Nursing Instructor/Student Orientation
Presented by Education & Quality Department
Vision: Stellar Performance in all Dimensions
Mission: Enhance the Health of the Communities and Customers We Serve
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Values: PRIDE, our caring shows through:
Partnership – a belief that we are at our best when working together – with our patients, with each
other and with our community
Respect – a dedication to treating our patients and one another with compassion and good will
Integrity – a commitment to always do the right thing
Determination – a proactive pursuit of challenging the status quo with confidence and enthusiasm
Excellence – an unwavering focus on quality and service in all that we do
Welcome to Elmhurst Memorial Hospital.
Please review the information in this booklet prior to
your clinical experience at Elmhurst Memorial Hospital.
Instructors: Prior to or at the beginning of the clinical rotation, please have the students review this
orientation handout.
Instructors are responsible to have themselves and the students complete the Environment of Care
Departmental Orientation checklist, Confidentiality Agreement, Waiver and Agreement and send back to
Anne Stezowski, education and Quality.
Instructors also need to have the ID request form completed and give to the Protection Office to have
student ID badges made. It is easiest if you submit the forms in advance (drop off or fax to 630-7585978) and then since the information would be pre-entered into the computer , the ID picture taking
process goes much quicker.
Instructors need to contact the unit manager prior to the start of clinical and request an appointment to
review student goals and unit requirements.
Just a reminder that the instructors are requested to have students’ clinical schedules including
observational experiences pre-planned and forward a schedule to each observation area and copy to
Education & Quality, attention to: Anne Stezowski
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Patient Care
Nursing Instructors will be given a Meditech and Pyxis code. Nursing instructors will be
allowed to document the medications on the online MAR. Instructors will be able to access
the EMR (electronic medical record) in the computer. Students will not document in the
Electronic record nor will they be given access to Pyxis.
Patient Identification Process
The 2 patient identifiers are the Patient’s Full name and Date of Birth. These 2 patient
identifiers must be compared each and every time against a hard copy or computer screen
(i.e. medication worksheet or profile) prior to medication administration, transfusions and
procedures.
Medication Administration
Following is the key information regarding medication administration here at Elmhurst
Memorial Hospital.
∞ Medications are not to be kept or carried in clothing pockets.
∞ Medications are not stored at the patient’s bedside or in the patient’s room.
∞ Instructors and students are not allowed to given any type of oral or IV chemotherapy.
∞ IV Push Policy located in Patient Care Manual Policy # PCS 3.18 online.
This policy lists all the medications RNs are allowed to administer IV Push and the
requirements for monitoring or level of nursing care needed, i.e. CCU, tele, etc.
∞ Double check Insulin and Heparin with another nurse before giving.
∞ New therapy of Metered Dose Inhaler (MDI) delivered medication is administered by
Respiratory Therapist. When Resp Tx deems that the patient has been sufficiently
instructed and is competent then the MDI can be transitioned to the RN for
administration. Check Medication Administration worksheet to determine who is
responsible for administrating these medications.
Retrieving medications from the Pyxis
Only one patient's medications are to be removed from Pyxis at a time. Medications must
be kept under the control of the RN at all times.
Due to the volume of the 9 a.m. medications you have the option to retrieve medications by:
1. Placing the 9 a.m. medications for each patient in a ziplock bag which is labeled with
the patient’s name and DOB (Meditech labels available in front of chart).
2. Store the medications in Pyxis in the patients’ specific bin.
3. Prior to administration, check patient’s orders for new or discontinuation of
medications.
4. Only administer medications to one patient at a time. Student/instructor should only
have one bag of medications for one patient at a time.
5. Identification process includes comparing the bag label, paper MAR and patient’s ID
band.
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Bedside Medication Verification (BMV)
All of the Patient Care Units are now using BMV. Medications are scanned and the patient
identified and administration is documented in real time. The unit staff will be able to walk
you through this process.
4 West Unit
If your clinical rotation is on 4 West, your students are allowed to pass
SCHEDULED medications. PRN medications are to be administered by the 4 West
patient primary nurse. Please have your students notify the patient’s primary nurse
when the patient requests a PRN medication (i.e. pain medication).
Glucose Monitoring
Instructors or students are not allowed to perform bedside glucose monitoring test. Training
is required and a confidential User ID is required to access the device.
DNR/PDNR (Do Not Resuscitate/Partial Do Not resuscitate)
The order sheet is placed in a plastic sleeve at the very front of the chart for easy access.
The patient will have an addition yellow plastic armband with the patient identification
sticker and is marked "P" with a circle around it to denote PDNR and not marked if DNR.
Restraints
Medical-Surgical Restraint observation and documentation is performed at least every 2
hours, preferably on the even hours, and documented on the Restraint Documentation tool
(hard copy). Additional Meditech documentation is required once per caregiver, This will
be done by the floor RN responsible for the patient.
Observations are continual and in person for Behavioral Management Restraint use, and
documented every 15 minutes on the Restraint Documentation tool. This must be
documented in real-time, not left until the end of the shift. Please discuss with primary
nurse if your patient is in restraints.
Assignment Board
Staff assignments will be listed on the assignment board. Many units indicate other duties on
the assignment board, i.e. extra cleaning responsibilities or Crash Cart. Some units have
special codes to indicate special patient needs, i.e. impending discharge, chemotherapy
nurse needed, DNR, Cardiac Cath, etc.
Navicare
We are trying to give our patient's the best possible experience while they are at EMH. One
way is to help keep care coordinated and to let the patient know when tests, procedures
and therapies are scheduled.
The Navicare Screen on each unit (large plasma screen) allows unit staff to see scheduled
times for each patient's day. Nursing staff is to refer to this frequently throughout the
day. The information is to be shared with patients and families. They want and need to
be informed. You will be able to plan your care around the other events to minimize
interruption for you and the other disciplines. Medicate patients, as appropriate, 30-45
minutes prior to test or therapy. Make sure patients are ready for scheduled events, offer
toileting 30 minutes prior to scheduled times.
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Fall Prevention
Low Fall Precautions (all patients)
Bed in low position, wheels locked
Adequate lighting
Room clutter free
Personal items and call light within reach
Patient is reminded to “Ask for Help” if needed
Staff is to ask “Is there anything else you need” before leaving the room
Medium Fall Risk Precautions (in addition to Low Precautions) 25-50 on Morse Fall Scale
Identify on chart and room with one “Falling Star” sticker
Utilize Standard Fall precautions
Call lights answered promptly
Check patient more frequently and offer toileting assistance
High Fall Risk Precautions (in addition to Low and Medium) 50 -150 on Morse Fall Scale
Identify on chart and room with two “Falling Stars” sticker
Utilize High Fall Risk Precautions
Bed place against wall if possible
Floor mat next to bed
Bed Check/bed alarm/Posey Sitter Alarm
Lift Equipment
Mechanical lift equipment or static lifting aids will be utilized in all patient care handling
situations. Please check with the primary nurse regarding transfers to bed to chair, etc.
Visiting Hours
∞ Recommended visiting hours are 9 a.m. to 9 p.m.
∞ Patients in a semi-private room, we recommend limiting visitors to two per patient
and to follow the recommended visiting hours.
∞ If a family member or guest is not completely healthy or has been exposed to a
communicable disease, please postpone visiting until symptoms subside.
∞ Visitors to wash their hands before and after your visit.
After-Hours Arrangements
∞ Visitors who arrive after 9 p.m. will need to enter through the Emergency
Department and receive a temporary visitor badge from security staff. Visiting is
limited to the patient’s room and family lounge, but visitors are welcome in the
first floor lobbies and cafeteria as well.
Children
∞ Children at least six years old who do not show any signs or symptoms of illness
may visit when in the supervision of a responsible adult. Younger children may
visit when special arrangements are made with the nursing staff and the patient
prior to the visit.
Isolation Precautions
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Visitors should talk with the nursing staff to find out about special precautions
before entering a room with an isolation sign posted on the door. All family and
guests must adhere to isolation requirements in order to maintain a safe
environment for all patients and visitors.
∞ Patient’s with C-Difficile infections will have a sign over the hand gel dispenser
in the room advising that hand WASHING is required.
∞ MRSA/VRE/KPC/Norovirus infections are extremely problematic for healthcare.
Extreme vigilance is necessary to prevent inadvertent patient/family/staff
transmission of disease. It is possible that the unit may exclude student
assignments from some of these patients.
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Behavioral Health Unit
∞ Visitors 18 and older are welcome to visit.
∞ Visiting hours are 1 – 2 p.m. and 6:30 – 7:30 p.m.
∞ Two visitors at a time are welcome.
Family Birthing Center
∞ Siblings are allowed to visit under the supervision of a responsible adult, other
than the patient, after a health screening has been completed.
Pediatrics
∞ Parents or legal guardians are welcome to stay overnight with the child.
ID Badges
You and your students should obtain picture ID's on the first day of clinical. You may
obtain Request for Photo ID forms from Safety and Protection, ext. 41500. Complete a form
for each student and yourself and return the forms to Protection. They will enter the
information into their computer and you can coordinate with them when/how to bring the
group down to get the pictures done. At the end of the clinical, you must collect the ID's and
return them to Protection.
To expedite the process, please contact Protection to make an appointment for your students
to have their IDs taken.
Contacts: Doug McCrea, dmccrea@emhc.org (630-833-1400, ext. 41088)
Kim Urbanek, kubane@emhc.org, ext. 41553
You may fax the completed ID forms ahead of time to: Fax #630-758-5978. Please make
sure your cover sheet includes your name and school.
Parking
Available parking spaces are limited for clients and staff. Please encourage your students to
carpool.
No Smoking Policy
EMHC is a smoke-free environment. Smoking is not allowed in the building or on the
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campus. Smoking is not allowed in cars if they are parked on the EMHC property.
Conference Room Scheduling
To schedule a room, call Conference Room Scheduling, ext. 35615 or srodrig@emhc.org
(Sonia Rodriquez). Note: Board Room and MEC are the only rooms that have a DVD
player.
If your conference room is locked, call Protection (dial 41500). They will come and open
the door for you.
Observation schedules
If your students will be observing in another area, please provide a schedule to the
observation area at the beginning of the clinical so they can organize their weeks. Note:
Surgery department request one month in advance to schedule observation time.
Recruitment
Our Human Resource Generalist, Vickie Riordan, would be happy to come to visit your
students at some point during your clinical experience and discuss interviewing techniques,
resume writing and other job search/recruitment topics. Vickie can be reached at ext.35373.
Cafeteria Hours
Monday through Friday:
Breakfast 6:30 a.m. to 10:30 a.m.
Lunch 11 a.m. to 2 p.m.
Snacks 2 p.m. to 4 p.m.
Dinner 4:45 p.m. to 7 p.m.
Saturday, Sunday and Holidays:
Breakfast 6:30 a.m. to 10 a.m.
Lunch 11:15 a.m. to 1:30 p.m.
Snacks 2:30 p.m. to 3:30 p.m.
Dinner 4:45 p.m. to 7 p.m.
Communications
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Outside call: Dial 9 to get an outside line.
How to page: To page in house, pick up any house phone and dial 50. Follow the
prompts (the ID to page is the pager number; the call back extension is the extension of
the phone you are at).
Emergency Calls @ EMH
Dial 66 for the Crisis Line.
Give the Attendant the location of the emergency and briefly explain the situation.
Voice Activation
Dial 55, state name or unit
Need operator, state “operator”
Transfer a call with the Desk/Wall Phones:
1. Press the Transfer (XFER) key.
2. Dial the extension number.
3. Announce call
4. Hang up.
To reconnect with the original call: Press the Connect (CNCT) key.
Cellular Telephones
Cellular telephones may be used in designated areas only, as they may interfere with
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sensitive equipment used in patient care areas. Please note signage designating approved
user areas.
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Access the online Environment of Care Manual
On the computer desktop, select the internet icon. On the Hospital Intranet webpage,
click on For Emergencies link. This will provide you with a brief overview of each
emergency code.
For manuals, click on the Manual tab on top to access manuals. There are several
departments whose policy manuals are not online. Their hard copy is available in the
individual departments. Policy Manuals are located on-line on the EMH Intranet.
The Patient Care Services (Nursing) Manual is online but also supplemented by the
hard-copy Perry and Potter Clinical Nursing Skills textbook. The textbook is the
reference to be used if the procedure in question is not covered in our on-line policy
manual.
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Release of info to media
All media calls, regardless of their origin or type of information requested will be
directed Marketing and Public Relations department.
Safety Management
Safety Officer: Debbie Reynolds
Safety Hotline: #866-623-1407 Call for unsafe practices or safety concerns. Confidential. Calls
may be made anonymously.
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Blood & Body Fluid Exposure
Wash the exposed area immediately.
Report the incident to an immediate supervisor.
Report to Employee Health or page Clinical Resource Nurse (pms & nights and weekends).
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Accident or injury
Talk to the Team Leader, there is a form to be completed. Go to Emergency Department as
warranted.
How to handle errors and occurrence reports
Tell the Manager. For patient safety we need to report all errors and near misses. The
Manager, Assistant Manager or the Team Leader will help you complete a Patient Care
Quality Report and any supplemental forms that might be appropriate.
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Escorts
The Protection & Safety Department will provide vehicular or pedestrian escorts to the
garages, lots and surrounding buildings during evening, night, and weekend hours upon
request. Escorts are subject to availability by calling the department Command and Control
Center at extension 41500.
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Emergency Management
Emergencies: Hospital dial 66, Offsite dial 9+911
Give the operator the location of the emergency and briefly explain the situation.
Operator will announce code overhead 3 times.
Code Blue
Cardiopulmonary Arrest/Medical Emergency-staff on unit respond, bring crash cart.
Code Pals
Pediatric Medical Emergency (<12 yrs); staff on unit respond, bring crash cart, Peds or
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ED RN responds with pediatric sized equipment.
RRT (Rapid Response Team)
This is used to bring the house MD, a CCU RN and a Respiratory Therapist to the
bedside to assist in intervention and communication.
It is used for inpatients that experience acute changes such as but not limited to:
∞ HR<40
∞ HR sustained >130
∞ Symptomatic SBP < or = to 88
∞ RR<8
∞ RR>28 and labored
∞ SpO2<90%
∞ Altered Mental Status
∞ Chest pain
∞ Acute significant bleeding
∞ Seizures
∞ Suspected Stroke
Code Rove-Missing Patient
First name and location announced.
Be alert for patient on your unit.
Dr. Strong-Combative patient
Protection Personnel and possibly Maintenance will respond.
The RN is in charge of the situation and in charge of directing the actions of the Dr.
Strong Team. Our goal is a safe patient and safe staff.
Code Pink-missing infant/child
Number announced after “Code Pink” indicates age of child in years
Hospital will lock down and control exits, be alert for people leaving with packages,
duffel bags or clothing.
Code Red-Fire
RACE:
R
Remove all patients and visitors from immediate danger, if possible.
A
Alarm - Pull the nearest Fire alarm Pull Box.
Call “66 - Crisis Line” with the exact location of the fire. Communications
will announce CODE RED three (3) times. (Including the location)
C
Contain – Close all windows and doors.
E
Extinguish – Extinguish the fire with the appropriate fire extinguisher, if
trained to do so OR evacuate the area.
Extinguishers: EXTINGUISHERS (P.A.S.S.):
P
Pull the safety pin.
A
Aim hose at the base of the fire.
S
Squeeze the trigger (Handle).
S
Sweep from side to side with the extinguishing agent.
Keep all patients and visitors in rooms, close all doors
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At least one staff person is to be in each smoke compartment (between the closed doors)
Staff are to remove fire extinguishers from wall compartments
Respiratory is in charge of the O2 valves The Respiratory Care & Facilities Management
staff assigned to the Code Red Response team shall jointly be responsible for closing the
oxygen shut off valves. Facilities will only operate the required valve once Respiratory has
verified all patient care needs first.
Do Not go through closed fire doors
Code Black-Severe Weather
1 “Watch”-be alert
2 “Warning”-move pts into hall or cover with blankets away from window in room
3 “Take Cover”-staff and visitors in hall or bathrooms, remain until “All Clear”
Code Gray-Bomb Threat
Listen to what caller says and note any noises or other info, ask where located, when
it will go off, why, etc.
Alert another staff person and have them call “66”
Staff will visually search their area, do not touch suspicious objects
Code Orange-Hazardous Material
Only trained Hazmat personnel will respond to ED
Code Purple-Evacuation
Relocation dependent upon severity and type of emergency
Keep chart with patient
Horizontal relocation first and then vertical
CodeTriage -Mass Casualty Disaster
Will be re-announced on each unit to increase audibility
Each unit will complete an “Emergency Discharge List” and send to Admitting
Each unit will complete a “Staff Availability List” and send to the Staffing Office.
Do not send staff to Ward, unit will be notified if staff needed
Ward area will be set up by Facilities by yellow elevators
Code Green-Utilities Failure
Call affected department: If there is no answer, call the operator “0” and ask them to page
the department.
Facilities, Biomedical, and Environmental – 44444
Respiratory Care – 27852
Communications – 44357
Info Systems – 44357
Red outlets are powered by hospital backup generator and work in power failure.
Chemo Safe Handling Precautions
Used in preparing and administering chemo medications
Used in handling excreta from patients getting these drugs within the past 48 hours
All staff to be aware of precautions
–Chemo Precaution sign on chart and above bed
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–Communication with other involved departments
Chemo Bucket is kept in the Dirty Utility Room is a special holder off the floor.
Safe Handling Practices
Urine Precautions
–All patients are encouraged to use toilet rather than commode or urinal
–Men are encouraged to SIT on toilet to void to decrease chance of splashing
–Toilet only needs to be flushed ONE TIME
Incontinent Patients
–Appropriate preventative skin care
– Use disposable underpads
–Use disposable diaper, if indicated
∞ Soiled Linen
Contaminated (wet) linen is to be placed in a clear plastic bag and then in a regular
laundry bag
Other linen can also be placed in the laundry bag and then sent to laundry in the
usual way
Laundry personnel know how to handle these items with special care
Chemo spill refers to the medication itself, i.e. IV med or liquid/powdered med (a
pill would be picked it up and discarded in the chemo bucket)
Only Chemo Certified RNs have been trained to clean up Chemo Spills
Sign should immediately be posted warning of cytotoxic spill
Notify 3 South Team Leader RN or Assistant Manager of spill
Notify Protection
Infection Control
Hand washing: Health Care Workers should wash their hands:
1. Before and after direct patient contact and whenever hands become soiled
2. Immediately after removing disposable gloves
3. Before and after eating
4. After using the restroom and after blowing or wiping the nose
5. When coming on duty and when going off duty
Artificial nails and nail tips are prohibited for all healthcare workers and providers
who provide direct “hands-on” patient care across the continuum of care.
Natural fingernails will be no longer than 3mm from the base of the nail at the finger tip.
Nail polish may be applied. Worn or chipped nail polish must be removed.
Hospital Scrubs: A clean cover gown shall be worn over the scrub dress when leaving the
surgical/FBC/PACU area.
PPE
All health care workers must use appropriate barrier precautions (known as personal
protective equipment or PPE) to prevent skin and mucous membrane exposure when
contact with blood, all body fluids, secretions, excretions (except sweat), non-intact skin
and/or mucous membranes from any patient is anticipated.
Needles, used disposable syringes, scalpel blades and other sharp items should be placed
in puncture-resistant Bioharzard containers for disposal. Never recap needles by hand.
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Isolation
Contact: Gowns and gloves are now required for each patient care encounter (basically,
when entering the room).
Airborne: Nursing Instructor and students should not take of any patient who is on
Airborne Isolation. Fit –tested N95 is required to enter an Airborne Isolation room.
Droplet: Surgical Mask required
Sensitive Areas
Family Birthing Center, Behavioral Health (4 East), Pediatrics are all locked units.
need to be buzzed in to enter the unit.
You
Obtain MSDS
Call the following number: Stickers are located on phone handles and on the intranet under For
Emergency link
Accidental Spills (Chemo, Chemical or Mercury)
∞ Obtain the proper personal protective equipment.
∞ Restrict traffic
∞ Contain and avoid tracking through the spill
∞ Notify Department Director/Manager/Assistant Manger/Team Leader
∞ Call Protection, dial 41500
∞ Hospital staff will clean up the spill according to established procedure on Material
Safety Data Sheet. (obtained by calling the 3E Company at 800-451-8346)
Medical Equipment
∞ A "Defective Do Not Use" tag shall be completed and delivered to Biomedical
Engineering attached to the malfunctioning device. Do use any equipment with a
“Defective Do Not Use” tag.
∞ Personal hygiene devices, limited to hair dryers and electric razors, will receive a
visual inspection only. Patient Care Services personnel will perform an assessment
prior to allowing patient use of these devices. This will include evaluating the patient's
physical and mental condition, the use of oxygen in the room, pacemaker or other
patient connections as well as visual inspection for obvious defects.
∞ Use of extension cords is prohibited except in emergency conditions.
∞ Red outlets are backed up by the generator, in the event of electrical power loss.
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All patient care equipment TAG
When a piece of patient care equipment is cleaned, a new tag is to be placed on the equipment.
When assigned to a patient, tear off the “clean” portion of the tag now showing that the equipment is
“in use”.
Once the patient is done with the equipment, tear off the “in use” portion of the tag so then the
equipment is tagged as “Return for Cleaning”.
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