Buffalo Hospital

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Buffalo Hospital

• Agency and Travel Non-Employee Patient Care
  Orientation

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• Audience
• Agency and Travel Staff in
• Lab
• Imaging/Radiology
• Cardiac Services including Respiratory Therapy,
  Sleep Center and others
• Other non-nursing departments

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Contents

• Contents
• Your Role in Restraint Use
• Patient Care Information
• Information Services and Clinical Systems
• Patient Safety
• Medication Safety
• Documentation Overview
• Department Specific Orientation Checklist

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Your Role in Restraint Use

• Contact the primary caregiver RN for assistance
  with the removal or reapplication of any
  restraining devices.
• Restraints any manual method, physical or
  mechanical device, material or equipment that
  immobilizes or reduces the ability of a patient
  to move his or her arms, legs, body, or head
  freely.
• Types
• Medical Healing devices
• Behavioral restraints or Seclusion
• Exclusions to Buffalo Hospital Restraint policy
• Devices used to aid with positioning and/or keep
  immobilized during medical, dental, diagnostic or
  surgical procedures.
• Adaptive/supportive devices, such as braces,
  orthopedic appliances which are used for
  voluntary support to achieve proper body position
  or alignment.
• Use of non-clinical restraints (handcuffs or
  shackles) applied by law enforcement officials.

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Patient Care Information
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Important Patient Care Information

• Patient Bill of Rights
• Patients have the fundamental right to receive
  considerate healthcare that safeguards their
  dignity and respects their cultural,
  psychological and spiritual values
• The Patient Self-Determination Act of 1990
• What is it?
• A Document based on a law that states the rights
  patients have while in a healthcare facility
• Available in six languages and Braille
• Why is it Important?
• The law requires that all patients or their proxy
  receive this information upon admission
• Patient Registration Department gives the patient
  the document

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Important Patient Care Information

• Grievances
• What is a it?
• A verbal or written complaint (an expression of
  dissatisfaction by a patient (or the patient's
  representation) that cannot be promptly resolved
  to the patients satisfaction by staff present.
• Why is it important?
• It is a patient right.
• It is a customer service issue.
• What do I do?
• Try to promptly resolve the issue (with-in your
  scope of practice) without assistance of staff
  outside the unit or department. If the complaint
  is resolved on the spot by staff, no written
  response to the patient is necessary.
• If not resolved, give patient the options of
  talking to the Patient Advocate, Care Management
  Specialist, Department Manager, Administrative
  Supervisor, or to the Minnesota Office of Health
  Facility Complaints (OHFC) listed in the Patient
  Bill of Rights. Fill out a Patient/Visitor
  Safety Report on the AKN.

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Important Patient Care Information

• Vulnerable Adult
• What is it?
• All patients in a health care facility are
  considered to be vulnerable.
• Why is it important?
• It is a MN Statute/law.
• What do I do?
• If patient alleges Abuse, Neglect, Harassment or
  Maltreatment while hospitalized
• Assure patient safety immediately
• Report to Social Services, Care Management
  Specialist, Manager or Administrative Supervisor
• Complete Patient/Visitor Safety Report on the AKN
• Route the report to Social Services, Care
  Management Specialist or to the Administrative
  Supervisor
• If Domestic Violence, refer to Social Services,
  Care Management Specialist or Patient Advocate

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Important Patient Care Information

• Informed Consent
• What is it?
• It is an on-going, collaborative process in
  which the physician and patient discuss the
  patients health care needs and agree on a course
  of treatment. While the informed consent process
  should be routinely followed before any
  significant procedure or treatment decision, the
  policy does not require documentation of this
  process necessarily to be in writing in every
  case. In such cases, a patients spoken consent
  may be sufficient and a brief note by the
  physician in the record is all the documentation
  the hospital will need to be confident that the
  patient has given consent and can let the
  procedure go forward.
• What is the physicians responsibility?
• The physician who performs a procedure or
  treatment, or who orders a procedure that will be
  performed by a non-physician practitioner, must
  obtain the patients informed consent and certify
  that fact in the medical record by signing the
  Verification of Informed Consent form.
• What do I do?
• It is your responsibility to
• Ensure that patient has been informed of risks
  and benefits and consents before allowing
  procedure to go forward
• If written consent is not necessary, verify that
  physician has noted consent discussion in the
  medical record
• You do not need to witness the informed consent
  conversation
• Ensure the form is complete with signatures of
  physician and patient
• Ensure the form is in or with the record before
  the procedure is begun
• The RN or Radiology tech should note in the
  record if a telephone consent was obtained

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Important Patient Care Information,Informed
Consent, cont
See Informed Consent Policy Section III. D. To
further clarify the list of procedures for which
written consent is required, the following list
of procedures is for your reference only See
policy for details. (This list is not all
inclusive)

• Any procedure done in the Operating Room
• Any procedure requiring moderate sedation
• Use of Neuroleptics for psychiatric treatment
• Any medical treatment necessary to preserve the
  life or health of a committed patient (Mental
  Health Patient)
• Chest tube/drainage tube placement
• Sentinel node mapping
• Imaging guided biopsies

• EGD/colonoscopy
• TEE
• Cardioversions
• Biopsy (see below for exclusions)
• Centesis
• LP including epidural and intrathecal injections
• Central venous access devices (including PIC
  central line placement but not a mid-line
  placement)
• Blood/products
• Circumcision
• Sterilizations

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Important Patient Care Information,Informed
Consent, cont

• Written consent is Not needed for the following
• When written consent is not needed, the physician
  may document the discussion and the patients
  consent in a progress note stating that the
  informed consent process has occurred.
• Joint injections
• Minor skin lesions biopsy/excisions
• Radiology procedures other than biopsies and
  tests with IV contrast
• Joint manipulation other than those with sedation
• I D of abscess other than those with sedation
• Routine OB deliveries
• Court ordered procedures
• Stress Tests

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Important Patient Care Information

• PATIENT SAFETY
• Physical Safety
• Call lights will be placed within easy reach of
  the patient.
• Beds will be kept in low position.
• Bed wheels will be kept in locked position except
  during transport.
• Floors will be kept free of spills.
• All ambulatory patients will use foot coverings.
• Restraints/seclusion will be implemented
  following the policy 0-PC-002 Restraints and
  Seclusion.
• Equipment
• Faulty equipment is reported to engineering or
  Clinical Equipment Services (CES) immediately and
  tagged out of service.
• Equipment brought from home by patients is
  limited to personal care items, such as electric
  razors and hair dryers, and must be checked by
  engineering prior to use.
• Patient owned respiratory equipment such as C-Pap
  and nebulizers must be checked by respiratory
  care and/or CES.
• Risk Management Safety Reports
• Any incidents with a potential or actual adverse
  occurrence involving patients, families,
  visitors, volunteers, physicians, employees, or
  students must be reported. File a Patient
  Visitor Safety Report on the Allina Knowledge
  Network (AKN). Ask a staff person or the
  department manager for assistance in filing this
  report.
• A visitor with an obvious injury due to an
  incident on hospital property is to be encouraged
  to be evaluated by a physician in the Emergency
  Dept.
• Notification of incident is to include the charge
  nurse, department manager and/or the
  administrative supervisor.

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Health Care Directives

• Key Points to Consider
• The admitting nurse must ask all inpatients if
  they have a Health Care Directive (HCD) and, if
  not, whether they would like additional
  information or assistance in developing one.
• No patient is required to have an HCD
• Completing an HCD while hospitalized may not
  always be the most appropriate time or place. It
  may be more appropriate for the patient to take
  the forms home following discharge giving them
  the opportunity to discuss their wishes with
  family, clergy and physician.
• DNR and DNI status is independent of, but can be
  a component of, the Health Care Directive. A
  patient does not need to have an HCD to request
  DNR or DNI status, nor is DNR or DNI always a
  component of a patients HCD.

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Information Services and Clinical Systems
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Patient Safety
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National Patient Safety Goals Initiatives

• To provide our patients with a safe healing
  environment Buffalo Hospital has implemented
  initiatives to follow The Joint Commission
  National Patient Safety Goals. Some of the
  initiatives you should be familiar with include
• Accuracy of patient identification
• Effective Communication Among Caregivers
• Read Back of verbal telephone orders
• Timeliness of reporting critical test results
• Hand off communication between departments
• Medication Safety
• Healthcare associated infections hand washing
• Accurate complete reconciliation of medications
  across the continuum
• Reduce risk of patient harm from falls

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National Patient Safety Goals

• Improve accuracy of patient identification
• Use Two patient identifiers/two sources
• Improve communication among caregivers
• Verify orders/critical test results with
  VORB/TORB from written documentation
• Improve the safety of using medications
• Standardized list of do-not use abbreviations is
  posted in all departments
• Prevent errors related to look alike /sound alike
  medications
• Improve the timeliness of reporting of critical
  test results

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National Patient Safety Goals

• Standardize approach to hand off communication
  (SBAR)
• Comply with hand-hygiene guidelines
• Reduce the risk of healthcare-associated
  infections
• Follow CDC hand hygiene guidelines
• FOAM IN/FOAM OUT
• NO ARTIFICIAL NAILS
• Accurately and completely reconcile medications
  across the continuum of care
• Reduce the risk of patient harm resulting from
  falls

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National Patient Safety Goals

• Label all medications and medication containers
  in surgical and other procedural settings
• Reduce patient harm associated with use of
  anticoagulation therapy
• Involve patients and families in their care
• Identify and reduce patient risk for suicide
• Improve recognition and response to changes
  patient condition
• Rapid Response Team
• Encourage patients involvement in their care as
  a safety strategy

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NPSG Use Two Patient Identifiers and Two
Sources

• Matching the right patient to the right treatment
  or service
• When obtaining blood samples, administering
  medication or applying the patients armband, two
  patient identifiers will be compared with two
  sources the patient, the patients arm band,
  printed identifiers on the request for service,
  medication record, or patients medical record.
• Patient Identifiers Include
• Patients stated name and date of birth
• Patients unable to state their name and DOB
• Verify their name with a family member
• Verify by carefully matching the name and DOB on
  the wristband with the same information on the
  medical record or specimen label.
• A patient room number is never to be used as a
  method of patient identification or verification.

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NPSG Improve the Effectiveness of Communication
Among Caregivers

• Verbal or telephone orders or critical test
  results Write/enter into computer complete
  order or test result. Read back and confirm
  accuracy. Document VORB-TORB FOR CONFIRMATION.
• Do not use UNACCEPTABLE ABBREVIATIONS in
  handwritten or electronic form.

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NPSG Improve the Effectiveness of
Communication Among Caregivers

• Critical Tests and Results
• See Policy O-PC-0224 for department-specific
  notification requirements (Lab and Imaging are
  required)
• Report critical test results/values to physician
  within 30 minutes. Lab will report critical lab
  values to staff within 15 minutes. Nursing staff
  will report ALL (Imaging and Lab) critical
  results to physician within 15 minutes. Nursing
  documents the call via Nsg Critical Test Result
  Note.

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Improve the Effectiveness of Communication Among
Caregivers Hand-Off Communication

• A hand-off is any transfer of information in the
  care of a patient this is a vulnerable point
  the most likely place for errors and harm to
  occur.
• Examples
• Nurse-to-department and department back to nurse
  for tests/procedures off the unit
• Nurse-to-nurse for unit-to-unit patient transfers
  or shift report
• Nurse-to-nurse for short-term break coverage
• Hand-offs require standardized communication that
  provides accurate, clear and complete transfer of
  patient information.
• Hand-off communication must include an
  opportunity to ask questions.
• Buffalo Hospital uses the SBAR model of
  communication
• Situation
• Background
• Assessment findings
• Recommendation

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NPSG Universal Protocol for operative and
invasive procedures

• Time-out and the prevention of wrong-site,
  wrong-patient, Wrong-procedure surgery
• Verify all relevant documents and studies are
  available prior to the start of the procedure and
  are consistent with each other, the patients
  expectations and the teams understanding.
• The person performing the procedure marks the
  site with their initials so they are visible
  after patient is prepped and draped.
• Conduct a time out immediately before starting
  the procedure to verify correct patient,
  procedure, position, side/site and, as
  applicable, implants or special equipment.

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NPSG Reduce the risk of patient harm
resulting from falls

• A patient at risk for falling is identified by
• A magnet with a leaf on it is placed outside the
  patients door so all members of the healthcare
  team are aware that the patient is at risk for
  falling.
• Alarms are used on the unit and when the patient
  is transported outside of the patient care unit.
• Patients at risk for falling will wear RED
  slippers when out of bed.
• Use lift equipment as appropriate to transfer
  patients safely
• Report patient falls to the Charge Nurse or the
  Administrative Supervisor
• File a Patient Visitor Safety Report to promote
  program effectiveness and evaluation. Have staff
  or department manager assist you in locating and
  filing this report on the AKN.

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Medication Safetyand Documentation Overview
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Medication Safety

• Allinas Nine Principles for Medication Safety
• 1. Do no harm
• 2. The Six Rights
• Right Patient
• Right Medication
• Right Route
• Right Dose
• Right Time
• Right Documentation
• 3. Nothing is taken for granted
• 4. Communication clarify, ask questions
• 5. Teamwork work with Licensed Independent
  Practitioner (MD or OD), pharmacist and patient
• 6. Report document significant patient
  information, medication given or omitted in the
  Electronic Medication Administration Record
  (eMAR)
• 7. Safety is a system
• 8. Engage the patient
• 9. Inform the organization complete the
  Patient/Visitor Safety form, do not record the
  completion of this report in the patients
  medical record and do not speculate to the cause
  of the event on your charting
• Learning is the goal of medication safety

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Medication Safety

• Safe Delivery Principles
• Patient information is double checked at
  point-of-care (bedside or procedure room)
• Pharmacist available 24/7
• Allergy wrist bands on ALL patients
• Computerized eMARs
• Look alike/sound alike drugs are separated and
  clearly marked
• Use of tall man lettering, when applicable.
• For example EPINEPHrine, EPHEDrine
• Medications prepared on the unit and not
  administered MUST have a label that includes
• Drug name, strength, amount
• Expiration time of less than 24 hours

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Waste Disposal


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Pharmaceutical Waste Disposal
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In Closing...

• Final Considerations

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Department Specific Orientation Checklist

• Minimally, your department specific orientation
  should include the following items
• Location of
• Crash Cart
• Emergency Equipment
• Fire Safety
• Personal Protective Equipment
• Evacuation Map
• Orientation to
• Documentation process and related technology
• Medication administration and related technology
• Accessing policies, procedures and other
  resources
• Hospital and unit care quality improvement
  initiatives
• Department specific equipment

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Youre Done! Please turn in the checklist used
for this training program to your agency.

• To exit this program press the Esc key.