal of pain management is prevention (when possible) and that early intervention in the course of pain management is important. Patient care providers will respond to the patient’s report of pain as quickly as possible. Nursing will assess the effectiveness of interventions within 1 hour or as appropriate according to the patient’s condition and/or the intervention utilized. The outcome goal for pain management is to bring the pain to a level acceptable to the patient. A pain assessment is performed and documented upon admission, after any known pain producing event, and with each new patient report of pain, and at every 2 hour rounds.
Restraints
A restraint is any involuntary method of restricting an individual’s freedom of movement or normal access to his/her body. Restraints may be physical or chemical and may only be applied after all other measures have failed (moving closer to nurse’s station, family or sitter at bedside, distraction, etc). A physician’s order must be obtained and reordered every 24 hours as needed. During the time the patient is in the restraint, the patient is assessed every 2 hours for the following elements to ensure that the patient’s safety and health are maintained:
Patient’s physical needs (circulation checks, elimination, hydration, nutrition and hygiene) are met at least every two hours while the patient is awake. During these checks, the nurse should release the restraint and perform range of motion to the limb. Only staff that has been deemed competent to apply restraints may do so.