Nursing Faculty-Student
Handbook
2012
Adventist
Adventist
Adventist
Adventist
Bolingbrook Hospital
GlenOaks Hospital
Hinsdale Hospital
La Grange Memorial Hospital
AMH/AHH – 09/12
1
2012 Academic Year
Dear Nursing Instructor,
We hope that you and your students will have an exceptional experience with us as we welcome
the opportunity to help shape the nurses of tomorrow. We are so pleased to have you be a part of
our Magnet journey!
Based on feedback from our nurse managers and nursing staff, we are now requiring that a list of
what students are able to do be given to the nurse manager at the beginning of the rotation, and
to the charge nurse each clinical day. In addition, a list of what students are NOT allowed to do
is to be signed by each student and instructor in addition to the customary required paperwork.
We have formalized the evaluation process used by our faculty/students regarding your
experience at Adventist Hinsdale Hospital. We are implementing an evaluation tool to be
completed by the instructor and each student. These evaluations are to be submitted to me at
the conclusion of each clinical rotation either by bringing them to my office in the basement of
Tupper Hall, Room 5 or by faxing them to me at 630-856-3046 or by scanning them to me at
Donna.Kanak@ahss.org.
As always, please contact me as soon as possible with any questions or concerns related to your
clinical experience so that I may intervene on your behalf. Please know that we want our program
to offer the most it can to our future nurses!
Our units are equipped with computers which offer many resources. Please know that we utilize
CPOE at AMH and therefore our computers are in high demand by physicians, nurses, and PCTs.
We ask that students defer to staff and physicians regarding computer use. To access our
policies, click on the “Internet Explorer” blue “e” icon, and then click on the tab “Forms and
Policies.”
If your students are interested in employment at one of our Adventist hospitals, please encourage
them to speak with the specific nurse manager and log-on to our website at
www.keepingyouwell.com to apply.
Welcome to the Adventist Midwest Health System!
Sincerely,
Donna M. Kanak, MS, RN
Clinical Educator and Quality Consultant
Nursing Education and Quality Management
Adventist Hinsdale Hospital and Adventist La Grange Memorial Hospital
120 N. Oak Street
Hinsdale, IL 60521
(o) 630-856-3056
(f) 630-856-3046
donna.kanak@ahss.org
www.keepingyouwell.com
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TRANSFORMING Care TRANSFORMING Lives Dear Nursing Instructor,
We are so happy to have you here! Adventist Hinsdale Hospital (AHH) offers tremendous learning
opportunities for students. We are a special team of nurses devoted to your career growth.
Nurses at AHH are among the best and the brightest, highly skilled nurses with a depth of experience
unequaled in Chicagoland. We hope you will love Nursing as much as we do.
Adventist Hinsdale Hospital nurses consider nursing a “calling.” We are called to transform care and
transform lives. Our SHARE values focus on the following key behaviors toward our patients and our
teammates:
Sensing patients’ needs;
Helping each other;
Acknowledging and Accepting peoples’ feeling;
Respecting the dignity and values of each person;
Explaining – by offering explanations without being asked.
We hope you will feel empowered, while you are with us, to embrace our SHARE values. Together
these values lead nurses to deliver quality care and profoundly impact our patients and their families.
We are honored to have you here joining us as we give great care to our patients. If I can be of any
assistance to you during your transition into Nursing, do not hesitate to call on me.
Sincerely,
Shawn
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Shawn O. Tyrrell, RN, MSN, MBA
Vice President & Chief Nursing Officer
Adventist Health System
Adventist Hinsdale Hospital
Mission & Values
Adventist Midwest Health Mission Statement
Extending the Healing Ministry of Christ
Our Values
Excellence: for quality care and service with optimal outcomes that seek to exceed patient
expectation
Christian Service Motivation: offering compassion, respect, and the belief that every life has
value
Stewardship: enhancing staff development, nurturing the environment, conserving resources,
and offering value for services
Integrity: that generates trust, and offers consistency in decision making
Inclusiveness: inviting and affirming people from a spectrum of ethnicities and cultures to join
with us in a healthcare ministry that extends the ministry of Christ
Our Clients and their Needs We Seek to Meet
Patients: to restore health and prevent illness in a compassionate, spiritual environment
Physicians: to provide a progressive environment for the interactive delivery of compassionate
care with optimal outcomes
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Employees: to provide an empowered environment of communication and career development
Families: to offer a comforting, communicating environment into which patient families are
integrated
Community: to be partners in creating community wellness and the stewardship of
community resources
Standards of Behavior
SHARE PRINCIPLES – Sense, Help, Acknowledge, Respect, and Explain
By taking these actions everyday, we demonstrate our commitment to fulfilling
Adventist Midwest Health’s mission of extending the healing ministry of Christ.
Sense people’s needs before they ask (Service Excellence + AIDET)
Help each other out (Teamwork)
Acknowledge people’s feelings (Empathy)
Respect the dignity of others (Courtesy)
Explain what is happening (Communications)
Communication
How to use AIDET (communications)
Acknowledge
Ø Have a positive attitude
Ø Make your patients/customers feel you have expected them and that you know them
o Use names when possible
o Make eye contact
Ø Put patients at ease and make them feel comfortable
Ø Always knock and ask permission to enter a patient’s room
Introduce
Ø Manage up yourself
o Job title
o Certification/licensure
o Years of experience, number of procedures you have done
o Special training
Ø Manage up a co-worker
Ø Manage up other departments
Ø Manage up a physician
Duration
Ø How long this will take
o Initial assessment or preparation
o Exam or test
o Waiting after the test
Ø When the results will be back
Ø Set expectations
Ø Be clear
Explanation
Ø Help patients/family members/customers understand
o What you will be doing and why
o What they should expect
o What the plan is for the future
Ø Use simple terms and key words
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Thank You
Ø Always ask “Is there anything else I can do for you? I have the time.”
Ø Let patients/customers know you have enjoyed working with them
Ø Thank the family for using our hospital and for entrusting us with the care of their loved one
Why use AIDET? Decreases patient anxiety, increase patient compliance, improve clinical
outcomes, increases patient satisfaction.
Patient Hourly Rounding
Hourly patient rounding is conducted by RNs and PCTs.
Ask the charge nurse for the location of rounding logs on your unit.
Although students are not able to sign rounding logs,
they are able to round on patients throughout their clinical day.
The student is to report needs he/she is unable to fulfill to the nurse
responsible for that patient.
The Rounding Behaviors that Reduce Call Lights
Perform AIDET
Use opening key words to reduce anxiety, stating you are there to round on them.
Perform scheduled tasks.
Address the 4 P’s of pain, position, potty and personal needs.
Assess additional comfort needs.
Conduct an environmental assessment – make sure the patient has their personal
things close by; garbage can, tissue, call light.
6. Prior to leaving the room ask, “Is there anything else I can do for you before I leave?
I have time while I am here .”
7. Tell each patient when you will be back.
8. Document the round on the rounding log.
1.
2.
3.
4.
5.
5.
“Why is hourly rounding so important?”
o It reduces patient falls.
o It reduces hospital-acquired pressure ulcers.
o It increases nursing staff satisfaction and gives them control over patient care. It’s
an opportunity to get back time. One unit went from walking 5.2 miles per shift to
4.3 miles per shift.
o It increases patient satisfaction.
o Families are happier with the care.
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Important Information regarding undergraduate
nursing clinical rotations
The following may not be performed by undergraduate student nurses
even under the supervision of an instructor or a preceptor.
Administer Chemotherapy
Bedside Glucose Monitoring
Blood and Blood Products Administration (RG) PTC.653
“Prior to administration of the blood product, two (2) RNs must check the blood at the
bedside.” Neither the student nurse nor the instructor may provide the 2nd nurse verification.
Blood Draws
Student nurses are not allowed to draw peripheral blood or from a venous access device.
Emergency Situation or Code Blue: Students should call for help and begin CPR. When
other staff arrive, students should move into an observation role only.
Intravenous Therapy, insertion
Administration of IVpush medication
Verbal, Telephone and written orders (RG) PTC.605
“Verbal and telephone orders may only be accepted by qualified personnel” as listed in
policy. Student nurses are not listed as a qualified personnel.
Witness to wills, Advance Directives or other legal documents
Documentation in the Electronic Medical Record, including documentation of medication
administration. Medication administration will be documented by the instructor or preceptor.
Students should not enter rooms of patients with TB or a suspected case of TB; students
have not been fitted with N95 masks
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Personal Safety and Hospital Security
As safe as our community is, we want to be proactive in maintaining that same safe environment on
our hospital campus. The safety of our patients, visitors, and staff is everyone’s business!
•
At AHH, and ALMH, wear your school issued photo ID badge at all times. In addition, each
student and faculty must also obtain a Visitor ID badge to clip onto their uniform with their school
ID badge. Obtain At AHH, obtain this Visitor badge from the Information Desk. At ALMH, obtain
this Visitor ID badge from Security. This Visitor ID badge is to be turned in on your last clinical
day.
•
Immediately report any suspicious people or activities to Security.
•
Utilize the “buddy system” especially when leaving your
unit for post-conference.
•
Bring sufficient money for a cafeteria meal; leave
valuables at home (expensive books, expensive coats,
credit cards). Unfortunately, there is no storage for
belongings on nursing units.
•
Respect security-sensitive departments such as the
Mother-Baby unit, Pediatrics, Behavioral Health, the
Pharmacy, and Health Information Management. If you
are scheduled in a secure area, be sure no one slips in
behind you without proper identification.
•
Guide patients, visitors and other guests to appropriate
entrances. Do not allow non-employees through secured doors.
•
Do NOT use your employee I.D. badge (if applicable) to provide secured area access to nonemployees.
•
Call Security with a question or low priority concern.
•
Call a Code Gray at extension at 555 for an emergency situation such as potential fighting or the
sighting of a weapon.
•
In the event of a Code Red (fire), assist staff in gently closing doors to patient rooms and follow
additional directions given by charge nurse.
•
When leaving the hospital, especially for evening rotations, please leave in a group.
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Student Injury Reporting
1. NOTIFY nursing instructor.
2. NOTIFY Charge RN and the Unit Manager.
3. A RiskMaster report of any incident needs to be completed.
4. The student is responsible for their own medical care. Should the student become ill or
injured, first aid is available in the Emergency Department; all charges incurred will be
assumed by the student. AMH assumes no Worker’s Compensation liability.
No Smoking Campus
No smoking or use of tobacco products are not allowed in the building, grounds, parking lots,
ramps, vehicles or sidewalks adjacent to hospital properties.
Nicotine Replacement Therapy (gum/lozenges) is available in the Gift Shop.
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at Adventist Midwest Health
Patients come to our doors every day with the need to share very personal information;
information they may be hesitant to share with those individuals they love and trust the most. As
health care providers, and receivers of this private information, we need to instill confidence in
our patients that the information will remain confidential and be used and disclosed only as
appropriate to treat their medical condition. This will promote more complete sharing of
information, thus increasing our ability to provide the best in medical care.
As a physician on the Medical Staff within AMH and a member of our Organized Health Care
Arrangement under the Privacy Rule, you must read and comply with our privacy policies and
practices. The following summary provides information and resources to promote patient
privacy. You may contact the AMH Compliance and Privacy Officer at (630) 856-4572 if you
have any related questions or concerns regarding your role in protecting patient privacy.
AHS Commitment to Patient Privacy
We believe that patient privacy is a cornerstone of healthcare and forms the basis of the rights of
those we serve.
We believe that our commitment to privacy of patient information is critical to comprehensive,
high-quality medical care..To that end, access to personal health information of our patients is guided
by a series of privacy principles based on respect for our patients’ right to informational privacy and in
accordance with existing federal and state rules and regulations.
Federal Regulation
Health Insurance Portability and Accountability Act (HIPAA): The Department of Health and
Human Services has issued final regulations (Standards for Privacy of Individually Identifiable Health
Information) that provide added assurance to all patients regarding the privacy of their personal health
information. We applaud these regulations. This is the first set of basic national privacy standards and
they provide our patients with protection and peace of mind that is essential to fully participate in
healthcare. The regulations require a host of policy and processes, with the primary goal of allowing free
flow of health information for those who need the information to effectively treat the patient, and at the
same time assuring that the information is optimally protected from improper disclosure.
Key Definitions
Protected Health Information (PHI):Individually identifiable health information that we create or
receive about our patients that can be used alone, or in combination, to potentially identify that patient. It
includes name, address, phone number, SSN, dates of service, diagnosis, treatments rendered, etc. This is
the information that is protected under the privacy rule. It is protected no matter what the format or
medium of communication (whether it is spoken, written, faxed, emailed, maintained electronically or
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read). If you have access to or use PHI relative to your work, you must assured that it is only accessed,
used and disclosed as allowed by AMH Policy.
Minimum Necessary: As health care providers, we need to assure that we access and use only the
minimum amount of PHI that is necessary to comprehensively provide care. Each of you have a
minimum necessary standard (which states the conditions under which you may access and use PHI and
specifically what information you may access). Please limit your access and use of PHI to only that
information which is required for you to provide comprehensive care to your patients, complete
operational activities to support our health care operations, or to facilitate payment for services.
Key Elements of Patient Privacy
Patient Rights
1.Right to Notice of Privacy Practices: Each patient has a right to adequate notice of the uses and
disclosures of PHI that we may make, and of their rights and our duties with respect to PHI. We provide
the patient with a copy of this Notice at the point of registration and make a good faith effort to get
written acknowledgement from patient that they have received the Notice (see AMH Notice of Patient
Privacy Practices). It is important that you read and understand AMH commitment to patient privacy.
2.Right to Request Privacy Protection: We must permit an individual to request that we restrict uses or
disclosures of their protected health information (PHI) to carry out treatment, payment or health care
operations. If a patient expresses a desire to restrict how their information is used or disclosed, please
notify administrative staff while under our care.
3.Right to Confidential Communications: We must permit patients to request and must accommodate
reasonable requests by patients to receive communications of PHI by alternative means or locations. If a
patient requests that AMH communicate with them by alternative means (e.g. no calls at work), please
record the patient request in the Medical Record on the PHI Tracking Form. Additionally, before you
make a disclosure to an individual or family member, it is critical that you access the PHI Tracking Form
in the medical record to assure that the intended communication is not restricted based on the patient
request for confidential communication.
4.Right of Access to PHI: Patients have a right of access to inspect and obtain a copy of PHI (however,
some exceptions apply). We require that this request be made in writing. Ask administrative staff for a
copy of the form entitled Authorization for Access, Use and/or Disclosure of Protected Health
Information.
5.Right to Request Amendment of Protected Health Information: Patient has the right to request
amendment of PHI. This right applies to requests for material change to the content of the PHI used to
make medical decisions about the patient. We require that these requests be made in writing. If you are
working with a patient who makes a request to change the material content of their record (either medical
or financial) please ask for assistance from administrative staff to initiate the appropriate process.
6.Right to an Accounting of Disclosures of PHI: Patient has a right to receive an accounting of
disclosures of PHI made by a covered entity in the six years prior to the date on which the request was
made. We require patients to make this request in writing. Please seek the assistance of administrative
staff if a request is made by the patient to have an accounting of disclosures of PHI.
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Disclosure of Information
1. Disclosure Guidelines: For any type of disclosure made on a routine and recurring basis,
Adventist Midwest Health (AMH) shall follow standard protocols to assure written authorization
of the patient if required, to verify the identity of the requestor, and to limit the PHI disclosed to
the amount reasonably necessary to achieve the purpose of the disclosure. When making a
disclosure of PHI, please consult AMH Region Policy for use and disclosure of information. This
policy defines for our workforce what requirements are necessary to make each routine or
recurring disclosure.
2. Verification Requirements: Workforce members shall receive verification from the requesting
party when PHI is requested for any disclosure to assure the appropriate patient record is accessed
prior to disclosure. If a legal representative is acting on behalf of the patient for request to access
or disclose information, verification is obtained by viewing a copy of the court order designating
the individual as the guardian of the patient, or documentation designating the person as the legal
representative.
3. Authorization Requirements: If an authorization for disclosure is required from the patient,
please access and use the form entitled Authorization for Use and/or Disclosure of Protected
Health Information. This form must be completed comprehensively prior to disclosure. If a third
party requests the disclosure and presents their own authorization form, all elements on the AMH
authorization form must be present on that authorization for the authorization to be considered
valid..
4. Accounting of Disclosures: There are many disclosures under the Privacy Rule that must be
“accounted for”. Disclosures requiring accounting are those that are made without need for
authorization from the patient, which are not made to carry out treatment, payment, or healthcare
operation functions. Disclosures which must be accounted for include those: required by law, for
public health activities, about victims of abuse, for health oversight activities, for judicial and
administrative procedures, to funeral directors and medical examiners, for organ donation, for
research, to avert a serious threat to health or safety, for specialized government functions, for
workers’ compensation. If you make a disclosure for any of these purposes on behalf of our
patients, please record the disclosure on the Protected Health Information Tracking Form.
Administrative Requirements
As a covered entity, AMH is obligated to assure a number of Administrative procedures are in place to
optimize patient privacy. To that end, please be aware of the following important facts:
•We encourage you to report any concerns you may have about patient privacy to your supervisor
or to the Compliance and Privacy Officer of AMH. We value the input of our workforce members
and will not retaliate against any individual making such complaint.
•We have obligations to mitigate any improper use or disclosure of PHI. If you improperly use or
disclose PHI please report it to the Compliance and Privacy Officer so that we can take immediate
action to mitigate the effects of that disclosure.
•Your pledge to confidentiality is mandatory. Please sign the attached Confidentiality Statement
and submit to the individual orienting you.
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Patient Rights
PATIENTS HAVE THE RIGHT TO
1. Have their Advance Directives honored
An ADVANCE DIRECTIVE is a document in which an individual either states choices for
medical treatment or designates who should make treatment decisions when they no longer
can. Examples of an advance directive are organ donation, Illinois Department of Public Health
(IDPH) Uniform Do-Not-Resuscitate (DNR) Order Form, livings wills and/or durable power of
attorney for health care.
2. Privacy
Patient privacy is a right afforded to patients upon admission, during treatment and upon
discharge from the hospital. It is everyone's duty to protect patient privacy.
3. Appropriate assessment and management of pain
Our PAIN MANAGEMENT POLICY requires health care workers to assess pain and implement
interventions according to patient’s needs and as ordered by the physician.
4. Receive information about the outcomes of their treatment
This right is addressed in the Regional UNANTICIPATED OUTCOME policy and states that
patients and families are entitled to information about the outcomes of diagnostic tests, medical
treatments, and surgical interventions whether those outcomes are anticipated or not.
5. Have their ethical issues addressed
The ETHICS COMMITTEE works to help support patients rights throughout the hospital and
assist with any physician, staff, patient or family member who may have a disagreement or
need concerning treatment that may be controversial or confusing. Every campus has its own
ethics committee. You can contact pastoral care, risk management, or social services/discharge
planning in order to access the ethics committee.
6.Have their rights and welfare protected if they decide to participate in research
The IRB (Institutional Review Board) follows established protocol in accordance with current
Department of Health and Human Services and Food and Drug Administration regulations. The
IRB assures that risks to research subjects are minimized; that subjects are selected fairly and
equitably, and participation is voluntary, and informed consent is obtained from each subject.
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Tips for Protecting Patient Privacy
As healthcare workers we are stewards of PHI. PHI is “Protected Health Information”. PHI is
any information that we receive or create about our patients that could (alone or in combination)
identify who the patient is. You may access PHI only as you needed to do your job. You may
disclose PHI only as needed to support the patient’s treatment or payment for services.
1. Know your Minimum Necessary Standard. This describes what PHI you may access,
use and disclose as you do your job. If you don’t know your Minimum Necessary
Standard, ask your manager or contact the Privacy Officer, Anne Herman at (630)
856.4572.
2. Monitor your Conversations. Patient information may only be discussed with those
who have a need to know. If you are having a discussion about a patient with others
who have a need to know, make sure it is in a private area, where it will not be
overheard.
3. Manage Your Password: If you have access to PHI that is in computer systems, make
sure you have your own unique password. Never, never, never share your password!
4. Manage Your Work Documents: PHI is everywhere; in medical records, on surgery
schedules, on lab reports and “to do” lists. Take perfect care of any PHI in your
possession; making sure it is secured and available only to those who have a need to
know.
5. Manage Your Workstation: If you have a computer to do your job, make sure you
complete:
1. Log off whenever you leave your workstation
2. Have operational screensavers that work.
3. Face monitors away from public traffic
6. Dispose of PHI in shredding bins: Located throughout your facility. Please make sure
to use these bins to dispose of all confidential information.
Respect your Coworkers’ Privacy: Employees have the same right to patient privacy as any
patient who receives care. If you see a coworker receiving care, you can acknowledge that
employee with a nod or a “hello”. Please remember that, unless you are supporting the care for
that patient, you have no right to access or disclose ANY information about their visit.
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Abuse and Neglect
It takes a Village when it comes to Victims. We have a community responsibility to protect
those who may be victims of abuse and neglect. Victims can be young or old and may be
members of the same household. Abuse can be physical, sexual or psychological.
Reporting abuse and neglect allows an investigation to be conducted.
Illinois law provides immunity for reporting suspected abuse and/or neglect which means there
must only be a reasonable basis for suspicion. For some patient care providers reporting
suspected abuse and neglect is not an option – it is mandatory. Many times victims and their
abusers go to great lengths to cover abuse when they know someone is watching.
Housekeepers, mechanics, food service workers, and volunteers are equally and vitally
important in protecting our patients from abuse and neglect. Refer to your hospital’s policy for
phone numbers to report and resources for victims.
What do you do if you observe something suspicious or a patient shares information
with you that would indicate that the patient may have been abused or neglected prior to
hospitalization but you are not sure if it is abuse or neglect?
-Immediately contact your primary RN and Charge Nurse on the unit.
Patient Safety
If an incident/variance/concern occurs when providing patient care, please notify the Charge
Nurse. Reports will have to be completed to help us understand the variance and its potential
or actual impact on safe patient care.
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Patient ID Bands
Place the additional ID Band on the same extremity of the hospital ID Band.
ID Bands
Purple= Do Not Resuscitate
Purple – P = Partial DNR, look in chart for details
-­‐ P
= Use Fall precautions
Red = Check chart for names of allergies
= Do not draw blood from this arm
= Pt has been typed for blood products
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Clinical Experience
Student and preceptor are required to review appropriate policy prior to performing skill.
Accessing Policies on the Intranet
•
All policies for Adventist Midwest Health hospitals are listed on the hospital intranet.
•
Click on the Internet Explorer icon
Choose the Forms and Policies and then click on view more then choose the location
Examples of list of policies
Policies that should be reviewed with students:
Abuse and Neglect (RG) PTC.637
Bloodborne Pathogen Exposure Control Plan (RG) INC.256
Fall Risk Assessment Fall Prevention Program Policy (RG) PTC.607
Hypoglycemia Management (hospital specific)
Restraints: Non-Violent Behavior (RG)PTC.603
Restraints and/or Seclusion: Behavioral Emergencies (RG)PTC.602
Linen Handling (RG) INC. 254
Standard Isolation and Transmission Precautions (RG) INC.261
Professional Appearance (Dress Code) (RG) HMR.264 with special note to “the use of perfume,
cologne or after-shave, particularly in areas where patient care is provided, is discouraged as it
may cause respiratory problems for patients, visitors or co-workers.”
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National Patient Safety Goals
From the Joint Commission
It’s everyone’s job to make it safer for patients in our hospitals
The purpose of the NATIONAL PATIENT SAFETY GOALS is to prevent patient harm
GOAL I: IMPROVE THE ACCURACY OF PATIENT IDENTIFICATION
Always use at least two patient identifiers (FOUND ON THE WRISTBAND) when drawing
blood, collecting specimens for clinical testing, providing other treatments or procedures or
administering medications. Acceptable identifiers are:
• PATIENT NAME
• DATE OF BIRTH
• MEDICAL RECORD NUMBER
Note: NEVER use the room number as an identifier!
• Be sure to compare the two patient identifiers from the wristband with the patient
information on requisitions, medications, and patient stickers.
And
• Always label specimens at the bedside point of collection in the presence of the patient.
• Doing these two things will help to prevent mislabeled specimens
GOAL 2: IMPROVE THE EFFECTIVENESS OF COMMUNICATION AMONG CAREGIVERS
Certain Lab test results, Cardiology, Respiratory, and Radiology test findings are Critical Values. Critical
values could have a significant impact for the patient. Critical Values must be received
by a hospital RN and communicated by a hospital RN to a physician who can act on
the results within one hour.
Reading back verbal & telephone orders and Critical Test Results means the nurse is
validating the information.
Avoid the Use of Unapproved Abbreviations.
Do Not Use Abbreviations
U
Zero after decimal (1.0)
No 0 before decimal (.5)
ug
IU
QD
QOD
MS or MS04
MgSO4
MTX
X “N”D
Recommendations
Units
No trailing zero (just be 1)
Should be 0 before decimal (0.5)
Use mcg
International Unit
Daily
Every other day
Morphine Sulfate
Magnesium Sulfate
No abbreviations for Chemotherapy drugs
For “N” days
Write and Print Clearly~
Legibility and readability improve patient safety!
Poor communication is the #1 cause of medical errors.
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GOAL 3: IMPROVE THE SAFETY OF USING MEDICATIONS
Label all meds, med containers, and other solutions on and off the sterile field.
(NPSG.03.04.01)
Reduce the likelihood of pt. harm associated with anticoagulant therapy. (03.05.01)
Record and pass along correct info about patient’s medication. (NPSG.03.05.02)
GOAL 7: REDUCE THE RISK OF HEALTH-CARE ASSOCIATED INFECTIONS
Meeting Hand Hygiene Guidelines (NPSG.07.01.01)
Preventing Multidrug-Resistant Organism Infections (NPSG.07.03.01)
Preventing Central Line–Associated Blood Stream Infections (NPSG.07.04.01)
Preventing Surgical Site Infections (NPSG.07.05.01)
GOAL 8: ACCURATELY AND COMPLETELY RECONCILE MEDICATIONS ACROSS THE
CONTINUUM
GOAL 9: REDUCE THE RISK OF PATIENT HARM RESULTING FROM FALLS
GOAL 14: PREVENT HEALTH CARE-ASSOCIATED PRESSURE ULCERS (DECUBITUS
ULCERS)
GOAL 15: THE ORGANIZATION IDENTIFIES SAFETY RISKS INHERENT IN ITS PATIENT
POPULATION
A. Identifying Individuals at Risk for Suicide (NPSG.15.01.01)
Infection Control
Standard Precautions
• Applies to all patients, all the time
• Requires health care workers to wear gowns, gloves, masks & eye protection when
contact with body fluids or blood is possible
• Are always in effect even when utilizing additional transmission precautions
Transmission Precautions
Contact Precautions
Droplet Precautions
• Wear gown and gloves every time you enter
• Wear simple mask when
the room
entering the room
• Change gloves after contact with infective
Airborne Precautions
material
• N-95 mask required when
• Remove gown and gloves upon leaving room
entering room
• Perform hand hygiene after gloves and
• Visitors wear a simple
gown are removed.
mask
• Use soap and water for patients with diarrhea
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Isolation Education
Patient Education
•
•
•
Family and Visitor Personal Protection
Explain to patients/visitors/family the
reason for isolation
Review with patients the personal
protective equipment that staff, family
and visitors must wear to safely care
for them
Document in the medical record that
this education took place on the
interdisciplinary Education form; check
off isolation type and write in the
diagnostic results.
•
•
•
•
Family and visitors of a patient requiring:
Contact Precautions – must wear same
personal protective equipment staff wear
Airborne Precautions – must wear a
simple mask
Droplet Precautions – must wear a simple
mask
Personal Protective Equipment (PPE)
Gloves
• Worn as part of Standard Precautions when handling all body fluids and broken skin
• Worn upon entry to a patient’s room for Contact Precautions
• Hands must be washed before putting on gloves and immediately after removing gloves
• Always inspect gloves for holes before wearing them
Gowns
• Worn as part of Standard
Precautions if clothing may come in
contact with body fluids or broken
skin
• Required to be worn upon entering
a patient’s room requiring Contact
Precautions
Masks with Eye Protection
• Worn when splashing is possible, as part
of Standard Precautions
• Simple masks are required of staff caring
for a patient requiring Droplet precaution
N-95 Respirator
• Health care workers must be fittested to wear an N-95 Respirator
• Health care workers must fit-check
the N-95 Respirator each time they
enter the room of a patient on
Airborne Precautions
• N-95 Respirators are required to
care for patients suspected or
known to have TB, SARS, Monkey
pox, Chicken pox and Measles.
• Replace worn out or torn gloves
20
Hand Hygiene
New Information: Hand Hygiene Alert!!!
CDC Hand Hygiene Guidelines and The Adventist Midwest Health Hand
Hygiene Policies state:
• No artificial nails or nail extenders on any clinical staff who directly or indirectly touch
patients such as: nursing, dietary, central sterile processing, pharmacy, respiratory
therapy, phlebotomy and neurophysiology
• Short natural nails are recommended for clinical staff
• Clear nail polish may be worn if it is not chipped
• Studies have shown that artificial nails have been associated with infection transmission
in hospitals.
Hand Hygiene
Soap and Water Hand Wash
Prevent the transmission of health care associated
• Wet hands
infections by proper hand washing and the use of gloves.
• Keeping hands lower than elbows, apply soap
• Wash for at least 15 seconds, working up a lather
When to wash your hands
• Cover all surfaces of hand, pay close attention to
under and around fingernails and the webbing in
• Before starting work
between the fingers
• Before and after touching a patient
• Rinse well under running water
• Before and after handling a patient’s equipment
• Pat dry hands with a paper towel. Don’t rub!
• Whenever hands are visibly soiled
• Turn faucet off with paper towel
• Between handling patients
• Before performing any invasive procedures
Alcohol hand wash
• Before giving medications
• Preferred method of hand hygiene.
• Before and after wearing gloves
• Apply alcohol based hand rinse
• After personal use of the toilet
• Rub vigorously, covering all parts of hand – in and
• After blowing or wiping nose
around the fingernails and the webbing in between
• Before and after eating
fingers
• Before preparing food
• Allow to air dry. Do not towel or dry off
• Before going home AND when in doubt
• DO NOT USE WHEN HANDLING STOOL
SPECIMENS OR CARING FOR PATIENTS WITH
DIARRHEA, especially C. Difficile
Hand Care
• Hand lotion provided by the hospital may be used.
• DO NOT USE HAND LOTION FROM HOME; IT
IS NOT COMPATIBLE WITH GLOVES AND
ANTIMICROBIAL SOAP.
21
Influenza
The Joint Commission (TJC) requires all health care workers to
receive influenza education. All health care workers are
encouraged to receive an annual seasonal influenza vaccination
because unvaccinated health care workers can transmit
influenza to patients.
Outbreaks of influenza have been documented in hospitals and
long term care facilities. Getting an influenza vaccination reduces
the transmission of influenza in health care setting as well as
reducing staff illness and absenteeism.
Influenza vaccine is free, available through Employee Health. Influenza is a viral disease that
occurs in annual epidemics in the U. S. It is a serious disease - each year 200,000 people are
hospitalized with influenza – about 36,000 die because of it.
The flu shot works to prevent influenza. You can get the flu shot at any time during the flu
season – usually October through March. You can not get influenza from the flu shot.
Bloodborne Pathogens
Bloodborne Pathogen Control
Route of Transmission
Work Related:
•
•
Accidental needle stick
Unprotected splash to the face
Bloodborne Pathogens
•
Human Immune Deficiency Virus
(HIV)
Hepatitis B (HBV)
•
Hepatitis C (HCV)
•
Others:
•
•
•
•
Unprotected sex with an infected
person
Tattoos
Body piercing
Sharing toothbrushes and razor
Prevention of Exposure at Work
Engineering Practices
Work Practices
EQUIPMENT WHICH REMOVES
INFECTIOUS AGENTS IN A SAFE MANNER
o
o
22
No eating, drinking and smoking in
Patient Care Areas
Hand Washing
•
•
•
•
•
SHARPS CONTAINER – All sharps
must be placed in a securely mounted,
puncture proof container Discard when
3/4 full.
SELF SHEATHING NEEDLES
NEEDLELESS SYSTEM
ISOLATION TRASH BINS – Red bins
that prevent leaking
BIOHAZARD LABELS – Should be
placed on any blood or body fluid
o
o
o
o
o
No Recapping of needles/use
safety needles
No mouth pipetting/use automatic
pipettes
Remove clothing contaminated with
blood or body fluids immediately
Use Personal Protective Equipment
Use hospital approved disinfectants
to clean. Pay attention to
disinfectant contact time.
Warning Labels
Warnings labels are affixed to the following:
• Containers of regulated waste
• Refrigerators and freezers containing
blood or other potentially infectious
materials
• Other containers used to store, transport,
or ship blood or other potentially infectious
material.
Blood and Body Fluid Exposure Follow-Up
After treating the exposure site and receiving appropriate treatment, document the exposure
using the Employee Injury Report which can be found on the INTRANET.
• Make sure to include the following information:
1. Route of exposure (Where were you splashed, stuck, etc…)
2. Describe the circumstances of exposure (Type of needle, etc…)
• Notify your supervisor and contact Employee Health. After hours go directly to
Emergency Department.
• You can expect:
1. To have appropriate testing of yourself and the source individual (if identified)
2. To be provided with your test results and those of the source individual through
Employee Health.
3. Post exposure counseling and medical evaluation as needed
• POST EXPOSURE PROPHYLAXIS WHEN MEDICALLY INDICATED
Code Blue
Dial 555 from any hospital phone for a respiratory or cardiac arrest or any urgent medical
situation. Give hospital, unit, and room number. You will hear an overhead announcement x 3
and team will receive a page.
At ABH, for Pediatric patients less than 8 yrs old, call “Code Blue Broselow.”
At AHH, a “Code Blue Pediatrics” is called.
Dial 911 for any person developing signs of cardiac/respiratory arrest on hospital property that
is not located in the main building
23
Rapid Response Team (RRT)
RRT may be called by staff, family, or the patient for a change in the patient’s status.
RRT calling criteria examples include, but not limited to
RESPIRATORY
• Sp02 less than 92% despite oxygen
• Sudden onset difficulty breathing
• RR greater than 28 per minute or less than 8 per minute
• Threatened
CARDIAC
• Acute chest pain
• Heart Rate less than 40 bpm
• Heart Rate greater than 120 bpm or less than 50 bpm
• Sustained or symptomatic arrhythmia
• SBP less than 90 and symptomatic or significant drop in baseline (20mmhg)
NEUROLOGICAL
• New onset or uncontrolled seizures
• Acute mental status change:
– decreased level of responsiveness
– confused
– agitated
OTHER
• IF a visitor/ family member feels there is a change in patients condition
• Acute significant bleed
• Seizure, uncontrolled pain
• Undetermined change in patient’s condition (e.g. nursing intuition)
• Medication intervention (Patient requires medications immediately that staff nurses are
unfamiliar or not permitted to give)
24
Fall Prevention
Fall Risk Assessment Fall Prevention Program Policy (RG) PTC.607
Guiding Principles
• Every patient is at risk for falls
•
Everyone who interacts with patients is responsible for fall prevention
•
Definition of fall: A fall is defined as an incident where a patient is on the ground
secondary to an unplanned event.
Can be witnessed or unwitnessed
Assisted falls are when a caregiver or family/visitor assists the patient to the floor
RN is responsible for performing risk assessment in Cerner
• On admission
• Daily reassessment
• When there is a change in the patient’s condition
Interventions for all patients
• Orient to environment and call devices
• Bed in low position and brakes on
• Call light, phone, & personal items within reach of the patient
• Patient to wear non-skid footwear
• Maintain clean and clear environment
• Provide additional lighting
• Fall safety education to patient & family
Moderate to High Risk Patients
• Yellow armbands for patients
• Fall Risk sign on doorframe of the patient’s room
• Provide assist with care & ambulation
• Dangle patient prior to ambulation
• Round patients frequently
• Bed exit device on
• Move patient closer to nurse’s station
• Provide divisional activities
• Place bedside commode, urinal or bedpan within reach
• Review lab results, medication profile, vital signs, oxygenation and I & O
25
Hand-off Communication
Poor communication at the time of patient hand-off is the most common cited root cause for all
types of medical errors.
Since 2006, the Joint Commission has mandated in the National Patient Safety Goal #2
“Improve the effectiveness of communication among care providers by using a standardized
approach for patient handoff”
SBAR
standardized approach to patient hand-off communication used at all AMH hospitals.
Situation
Background
Assessment
Recommendation
Who uses SBAR? Everyone!
SITUATION
Patient name and reason for hand off
BACKGROUND
Allergies, Fall Risk, Isolation (type & date started), summary of relevant historical data and
current medical status, recent changes, blood sugars, care recently provided,
procedures/labs/tests (results & pending results), problem list, rehab treatment, Code Status,
Gift of Hope, Braden score, skin care interventions, nutritional assessment
ASSESSMENT
What to watch for, anticipated changes, safety concerns
RECOMMENDATION
Explain what needs to be done, repeat back or read back, as appropriate, ALLOW RECEIVING
PERSON TO ASK QUESTIONS
26
Restraints
(RG)PTC.603 Restraints: Non-Violent Behavior
(RG)PTC.602 Restraints and/or Seclusion: Behavioral Emergencies
•
•
•
•
•
•
•
•
Use least physically restrictive method
AMH is committed to preventing and reducing restraint use and using non-;physical and
less restrictive interventions.
Identify opportunities to reduce risks associated with restraint use
Patients have the right to be free from restraints (physical & chemical) that are not
medically necessary.
Restraints shall not be used as punishment, coercion, retaliation, discipline, or for
staff convenience.
If restraints are necessary, all patient rights are met through maintenance of pt. safety
& dignity regarding the physical and emotional well-being of the patient.
Restraints will be downgraded or discontinued ASAP as patient’s condition permits.
Documentation of initiating, downgrading, and discontinuing of restraints must be
included in the patient’s medical record. Document education upon initiation and PRN.
Restraints type: Wrist, ankle, vest, locked, waist devices, protective nets, or 4 raised side
rails intended to keep the patient in bed and limit freedom of movement.
Alternatives to Restraints
• Place call light, urinal, phone, & water within easy reach
• ↑ observations
• Reorient to safety measures/ environment
• Evaluate medication regime
• Move pt closer to nurses’ station
• ↑ toileting needs assessments
• Redirect from inappropriate activities
• Request that family stay with pt.
• Reinforce fall prevention education with pt/family/sitter.
• Place commode at bedside.
• Other
• Physical Restraint
For Med/Surg Restraint; Assess/Reassess/Document minimally q 2 hours
• Airway, breathing, circulation
• Skin integrity & circulation at restraint site
• ROM to restrained extremity or reposition
• Fluids & nutrition
• Bedpan/Urinal/Assist to bathroom
• Mental status
• Rights, dignity, and pt. safety
• Alternatives to restraints attempted
• Behavior warranting continued application
• Device type, intact, & correct positioning
• Less restrictive devices
• Readiness for restraint removal
27
Environment of Care Safety
Emergency Management
CODES - When the Alarm Sounds . . . Know Your Emergency Codes
Code Triage is the emergency code that tells us to expect an influx of patients. The command center opens and
communication flows from the command center to the managers by pager, e-mail or courier.
As part of the emergency preparedness and infection control plans, a broad range of options can be implemented
to accommodate a large number of patients at one time and for weeks to come.
Such options are to:
• Temporarily stop or limit services like outpatient tests or surgeries
• Increase patient discharge to home with home health support
• Transfer patients to other hospitals or nursing homes
• Limit visitors
• Allow only necessary staff and others to enter the hospital
Communication with emergency responders, public health authorities and staff at the hospital are very important.
Code
Description
Trauma Team Respond
Category 1 – major trauma Trauma patient in the ED
Category 2 – minor trauma
Triage
Disaster conditions exist; incoming patients to ED
Gray
Security Assistance needed
Yellow
Internal Disaster
Green
Utilities Failure
Brown
Bomb Threat
Orange
Hazardous spill
Blue
Person Unresponsive/ in Cardiac or Pulmonary Arrest
Purple
Patient Elopement – pt. has left without staff notification
Pink
Infant or Child Abduction
Red
Fire, smoke or smell of something burning
Black
Severe Weather – potential damage to building
Silver
Person threatening and displaying a deadly weapon
White
Blizzard conditions
BRT
Behavioral Response Team
28
Fire Prevention/Life Safety
CODE RED
It is each employee’s responsibility to know and participate in drills for their department’s fire
and evacuation plan. Read it….review it often….practice…..be ready to put into action if it
becomes necessary!
If you discover a fire, smell or see smoke, you should LOUDLY call out CODE RED and with
your departmental coworkers, immediately implement R-A-C-E procedures.
R.A.C.E. Procedures
R
A
=
RESCUE anyone in immediate danger of being burned by the fire
=
ACTIVATE the ALARM by pulling the closest fire alarm pull station, AND report the fire by calling
your facility’s emergency telephone extension below:
Adventist Bolingbrook Hospital = x555
Adventist GlenOaks Hospital = x555
Adventist Hinsdale Hospital = x555
Adventist La Grange Memorial Hospital = x555
C
E
=
Non-Hospital Departments = 9-911 (If hospital based phone system is utilized)
x911 (If NO hospital based phone system is utilized)
CONTAIN the smoke by closing all corridor/hall doors
=
EXTINGUISH the fire if possible, and be prepared to EVACUATE to a safe area as needed
Know How to Use a Fire Extinguisher
P
A
S
S
=
=
=
=
Pull the safety pin
Aim the hose/horn at the base of the fire
Squeeze the handle to discharge the extinguisher
Sweep the hose/horn at the base of the fire
29
Egress Safety & Compliance
Who do we need to comply with?
Joint Commission
IDPH
OSHA
Fire Inspector
These agencies monitor regulated
Life Safety Codes.
EGRESS SAFETY & COMPLIANCE
Life Safety Code 7.1.10 Means of Egress
Reliability
What about the 30 minute rule?
7.1.10.1 Means of egress shall be continuously
maintained free of all obstructions or
impediments to full instant use in the case of
fire or other emergency.
There is no written rule by any of the
Regulatory Agencies. Surveyors do
understand that items may be in the
hallway or in a doorway momentarily, but
they monitor how long the object stays
there. Some surveyors have been
known to time on this time boundary
7.1.10.2.1 No furnishings, decorations, or
other objects shall obstruct exits, access
thereto, egress there from, or visibility thereof.
What about items in use?
What does this mean for your department?
•
All egress of (pathway to any exit – you
should see an exit sign) must be clear at all
times.
•
Any time the FIRE ALARM sounds, all
items in the means of egress shall be
removed immediately.
•
See the 30 minute rule question.
However, charging items in the corridor
and then calling them “in use” is
unacceptable and a violation of egress.
Surveyors will watch to see if an item has
moved, even the shortest distance.
Can crash carts remain in the means
of egress?
Other unacceptable commonly found items
in corridor: items charging, WOWs not in
use, chairs at countertops located in the
hallway, transportation items left
unattended, any obstructions that expands
beyond 7” from the wall, decorations, items
stored in alcoves that go beyond the
designated space of the alcove.
Crash carts can remain in the means of
egress, but a permanent location is
preferred since items cannot be charged
in the means of egress. Isolation carts
and Latex Free carts for clinical need
patients only can remain right outside the
room. However, please remove out of
the means of egress if FIRE ALARM
sounds.
For more information on egress safety &
compliance or reporting of any safety hazards
contact your hospital Safety Officer.
30
Interim Life Safety
Interim Life Safety
What is Interim Safety?
Interim Life Safety measures are special safeguards
which may be in place to protect people in a
department or building from physical and fire hazards
during construction or renovation. Measures include:
•
Change in normal exit routes;
•
Special direction or caution signage;
•
Temporary construction partitions;
•
More fire extinguishers;
•
Special training for the staff in and around the area;
•
Extra daily inspections to ensure the environment remains safe;
•
Extra Fire Drills;
•
Stay out of construction areas;
•
Only those with hard hats may enter the area;
•
Employees must participate in extra fire drills;
•
Be aware of exit and evacuation route changes;
•
Be aware of who is in the department – construction workers should display appropriate identification at all
times;
•
Follow the Interim Life Safety Plan developed for your area;
•
Keep corridors and exits free from obstacles;
•
Employ your best housekeeping practices at all times;
•
Immediately report any concerns or problems to your Safety Officer.
31
Utilities
CODE GREEN
When a utility fails in the hospital, we call a Code Green. It is your responsibility to report utility failures to your
supervisor, administrator on-call, or by checking any Quick Response Wall Cards or emergency manuals and
following the directions.
These are Our Utilities
“Utilities” includes many things, some the same as you have in your home. In a hospital, utilities include:
• Oxygen
• Heat
• Vacuum
• Air conditioning
• Medical air
• Ventilation
• Nurse call
• Elevator
• Intercom system
• Electricity
• Telephone
• Water
• Computers
• Sewage
Scope of Problem
• If a utility fails in one department, the problem will be resolved without calling a Code Green. There is a
difference in resolving a sink drain back-up in one department from a sewer back-up that affects multiple
departments.
•
A Code Green will only be called when there is the potential for significant impact on the health and safety
of our patients.
32
Hazardous Materials & Waste
CODE ORANGE
Material Safety Data Sheets
The Government Says You have a Right to Know!
§
§
§
the chemicals in your department
how to protect yourself when using those chemicals
how to safely handle hazardous materials
The healthcare setting is not the place to play loose and carefree with
the chemicals and wastes that can be harmful to employees as well as
patients.
You have a responsibility to know
•
all of
Where do I find MSDS Information?
On the Adventist Midwest Health
Intranet under "Online
Applications"
What is MSDS?
o Material Safety Data Sheet
What information is on a MSDS?
Not all MSDS look the same but they are required to contain the same
data.
Here are some of the items that are included:
•
•
•
•
•
Full Chemical Name
Manufacturer Name
Manufacturer Contact Information
First Aid Procedures
Types of Personal Protective Equipment Needed
Stop any activity that may cause contact with
Access via intranet > Online Application > MSDS
Fax sheet: #1-888-362-7416
Environment of Care
Do you know if your department has or needs a spill kit?
Any department that handles or stores hazardous materials should
have an appropriate spill kit(s) for their area.
the substance
Protect: all personnel keep area free from
people
Initiate: call 555 and initiate a Code Orange
Locate MSDS (available on-line)
Let responding personnel handle the
communication procedures
Only trained personnel is allowed to clean up a
spill
The Plan for Safety
Department Managers should train their employees annually on the
AMHand
hospitals
plankits.
to reduce your risk of injury at work.
location
use offollow
theseaspill
1. Safety Information
• In Orientation: fire, hazardous chemicals, body fluid exposure, infectious disease
• In Your Department: equipment, safety devices, safe practices.
2. Finding and reducing job-related hazards, including use of safety devices, respirators, and safety
equipment
3. Following safe work practices
33
4. Investigating incidents that occur
5. Everyone is responsible for the plan. YOU, your SUPERVISOR, the SAFETY OFFICER, the SAFETY
COMMITTEE
Report unsafe conditions immediately to Plant Operations/Building Services or the appropriate person/department
Use all safety and protective equipment appropriately
Oxygen Tank Safety
Oxygen = green cylinder
Full unused tanks must have a protective cap covering the gas outlet
Tanks must be lifted by the handle
Transport O2 tanks only in designated rolling carriers.
• NEVER let patients hold O2 tanks in their arms
• NEVER lay an O2 tank on a patient’s bed or carrier
Always store O2 tanks in the approved storeroom, at least 5 feet away from anything else in
the room
Return empty tanks to tank room, place in a holder, mark “EMPTY
Remember --Empty tanks are still a hazard—some O2 is still inside
Appropriate Fractional Inspirational Oxygen Percentage (FIO2) by Nasal Cannula
• 1 Liter – 24%
• 2 Liters – 28%
• 3 Liters = 32%
• 4 Liters = 36%
• 5 Liters = 40%
• 6 Liters = 44%
Oxygen administration
Nasal Cannula Humidification: All neonatal and pediatric nasal cannulas must be humidified.
All adult cannulas over 4 liters must be humidified.
Simple mask: Mask that delivers moderate oxygen flow to nose and mouth, Delivers oxygen
concentration of 40% to 60%. Never run at less than 6 liters.
Venturi Mask: Mask with device that mixes air and oxygen to deliver precise oxygen
concentration,. Moves a fixed flow of oxygen with a high but variable flow of air to produce a
constant oxygen concentration, Mask output ranges from 24% to 50%. Virtually eliminates
rebreathing of CO2.
34
MRI (Magnetic Resonance Imaging) Safety
The magnet is ALWAYS ON, even when not in use
•
•
•
•
Things that contain metal may be pulled into the scanner, like: scissors, tools, IV poles,
oxygen tanks, wheelchairs, floor buffers, even jewelry
Patients are screened before they enter the scanner, especially for pacemakers,
neurostimulators, aneurysm clips, cochlear implants, & some orthopedic hardware
NEVER enter the scanner room until cleared by the MRI technician
No “Codes” or resuscitative efforts are attempted in the scanner room. The MRI tech will
immediately move the patient to the holding area, if necessary
Sharps Safety
Did you know?
AMH hospitals provide a wide variety of sharps safety devices
To protect employees from accidental needle sticks and other
sharps injuries.
Employees who use sharps are instructed about the safety
features and are expected to use them properly.
Safety features must be activated after every use and before disposal.
Activated sharps safety devices must be disposed of by
placing into rigid sharps containers
Each facility has an Exposure Control Plan that explains how we plan and implement for
prevention of exposure to blood and bloody body fluids.
Blood Borne Pathogen Exposure Control Plan (RG) INC.256
Sharps users are involved in evaluating and selecting safety engineered devices
Sharps containers must be changed when ¾ full. Don’t wait!
35
Safe Patient Handling
THINK IT THROUGH
•
•
•
Assess the patient’s ability to participate
Clear away obstacles
o Get help as needed:
o slide boards
o draw sheet
o trapeze
o CO-WORKER
Use good form
USE GOOD FORM
•
•
•
Push a carrier, cart or
wheelchair. You can push twice
as much without back strain as
you can pull
Stay close to the cart or
wheelchair
Use both arms and tighten your
stomach muscles
DON'T
DO
DON’T
***********************
USE GOOD FORM
• Always lock wheelchairs, carriers and beds
• Position height of bed at elbow level of caregivers or same height as the carrier
• Ask the patient to assist if possible
• Use both arms and tighten your stomach muscles
• Keep your head up and back aligned. A forward bend to lift can put 1000 pounds of pressure on your
lumbar (lower) spine
• Tighten your stomach muscles and pull on the draw sheet to move the patient to a carrier
DON'T STRAIN
DO GET HELP
36
Safe Lifting Basics
USE GOOD FORM
•
•
•
•
•
•
•
DO
Keep back straight
Bend your legs at hips & knees
Tighten stomach muscles
Keep object closer to body
Use smooth, controlled movements
Avoid twisting & jerking
Avoid overhead lifting. Use approved stool or ladder
DO
DON’T
DON'T
DO
DON'T
37
DO
Language Interpretation
Language and Culture impact the health care experience. Our “duty to serve” crosses all
cultures, religions, and languages. If you encounter a patient who does not reliably speak
or understand English, you have a duty to offer the patient free interpreter services
during critical communications. This includes individuals who are hearing impaired or who
have a primary language other than English. Work with your manager to arrange for an
interpreter, as needed. We have employees who are trained interpreters in addition to having
contracted interpreter, and telephone interpretation via use of the Language Line. Below are
tips for effective use of an interpreter for patients who do not speak or understand English
reliably:
TIPS For Effective Use of An Interpreter
Brief the Interpreter: Identify who you
are and the objective of the interpretation
session.
Speak Directly to the Patient: All
communication should be directed to the
patient, not the interpreter.
Segments: Speak in one or two short
sentences at a time. Pause to allow the
interpreter to deliver the message.
Ask Patient if they Understand: Inquire
periodically to assure the patient has
understood the message.
Do Not Ask the Interpreter’s Opinion:
The interpreter’s job is to relay meaning
without a personal opinion.
Everything You Say will be Interpreted:
The interpreter’s job is to relay your entire
message to the patient. Do not relay
information unless it is intended for
interpretation.
Avoid Jargon or Technical Terms:
Clarify any potentially confusing technical
terms as you speak. There is often not a
1:1 correlation between technical terms in
English and in another language.
Avoid Interrupting the Interpreter: The
interpretation may be of greater length
(more words) than your English message.
Many concepts have no equivalent in
another language. Give the interpreter
time to provide the message to the patient.
Reading Script: When reading prepared Culture: The interpreter may point out a
text or documents, slow down to give the cultural issue and ask you to rephrase if
interpreter time to keep up.
they believe a particular question is
culturally inappropriate.
Currently Adventist Midwest Health uses the services of Language Line®. Review flyers are
posted on the units for phone number and access code.
38
AHH Parking: Park in the Visitor garage (garage attached to the hospital) on the roof.
ALMH Parking: Park in the staff parking area behind the hospital, behind the fence.
Enter thru entrance D, the door with the picture of the wheelchair.
ID Badges: New Instructor: on your orientation day/Continuing Instructor: prior to
starting with your students, at AHH go to the Information Desk/at ALMH go to Security
and request Visitor Nursing Student badges for you and your students. You will need to
tell the Information Desk the first and last date of your rotation as well as how many
students you will have. Depending upon how busy the Information Desk/Security staff
are, badges may be ready later that day for pick-up or you may negotiate to pick them up
on the morning of your student orientation. Visitor badges will be dated for the duration
of your rotation. Turn the badge in on your last day.
AHH/ALMH Clinical Educator Contact Information:
Donna Kanak-Tupper Hall – Basement – Room 5
Office: 630-856-3056
Fax: 630-856-3046
Email: Donna.kanak@ahss.org
39
(Staff Development Office)
Guidelines for Clinical Practicum at
Adventist Midwest Health
Request for Clinical Placement
1. Request for clinical placement of undergraduate students must be submitted to the
respective hospital Clinical Educator who has the responsibility for Clinical Affiliations.
2. All requests must be received on AMH “Request for Clinical Placement” form. If school
does not have appropriate form, it will be provided electronically.
3. When request is received, verification of current affiliation agreement and certificate of
liability policy or establishment of a new clinical affiliation agreement will follow.
4. For new or renewal contract affiliations, the process for contract establishment is
a. The Clinical Educator will send the AMH Clinical Affiliations Agreement
electronically to the school.
b. Two originally signed contracts along with a current certificate of liability should be
sent via certified mail to the Nursing Education Department at the specific
hospital.
c. Thereafter, the annual renewed certificate of liability should be sent to the
Regional Coordinator of Nursing Education.
Katherine.weibel@ahss.org or fax 630-545-7356
5. Once clinical request has been confirmed, Affiliating school must send confirmatory letter
with collegiate letterhead for faculty/student affiliation. This letter is submitted annually
and should include
a. Name of faculty
b. Faculty status: full time or adjunct
c. Faculty contact information: email address, phone number
d. Faculty’s Curriculum Vitae
e. Previous clinical teaching experience, if applicable. (This provides a foundation for
orientation and assists in identifying faculty learning needs.)
f. Affiliation start date and end date
g. Clinical hours per week
h. Assurance that health requirements of faculty and students have been met by
completion of AMH Verification of Requirements.
AMH Verification of Requirements form will be provided to the Affiliating School.
This will be completed and submitted to the Clinical Educator for both instructor and students.
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REQUEST FOR CLINICAL PLACEMENT
(One request form for each group of students)
____________________________________
HOSPITAL
____________________________________
SEMESTER (Fall, Spring, Summer)
___________________________________
SCHOOL NAME
___________________________________
YEAR
DIRECTIONS: PLEASE COMPLETE THIS FORM AND MAIL, FAX, or E-MAIL IT TO
Adventist Hinsdale Hospital
Nursing Education
120 N. Oak Street
Hinsdale, IL 60521
ATTENTION: Donna M. Kanak, MS, RN
E-Mail: donna.kanak@ahss.org
FAX: 630-856-3046
PHONE: 630-856-3056
1. COURSE NAME: __________________________________________________
2. NUMBER OF STUDENTS: ______________________________(8 maximum)_
3. UNITS(S) REQUESTED: ____________________________________________
4. FIRST CLINICAL DAY: _____________________________________________
5. LAST CLINICAL DAY: ______________________________________________
6. CLINICAL DAY(S): (Underline) MON
TUES
WED
THURS
FRI
SAT
SUN
7. TIME: ___________________________________________________________
8. HOLIDAY/BREAKS THIS CLINICAL: ___________________________________
9. INSTRUCTOR: _________________________________________________________
CELL PHONE: _______________________ E-MAIL __________________________
10. CONTACT PERSON: ____________________________________________________
PHONE: ____________________________ E-MAIL ___________________________________
REMINDER: “Verification of Requirements” are due in my office by the first week of clinical.
(Do not write below this line.)
____ Faculty “Verification of Requirements”
____ Student “Verification of Requirements”
____ Valid Agreement
____ Faculty Confidentiality,Test, List forms
____ Student Confidentiality,Test, List forms
____ OpIDs to Instructor
____ Faculty Cerner Training (power point)
____ Student Cerner Training
____ Faculty Cerner Security Request Form
____ Student Cerner Security Request Form
____ Faculty iConnect Competency Checklist ____ Student iConnect Competency Checklist
08/11dmk
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Faculty Responsibilities
1. The AMH Faculty/Student handbook and required forms will be emailed to the instructor prior to
each clinical rotation. The new instructor is to review the manual before Hospital Orientation.
2. Prior to Hospital Orientation, the instructor will
a. Read the AMH Faculty/Student Handbook
b. Read PowerPoint presentations on Computer Charting and Medication Administration.
3. Schedule an appointment with unit Manager to shadow on the unit prior to beginning with
students and provide the managers with the following:
a. Student roster on collegiate letterhead
b. Start date and end date of clinical rotation
c. Student learning objectives
d. Student Competencies
e. Contact information for faculty
4. Attend hospital orientation.
a. Unit orientation on the shift you will bring students (Coordinate with unit manager.)
b. Orientation with hospital Clinical Educator
5. Complete and submit to the Clinical Educator 1 packet per instructor and 1 packet for each
student, copied back-to-back
a. Faculty/Student Orientation test
b. Confidentiality Agreement
c. Activities Students Are NOT to Participate In
d. I-Connect Skills Checklist
e. Cerner Security Request Form – (single page) Must be signed by Clinical Educator and
then submitted to Recruitment, Diane Krygier at AHH and HR, Melissa Maher at ALMH.
Note: SSN must be provided in order to receive computer access.
6. Schedule room to provide students hospital orientation, Cerner training, & post-conferences.
For AHH, go to https://ahh.sentact.com/ and click on Conference Rooms. For computer
orientation, choose Tupper Hall either Classroom C (basement) or Classroom D (2nd
floor).
For ALMH, contact Louella in EVS at 708-245-3776.
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7. Provide student orientation to hospital and
a. Instruct students on hospital policies/procedures/practices.
b. Review Faculty/Student Orientation Handbook and have each student complete.
c. Teach “view only” of Cerner when appropriate.
d. Assure student completion and then submit with instructor forms to Clinical Educator as
listed in #5 above.
e. Submit Cerner Security Request Form signed by Clinical Educator and Instructor to HR.
8. On last day of rotation, complete Instructor/Student Nurse Evaluation of Clinical Rotation and
submit to Clinical Educator.
9. An evaluation of faculty will be completed by Nurse Manager and staff with each rotation.
10. Faculty is required to be on site during all student clinical experiences, including
leadership/capstone.
11. If a faculty is absent or ill, it is the responsibility of the school to either cancel clinical or provide a
qualified faculty replacement.
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Instructor Checklist
__
Instructor Orientation
__
Unit Orientation
__
Hospital orientation for instructor __________
__
Pre and Post conference room scheduling
At AHH, go to https://ahh.sentact.com/ and click on Conference Rooms.
At ALMH, contact Louella in EVS at 708-245-3776.
Student Reminders
__ Wear school ID & Hospital issued Visitor badge
__ Bring model & make of car, and license plate number
__ Bring just enough money for meal in cafeteria (no valuables)
__ Computer Orientation for students by instructor ________
__ Reserve computer classroom thru appropriate contact for each hospital
- For AHH, go to https://ahh.sentact.com/ and click on Conference Rooms.
Choose Tupper Hall either Classroom C (basement) or Classroom D (2
for computer orientation.
nd
floor)
- For ALMH, contact Louella in EVS at 708-245-3776.
__ Complete and submit forms for each student and yourself
___ “Cerner Security Request Form” after signed by Educator to Human Resources
___ **“iConnect Skills Checklist” to Nursing Education
__ Hospital Orientation for students by instructor __________
__ Review applicable policies and procedures
__ Complete forms and submit by the end of the first clinical day
__ Submit Parking pass application to Security (x3999) AHH in ED, ALMH near cafeteria
__ Submit to Nurse Educator 1 packet/student forms in this order
1. “Faculty/Student Orientation Post-Test”
2. “Confidentiality Agreement”
3. “Activities Students are NOT to Participate In”
4. **“iConnect Skills Checklist”
(Please copy these 4 documents back-to-back for each student as they must be maintained for 10 years.)
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____
__________________________
Name School ____ __ __________________________ Area for Experience First Day – Last Day of Rotation/Year FACULTY/STUDENT ORIENTATION POST-­‐TEST 1. T / F The Adventist Midwest Health (AMH) policy on Patient Privacy allows for students to talk with their own family as well as at school about hospitalized patients. 2. T / F Your school photo ID badge AND a hospital issued Visitor badge (obtain from Information Desk in hospital lobby), or the hospital issued ID badge must be prominently displayed on your clothing whenever you are working at the Hospital. 3. State the values upon which Adventist Midwest Health institutions provide health care. ________________________________________________________________________ ________________________________________________________________________ 4. T / F Students are expected to follow the AMH SHARE customer service philosophy: S______________________________________________________ H_____________________________________________________ A_____________________________________________________ R_____________________________________________________ E_____________________________________________________ 5. T / F Students must use AIDET at AMH hospitals: A______________________________________________________ I______________________________________________________ D______________________________________________________ E______________________________________________________ T______________________________________________________ 6. According to the Hospital which of the following is not a patient right? a. reasonable response + quality health care b. information about illness + method of treatment c. private room d. privacy 7. T / F No smoking is permitted on the hospital campus. 8. T / F Supervised and documented by the instructor or staff nurse, the student nurse may administer oral and IM medications. 45
9. T / F If asked to sign as a witness on a surgical permit, Advance Directive, living will, or Blood Component Transfusion Record, the student should do so. 10. T / F SBAR (Situation, Background, Assessment, Recommendation) is the name of the patient hand-­‐off tool AMH has chosen to implement. Furthermore, students are required to use SBAR when reporting off to the RN. 11. Define the RACE acronym and briefly describe the action to take. R_________________________________________________________ A_________________________________________________________ C_________________________________________________________ E_________________________________________________________ 12. When discussing hazardous communication, define MSDS and explain its purpose. M______________ S______________ D______________ S______________ ______________________________________________________________ ______________________________________________________________ After reviewing Hospital Policies, please answer these questions: 13. T / F If a protective device (restraint) has been applied to a patient, the patient should be toileted and given fluids/food, have their circulation, ROM, sensation, and skin condition checked every two hours. 14. T / F The use of a cane or walker, confusion, wearing glasses, and hearing aid, are not fall risk factors. 15. T / F If you suspect your patient is a victim of abuse or neglect, you are to discuss your concern with the AMH nurse responsible for the patient. 16. T / F After checking your patient’s ID band for name and birthdate at the beginning of your clinical day, you do not need to check it again prior to administering medication, collecting a specimen, or providing other treatments/procedures. 17. In order to protect yourself, your patients, your coworkers, and your family, you should wash your hands a. Before beginning work and prior to leaving the unit b. Before donning gloves and after removing gloves c. With each patient encounter d. After touching your face and coughing, sneezing, and blowing your nose e. All of the above 46
Match the emergency condition to the correct color/code. A. Blue 18.___ Child abduction B. Red 19.___Hazardous spill C. Pink 20.___Patient has left building without staff notification D. Yellow 21.___Fire / smoke / odor of something burning E. Black 22.___Person threatening and displaying a weapon F. Gray 23.___Blizzard conditions G. Silver 24.___Cardiac arrest H. Purple 25.___Behavioral Response Team I. Brown 26.___Severe weather J. Orange 27.___ Security assistance needed K. Green 28.___ Internal Disaster L. Triage 29.___ Bomb threat M. White 30.___External Disaster – incoming patients to the ED N. BRT 31.___ Utilities failure Welcome to Adventist Midwest Health! Return the following completed forms for each student and instructor to the Clinical Educator in Nursing Education, prior to beginning the clinical experience/on your first day of clinical: 1) Orientation Post-­‐test 2) Confidentiality Form 3) Activities in which “students are not able to participate” 4) iConnect Skills Checklist 5) If students receive computer training, submit Cerner Security Request Form separately. Thank you! Revised 05/12 AHH/dmk 47
Adventist Midwest Health Confidentiality Agreement
Name: ______________________________________________________________
Last,
First
Middle Initial
SS#: ______________________________________________________________
Workforce Member (circle):
Employee
physician
volunteer
contract/agency
student
vendor
other
In understand that I may be exposed to a variety of clinical, financial, and other types of information
generated in the course of business. To assure the integrity of the data, and protect it from
accidental loss, alteration, destruction, or tampering by unauthorized individuals, I agree to the
following:
1. I understand that I will refrain from releasing confidential information (verbally, copies, faxes, downloads)
to individuals who are not authorized to receive this information. This includes refraining from accessing
confidential information or discussing sensitive information with coworkers, friends, families, or other associates
without a legitimate “need to know” and /or proper authorization.
2. Any ID number and passwords for information systems which I may be granted access to are strictly
confidential, unique to me, and will not be shared with other users. I understand these computer key codes are
equal to my handwritten legal signature.
3. I understand these codes have been granted to me under a privileged “right to know” and I will limit my access
only to the information pertinent to the care of the patient or within the scope of my job responsibilities.
4. I understand that cellular phones, personal digital assistants (PDAs), or other electronic devices that have the
capability to record images (such as taking pictures) are not permitted to be used for imaging purposes on any
AMH campus unless specifically authorized to carry out assigned job duties.
5. If I suspect or have knowledge of someone else inappropriately using my password or sign-on I will report this
immediately to the Compliance and Privacy Officer at (630) 856-4572.
6. I understand this document will be retained on file and that a violation of this policy and/or releasing any
confidential information which I am exposed to in the course of my activities, can result in limited or termination of
access to these systems, change in ID number or password assignment, possible disciplinary action, according to
hospital policy and/or Medical Staff Rules and Regulations, including termination, and potential liability.
7. My responsibility for maintaining confidentiality continues even after my employment with Adventist Midwest
Health ends.
______________________________________________ ________________________
Signature
Date
Routing: Employee (Personnel File-Human Resources), Physician (Medical Staff Office),
Volunteer (Volunteer Office), Student/Contract/Agency/Vendor (Sponsoring Department)
48
IMPORTANT
Activities in which Undergraduate Student Nurses are NOT to Participate even under the supervision of the instructor or staff nurse Administer Chemotherapy
Nurses must be certified in order to administer chemotherapy.
Administration of IV push medication
Bedside Glucose Monitoring
Blood and Blood Products Administration
(RG) PTC.653 “Prior to administration of the blood product, two (2) RNs must check the blood at the
bedside.” The student nurse can never provide the 2nd nurse verification.
Blood Draws
Student nurses are not allowed to draw peripheral blood or from a venous access device.
Documentation in the Electronic Medical Record
Medication administration will be documented by the instructor or staff nurse.
Emergency Situation or Code Blue
Students should call for help and begin CPR. When other staff arrive, students should move into an
observation role only.
Intravenous Therapy, insertion
TB/Suspected TB Cases
Students should not enter rooms of patients with TB or a suspected case of TB; students have not been
fitted with N95 masks.
Verbal, Telephone and written orders
(RG) PTC.605 Verbal and telephone orders may only be accepted by licensed and registered hospital
personnel. Student nurses and instructors do not qualify.
Witness to wills, Advance Directives or other legal documents
I acknowledge and understand that as a student nurse I am not to engage in any of the preceding activities. If I am asked to perform any of these activities, I will politely decline. ______________________________________
____________________________________
Printed Name Date ______________________________________ ____________________________________ Signature School of Nursing 5/12 AHH/dmk 49
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Evaluation of Clinical Rotation by Student Nurses/Faculty
at Adventist Bolingbrook / Glen Oaks / Hinsdale / LaGrange Hospital
Please circle your hospital.
School: _________________________ Clinical Dates: ___________________
Unit: ___________________________ Instructor: ______________________
Evaluation Criteria of your experience
with our nurses
Strongly
Agree
4 points
Agree
Disagree
3 points
2 points
Strongly
Disagree
1 point
The nurses …
1. Assisted me to achieve the clinical
objectives of my rotation.
2. Communicated clearly using SBAR/AIDET.
3. Constructively provided me pertinent
feedback.
4. Utilized spontaneous learning situations to
enhance my experience.
5. Facilitated my inclusion in patient care by
introducing me to other members of the
healthcare team as well as patients.
6. Served as a positive role model.
7. Impressed me to the degree that I would
consider working at this hospital based on this
clinical experience.
8. If you were to apply for hospital employment at this time, which hospital would you most
like to work at?
Why?
9. If there is a nurse who you would like to recognize for being especially helpful to you,
please write his/her name and describe the situation.
10. Expected graduation date:
Additional Comments:
jmad71 7/20/10 4:20 PM
Deleted:
Reviewed 5/12dmk/jm
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