Infection Control Shaping Client Outcomes. Leader Guide

Transcription

1 4516 Infection Control Shaping Client Outcomes Leader Guide

2 OUTLINE OF COURSE CONTENT CONTINUING EDUCATION Title of Educational Activity Contact Hours 3 The presenter for our program is the script writer who writes the program guide and the script for the program. The facilitator/subscriber/purchaser of our program can also be considered the presenter as he/she directs the class and the participants through the guide and the video. The distribution of handouts, review of glossary of terms, taking of the pretest and discussion of correct answers takes about 30 minutes. The post test and discussion of correct answers takes about 15 minutes. Each part of the video has a pre test/post test to be distributed, completed and discussed. The discussion questions take approximately 15 minutes for part one and 15 minutes for part two. 2

3 OUTLINE OF COURSE CONTENT CONTINUING EDUCATION (continued) Objectives Content (Topics) Time Frame List objectives in Operational and Behavioral terms Part I Define the goal of Infection control Explain the role of CDC and OSHA Define what an infection is List the signs and symptoms of an infection Describe the Chain of Infection Explain the three levels of the body s defense List when to perform handwashing Demonstrate how to perform proper handwashing Define what are Standard Precautions Acknowledge whose responsibility it is to follow Standard Precautions Accepts OSHA standards Practices the basic guidelines of Standard Precautions List the body s defenses against infection Demonstrate proper handwashing technique Implement Standard Precautions Explain the relationship of Infection Control to decreasing infections Acknowledge the benefits of Infection Control List each topic area covered and provide a description or outline of the content to be presented Part I Introduction Goal of Infection Control Brief overview of CDC & OSHA Infection Definition S/S of infection Chain of Infection Risk factors Body Defenses First line of defense Second line of defense S/S of inflammation Third line of defense Handwashing When to perform it How to perform it Standard Precautions What are they Who is responsible for following Standard Precautions OSHA Standards Basic guidelines for Standard Precautions Summary State the time frame for the topic area Part I 85 minutes for entire portion of part one Facility List the faculty persons or presenter for each topic Part I Script writer and on-site facilitator Teaching Method Describe the teaching method(s) used for teaching Part I Presentation Scenario Demonstrations Pre & Post Tests Supplemental handouts Discussion questions 3

4 OUTLINE OF COURSE CONTENT CONTINUING EDUCATION (continued) Objectives Content (Topics) Time Frame List objectives in Operational and Behavioral terms List each topic area covered and provide a description or outline of the content to be presented State the time frame for the topic area Facility List the faculty persons or presenter for each topic Teaching Method Describe the teaching method(s) used for teaching Part II Part II Part II Part II Part II Define biohazardous waste Employ appropriate techniques for disposing of biohazardous waste Define engineering and work practice controls Apply various types of engineering and work force practice controls Utilize the proper method of disposal for different types of biohazardous waste Introduction Biohazardous Waste Definition How to handle Biohazardous Waste Safely Engineering and Work practice controls Definition Examples of various Types of Engineering Practices and Equipment 85 minutes for entire portion of part two Script writer and on-site facilitator Presentation Scenario Demonstrations Pre & Post Tests Supplemental handouts Discussion questions Define PPEs Identify when each of the various types of PPE should be utilized Demonstrate the application and removal of PPE Biohazardous bags Sharps containers Cleaning, disinfection, and sterilization Handling of linen Atmospheric controls PPE Gloves Eye Protection, masks, face shields Gowns 4

5 OUTLINE OF COURSE CONTENT CONTINUING EDUCATION (continued) Objectives Content (Topics) Time Frame List objectives in Operational and Behavioral terms List each topic area covered and provide a description or outline of the content to be presented State the time frame for the topic area Facility List the faculty persons or presenter for each topic Teaching Method Describe the teaching method(s) used for teaching Part II (cont d) Part II Part II Part II Part II Recall specific infectious diseases as they relate to their individual chain of infection Describe how the different types of precautions taken for the specific diseases helps break their chain of infection Acknowledge the necessity for the Bag Technique Follow the procedure for the Bag Technique Explain Latex Allergy Infection control when working with selected diseases Dealing with Bloodborne pathogens HIV/AIDS Hepatitis Transmission-Based Precautions TB MRSA VRE 85 minutes for entire portion of part two Script writer and on-site facilitator Presentation Scenario Demonstrations Pre & Post Tests Supplemental handouts Discussion questions Identify who is at risk List related food allergies Recall different types of allergic responses Employ techniques to minimize exposure for clients who have or are at high risk for latex allergy. Bag Technique Why it is utilized P&P for bag technique Latex in the environment Introduction Who is at risk Related food allergies Allergic responses Guide for caring for high risk individuals Summary 5

6 PROGRAM DESCRIPTION Infection Control is more important today than ever before, both for the safety of the client and for the safety of the health care professional. This is due, in part, to some bacteria becoming resistant to antibiotics. In addition, the continuing development and use of high tech invasive therapies, and increasing survival rates of the very young, chronically ill, and the elderly also increases the potential for infection. In part one of this program we will explain the role of CDC and OSHA, define what an infection is and some typical signs and symptoms. The Chain of Infection will be described and all the necessary steps to Standard Precautions will be explained and demonstrated. In part two of this program engineering and work practice controls will be explained along with the proper method for disposal of biohazardous waste. PPE s will be demonstrated in detail along with the proper procedure for using the Bag Technique and a brief overview of MRSA, VRE, TB, HIV/AIDS, Hepatitis and Latex Allergy. (Video running time: 50 minutes (3 contact hours), including learning guide.) OBJECTIVES At the completion of this program, the participant will be able to: 1. Define the goal of Infection control and explain the role of CDC & OSHA. 2. Define what an infection is, list the signs and symptoms of an infection and describe the Chain of Infection. 3. Demonstrate how to perform proper handwashing and when to perform. 4. Define what are standard precautions and whose responsibility it is to follow standard precautions. 5. List the body s defenses against infection. 6. Explain the three levels of the body s defense. 7. Define what constitutes biohazardous waste and how to employ appropriate techniques for disposing of biohazardous waste. 8. Define engineering and work practice controls 9. Define what PPE is and identify when each of the various types of PPE should be utilized with demonstrations of each. 10. Discuss the necessity for the Bag Technique and demonstrate the correct procedure for the Bag Technique. 11. Explain what latex allergy is and identify who is at risk. 12. Employ techniques to minimize exposure for clients who have or are at high risk for latex allergy. 13. Provide brief overview of bloodborne pathogens (HIV/AIDS, MRSA, VRE, and Hepatitis). 6

7 The Nursing Process The nursing process is a systematic method of problem solving. It is based on the scientific method. The nursing process is called "process" because it is ongoing. These are the steps of the nursing process: Assessment: This is the systematic, ongoing collection of information from multiple sources. Assessment is done when a nurse interviews a client and the client s significant others. A physical assessment of the client is also completed observing the following: laboratory data, daily client actions, assessing the client s ability to carry out daily activities, symptoms and the client s response to treatment. In long term care, resident assessment instruments are used to provide a comprehensive multidisciplinary assessment. Problem Identification or Nursing Diagnosis: Assessment data leads to identifying client strengths and client problems. These may be actual problems the client currently experiences, or potential problems that may occur with that client in the future. Problems are stated and related to a cause or influencing factor. Planning: The systematic steps that the nurse will enact, with others, to assist the client to meet the goals (or outcomes) that are set. For each problem, a measurable, specific goal is identified. The plan includes nursing actions, based on aspects of nursing theory, nursing science, other sciences, and research findings. The beliefs and values of the nursing profession as well as the values of the client are taken into account. Implementation: Carrying out the plan. Evaluation: This is the systematic process of examining each client goal-related outcome to determine if it were met and to revise the plan accordingly. Evaluation may also identify the resources that are needed for the client or the health care provider in their continuing plan of care. Professional Nursing Roles As the nurse carries out the nursing process, the nurse enacts a variety of professional roles. These are: clinician teacher client advocate leader These roles may overlap. In the clinician role, the nurse may provide direct "hands on" care, or may assess a client's needs and direct others to provide services to meet those needs. The nurse may conduct patient and family teaching in a teaching role. The nurse may also teach other health professionals when a multidisciplinary team addresses the client's needs. The nurse is a client advocate when collaborating with the client, finding resources for the client, and acting on behalf of the client. The nurse is a leader when planning and assigning the care of a client to others, maintaining overall responsibility and accountability for that care, assisting other members of the health care team to set and meet goals or when providing resources to other health care providers. 7

8 GLOSSARY OF KEY TERMS Aerosolized Anaphylaxis Antimicrobial Atopic B-cells Colonization Cross-sensitivity Endogenous Epidemiologically Exogenous Fomite Germicide Perinatal Retrovirus T-cells Urticaria producing an aerosol; dispensed as a mist/airborne a very severe form of a type I allergic reaction; it can occur very quickly, can produce life threatening changes in circulation and bronchioles and can be fatal destroys or prevents the development of microorganisms Type 1 hypersensitivity or allergic reaction for which there is genetic predisposition lymphocytes produced in the bone marrow; provide body with immune capabilities refers to the presence of infectious organisms in or on a host, but no tissue invasion and damage and no signs of symptoms. the potential for causing allergic reaction produced or originating from within a cell or organism has to do with epidemic diseases caused by infectious agents originating outside an organ or part any substance that adheres to and transmits infectious material; inanimate objects such as linen a substance that destroys microorganisms the period beginning after the 28 th week of pregnancy and ending the 28 th day after birth a virus that overtakes the biosynthesis of living cells to duplicate itself lymphocytes that develops in the bone marrow and migrates to the thymus and provide the body with an immune response vascular reaction of the skin, also called hives. 8

9 PRE TEST PART I Circle T if the following statement is true. Circle F if the statement is false. 1. T F Medical asepsis and aseptic technique are the same. 2. T F All reservoirs are organic. 3. T F Pathogens will produce infection as long as the chain of infection remains unbroken. 4. T F We all have the power to break the Chain of Infection. 5. T F Airborne infections are transmitted on droplets of moisture from the respiratory tract. 6. T F The body has four main lines of defense, including inflammation. 7. T F CDC recommends a second handwash only when the hands are obviously soiled. 8. T F When turning off the faucet after drying your hands, it is permissible to use the paper towel you dry your hands with to turn off the faucet as long as you don t touch the faucet with your skin. 9. T F Standard Precautions are the same as Universal Precautions. 10. T F Standard Precautions requires that a healthcare worker change gloves after each contact with a patient. 9

10 DISCUSSION QUESTIONS PART I 1. What does OSHA stand for and what is the purpose of this organization? What is the difference between OSHA & CDC? 2. List some of the body s defenses against infection. Explain the difference between naturally acquired active immunity and naturally acquired passive immunity? 3. What does Standard Precautions mean to you and what does it require of you? 4. How do you assure that good infection control standards are being carried out by all those you work with? 10

11 POST TEST PART I 1. The regulating agency responsible for requiring and enforcing the implementation of safety measures in the workplace is: A. CDC B. OSHA C. JCAHO D. NOTA 2. The signs and symptoms of infection: A. depends on where the infection is located B. depends on the severity of the infection C. b only D. both a & b 3. In the Chain of Infection, all body orifices would be classified as a: A. reservoir B. vehicle of transmission C. portal of exit D. vector 4. Micro-organisms can be transmitted through: A. contact with an infected client B. contaminated food or water C. by inhaling dust particles which contain pathogens D. all of the above 5. The client s susceptibility to infection could be due to: A. a chronic disease, such as diabetes or congestive heart failure B. side effects of medications C. stress D. all of the above 6. One of the body s second line of defense is : A. intact skin B. immunity C. natural body secretions D. phagocytosis 11

12 POST TEST PART I (continued) 7. If a person develops antibodies after contacting the measles, they would have what kind of immunity? A. artificial acquired active immunity B. artificial acquired passive immunity C. natural acquired active immunity D. natural acquired passive immunity 8. PPE, work practices, engineering controls, and housekeeping are all included in this type of infection control: A. transmission-based precautions B. standard precautions C. atmospheric controls D. protective isolation 9. To accomplish effective handwashing it is necessary to: A. scrub your hands for at least seconds B. always use a sink with a knee or foot pedal C. keep your hands level with your elbows D. use only liquid soap, never bar soap 10. Standard Precautions means the following precautions are in place: A. PPE s B. engineering and work practice controls C. Hepatitis B vaccine D. all of the above 12

13 PRE TEST PART II Circle T if the following statement is true. Circle F if the statement is false. 1. T F HIV is more prevalent amount white, middle aged homosexuals. 2. T F HIV and HBV are similar in some of their modes of transmission. 3. T F Transmission-based precautions are put in place for specific diseases to replace Standard Precautions. 4. T F All isolation gowns need to be fluid resistant. 5. T F TB is a disease that we have almost eradicated. 6. T F MRSA can be transmitted via droplet and/or direct contact. 7. T F MRSA is a strain of Staphylococcus that is resistant to all types of antibiotics. 8. T F VRE has the capability of extensively contaminating the environment. 9. T F The Bag Technique is an outdated ritual that has recently been revived. 10. T F Patients with a latex allergy need to be cautious handling all types of latex. 13

14 DISCUSSION QUESTIONS PART II 1. What is the difference between engineering controls and work practice controls? List some examples of each. 2. Explain the difference between cleaning, disinfecting and sterilization of medical equipment? 3. List some of the precautions and protocols to follow if one of your clients or residents has MRSA? 4. How would you know if you had a latex allergy or sensitivity? If your client or resident has a known allergy, what precautions are in place to care for him or her effectively? 14

15 POST TEST PART II 1. The following is true about biohazardous waste: A. requires disposal in a special red bag or rigid, puncture proof container B. biohazard containers must be sealed at the point of origin C. a only D. both a & b 2. If you have to place a patient in airborne precautions, it is important to remember to: A. always keep the door closed B. make sure the room is private C. make sure the room has special air handling and ventilation controls in place D. all of the above 3. As part of PPE s, eye protection should be worn: A. only in the operating room B. if there is potential for splash or spray with blood or other potentially infectious body fluids C. at all times for all patient care delivered D. only in the delivery room 4. To obtain a culture from a draining wound it is necessary to: A. wear a clean pair of gloves B. clean the wound with a sterile gauze moistened with saline C. culture the damaged tissue using a rolling motion D. all of the above 5. When caring for someone with MRSA, the health care worker needs to know: A. MRSA is spread by direct hand contact B. MRSA can be spread through droplet transmission C. MRSA can live in the environment for as long as 30 days D. All of the above 6. People can carry the MRSA organism without showing any signs of infection. This is called: A. immunosuppressed B. colonization C. natural acquired active immunity D. artificial acquired active immunity 15

16 POST TEST PART II (continued) 7. The Bag Technique utilizes basic techniques of infection control such as: A. use of barriers B. contact precautions C. surveillance controls D. terminal cleaning 8. As a safety precaution, when using the Bag Technique always: A. make sure you have a lock on the bag B. keep the bag out of sight when it is in the car C. allow only a select few of your employees to use D. leave the bag in your car and never take it in your client s home 9. An allergic reaction to latex includes: A. anaphylaxis B. immediate dryness of skin when in contact with latex C. urticaria D. all of the above 10. Vancomycin Resistant Enterococci (VRE) can be: A. spread by contact with contaminated equipment B. spread by person to person contact C. airborne D. a+b only 16

17 ANSWER SHEET PRE TEST PART I PART II 1. F 1. F 2. F 2. T 3. T 3. F 4. T 4. T 5. T 5. F 6. F 6. T 7. F 7. F 8. F 8. T 9. F 9. F 10. T 10. F POST TEST PART I PART II 1. B 1. D 2. D 2. D 3. C 3. B 4. D 4. D 5. D 5. D 6. D 6. B 7. C 7. D 8. B 8. B 9. A 9. D 10. D 10. D 17

18 RESOURCE ADVISOR MARYANN O BRIEN RN, PA/HCA is a graduate of Temple University Hospital School of Nursing in Philadelphia, PA with a Bachelor in Professional Arts from Saint Joseph s College in Windham, ME. Mrs. O Brien s work experience has been in acute care, home health and skilled nursing facilities. She has also been a reviewer and contributing writer for Rosdahl Textbook of Basic Nursing (1994). As well as an item writer for NCLEX-PN. Presently, Mrs. O Brien is employed as an LPN instructor at Lorenzo Walker Institute of Technology in Naples, Florida. NEVCO video educational programs are prepared using specific criteria designed by National Educational Video, Inc. TM All educational programs are coordinated and reviewed under the direction of the NEVCO Director of Education, who is a master s prepared nurse. 18

19 REFERENCES Citarella, Barbara B., Mueller, Cynthia J., Citarella, Robert J. (Summer 1996) Bag Technique, Practice Infection Control and Prevention in Home Health Care Volume 3. Issue 3. RBC Limited pp. 8-9 Edmond, Michael B., Wenzel, Richard P., Pasculle, William A. (February 1996) Vancomycin-Resistant Staphylococcus Aureus: Perspectives on measures needed for control, Annals of Internal Medicine Volume 124. Number 3. pp Fisher, Deborah, Sawin, Kathleen (May 1998) Pearls for Practice: Latex Allergy in the Primary Care Setting, Journal of the American Academy of Nurse Practioners Volume 10. Number 5. pp Marx, James F. (July 1998) Understanding the varieties of viral hepatitis, Nursing 98 p. 44 Miller, Kristi K. & Weed, Page (April 1998) The latex allergy triage or admission tool: An algorithm to identify which patients would benefit from latex safe precautions, Journal of Emergency Nursing Volume 24. Number 2. pp , 149 Rosdahl, Caroline Bunker (1999) Texbook of Basic Nursing 7 th ed. Lippincott Williams & Wilkins: Philadelphia pp. 5, 77, 423, 425, , , 888, 1156, 1192, 1200, 1214, 1215, , 1545 Seigel, R., (March 1999) Biohazardous Waste, Philadelphia College of Pharmacy and Science p. 1 Thomas, Clayton L. MD, MPH (1997) Taber s Cyclopedic Medical Dictionary 18 th ed. F.A. Davis Co: Philadelphia pp Unknown, (July 1998) Infectious Disease: A guide to TB, VRE, and MRSA, RN p. 24DD While NEVCO strives to remain current with federal and state regulatory requirements, the information contained in this program is always subject to governmental amendment. Therefore, we suggest that you contact your state and federal authorities for any possible revisions to regulatory requirements. 19

20 Participant Evaluation of Objectives Please evaluate this program by circling the number that best represents how well this program met the following objectives: 4=Excellent 3=Good 2=Average 1=Poor 1. Define the goal of Infection control and explain the role of CDC & OSHA. 2. Define what an infection is, list the signs and symptoms of an infection and describe the Chain of Infection. 3. Demonstrate how to perform proper handwashing and when to perform. 4. Define what are standard precautions and whose responsibility it is to follow standard precautions List the body s defenses against infection Explain the three levels of the body s defense Define what constitutes biohazardous waste and how to employ appropriate techniques for disposing of biohazardous waste Define engineering and work practice controls Define what PPE is and identify when each of the various types of PPE should be utilized with demonstrations of each. 10. Discuss the necessity for the Bag Technique and demonstrate the correct procedure for the Bag Technique. 11. Explain what latex allergy is and identify who is at risk

21 Participant Evaluation of Objectives (continued) 4=Excellent 3=Good 2=Average 1=Poor 12. Employ techniques to minimize exposure for clients who have or are at high risk for latex allergy. 13. Provide brief overview of bloodborne pathogens (HIV/AIDS, MRSA, VRE, and Hepatitis) Do you feel you met your personal objectives? Time required to complete this program? minutes COMMENTS: Return this form to the facilitator who distributed the learning materials. Thank you. 21

22 Addendum October 30, 2002: CDC issues New Hand Hygiene Guidelines In the October 25, 2002, issue of MMVR, the Centers for Disease Control and Prevention presented new handwashing guidelines for healthcare providers: Categories As in previous CDC/HICPAC guidelines, each recommendation is categorized on the basis of existing scientific data, theoretical rationale, applicability, and economic impact. The CDC/HICPAC system for categorizing recommendations is as follows: Category IA: Category IB: Category IC: Category II: No recommendation: Strongly recommended for implementation and strongly supported by welldesigned experimental, clinical, or epidemiologic studies. Strongly recommended for implementation and supported by certain experimental, clinical, or epidemiologic studies and a strong theoretical rationale. Required for implementation, as mandated by federal or state regulation or standard. Suggested for implementation and supported by suggestive clinical or epidemiologic studies or a theoretical rationale. Unresolved issue. Practices for which insufficient evidence or no consensus regarding efficacy exist. Indications for handwashing and hand antisepsis: Recommendations a. When hands are visibly dirty or contaminated with proteinaceous material or are visibly soiled with blood or other body fluids, wash hands with either a non-antimicrobial soap and water or an antimicrobial soap and water. b. If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating hands in all other clinical situations described in item 1C. Alternatively, wash hands with an antimicrobial soap and water in all clinical situations. 22

23 NEVCO Account # REQUEST FOR CERTIFICATES FOR CONTACT HOURS TYPE the NAMES, LICENSE NUMBERS AND JOB TITLES (RN, LPN, MSW, CNA, PT, etc.) of the people who are to be issued a certificate for contact hours for attending the continuing education program: (Facility Name) (Title and Number of Video Program) This request must be submitted along with the completed roster and evaluation sheets for the above named program NAME LICENSE NO. JOB TITLE

24 Must be completed by the facilitator EVALUATION OBJECTIVES: TIB Bank Center th Street N., Suite 207 Naples, Florida (800) Fax (888) FACILITATOR S EVALUATION (NEVCO Video Education Program) (1) To assess extent to which the program was appropriate, adequate and effective. (2) To identify, continue to develop and evaluate effective quality assurance activities. Title of Program Date Place of Employment Job Title Please evaluate the presentation by circling the number that best describes your rating. 4 Excellent 3 Good 2 Average 1 Poor ORGANIZATION OF COURSE Material was organized to facilitate learning The amount of material covered was adequate and accurate There was effective use of time to cover the subject CONTENT OF THE FACILITATOR S GUIDE List total number of objectives in this facilitator s guide List by number the objectives that were met The test material reflected the objectives listed Content can be used to improve nursing practice Content reflected knowledge level and needs of learner The material was current Evaluate Test Questions Pre-Test Discussion Questions Post-Test FACULTY PRESENTING (Video) The presentation was The presenter explained the material The presenter demonstrated knowledge of material OVERALL RATING I felt this teaching method was COMMENTS (Please make suggestions for future topics and additional comments about the presentation or instructor) Thank you for your time in completing this evaluation! We appreciate your comments and suggestions. The NEVCO Educational Staff 1995 Revised 10/2004

25 EVALUATION (NEVCO Video Education Program) TIB Bank Center th Street N., Suite 207 Naples, FL (800) Fax (888) Must be completed by every participant EVALUATION OBJECTIVES: (1) To assess extent to which the program was appropriate, adequate and effective. (2) To identify, continue to develop and evaluate effective quality assurance activities. Title of Program Date Place of Employment Job Title OBJECTIVES Total number of objectives in program Circle the number of objectives that WERE met Circle the number of objectives that were NOT met Please evaluate the presentation by circling the number that best describes your rating. 4 Excellent 3 Good 2 Average 1 Poor ORGANIZATION OF COURSE Material was organized to facilitate learning The amount of material covered was adequate and accurate CONTENT OF THE PRESENTATION The test material reflected the objectives listed Content and/or skills demonstrated can improve my ability to perform my job Content reflected knowledge level and needs of learner The material was current Time for questions was Effective use of time to cover subject was Graphics were beneficial NEVCO FACULTY (who prepared the program and/or appeared in interviews) The presentation was well prepared The presentation explained the material well The presenter demonstrated knowledge of material OVERALL RATING I felt this teaching method was Facilities and classroom were adequate COMMENTS (Please make suggestions for future topics, content of program and instructors) Thank you for your time in completing this evaluation! We appreciate your comments and suggestions. The NEVCO Educational Staff 1995 Revised 10/2004

26 PRINT OR TYPE TIB Bank Center th. Street N., Suite 207 Naples, FL (800) Fax: (888) CONTINUING EDUCATION ROSTER This form must be completed and returned to NEVCO. Keep a copy for your facility, but return the original to NEVCO. Account # Number and title of Video Program Dates Given Contact Hours Name of Facility Address of Facility City/State/Zip RN Facilitator Signature ROSTER OF PARTICIPANTS Participant Name Participant Signature License # Soc. Sec. # National Educational Video, Inc. TM is an approved provider of continuing education. State Board provider numbers: Florida NCE2896, Alabama , California CEP8803 and Kentucky This activity provided by National Educational Video Inc. is approved as a provider of continuing education in nursing by Alabama State Nurses Association, which is accredited as an approver of continuing education in nursing by The American Nurses Credentialing Center's Commission on Accreditation.

27 Participant Name Participant Signature License # Soc. Sec. #

28 599 9 th Street N., Suite Naples, FL Fax: Certificate of Completion This is to certify that Attended and Completed National Educational Video, Inc. TM Program Number and Title For contact hours On Date Facility / Agency Name Facility / Agency Address RN / Facilitator CERTIFICATE FOR ASSISTANTS ONLY National Educational Video, Inc.TM is an approved provider of continuing education. State Board provider numbers: Florida NCE2896, Alabama , California CEP8803 and Kentucky This activity provided by National Educational Video Inc. is approved as a provider of continuing education in nursing by Alabama State Nurses Association, which is accredited as an approver of continuing education in nursing by The American Nurses Credentialing Center's Commission on Accreditation.

29 CERTIFICATE OF COMPLETION For each participant who has successfully completed a continuing education program, please make a copy of the blank NEVCO Certificate (on reverse side) and fill in the following information: 1. Name of the learner 2. Program title and number 3. Number of contact hours 4. Date the program was completed 5. Name and address of your Agency / Facility 6. Signature of the RN / Facilitator responsible for offering the program