2. BUMEDINST 6300.19; BUMEDINST 6280.1C; MCTP 3-40A; MCTP 3-40G; BUMEDINST 6230.15B Flashcards
What has the mission of providing Force Health Protection and supporting the medical needs of the Navy and Marine Corps Team across the entire spectrum of operations?
Navy Medicine
What is the foundation on which Force Health Protection is built?
Primary Care services
What will PCMH be known as in Navy Medicine?
Medical Home Port
Oversight of this instruction will be provided by three Navy Medicine clinical Region Commanders, reporting implementation progress and subsequent performance to the Bureau of medicine and Surgery (BUMED) M3/5 on what basis?
Monthly
All primary care clinics in Navy Medicine will have transitioned to the Medical Home Port model by what date?
June 30th, 2011
Who will act as the resource sponsor for all resource requirements necessary to fully implement Medical Home Port?
Deputy Chief, BUMED, Resource Management (M8)
Who will lead a diverse, multidisciplinary team in the implementation, monitoring, and assessment of Medical Home Port?
MTF Clinical Champion
Who will identify board members to augment National Committee for Quality Assurance (NCQA) site surveyors to assist in site evaluation for recognition by NCQA and compliance with the standards in BUMEDINST 6300.19?
Chairman, Primary Care Advisory Board
What is an integrated, comprehensive, continuous way of meeting the health care needs of patients by the Navy Medicine Team?
Navy Medicine Primary Care
What is Navy Medicine’s new model of primary care services?
Medical Home Port
What has established nationally recognized standards for PCMH?
National Committee for Quality Assurance (NCQA)
It is expected that all Medical Home Port locations will attain recognition for Level I within how many months of establishing a Medical Home Port clinic?
Four
Once achieving National Committee for Quality Assurance (NCQA) Level I recognition through a self-assessment, Medical Home Port clinics have an additional how many months to achieve NCQA Level II recognition?
6
A clinician who is available for how many fully bookable hours each week shall be defined as a full time equivalent of 1.0?
36
Family Medicine Training Program Faculty members are required to comply with the requirements of the Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committee (RRC) mandate of how many hours per faculty full time equivalent per year spent in resident teaching, oversight, or other faculty-related activities, exclusive of other patient care responsibilities?
1400
New hiring actions to support Medical Home Port are not authorized unless specifically approved by whom?
Navy Medicine Region Commander
BUMED strongly recommends that providers should realize 1,100 patients is the minimum, but not to exceed how many patients, for every full time equivalent provider on the Medical Home Port Team for patient empanelment?
1,300
CNO guidance specifies that MTFs cannot enroll students who are assigned to that command for less than how many days?
179
Closed panel. Once NCQA recognition is attained, then that Medical Home Port clinic will serve a closed panel. They will only be responsible for meeting the needs of their enrolled patients. Medical Home Port clinics will not be responsible for the patients of other providers outside their clinic or non-enrolled patients. Who are the only exceptions?
Newborns of enrolled patients who are less than 60 days old and are awaiting TRICARE enrollment, as well as, foreign nationals or dignitaries
Each Medical Home Port team will consist of how many privileged providers?
3-5 providers
When a Medical Home Port provider team consists of three providers, at least how many of them must be physicians?
One
When a Medical Home Port provider team consists of five providers the team will have no more than what total of administrative discounts?
1.25
What percentage of civilians should command strive to ensure that each Medical Home Port provider team consists of?
50%
Each Medical Home Port team shall have one Behavioral Health Provider for every how many enrollee’s?
7,500
Who serves as the care manager for assigned patients to coordinate care and other necessary services to meet the needs of the patient, as determined by the patient’s primary care provider?
RN
As a general rule, commanders, COs, and OICs will make every effort to not rotate Medical Home Port Team Nurses for a minimum of how many years?
One
Who is responsible for the care, career progression, and Sailorization of enlisted personnel in the primary care department of which the Medical Home Port clinic is a part?
SEL
Who facilitate patient check-in, verification of DEERs eligibility and collection of other Health Insurance Information?
Clerical Staff
What is the recommended ratio of behavioral health providers to enrolled patients?
1:7,500
In general, one Nurse Educator can serve the needs of approximately how many patients?
7,500
In general, one case manager can meet the needs of approximately how many patients?
7,200
Who provide advice on diet, food , and nutrition?
Nutritional Supports
How many types of appointments will be used in Medical Home Port clinics?
Four
Acute Appointment Types (ACUT) appointment types are for patients to be seen within what time frame?Open Access Appointment Type (OPAC) is the same as ACUT, but patients are seen when?
24 hours
Same Day
Established Appointment Types (EST) appointments are for patient to be seen within what time frame?
One week
All Wellness Appointments Types (WELL) are only used for patient wellness visits and provisions of preventative services. This type of appointment will be seen within what time frame?
One week
Primary care providers that routinely perform minor outpatient procedures on their patients are booked under what type of appointment?
Procedure Type Appointment (PROC) or Specialty Type Appointments (SPEC)
What two factors will be considered when deciding which appointment type to use?
Medical acuity and Patient desires
Civilian experience suggests that what percent of patients requesting a primary care appointment will desire a same day appointment?
50%
Medical Home Port clinics that attain what recognition will no longer be subject to traditional productivity-based PPS incentives, but will be judged on access, quality, outcome, and other related measures?
National Committee on Quality Assurance (NCQA) Level II
What type of offices are used for providers, nurses, support staff, as well as associated rooms for treatment or private consultation?
Combined offices (PODS)
How many exam rooms per provider is required?
2
All primary care providers participating in a Medical Home port clinic shall be a member of the Medical Home Port clinic team of how many providers?
3-5 providers
BUMED strongly recommends that providers realize 1,100 patients is the minimum, but not to exceed how many patients for every provider or full time equivalent?
1,300
Enrolled patients calling for an appointment and requesting to be seen the same day will be seen that same day by a member of the Medical Home Port team. All other patients will be seen within how many days unless they specifically request a later appointment or it would be medically inappropriate for them to wait that long?
7
What is the process used to empower patients to make wiser health care decisions?
Demand management
Quality care is realized when patients and providers partner together to set and attain health care goals. what is essential for this to succeed?
Continuity of care
Which instruction provides standards for management of regulated medical waste (RMW) generated from processes at Bureau of Medicine and Surgery (BUMED) Budget Submitting Office (BSO) 18 facilities or received by BUMED facilities prior to treatment and disposal?
BUMEDINST 6280.1C, Management of Regulated Medical Waste
Personnel conducting activities outside of the Continental United States, Hawaii, Alaska, and its territories will adhere to their host nation _____ _________ _________.
Final Governing Standards (FGS)
If a host nation Final Governing Standards (FGS) does not exist, what is adhered to?
Overseas Environmental Baseline Guidance Document (OEBGD)
Regulations provided in 29 CFR Part 1910.1030 and the policies in which other reference describe the processes that BUMED facilities will implement to protect personnel from occupational exposures to blood and other potentially infectious material?
BUMEDINST 6220.14, Bloodborne Pathogen control Program
Wastes generated from the management of biological select agents and toxins must be managed per which reference?
BUMEDINST 6210.3, Handling and Shipping of Potentially Hazardous Biological Materials, DiagnosticSpecimens, and Etiologic Agents
Shipboard personnel are governed by what guide?
Afloat Medical Waste Management Guide
Regulated medical wastes generated by non-BUMED facilities or received by non-BUMED facilities for management are governed by the requirements of which reference?
OPNAVINST 5090.1D, Environmental Readiness Program
What is solid material intended for disposal which is produced as the direct result of non-infectious patient diagnosis, treatment, therapy, or medical research other than those characterized as Regulated Medical Waste (RMW)?
Non-Regulated Medical Waste
Non-Regulated Medical Waste requires no further treatment and is disposed as?
general waste and trash
What is generated during diagnosis, treatment, or immunization of humans or animals and is capable of causing disease or would pose other adverse health risks to individuals or the community if improperly handled?
Regulated Medical Waste (RMW)
How many groups is Regulated Medical Waste (RMW) organized into that are managed based on associated risks?
9
How many primary groups of Regulated Medical Waste (RMW) are there each with specific management, treatment, and disposal criteria?
9
Which group of Regulated Medical Waste (RMW) deals with cultures, stocks, and vaccines?
1
Which group of Regulated Medical Waste (RMW) deals with pathological waste?
2
Which group of Regulated Medical Waste (RMW) deals with blood and blood products?
3
Which group of Regulated Medical Waste (RMW) deals with used sharps?
4
Which group of Regulated Medical Waste (RMW) deals with animal Waste (from animals exposed to infectious agents during research, production of biologicals, or testing of pharmaceuticals)?
5
Which group of Regulated Medical Waste (RMW) deals with isolation Wastes (including bedding from patients or animals from BioSafety Level 4 (BSL 4) agents)?
6
Which group of Regulated Medical Waste (RMW) deals with unused sharps?
7
Which group of Regulated Medical Waste (RMW) deals with other (including fluids that are designated by the local infection control authority)?
8
Which group of Regulated Medical Waste (RMW) deals with Chemotherapy Trace Wastes?
9
Which category of Regulated Medical Waste (RMW) is specific to infectious animals, contaminated animal carcasses, body parts, and bedding of animals known to have been exposed to infectious agents during treatment, research, productions of biologicals, or testing of pharmaceuticals?
Animal Waste
How many Bio Safety Levels are there with specific combination of work practices, safety equipment, and facilities, which are designed to minimize the exposure of workers and the environmental to infectious agents?
4
Which Bio Safety Level is the most stringent and applies for work with dangerous and exotic agents that pose a high individual risk of life threatening disease, which may be transmitted via the aerosol route and for which there is no available vaccine or therapy?
Level 4
Which type of waste is a free-flowing liquid human blood, plasma, serum, and other blood derivatives (e.g., blood in blood bags or bloody drainage in suction containers); absorbent materials soaked or dripping with blood; and items caked with dried blood, capable of releasing blood if handled?
Blood and blood products
What are defined as infectious agents and associated biologicals, including those from medical and pathological laboratories, as well as dishes and devices used to transfer, inoculate, and mix cultures?
Cultures and stocks
Which type of waste qualifies as both Regulated Medical Waste (RMW) and hazardous waste? For example a syringe used to administer a medication that classifies as a pharmaceutical Hazardous Waste (HW) or dental amalgam waste be an example of?
Dual
What is a Solid Waste (SW), or combination of Solid Waste (SW), which, because of its quantity, concentration, or physical, chemical, or infectious characteristics, may cause or significantly contribute to an increase in mortality or an increase in serious irreversible or incapacitating reversible illness or pose a substantial present or potential hazard to human health or the environment when improperly treated, stored, transported, disposed of, or otherwise managed?
Hazardous Waste (HW)
Which type of waste would include biological waste and discarded materials contaminated with blood, excretion exudates, secretions from humans who are isolated to protect others from highly communicable disease, and secretions from isolated animals known to be infected with highly communicable diseases caused by BSL 4 agents including pox viruses and arboviruses?
Isolation
Which type of waste would include used personal hygiene products (e.g., diapers, facial tissues, and sanitary napkins not originating from post-partum suites or gynecological surgical wards) and absorbent materials containing very small amounts of blood or other body fluids (e.g., bandaids)?
Non-Regulated Medical Waste (RMW)
Which type of waste would include organs, tissues, body parts other than teeth, products of conception, and fluids containing tissue removed by trauma or during surgery or autopsy or other medical procedure?
Pathological
These wastes are typically not considered pathological waste if they have been fixed in ________ and should then be disposed of per state, local, or Final Governing Standards (FGS) regulations.
Formaldehyde
What is a devise or item to be worn, used, or put in place for the safety or protection of an individual or the public at large, when performing work assignments in or entering hazardous areas or under hazardous conditions? Equipment includes an article of clothing, hearing and eye protection, respirators, etc.
Personal Protective Equipment (PPE)
Which type of waste is generated during diagnosis, treatment, and immunization of humans or animals and is capable of causing disease or would pose other adverse health risks to individuals or the community if improperly handled?
Regulated Medical Waste (RMW)
Which type of waste are used or unused hypodermic needles, syringes (with or without the attached needles), Pasteur pipettes, scalpel blades, blood collection and vials, test tubes, needles attached to tubing, dental burs, endodontic files, culture dishes (regardless of presence of infectious agents), glassware (broken or unbroken), damaged dishes, dishes with sharp edges that were in contact with infectious agents, microscope slides, and cover slips?
Sharps
Chemotherapy trace waste is defined as needles, empty vials, syringes, gowns, and tubing that contained chemotherapeutic pharmaceuticals or were exposed to chemotherapeutic pharmaceuticals during treatment of the patients. These wastes must be classified as empty (less than what percent of its full capacity remaining) to meet this definition?
3%
Chemotherapy trace wastes that are not classified as empty must be managed as?
Bulk chemotherapy waste
Who is responsible for formulating and disseminating Navy Medicine policy and guidance related to the management of Regulated Medical Waste (RMW)?
Chief, BUMED
Who is responsible for ensuring that Regulated Medical Waste (RMW) is identified and managed according to existing regulations and policies, including adherence to the most stringent requirements applicable to a site are followed?
Environmental Program Manager (EPM)
How many years after being appointed must the Environmental Program Manager (EPM) take environmental training?
1 year
How often at a minimum must the Environmental Program Manager (EPM) visit each subordinate command to assess the environmental compliance posture and provide assistance as required?
Annually
Who is responsible for providing overall management of the Regulated Medical Waste (RMW) program for the site, including proper segregation, collection, storage, preparation for transport, and recordkeeping?
Environmental Point of Contact (EPOC)
How often must employees handling Regulated Medical Waste (RMW) receive environmental refresher training?
Annually
Within the facility, all non-sharps RMW must be placed in containers appropriate for the waste that are clearly marked with the universal biohazard symbol, labeled with the word “BIOHAZARD”, and what in color?
Red
Containers used for the collection of non-sharp RMW must be lined with plastic RMW bags that are marked and certified by the manufacturer to meet the 165 gram (g) Impact Strength American Society for Testing and Materials (ASTM) D 1709-01 and the how many grams Tear Strength ASTM D 1922-00a standards?
480g
Sharps must be collected in rigid, red, or clear containers that are ________-________ and both the container and exterior container (i.e., wall mount) must be marked with the international biohazard symbol.
puncture-resistant
Per Occupational Safety and Health Administration (OSHA) interpretation, all Regulated Medical Waste (RMW) containers must remain what when not in use?
Closed
What are vaccines containing thimerosal managed as?
Hazardous Waste (HW)
What type of waste must be placed in a rigid Regulated Medical Waste (RMW) container lined with a compliant RMW bag or double-bagged and labeled appropriately? Ethical considerations may dictate using alternative means of disposal such as cremation or burial by whom?
Pathological WasteLicensed mortician
Pathological waste must be placed in frozen storage if it is to be maintained on-site longer than how many hours?
24 hours
Which type of waste are extracted teeth considered to be?
Regulated Medical Waste (RMW)
Which type of waste are extracted teeth with amalgam considered to be?
Dual
Which type of waste are placentas considered to be if managed by the facility?
Pathological
Which Regulated Medical Waste (RMW) group may include but are not limited to semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, and amniotic fluid?
** This group includes fluids that are designated as Regulated Medical Waste (RMW) by the local Infection Control (IC) authority **
Group 8
Generally, what color are the chemotherapeutic trace waste containers?
** Do not mix chemotherapy trace wastes with non-chemotherapy Regulated Medical Waste (RMW) or Hazardous Waste (HW) **
Yellow
What should not be used to transport Regulated Medical Waste (RMW)?
** Avoid busy patient areas or use freight elevators **
Chutes and Dumbwaiters
If frozen, pathological waste may remain in storage on-site up to how many calendar days?
30 days
Non-pathological RMW may be placed unrefrigerated in final storage (i.e., the location where RMW is held to await off-site transport or disposal) for up to how many calendar days unless the waste becomes putrescent within a shorter storage duration?
7 days
Interim and final Regulated Medical Waste (RMW) storage areas must be constructed to prevent pest access, and to allow for easy cleaning, especially of spills. The entrance(s) to the storage area must be labeled as “BIOHAZARD” and marked with the universal biohazard symbol. If the signage cannot be placed on the door, it must be placed on the wall directly adjacent to the entry. Per BUMEDINST 6220.14, the signage must be fluorescent orange or orange-red with lettering and symbols in a contrasting color such as black. The signage must be legible from a distance of at least how many feet?
5 feet
What type of vehicles are authorized for use to transport Regulated Medical Waste (RMW) between locations and are easily cleaned and disinfected? It contains a spill kit with appropriate PPE.
Designated government-owned vehicles
Regulated Medical Waste (RMW) that will be transported over public roadways to an off-site treatment and disposal facility is typically removed by a Regulated Medical Waste (RMW) disposal contractor. This waste must be packaged per which reference including labeling requirements?
49 CFR 100-185, Hazardous Waste Regulation
Which type of waste is treated or disposed by being incinerated, thermally inactivated, chemically disinfected (liquids only), or treated by steam sterilization followed by incineration or grinding?
Group 1: Cultures, stocks, and vaccines.
What type of waste is treated or disposed by being discharged to the sanitary sewer or if not allowed, be steam sterilized or incinerated?
Group 3: Blood and blood products
Steam sterilization must be achieved per equipment manufacturer recommendations, including equipment maintenance and testing. In the absence of manufacturer recommendations, steam sterilization requires temperatures of at least 121° C (250° F) for at least 90 minutes at 15 pounds per square inch of gauge pressure, and Geobacillus stearothermophilus spore strips must be used how often to test the sterilization process?
Weekly
Command and job specific training must occur prior to beginning work, and how often thereafter for all employees with occupational exposure to Regulated Medical Waste (RMW)?
Annually
Employees in continental United States locations responsible for packaging the Regulated Medical Waste (RMW) for off-site transport or signing the shipping documents and manifests must complete training that is specific for Class 6-Division 6.2 hazardous materials and compliant with the requirements of 49 CFR 100-185. Initial training is required as soon as possible, but not longer than how many days, upon assuming duties?How often is this training refreshed thereafter?
90 days24 months
What document outlines the cradle-to-grave management of RMW specific to the generating processes at the facility and must include a contingency plan for the management of RMW should the primary means become unavailable or should environmental conditions temporarily prevent the removal of RMW from the facility?
Medical Waste Management Plan
How often is the Medical Waste Management Plan reviewed?
Annually
Each facility must develop a site-specific Medical Waste Management Plan. Modifications to the plan must be made within how many days of the annual review or following a significant process change?
90 days
How many years from the date of training must all training records be retained for?
3 years
Facilities must maintain Regulated Medical Waste (RMW) shipping documents and manifests for at least how many years after the waste was accepted by the transporter?
2 years
If Regulated Medical Waste (RMW) is transported off-site, the receiving facility must provide written documentation certifying proper treatment and disposal to the generating facility. In the event that this documentation is not received within how many days, the Environmental Program Manager (EPM) must notify the contracting officer representative for the RMW disposal contract to determine appropriate means of contacting the transporter and receiving facility to trace the disposal?
60 days
What departments are consulted for additional information about potential occupational exposure to RMW?
Safety Department and Occupation Health Department
Who are AMALs/ADALs maintained and resupplied by?
MEDLOG, Supply Company, MLG
What AMAL contain equipment and reusable materiel to establish a laboratory capable of hematology, microbiology, urinalysis, collecting, and chemistry testing?
618 - Lab Equipment
What AMAL contain consumable supplies to perform hematology, microbiology, urinalysis, and chemistry testing for 100 patients?
619 - Lab Supply
What AMAL contain equipment, consumable supplies, and reusable materiel to establish 1 X-ray suite?
627 - X-Ray
What AMAL contain equipment and reusable materiel to establish a basic shock trauma surgical team or triage supporting the receipt, resuscitation, sorting and temporary holding of casualties?
631 - Shock Surgical/Triage Equipment
What AMAL contain consumable supplies required to receive, resuscitate, sort, and temporarily hold 50 casualties with major wounds?
632 - Shock Surgical Team/Triage Supply
What AMAL contain equipment and reusable materiel to establish a 10-bed unit providing care for patients?
633 - Acute Care Ward Equipment
What AMAL contain consumable supplies to ward support for 100-bed days to patients?
634 - Acute Care Ward Supply
What AMAL contains consumable supplies to provide aid station support, initial resuscitative and stabilizing care for 50 casualties with major wounds prior to evacuation and resupplying basic line Corpsman?
635 - Battalion Aid Station Equipment636 - Battalion Aid Station Supply
What AMAL contains consumable supplies required to support PVNTMED effort of the MEF in 12, 5-day packages for 60 days?
638 - Preventative Medicine Technician
What AMAL contain equipment and reusable materiel required to support 1 operating room for performing major surgical procedures, administrating general anesthesia, sterilizing, and maintaining sterile materiel?
639 - Operating Room Equipment
What AMAL contain consumable supplies required to provide operating room support for 25 surgical cases?
640 - Operating Room Supply
