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OnLine Faculty Orientation

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We are pleased to provide a worthwhile clinical rotation for your students. ... completed information into the education office at the Saint Joseph Office Park. ... – PowerPoint PPT presentation

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Title: OnLine Faculty Orientation


1
On-Line Faculty Orientation
2
Greetings
  • On behalf of SJHS, WELCOME! We are pleased to
    provide a worthwhile clinical rotation for your
    students. In order to provide quality 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 at 859-313-4493 or
    marjoriefuller_at_catholichealth.net
  • Thank You, Margie Fuller

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 into the education office
    at the Saint Joseph Office Park.

4
Resources
5
SJHS Directors
  • Medical-Surgical
  • LaJava Chenault
  • Critical Care Telemetry
  • Jennifer Drumm
  • Pharmacy
  • Eric Miller
  • Lab/Radiology
  • Dennis Netzel
  • Rehab Services
  • Debbie Ison
  • Women's Services
  • Denise Hundley
  • Emergency Services
  • Marilyn Swinford
  • Educational Services
  • Rose Patrick
  • Continuing Care Hospital
  • Gwen Howard
  • Respiratory Therapy
  • Marlene Riggle
  • Surgery (West)
  • Linda Watt
  • Surgery (East)
  • Nursing Service Berea
  • Pat Patton

6
Clinical Nurse Specialists
  • Debbie Griffith Critical Care (Surgical) Ext.
    1765
  • Jennifer Drumm CC, ED, Cath Lab Ext. 1836
  • Billie May Palliative Care Ext. 1988
  • Debbie Kitchen Gerontology, 4A/5B Ext. 1168
  • Marge McMillan Medical-Surgical Ext. 3229

7
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)
  • Chrystal Hackney
  • Heart Institute (SJH, SJE)
  • Margaret Kramer
  • Womens Care

8
SJHS 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.

9
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

10
The Intranet
  • SJHS internal communication and resource site.
    Accessed only from a computer within the
    hospital. Click on Internet Explorer icon
    defaults to the intranet not internet
  • Intranet resources
  • Policies and Procedures-Click on PP Seeker
  • Standing Orders/Consents
  • Education-Patient Care Information (Click on
    Micromedex, Up To Date, etc.)
  • Variance Reports (IRIS-Reporter)
  • Clinical Care Site/VSDS
  • Unit Specific Scopes of Service

11
Documentation
12
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.

13
Departmental Forms
  • Each department has specific documentation forms.
    Please contact the unit manager or the clinical
    educator for the area to review.

14
Infection Control
  • Hand Hygiene
  • SJHS follows CDC hand hygiene guidelines
  • Alcohol-based hand cleansers are as effective as
    soap and water

15
Alcohol-Based 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

16
Alcohol-Based 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

17
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.

18
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

19
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.

20
Isolation Categories
21
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

22
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

23
Transmission-Based Precautions
  • Serves the following functions
  • Prevents the spread of infection
  • Controls the spread of communicable diseases and
    drug resistant organisms

24
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
  • Head and body lice
  • Viral conjunctivitis
  • Deep skin infections

25
Contact Isolation
  • 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.

26
Contact Isolation
  • 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.

27
Airborne Precautions
  • For patients with diseases or conditions
    transmitted by airborne droplet nuclei including
  • TB
  • Chicken pox
  • Measles
  • SARS
  • Smallpox

28
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.

29
Droplet Precautions
  • For patients with known or suspected diseases or
    conditions transmitted by droplets produced
    through coughing, sneezing, talking, or laughing
  • Illness examples
  • Pertussis
  • Influenza
  • Virulent bacterial infections
  • Meningitis
  • Diptheria

30
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.

31
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

32
JCAHO NPSGs
  • 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

33
Goal 1 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

34
Goal 2 Improve the Effectiveness of
Communication Among Caregivers
  • 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)

35
Goal 2 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

36
Goal 2 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.

37
Prohibited List (Do Not Use Anywhere Within
Medical Record)
38
Goal 3 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

39
High-Alert Medications
  • Potassium Chloride
  • Neuromuscular Blockers
  • Intravenous calcium
  • Benzodiazepines
  • Chemotherapy
  • Lidocaine
  • Vasoactive substances
  • Parenteral narcotics
  • Theophylline
  • Anticoagulants (heparin)
  • Insulin
  • Magnesium Sulfate
  • Digoxin

40
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

41
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)

42
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

43
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

44
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

45
Goal 7 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

46
Goal 8 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

47
Goal 8 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

48
Goal 9 Reduce the Risk of Patient Harm Resulting
From Falls
  • Use interventions when patient is cognitively
    impaired
  • Consider bed exit alarm
  • Ambualarm
  • Bed check at SJE
  • Assess and re-assess frequently
  • Place falling star outside patients door on
    M/S and telemetry

49
Goal 13 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

50
Goal 15 The Organization Identifies Safety Risks
Inherent in its Patient Population
  • Identifying individuals at risk for suicide

51
Goal 16 Improve Recognition and Response To
Changes in a Patients Condition
  • Rapid Response Team (SJH/SJE/SJB/SJMS)
  • Activate by calling the hospital emergency number
    (SJH/SJE1111 SJB66 SJMS68)
  • Team consists of a critical care RN and/or ARNP
    and a respiratory therapist

52
IV Use and Care
53
IV Infections
  • Infections associated with the use of
    intravascular devices represent 10-20 of all
    hospital-acquired infections

54
CDC Guidelines
  • Support the use of alcohol in IV port. It is
    necessary to wipe the IV port every time,
    regardless of whether the package was just
    opened.
  • Alcohol-based hand lotions should be used as
    often as possible to cut down on bacterial
    infections that may be caused by hands

55
Aseptic Technique?
  • Do you always wash your hands between patients?
  • Do you always wash your hands before working with
    IVs?
  • Do you wipe off your IV ports with an alcohol
    wipe before accessing every time?
  • Do you label your IVs and look at your expiration
    dates?
  • Do you wear gloves when you start an IV?

56
Starting a Peripheral IV
  • You must wash your hands and wear gloves.
  • Chloraprep is applied at the site using a back
    and forth motion for 30 seconds and allowed to
    dry. Do not wipe off. Groin site requires 2
    minutes
  • If you start the IV, you MUST label it with the
    date, time and initials. Document in nurses
    notes.
  • Clave and extension must be used

57
Peripheral IV Care
  • Hospitalized patients must have an extension
    tubing placed (no direct running of fluids
    through the hub).
  • Avoid antecubital IV placements for long-term
    therapy.
  • IV site assessment must be documented once a
    shift. Check for redness, swelling, pain, etc.
  • Check IV placement date (part of routine
    assessment)

58
Peripheral IV Site Guidelines
  • IV may stay in place if functioning properly up
    to 96 hours.
  • Look for signs of redness, swelling, and
    infiltration prior to any IV medication
    administration.
  • Change the dressing if it is wet or bloody.
  • If IV is kept in longer than 96 hours a Doctors
    order MUST be obtained.
  • Capped peripheral IVs are to be flushed q 8 hours
    and documented on the MAR.
  • Assess your IVs frequently. There are over
    300,000 catheter related peripheral IV infections
    annually according to the CDC!!!!

59
IV Solutions
  • All IV bags must be labeled
  • Bags from pharmacy have a label and expiration
    time. Date and Time them when they are hung.
  • Commercially prepared and pharmacy prepared bags
    IV bags, may only hang for 24 hours and have a
    label placed on them.

60
IV Tubing
  • IV tubing and bags that are hanging must be
    labeled.
  • If you hang the tubing YOU must label it.
  • IV tubing that is NEVER disconnected from the
    patient is good for 72 hours.
  • If disconnected and hanging on the IV pole 24
    hours (antibiotic tubing)
  • TPN/ tubing is changed every 24 hours.
  • Lipids may now hang up to 24 hours!
  • Blood or blood product tubing- maximum 4 hours.
    This tubing does not have to be labeled. Throw it
    out after 4 hours
  • NEVER leave IV tubing uncapped!

61
Biopatch Use
  • Place on central lines (including PICCs) after 24
    hours of insertion
  • Cleanse the central line insertion site for 30
    seconds with a back and forth motion Allow
    Chloraprep to dry completely prior to Biopatch
    application
  • Place Biopatch BLUE SIDE UP with slit towards the
    end of the catheter not towards the insertion
    site
  • Biopatch good for 7 days if it does not get wet
    (white ring present) or bloody
  • If a Biopatch is stuck dont pull wet with NS
    and then remove

62
CLC 2000 Adapter
  • Positive pressure adapter used for central lines.
  • Placed on the lumens of all PICCs to help
    prevent the line from clotting off
  • Line must be flushed q 8 hours with NS before and
    after meds do not use needles
  • Heparin is not used in central lines or PICCs to
    maintain patency
  • White end of the CLC 2000 must remain popped out-
    not indented. Disconnect the syringe before
    clamping the IV (white part of the CLC will
    indent if you dont)
  • Change every 7 days

63
Central Venous Catheters
  • Used for 14 days- then assess for a more
    permanent line (PICC, Groshong, etc.)
  • Sterile technique with barrier precautions on
    insertion is the 1 way to prevent a central line
    infection

64
Peripherally Inserted Central Catheter (PICC)
  • Placed by specialized contracted nurse at the bed
    side or in Radiology
  • Requires an order and a consent form
  • Placed using central line sterile barrier
    precautions

65
Indications for PICC Placement
  • Hyeremesis gravidarum
  • Cholecystitis
  • Pancreatitis
  • Bowel Obstruction
  • Ulcerative Colitis

66
PICC Exclusion Criteria
  • History of chronic renal failure
  • Creatinine gt 2mg/dl
  • Diabetic with history of proteinuria
  • PICC placement could diminish the chance of a
    potential AV shunt for the patient

67
PICC X-Ray Confirmation
  • X-Ray must be done after placement
  • 3-5 of central lines nationally have problems
    (pneumothorax, hemothorax etc.)
  • Start IV fluids after confirmation of the tip is
    known.
  • Document X-Ray confirmation in the nurses notes.

68
PICC Post-Insertion Complications
  • Catheter embolus (PE)
  • Hematoma at site
  • Phlebitis- catch early!
  • DVT
  • Infection
  • Nerve Injury
  • Abscess

69
PICC Clotting Prevention
  • SJHS Protocol
  • Flush all lumens q 8 hrs with 10 ml of NS
  • After blood draws use 20ml of NS
  • Declotting agents are contraindicated so take
    extra care to flush the lumens

70
Thrombosis S/S
  • Edema of affected hand, arm, shoulder and/or neck
  • Tenderness in area
  • Inconsistent flow

71
Statlocks
  • Place on PICC lines to decrease movement of
    catheter
  • Apply skin protectant and allow to dry 10-15
    seconds
  • Place catheter in the plastic doors of Statlock
    and anchor by removing adhesive backing
  • Apply a sorbaview or large tegaderm over the site
  • Change every 7 days
  • Remove with alcohol wipe (prevents skin tears)

72
PICC Dressing Example
73
PICC Line Blood Draws
  • Blood can be drawn through the CLC 2000 adapters
  • Flush line with 10 ml of NS before drawing blood
  • Discard initial 6ml of blood (10 ml if heparin
    present)
  • Flush with 20 ml of NS after complete

74
PICC Line Removal
  • Requires MD order (RNs only allowed to remove)
  • Have patient lay down and perform Valsalva
    maneuver
  • Withdraw PICC with smooth gentle pressure in
    small 1 inch increments. Do not pull on catheter
    if you meet resistance. Apply a sterile dressing
    and wait 20-30 minutes. A warm compress can be
    applied. If continued resistance is met, call the
    physician.
  • Apply pressure until bleeding has stopped and
    label the occlusive dressing which remains in
    place for 24 hours
  • After discontinued assess and document the tip of
    the catheter.

75
Port-a-Caths
  • Assess port type
  • Regular port
  • Double Lumen
  • Power port
  • Know what length of needle is needed (¾ inch. I
    inch, 1.5 inch, etc.)
  • Do not access if you have not been checked off
    with someone who is experienced with port-a-caths

76
Port-a-Cath Power Port
  • Document this in the Kardex
  • Ask patient if they have a Power port card or
    bracelet
  • Used to power inject contrast during CT scans
  • Radiology can do a scouting X-Ray to see if it is
    a power port. It has the shape of a triangle and
    3 bumps can be palpated

77
Port-a-Caths
  • Make sure line can draw back blood if not why
    not? A dye study may need to be ordered - Get an
    MD order to use the line if it flushes but does
    not draw back before IV administration
    (extravasation can happen).
  • Make sure the needle is the correct type. Needles
    may stay in place 7 days with the Biopatch and
    CLC 2000.
  • Make sure the needle does not rock and is not too
    short
  • Deaccessing 500 units of heparin needed (order
    from pharmacy). Hold on to the bottom wing and
    pull straight up

78
IV Care Summary
  • Wash your hands when entering and exiting a
    patients room
  • Wash your hands before working with IV lines
  • Wear gloves when starting IV lines
  • Use sterile technique with central lines
  • Use alcohol wipes before accessing an IV port

79
Thank you for your time and effort to familiarize
yourself and your students with Saint Joseph
Health System
  • Please remember to complete and return via fax or
    interdepartmental mail
  • Required documents from both Handbooks to
    Educational Services
  • On-line rotation evaluations
  • Fax 859-313-3104
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