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OnLine Faculty Orientation

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Thank the patient for choosing Saint Joseph Health System. Direct conversation to patient ... Admission History Record-PCS-III-40E. Patient Flow Sheet-PCS-III-43F ... – PowerPoint PPT presentation

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Title: OnLine Faculty Orientation


1
On-Line Faculty Orientation
  • Saint Joseph Health System (SJHS)
  • 2008-2009

2
Greetings
  • On behalf of SJHS, WELCOME! We are pleased to
    provide a worthwhile clinical rotation for your
    students. In order to provide the best and safest
    care for our patients, we will adhere to certain
    mandatory requirements that JCAHO, OSHA, HIPAA,
    and legal counsel have recommended. Based on
    this, we are required to request certain
    information from you on an annual basis.
  • To communicate this necessary information,
    please review this entire presentation and
    complete the acknowledgement agreement. A
    faculty handbook and student handbook should be
    printed as orientation tools to accompany this
    presentation. If this is your first clinical
    group at SJHS please contact me for information
    regarding unit orientation, 859-313-4493,
    marjoriefuller_at_catholichealth.net
  • Thank you,
  • Margie Fuller, RN
  • Education Coordinator

3
Faculty Responsibility
  • Prior to the first day of the clinical rotation,
    each instructor should review the orientation
    handbook with the students. This handbook
    outlines general information on basic procedures
    utilized at SJHS. On the last page of the
    handbook is a form that must be signed by the
    student and faculty/preceptor. Please turn this
    completed information in to the education office
    at the Saint Joseph Office Park.

4
SJHS Mission
  • To nurture the healing ministry of the Church by
    bringing it new life, energy and viability in the
    21st century. Fidelity to the Gospel urges us to
    emphasize human dignity and social justice as we
    move toward the creation of healthier
    communities.

5
Our Core Values
  • Reverence Profound spirit of awe and respect for
    all of creation, shaping relationships to self,
    to one another and to God, and acknowledging that
    we hold in trust all that has been given to us.
  • Integrity Moral wholeness, soundness,
    uprightness, honesty, sincerity, as the basis of
    trustworthiness.
  • Compassion Feeling with others, being one with
    others in their joy and sorrows.
  • Excellence Outstanding achievement, merit,
    virtue continually surpassing standards to
    achieve/maintain quality.

6
Customer Service…thats what we are here for!
  • Please join us in maintaining our high Service
    Standards

7
Communication Attitude
  • Greet the patient/customer promptly with a
    friendly smile
  • Correct problems apologize for inconveniences
  • Listen attentively and do not interrupt
  • Address the customer by name
  • Keep all patient information confidential
  • Thank the patient for choosing Saint Joseph
    Health System
  • Direct conversation to patient

8
Introductions / Telephone Etiquette
  • Use please, thank you", "sir maam
    appropriately in conversations
  • Answer all calls within 3 rings
  • When answering calls, identify your department
    and yourself
  • Ask all callers, How may I help you?
  • Ask permission before placing caller on hold

9
Call Lights
  • Do not leave the floor until the patients
    request has been conveyed to the appropriate
    caregiver
  • Acknowledge all call lights by the 5th ring
  • When answering calls, address patient by name
    ask, What can your nurse bring you?
  • The appropriate caregiver must respond to a
    patient call/request within 3 minutes
  • Before leaving the floor, notify patients when
    you will return

10
Privacy
  • Always knock before entering
  • Interview customers in private
  • During examinations, procedures interviews,
    close curtains or keep a distance between
    customers
  • Close doors if available
  • Provide robe or 2nd gown if patient is ambulating
    or in a wheelchair
  • Provide sheets or blankets when transporting a
    customer

11
Customer Service
  • Prior to leaving a patients room, please ask,
    Is there anything else that I can do for you?
  • At the beginning of your shift, introduce
    yourself by name and title to the patients and
    families.
  • Communicate to them regarding how to notify you
    directly if your are carrying a phone (as
    appropriate).
  • Set a goal of a 5 minute response time for all
    patient call lights.
  • If you are unable to reply to a patients
    request, please redirect the request back to the
    nurses station so someone else can respond to
    the patient

12
Service Recovery
  • Initiate service recovery if a patient has been
    waiting longer than 15 minutes for a response
  • Apologize for the wait (Im sorry that I kept
    you waiting)
  • Do not blame delays on another department of SJHS
  • Communicate angry patient complaints immediately
    to a supervisor for quick follow-up.

13
SJHS Celebrates Diversity
14
Diversity Categories
  • Race
  • Religion
  • Gender
  • Age
  • Disability
  • Lifestyles, Class
  • Language
  • Culture, Customs and Traditions
  • Abilities and Conditions
  • Human Relations
  • Physical Appearance
  • Family Values and Composition
  • Life Experiences
  • Personal Beliefs
  • Personalities
  • Communication Styles
  • Behaviors and Etiquette
  • Education Levels

15
How SJHS Meets Patient Diversity Needs
  • Patients Rights Responsibilities
  • (Administrative Policy-093-P-9f)
  • Kids Traxx _at_ SJE
  • 24-hour Interpretative Services
  • Alternative types of patient education materials
    videos, classes, written, etc.
  • Case Management
  • Ethics Committee Consultation
  • (Administrative Policy-093-P-43g)
  • 24-hour Chaplaincy Services
  • Language Line
  • Spanish patient education and consent forms.
  • Dying Customs Reference Hospice Care

16
Cultural Diversity Its not just what you know
but how you act!
  • How SJHS does it
  • Reverence for those we serve
  • Integrity in what we do
  • Compassion for those less fortunate
  • Excellence in the service delivered

17
Resources
18
Who are the Directors?
  • Medical-Surgical
  • LaJava Chenault
  • Critical Care Telemetry
  • Debbie Hampton
  • Pharmacy
  • Eric Miller
  • Lab/Radiology
  • Dennis Netzel
  • Rehab Services
  • Debbie Ison
  • Women's Services
  • JoAnn Lytton
  • Emergency Services
  • Marilyn Swinford
  • Educational Services
  • Rose Patrick
  • Continuing Care Hospital
  • Gwen Howard-Gamber
  • Respiratory Therapy
  • Marlene Riggle
  • Case Management
  • Cinda Fluke
  • Surgery (West)
  • Dwayne Gossett
  • Surgery (East)
  • Linda Watt
  • Nursing Service Berea
  • Pat Patton

19
Clinical Specialists
  • Debbie Griffith Critical Care (Surgical) Ext.
    1765
  • Jennifer Drum CC, ED, Cath Lab Ext. 1836
  • Billie May Palliative Care Ext. 1988
  • Teresa McKinney-Enterstomal Therapy Ext. 1237
  • DTC-Diabetes Treatment Center Ext. 2958
  • Debbie Kitchen Gerontology, 4A/5B Ext. 1168

20
Clinical Educators
  • CTVU(SJH),ICU (SJE), 3East (SJH)
  • Cheryl Watson
  • CCU/ICU-N S (SJH), 4MS (SJE), 3B
  • Karen Cooper
  • 2E, 4IC (SJH), 3 Tele (SJE), 5A
  • Jan Hovekamp
  • 3A, 4A,5A, 5B, 6 ONC (SJH)
  • Tracey McFarland
  • ED (SJE,SJB,SJH)
  • Tammy Whitehead
  • Heart Institute (SJH, SJE)
  • Margaret Kramer

21
Policies Procedures
  • Administrative, Patient Care Services, and Human
    Resources policies and procedures are all
    available on-line via the Intranet.
  • Each department may have a department specific
    manual. Please inquire with the manager to review
    if necessary.
  • Unit Specific Resource Manuals are located on the
    individual Units.

22
Medical Library
  • Librarian-Laurie Henderson (313-1677)
  • Hours 8-430, M - F
  • Located on the ground floor of the West Campus
  • Multiple computers with printing capability
  • Small conference room
  • Textbooks, journals, and other research material
    available
  • Small TV/VCR for in-library viewing

23
The Intranet
  • SJHS internal communication and resource site.
    Accessed only from a computer within the
    hospital.
  • Intranet resources
  • Policies and Procedures-Click on P P Seeker
  • Standing Orders/Consents
  • Education-Patient Care Information (Click on
    Micromedex, Up To Date, etc.)
  • Variance Reports
  • Clinical Care Site/VSDS
  • Unit Specific Scopes of Service

24
How to Access
  • Click on the Big E (Internet Explorer icon) on
    any computer desktop. This will take you to our
    hospital intranet not the internet.
  • On this page you can click on
  • Hospital Departments
  • Administration
  • Nursing
  • Human Resources
  • Education
  • MD Orders
  • P P Seeker
  • From there, you can access volumes of necessary
    information

25
Documentation
26
Multi-Disciplinary Forms
  • Admission History Record-PCS-III-40E
  • Patient Flow Sheet-PCS-III-43F
  • Medication Administration Record
    (MAR)-PCS-III-28C
  • Interdisciplinary Consult and Education Record
  • and Discharge Record-PCS-III-53A
  • Care Maps/Care Guide-PCS-III-63
  • Medication Reconciliation Sheet
  • Please refer to the listed policy for detailed
    information.
  • Policies can only be accessed on the in-hospital
    intranet.
  • Intranet instructions are also listed in the
  • faculty handbook.

27
Departmental Forms
  • Each department has specific documentation forms.
    Please contact the unit manager or the clinical
    educator for the area to review.

28
Infection Control
  • Hand Hygiene
  • New CDC guidelines outline hand washing and also
    state that alcohol-based hand cleansers are as
    effective as soap and water.

29
Alcohol-Based Hand Cleansers
  • Use before and after all patient care unless
    hands are visibly soiled
  • Apply cleanser to hands and rub until dry. Use
    only a small amount- too much product will not
    evaporate and will result in a slimy or sticky
    feeling
  • Do not alternate with soap and water-this will
    result in an increase in chapping and drying of
    the skin

30
Alcohol-Based Hand Cleansers
  • Let the patients see you use the product-it is a
    great patient satisfaction practice.
  • Offer alcohol hand rub to patients prior to meals
    and after bathroom visits-also to family members
    who provide care.
  • Pay close attention to nail beds and finger nails

31
Artificial Nails
  • CDC guidelines discourage the use of artificial
    nails in patient care settings. Bacteria can
    build up under the artificial nail, thus
    increasing the risk of bacterial contamination.
  • SJHS policy states NO artificial nails or
    extenders (are to be) worn by RNs, LPNs,
    Physical Therapists in direct patient care.

32
Radiation Safety
  • Minimize time in radiation area
  • Dosimetry Monitoring
  • Do not place your body in the direct path of an
    x-ray field
  • Wear lead aprons when around x-ray
  • Stay as far from the source of radiation as
    practical
  • Patient is a greater source for personal exposure
    than the x-ray

33
MRI Safety
  • Magnet is always on
  • Move patient from the scanner to the holding room
    in the event of a Code Blue
  • NO metal objects in the MRI scan room because it
    can cause serious injury/death
  • Only MRI SAFE oxygen tanks and regulators are
    allowed in the MRI area. Patient beds and IV
    pumps are not MRI SAFE. Pumps must be removed
    prior to entering the MRI scan room.

34
Isolation Categories
35
Standard Precautions
  • Assume all patients/body fluids are potentially
    infectious.
  • Perform hand hygiene before and after contact
    with patient or patients environment
  • Dispose of bio-hazardous waste in the proper
    container (sharps in sharps containers, etc.)
  • Use sharps safety products and work practice
    standards to prevent exposures

36
Standard Precautions
  • Perform hand hygiene before and after each
    patient contact.
  • Use Personal Protective Equipment (PPE) whenever
    there is a possibility of exposure to blood or
    body fluids (wear mask and eye protection when
    patient shows signs/symptoms of respiratory
    infection)
  • Report all exposures immediately to your
    supervisor
  • Clean all patient care areas regularly with the
    hospital disinfectant. Clean all spills
    immediately
  • Handle soiled linen as little as possible and
    place in covered hamper

37
Transmission-Based Precautions
  • Serves the following functions
  • Prevents the spread of infection
  • Controls the spread of communicable diseases and
    drug resistant organisms

38
Contact Isolation
  • For patients with known or suspected diseases or
    conditions transmitted by direct contact with the
    patient or patients environment.
  • Examples include
  • MRSA
  • VRE
  • Clostridium difficile
  • Shigella species
  • Head and body lice
  • Viral conjunctivitis
  • Deep skin infections

39
Contact Isolation Precautions
  • Wear gloves every time you enter the room. After
    glove removal perform hand hygiene.
  • Wear a gown when performing patient care
    activities or when in contact with patient
    environment. When the patient has diarrhea, a
    colostomy, an ileostomy, or wound drainage, wear
    a gown.
  • Dedicate a thermometer and blood pressure cuff to
    the patient.

40
Contact Isolation Precautions
  • Limit the movement of the patient perform
    procedures in their room when possible.
  • Teach the patient and family about hand hygiene.
  • Communicate the need for contact precautions to
    all departments/staff.
  • Frequently clean the room and patient care
    equipment using the hospital approved
    disinfectant.

41
Airborne Precautions
  • For patients with diseases or conditions
    transmitted by airborne droplet-nuclei including
  • TB
  • Chicken Pox
  • Measles
  • SARS
  • Smallpox

42
Airborne Precautions
  • Keep the door closed.
  • Limit all persons entering the room. (provide a
    surgical mask for visitors).
  • Wear a N-95 respirator prior to entering the
    room. (Ensure you have been fit-tested for the
    respirator).
  • Communicate airborne precautions to all
    departments and staff.

43
Droplet Precautions
  • For patients with known or suspected diseases or
    conditions transmitted by droplets produced
    through coughing, sneezing, talking, or laughing

44
Illness Examples
  • Examples of illnesses include
  • Pertussis
  • Influenza
  • Virulent bacterial infections
  • Meningitis caused by
  • N. meningitis
  • H. influenza
  • Streptococcus group A
  • Diphtheria

45
Droplet Precautions
  • Place a surgical mask on the patient or give them
    tissues to cover their mouth when moving through
    the hospital.
  • Place patient in a room with a door. Keep the
    door closed.
  • Wear a surgical mask when entering the room to
    perform patient care.
  • Maintain a distance of 3 feet (arms length) if
    not wearing a surgical mask.

46
Drug Resistant Organisms
  • Things to remember
  • Frequent hand hygiene
  • Minimize indwelling time of invasive catheters
  • Monitor the antibiotic appropriateness
  • Observe proper isolation techniques
  • Reduce risk of transmission through proper
    communication

47
JCAHO 2008 National Patient Safety Goals
  • Goal 1 Improve the accuracy of patient
    identification
  • Goal 2 Improve effectiveness of communication
    among caregivers
  • Goal 3 Improve the safety of using medications
  • Goal 7 Reduce the risk of health care associated
    infections.
  • Goal 8 Accurately and completely reconcile
    medications across the continuum of care
  • Goal 9 Reduce the risk of patient harm resulting
    from falls
  • Goal 13 Encourage patients active involvement
    in their own care as a patient safety strategy.
  • Goal 15 The organization identifies safety risks
    inherent in its patient population
  • Goal 16 Improve recognition and response to
    changes in a patients condition

48
Improve the Accuracy of Patient Identification
  • Have patient state their name and birth date
    (check armband) prior to meds, blood transfusion,
    lab specimen collection, any procedures or
    treatments.
  • Prior to OR and invasive procedures, perform a
    TIME-OUT , ask patient to state their name,
    birth date, and planned procedure (check
    armband).
  • Verify necessary paperwork in chart and
    equipment/supplies are ready.
  • Check armband and verify with MAR, chart, or
    order

49
Improve the Accuracy of Patient Identification
  • Final verification process prior to start of any
    surgical or invasive procedure
  • Time-out confirms
  • Correct patient
  • Correct procedure and position
  • Correct site
  • Readiness of the team
  • ( Requires documentation)

50
Improve the Effectiveness of Communication Among
Caregivers
  • Verification and documentation of all
  • Verbal and Telephone Orders and/or Critical Test
    Results
  • Example of Telephone Order Read Back Verified
  • TORB Dr. Smith/P. Jones, Office Clerk/Any Nurse
    R.N.
  • Example of Verbal Order Read Back Verified
  • VORB Dr. Smith/Any Nurse R.N.
  • CRITICAL LABS Read back verified by MD to RN
  • RBV/Dr. Smith/Any Nurse RN

51
Improve the Effectiveness of Communication Among
Caregivers
  • Use standardized abbreviations, acronyms and
    symbols. Do NOT use prohibited abbreviations,
    acronyms or symbols within the medical record.

52
Prohibited List (do not use anywhere within the
medical record)
53
Improve the Safety of Using Medications
  • Always identify the patient using name and date
    of birth (2-identifier system)
  • Always triple check medications
  • Chart medications immediately after administering
  • Double-check calculated doses or flow rates
    consider having another nurse or pharmacist check
    your calculations

54
High-Alert Medications
  • Potassium Chloride
  • Neuromuscular Blockers
  • Intravenous calcium
  • Benzodiazepines
  • Chemotherapy
  • Lidocaine
  • Vasoactive substances
  • Parenteral narcotics
  • Theophylline
  • Anticoagulants (heparin)
  • Insulin
  • Magnesium Sulfate
  • Digoxin

55
High Alert Medication Issues
  • Anticoagulants should not be administered for 2
    hours after an epidural catheter is removed
  • Heparin doses that are miscalculated or sliding
    scale orders that are misinterpreted
  • Benzodiazepines (sedatives) should be
    administered with caution to identified sleep
    apnea patients

56
High Alert Medication Issues
  • Teaching the patient and family that IV PCA is
    controlled by the patient and only the patient
    should be pushing the button for pain relief
  • Nurses should avoid multiple forms of
    pharmacologic pain management for a patient (e.g.
    administering oral narcotic pain meds to a
    patient with an epidural)

57
How Can Nurses Minimize Medication Errors?
  • Complete the Medication Reconciliation Form
  • If in doubt check it out!
  • If unsure about a medication or a dose, contact
    the pharmacy before administering
  • Carefully read all drug labels
  • Never borrow medications from another patient
    or from drugs that need to be returned to the
    pharmacy

58
How Can Nurses Minimize Medication Errors?
  • Verify secondary tubing is unclamped after
    hanging
  • Use only standardized abbreviations
  • Always read back telephone orders to ensure
    accuracy
  • Always clarify unclear verbal or written orders
  • Never assume the physician has more information
    than you

59
Medication Safety
  • Label all medications, medication containers
    (e.g., syringes, medicine cups, basins) or other
    solutions on and off the sterile field in
    operative and other procedural settings

60
Reduce the Risk of Health Care Associated
Infections
  • CDC Guidelines
  • Use alcohol rub upon entering and exiting
    patients rooms, prior to and after procedures
  • Manage as sentinel events all identified cases of
    unanticipated death or major permanent loss of
    function associated with a health care-associated
    infection
  • Wash hands with soap and water if visibly
  • soiled or exposure to C-diff/anthrax or caring
  • for an immuno-suppressed patient

61
Accurately and Completely Reconcile Medications
Across the Continuum of Care
  • Accurate documentation of all meds upon
    admission, transfer, and at discharge
  • Place medication reconciliation form under MD
    order section in the medical record
  • Fax to pharmacy once reconciled

62
Accurately and Completely Reconcile Medications
Across the Continuum of Care
  • Greatest risk at transitions of care
  • Admission
  • Transfer to lower or higher levels care
  • Medical-surgical to critical care
  • Critical care to surgery
  • Telemetry to critical care
  • Discharge

63
Reduce the Risk of Patient Harm Resulting From
Falls
  • Use interventions when patient is cognitively
    impaired
  • Consider bedexit
  • Ambualarm
  • Bed check at SJE
  • Assess and re-assess frequently
  • Place falling star outside patients door on
    M/S and telemetry

64
Reduce the Risk of Influenza and Pneumococcal
Disease in Institutionalized Adults
  • Patients screened with the admission medication
    reconciliation form (MR-17ADM)
  • Complete pneumococcal influenza vaccination
    assessment if unable to obtain information from
    the patient

65
Encourage Patients Active Involvement in Their
Own Care as a Patient Safety Strategy
  • Define and communicate the means for patients to
    report concerns about safety and encourage them
    to do so
  • Safety posters/brochures placed in patient rooms
    and waiting areas

66
Prevent Healthcare-Associated Pressure Ulcers
  • Turn patients frequently
  • Keep skin clean and dry
  • Monitor skin closely
  • Identify high risk patients

67
Improve Recognition and Response to Changes in a
Patients Condition
  • Rapid Response Team (SJH/SJE)
  • Activate by calling hospital operator at
    extension 1111
  • Team consists of a critical care RN and/or ARNP
    and a respiratory therapist

68
We all have a role in ensuring the safety of our
patients…
  • Do your part!
  • Apply the National Patient Safety Goals to your
    practice!

69
Thank you for your time and effort to familiarize
yourself and your students with Saint Joseph
Health System
  • Please remember to
  • Print both the Faculty and Student Handbooks
  • Complete and return required documents from both
    Handbooks to Educational Services
  • Print the on-line rotation evaluations
  • Thank you,
  • Margie Fuller, RN
  • Student/Faculty Coordinator
  • Saint Joseph Health System
  • 859/313-4493
  • marjoriefuller_at_catholichealth.net
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