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Agency and Travel Non-Employee Orientation Program

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Title: Agency and Travel Non-Employee Orientation Program


1
Mercy Unity Hospitals
  • Agency and Travel Non-Employee Orientation Program

2
Welcome to Mercy Unity Hospitals Non-Employee
Orientation Program
  • The following slides will aid you in preparing
    yourself to provide an excellent healthcare
    experience for our patients.
  • To progress through the orientation information
    use the action buttons at the bottom right of the
    screen to proceed forward (right button) or
    backward (left button) by clicking on it with the
    mouse.
  • While you are reading through these slides
    check-off your progress on the Non-Employee
    Patient Care Staff Orientation Checklist This
    form can be obtained from the site you found this
    program on or your agency. It is then to be
    returned to your agency upon completion of this
    program.
  • We hope you find this information helpful and
    look forward to having you join our exceptional
    health care team.

3
Contents
  • Who Are We
  • Mission, Vision Values
  • Allina Hospitals Customers
  • Accessing the Allina Knowledge Network
  • Confidentiality / HIPAA
  • Extraordinary Workplace with Extraordinary
    Employees
  • Safety Awareness
  • Infection Control
  • Your Role in Restraint Use
  • Vital Patient Care Issues
  • Advanced Directives
  • Medication Safety
  • Documentation Overview
  • Information Services and Clinical Systems

4
Who We Are
  • Mercy Unity Hospitals are part of Allina
    Hospitals Clinics
  • Allina is a not-for-profit healthcare
    organization serving Minnesota and western
    Wisconsin
  • Although we are not-for-profit, it is still
    necessary to watch the financial bottom line. We
    need to be able to meet the current and future
    needs of the communities we serve. We reinvest
    profits in new equipment and advanced
    technologies to better care for our patients.
  • Allina Hospitals Clinics
  • 13 hospitals
  • 42 clinics
  • Medical transportation services serving 70
    Minnesota communities
  • Home care, Hospice, and Palliative Care
  • Metro Hospitals
  • Mercy
  • Unity
  • Abbott Northwestern
  • United
  • Phillips Eye Institute
  • Regional Hospitals
  • Buffalo
  • Cambridge
  • Owatonna
  • St. Francis
  • River Falls
  • New Ulm

5
What we strive for...
  • Allina Mission
  • We serve our communities by providing exceptional
    care, as we prevent illness, restore health and
    provide comfort to all who entrust us with their
    care.
  • Allina Vision
  • Put the patient first,
  • Make a difference in peoples lives by providing
    exceptional care service,
  • Create a healing environment where passionate
    people thrive excel, and
  • Lead collaborative efforts that solve our
    communitys health care challenges.
  • Allina Values
  • Integrity - Match our actions with our words. We
    live our values and mission in all decisions and
    actions.
  • Respect - Treat everyone with honor, dignity and
    courtesy. Respect values, cultures, beliefs and
    traditions of others. Value each others talents
    and contributions.
  • Trust - We act in the best interests of out
    patients, physicians, communities and one
    another.
  • Compassion - Dedicated to creating a healing and
    caring environment to support the emotional,
    physical spiritual well-being of all.
  • Stewardship - Use our resources wisely. Commit
    to being thoughtful stewards of time, energy and
    talent.

6
Living the Values
  • Why is it that some patients can have poor
    outcomes and still say that they wouldnt go
    anywhere else for their healthcare?
  • The difference is the relationships that we
    create with our patients.
  • Its the customer service we provide.
  • People come back to our hospitals because we live
    out our values and walk the talk-not just give
    them lip service.
  • Customer Service Basics
  • Creating an excellent experience where patients
    feel assured, included and appreciated.
  • While much of our work is of a high tech nature,
    we know the importance of connecting with our
    customers on a human/emotional level when
    beginning and ending any interaction.
  • Who are our customers?
  • External Customers
  • Patients
  • Families
  • Physicians
  • Internal Customers
  • Coworkers
  • Other departments

7
The impact of body language, voice, tone and words
  • Are the words you are saying congruent with your
    body language and our tone of voice?
  • Do we say one thing but project the opposite?
  • Do we ask What else can I do for you? each time
    before we leave their room?
  • When we breakdown communication, we realize that
  • 55 of the message is our body language
  • 38 of the message is our tone of voice
  • 7 of the message is the actual words we use.
  • To make the biggest impact, youre actions must
    match your words

8
How to access policies on the Allina Knowledge
Network (AKN)
  • All policies are located on the AKN, an
    intranet site which can be accessed using our
    network computers. Ask the charge nurse to show
    you this site during your first shift.

9
Confidentiality
  • HIPAAs Privacy Law

10
Confidentiality
  • Maintaining a patients privacy and
    confidentiality is not only the ethical thing to
    do, its the law.
  • We are committed to preserving the
    confidentiality of patient information.
  • The inappropriate use and or release of
    information will result in disciplinary action
    and possible legal action.
  • HIPAA - The Health Insurance Portability and
    Accountability Act
  • This revised Privacy Law places strict
    regulations around the privacy and security of
    patients health information.
  • The law also mandates that we train everyone in
    the rules and provisions of this law.

11
Protected Health Information
  • PHI is basically any information that identifies
    an individual or could reasonably be used to
    identify an individual.
  • This includes, but is not limited to
  • Name, address, age or SSN
  • Health history and conditions, treatment or meds
  • Hospital or clinic bill or payment record
  • Any identification that an individual is a
    patient.
  • It can be in any form
  • Verbal, written or electronic
  • Past, present or future medical information
  • Minimum Necessary Rule
  • Minimum Necessary Rule We must only use and
    disclose the minimum amount of patient
    information needed to do our jobs.
  • Simply put You may only ask for, use and
    disclose patient information as needed for
    legitimate patient care or business purposes.

12
Curiosity Killed the Cat Dont let it get you!
  • Sharing with others that you saw someone at the
    hospital or sharing of their health information
    may seem harmless to you- but it can be very
    harmful to the patient-and its illegal!
  • You might be curious to look up information on a
    family member that is a patient here. Unless you
    need that information to do your job, you are
    prohibited from accessing that info.
  • If in doubt, caution on the side of maintaining
    patient privacy.
  • Release of Health Information
  • We must have consent from the patient before
    giving any information to others, including
    spouse, family members, or friends.
  • The inappropriate release of protected health
    information is illegal and we must address any
    harm that occurs because of its inappropriate
    release.
  • You are held legally accountable to maintain a
    patients privacy and confidentiality.

13
An Extraordinary Workplace with Extraordinary
Employees
  • A Culture of Caring

14
An Environment for Healing
  • When patients see how well we treat one another,
    they will know this is a good place for healing.
  • We cannot provide to patients what we are unable
    or unwilling to provide each other.
  • If they see or hear uncaring behaviors, they will
    not find the healthy, healing environment they
    need.
  • Create a Respectful and Professional Workplace
  • Where You Would Want to Give and Receive Care

15
Diversity
  • Defined as all the differences and similarities
    that exist among people - including race, gender,
    age, sexual orientation, job status, physical
    differences, political affiliations and religious
    beliefs.
  • We value the differing points of view, varied
    experiences and the talents of each and every
    person!
  • Harassment Free Workplace
  • We have a zero tolerance policy for harassment in
    all of its forms. Including, but not limited to,
    harassment based on
  • Sex
  • Race
  • Age
  • National Origin
  • Religion
  • Sexual Orientation
  • Political Preference

16
Key Points on Harassment
  • Its the impact, not the intent.
  • Whether or not you intended harm doesnt change
    the fact that someone was impacted by your
    actions or behavior.
  • Direct or indirect, subtle or obvious
  • Employees expect to work in an environment that
    is not hostile or intimidating. This includes
    jokes, slurs, pictures, comments anything that
    could be felt as harassment.
  • It can take place at the workplace or at off duty
    related activities such as social gatherings or
    calls to your home.
  • Act early and talk to the accused. Ask them to
    stop the behavior. If not resolved, escalate
    this situation by discussing with your leader or
    manager who will then investigate the activities
    with the assistance of human resources. If you
    are uncomfortable talking with the person contact
    your manager. If it is your manager that is the
    cause of the problem then speak with an human
    resource generalist.

17
Safety Vision
  • To make Mercy Unity Hospitals a safer place to
    give and receive care

18
Minnesota Employee Right to Know Act (ERTK) 1983
  • The law was passed to make sure employees are
    told about the dangers associated in working with
    hazardous substances and harmful physical or
    infectious agents.
  • The law outlines both employer and employee
    responsibilities for safety from work related
    injury or illness.
  • What does exposed to mean?
  • You are considered routinely exposed to a
    substance or agent if there is a reasonable
    possibility youll be in contact with one of the
    items during the normal course of your assigned
    work.

19
Employer Requirements
  • Education of staff and new employees on
  • The types of hazardous materials, agents and
    equipment in your work area.
  • How to properly handle and work safely with the
    products.
  • Where information about hazardous materials is
    located.
  • Education specific to the materials/agents in
    your work areas will need to be covered during
    unit specific orientation. Material Safety Data
    Sheets can be located on the AKN, but clicking on
    the Safety button.
  • Employee Requirements
  • The law gives you the right to refuse to work
    under imminent danger conditions or if
    information or training about how to safely
    proceed with your job is not provided.
  • Use personal protective equipment (PPE) available
    on each unit you will be assigned to. It is your
    responsibility to use this equipment when
    situations require protection. Ask the charge
    nurse if you have questions about the PPEs for
    that unit.

20
What if Im asked to work in an unsafe situation?
  • Tell the unit charge nurse if you feel a work
    situation may be dangerous
  • Tell the unit charge nurse if you dont know how
    to use or handle hazardous materials and/or
    equipment.
  • Report faulty equipment so it can be repaired or
    replaced.
  • Dont put yourself in any situation where you
    could be injured or harmed. You have the right to
    refuse to work under dangerous conditions.
  • What Happens Next?
  • The unit charge nurse will
  • Evaluate the situation for safety and the
    presence of hazards.
  • Teach you how to safely use the product, direct
    you to the appropriate resource, provide you with
    learning materials, give you the appropriate
    Personal Protective Equipment.
  • Reassign you to an alternate job until a
    hazardous condition can be corrected or
    eliminated.

21
Chemical Spills/Release
  • Each department maintains procedures for the safe
    handling and spill clean-up of the hazardous
    products used in their areas.
  • You need to receive unit specific orientation on
    the hazards found in your area.
  • With any chemical spill, you should notify the
    supervisor and maintenance.

22
Locating information on Hazardous Substances
Chemicals
Material Safety Data Sheets (MSDS) provide
information on the effects and properties of
hazardous substances. These can be accessed on
the Allina Knowledge Network (AKN).
23
Emergency Codes
  • You might hear these emergency codes paged
    overhead, so it is important to know their
    meanings. Ask the charge nurse for your role
    when one of these codes is paged.
  • Red Alert Fire Alarm
  • Pink Alert Infant Abduction
  • Code Blue Cardiac and/or
    Respiratory Arrest (All

  • ages)
  • Green Alert Restraint Personnel Respond
  • Orange Alert Disaster Plan in effect
  • Yellow Alert Bomb Threat

24
Severe Weather Codes
  • Severe Thunderstorm Warning-conditions are
    favorable for severe weather
  • Tornado Warning (phase 1) - a tornado has been
    sighted. Close windows, blinds and curtains.
    Keep corridors clear.
  • Tornado Warning (phase 2) - hospital is in the
    path of the tornado. Move patients and visitors
    away from windows to interior corridors closing
    all doors. Visitors should stay with the
    patients and staff should move the the best
    shelter in the department.
  • Fire Safety Essentials in
  • Your Department
  • You will need to locate this information in the
    areas you work.
  • Location of the fire alarm pull boxes
  • Location and type(s) of extinguishers
  • Emergency phone number x63333
  • The stations main oxygen shutoff valve(s)
  • Evacuation plans and routes

25
R.A.C.E.
Rescue
  • Rescue Move anyone in danger to a safe area.
  • Alert Pull fire alarm box and call x63333 to
    report the fires location.
  • Confine Close doors windows in area, clear
    corridors and fire exit areas.
  • Extinguish Fight the fire only if it will not
    place you in danger. Blankets can be used to
    smother the flames of small fires or waste basket
    fires as well as using extinguishers.

Alert
Confine
Extinguish
26
How to Use Extinguishers
  • Know the types of extinguisher in your work
    area. Choose the appropriate extinguisher for
    the type of fire.
  • Then
  • P Pull-the pin
  • A Aim-the extinguisher
  • S Squeeze-the handle
  • S Sweep-the extinguisher hose at the base of the
    fire.

27
Patient Safety Initiatives
  • To provide our patients with a safe healing
    environment we have initiated safety goals around
    the care of the patient. Some of the goals you
    should become familiar with include
  • 2 Patient Identifiers
  • Unacceptable abbreviations
  • Clinical Alarms
  • Time Out Surgical Site Marking
  • Reduce hospital acquired infections hand hygiene
  • Fall Risk Reduction
  • Increased Patient Involvement in their own Care
  • Suicide/Violence Risk Assessment
  • Verbal Order Read Back and Telephone Order Read
    Back
  • Sound-alike and Look-alike Medications
  • Hand Hygiene
  • Medication Reconciliation
  • We will discuss several of these initiatives on
    subsequent slides. Please talk to your preceptor
    or charge nurse about the remaining initiatives.

28
  • Matching the right patient to the right treatment
    or service
  • When obtaining blood samples or administering
    medication or applying the patients armband, two
    patient identifiers will be used to compare to
    the same two printed identifiers on the lab
    request, medication record, or patients medical
    record.
  • Patient Identifiers Include
  • Patients stated name and date of birth are
    compared against the printed name and DOB on the
    medication record, specimen label, or medical
    record.
  • Patients unable to state their name and DOB
  • Verification by a family member
  • Verification by carefully matching the name and
    DOB on the wristband with the same info on the
    medical record, specimen label.
  • A patient room number will never be used as a
    method of patient identification or verification.
  • Exception to above is the administration of blood
    products. In this instance, use patient name,
    birth date and social security number.

29
Unacceptable Abbreviations
  • We have developed a list of abbreviations that
    are not approved for use within the medical
    record (documentation, notes or orders).
  • Orders written with an unacceptable abbreviation
    will not be accepted or executed.
  • Unacceptable orders will be clarified by the
    nurse and documented as a verbal order before
    executing.
  • Ask the unit charge nurse for more information
    regarding unacceptable abbreviations
  • Clinical Alarms
  • Goal Improve the effectiveness of clinical
    alarms.
  • Examples of clinical alarms are cardiac monitor
    alarms, fetal monitor alarms, apnea alarms, door
    alarms, elopement / abduction alarms, infusion
    pump alarms, bed alarms, bathroom alarms or
    respirator alarms
  • Clinical Alarm Considerations
  • Clinical alarms are basically all patient care
    equipment containing alarm functions
  • Alarm functions should be managed/adjusted by the
    assigned staff RN or other hospital designee.
    Collaborate with the charge nurse if you are
    having difficulty setting/adjusting alarm
    parameters with your patients.
  • Alarm policies are practiced
  • If an alarms fails, a Patient/Visitor Safety
    Report is completed, Risk Management is notified,
    and the equipment is immediately sent to Clinical
    Equipment Services (CES) for evaluation

30
Time Out
  • Goal Eliminate wrong site, wrong patient, wrong
    procedure/surgery. Done prior to local
    injection/incision/start of procedure
  • Surgical Site Marking The surgical site is
    marked for correct site and laterality, per
    policy.
  • Time Out The circulating RN reads the
    patients full name and procedure including site
    / side, from the consent form. All members of
    the surgical team listen and confirm the correct
    procedure, patient, surgical site and side
    (laterality).

31
Safety Ethical Situations
  • If you encounter a potential hazard or unsafe
    situation in our hospital or if you have an
    ethical concern regarding our practices or a
    patient care situation, you should discuss this
    with the charge nurse.
  • We encourage reporting of safety concerns,
    incidents, hazards and ethical concerns.
  • We have committees and processes in place to
    address these issues and make changes when
    appropriate.
  • Concerns reported to the charge nurse may be
    escalated to the unit leadership.
  • You may be asked to complete a Patient/Safety
    Visitor Report or Area of Concern Form to
    document the events.
  • When in doubt fill it out!

32
Safety Contacts
  • Security Manager
  • Employee Safety Specialist
  • Patient Safety Director
  • 763/236-SAFE
  • Phone Numbers can be found on each unit.

33
Infection Control
34
Where do germs come from?
  • Environment
  • surfaces
  • floors
  • gardens
  • People
  • skin
  • intestines
  • Equipment
  • Water
  • Flowers/plants

Chain of Infection
All links must be complete for an organism to
spread from one place to another. Our goal is to
break the chain in one or more links.
35
Risk of Transmission
  • Intact skin is a good barrier to organisms but
    remember that organisms can enter through
    non-intact skin (cuts, scrapes, eczema)
  • Mucous membranes allow transmission, such as
    through
  • eyes
  • nose
  • mouth
  • Most transmission occurs through contact
  • Direct contact- touching patient
  • Indirect contact - touching a contaminated
    surface
  • Spray/splashes Fluids, sputum, etc
  • Most contact is with our hands

36
Hand Washing
  • Hand washing is the single most effective way you
    can break the chain of infection.
  • Hand Washing Basics
  • Soap - Use only hospital approved soaps, lotions
    foam products.
  • Warm running water
  • 15 seconds sing the ABCs song or Happy
    Birthday twice
  • Use friction
  • Turn off faucet with paper towel.
  • Waterless Hand Washing (Quik-Care Alcohol foam)
  • Preferred method of hand cleaning if hands are
    not visibly soiled or contaminated with blood or
    body fluids.
  • Dispense a walnut size amount and rub hands and
    under nails until dry.
  • Use before and after every patient contact or
    contact with contaminated equipment.
  • Contains emollients, therefore is better for your
    hands and is less drying to hands than soap and
    water.
  • The emollients can build up on the hands after
    repeated use, so, wash with soap and water
    occasionally.
  • Lotion
  • Accent Plus is the hospital approved lotion which
    is compatible with hospital microbial soap and
    gloves.
  • Use at least 3-4 times each shift.

37
Artificial Nail Restriction
  • This restriction must be followed by everyone who
    has direct patient contact, cleans rooms, handles
    patient supplies, prepares or serves food/drinks,
    handles medications or blood products.
  • Artificial nails including tips, wraps, overlays,
    acrylics, gels, any appliques, nail piercing,
    nail jewelry or any other artificial nail
    enhancements of any kind are not allowed in our
    facility.
  • Natural nails must be kept 1/4 inch or less.
  • Blood Spills
  • Potential exposure to blood or body fluids could
    occur at any work site
  • There is a plan in place for each work site
  • Guiding principles of each plan
  • Avoid direct contact with body fluid.
  • Wear gloves.
  • Cleanup Twice once for the spill and once to
    disinfect the area.
  • Remove gloves
  • Wash hands.
  • Allow area to air dry e.g. 10 minutes

38
Standard Precautions
  • Standard Precautions considers all patients as
    potentially infectious.
  • Prevent exposure to infectious organisms by
    wearing Personal Protective Equipment (PPE) when
    contact with the following is anticipated
  • blood
  • body fluids, secretions and excretions
  • non-intact or broken skin
  • mucous membranes
  • Personal Protective Equipment (PPE)
  • PPE is located in all patient care areas. Exact
    location should be sought out during unit
    specific orientation.
  • Gloves - to keep hands clean
  • Gowns - to protect uniform from getting splashed
    or wet
  • Facial protection - to protect mucous membranes
    from getting splashed or sprayed

39
Other Infection Control Issues

Issue Implementation Resources
Transmission-Based Precautions Second tier of Infection Control Precautions assess each patient for need and print custom document Droplet Contact Resistant Organism Contact Other Airborne TB Airborne - Other Infection Control Precautions policy and procedure on AKN
Post Blood/Body Fluid Exposure Initial assessment and treatment will be done Complete Employee Exposure Report form Report to EOHS Other times report to ED Allina EOHS policies on AKN
Cleaning of environmental surfaces and spill clean-up Quaternary ammonium compound Infection Control Precaution policy and procedure on AKN
Sharps Containers Most are wall mounted in holder some free standing in stabilizer at patients bedside everyone is responsible for change out when fullness criteria are met Infection Control Precautions and Waste Management policy and procedure on AKN
40
Other Infection Control Issues
Issue Implementation Resources
Safe Needle Devices Safety IV start catheters, lancets, butterfly needles, vacutainer needles, injection needles, blood transfer device, blood collection device, scalpel, fetal electrodes needleless IV tubing system. activate device immediately after use place in sharps container Infection Control Precautions policy and procedure on AKN
Infectious Waste Management Items containing and saturated with blood and regulated body fluids place in red bag place sharps in sharps containers place bags and sharps containers in infectious waste barrel As above and Waste Management policy and procedure on AKN
Tuberculosis Special Airborne Precautions Negative pressure room Respiratory protection using N95 respirator mask or PAPRs (fit testing required) DO NOT care for patient provide support outside of patient TB Exposure Control Plan on AKN
Neutropenic Patients Neutropenia Precautions Do not care for patient when ill Infection Control Precautions policy and procedure on AKN
Patient Linen Bag used linen in universal linen bag, close bag and place in linen chute As above
Patient Care Equipment Reprocess (disinfection/sterilization) between patient uses or discard disposables into appropriate waste stream As above
MN Employee-Right-to-Know Law OSHA Bloodborne Pathogens Rule Incorporated into Infection Control Precautions OSHA Exposure Control Plan and MN ERTK policy and procedure on AKN
41
Location of Exposure Control Plan and Infection
Control Policies
The Allina Knowledge Network (AKN) Ask your
charge nurse about access to the AKN.
42
Patient Care Orientation
43
Your Role In Restraint Use
  • The restraint event begins with the RN
    assessment. Other disciplines contribute data to
    this assessment.
  • Alternatives to Restraints
  • Each department has its own set of restraint
    alternatives that they have chosen for use with
    their patient populations. Alternatives must be
    trailed and documented before restraints can be
    considered. Each policy has a list of restraint
    alternatives.
  • Mercy and Unity have 3 types of restraints
  • Waist Restraint disposable
  • Velcro Tying Restraints disposable
  • Velcro Locking Restraints cleaned and reused
  • There are 7 points of restraint taught to the
    staff as well as positioning the patient on the
    bed.
  • 1 point waist restraint
  • 2 points most frequently are the two wrists
  • 3 points waist and wrists
  • 4 points ankles and wrists
  • 5 points ankles, wrists and waist
  • 7 points ankles, wrists, waist and biceps
  • The patient can be positioned face up or face
    down based on status. When ankles are in
    restraints they should be anchored straight to
    the bottom of the bed and not spread eagle to
    the sides of the bed.

44
Restraints Continued
  • Safe discontinuation Restraints will be removed
    one at a time as the RN assesses the patients
    readiness for restraints to be removed. The
    patient must never be in one point of restraint
    unless that is a waist restraint. When a patient
    is in four point restraints the RN should remove
    an ankle or wrist first. The next restraint
    removed must be the opposite limb for example
    if the right wrist is removed the next restraint
    removed is the left ankle. The time of
    discontinuation must be charted.
  • There are two restraint policies (AKN)
  • Restraints for Non-Behavioral or Acute Medical
    Surgical Care
  • Restraint/Seclusion for Behavioral Management of
    Patients
  • There are basically 3 exclusions to the policies
  • 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 forensic restraints (such as handcuffs or
    shackles) applied by law enforcement officials.

45
Restraints Continued
  • Restraints for Non-Behavioral or Acute Medical
    Surgical Care (AKN)
  • This policy is used for anticipated situations
    when there is a need to restrict the patients
    free movement and access to the tubes, drains,
    etc. (Restraint during detoxification is to
    follow the medical/surgical restraint policy.)
  • The order is for 24 hours and the preprinted
    order set must be used. The MD will authenticate
    the order within 24 hours along with their face
    to face assessment of the patient and the need
    for continued restraint on this preprinted order
    set.
  • The patient will receive the following cares at a
    minimum
  • Q hour CMS
  • Q 2 hours Fluid, elimination and repositioning
  • TID and PRN Food
  • Q12 hours ADLs and hygiene
  • Cares are documented on the flow sheet.
  • The MD will complete a face to face assessment
    for continued need every 24 hours.
  • RN re-assessments are done q 8 hours.
  • If after a period of time without restraints the
    patient needs to have them re-applied, a new
    order must be obtained.

46
Restraints Continued
  • Restraint/Seclusion for Behavioral Management of
    Patients (AKN)
  • This policy is for unanticipated situations of
    sudden aggressive behavior that could result in
    harm to self or others.
  • The order is age dependent there are order sets
    for each age group. The MD will authenticate the
    order within 24 hours.
  • A MD Face to Face Assessment is completed within
    1 hour after the restraints have been applied.
  • Care for the patient includes 11 staffing the
    entire time they are in restraints and cares
    given the same as the acute med/surgical policy.
    The patient will be checked every 15 minutes and
    those checks documented.
  • The order renewal and face to face MD
    reassessment are guided by the age of the patient
    as follows
  • Order Renewal
  • Adult (18 yr.-older)
  • Adolescent (9-17 yrs)
  • Child (under 9 yrs.)
  • Face to Face Assessment
  • Adult Q 8 hours
  • Adolescent and child Q 4 hours
  • Once restraints are released the patient will
    have a debriefing with the staff and it will be
    documented in the chart. The family, patient and
    staff will also have a debriefing and it will be
    documented as well. The only exception is if the
    patient does not want the family involved.

47
Final Restraints Comments
  • Notify hospital leadership if the patient remains
    in restraints for more than 12 hours. They will
    be involved in reassessment of the need for
    restraints. During the day it is the Nurse
    Manager, on other shifts it is the Administrative
    Supervisor.
  • If the order for restraint was obtained from an
    MD that is not the attending physician, then the
    attending must be notified. The attending will
    have more information about the patient that may
    impact the continued use of restraints.
  • Remember to document and get credit for all the
    alternatives that you attempt before during and
    after restraint are utilized.

48
Vital Patient Care Issues
  • 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
    that patients have while in a facility
  • Available in 6 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.
  • What do I do?
  • Verify and Document that the patient or proxy
    received the document.
  • Explain that these are their rights as a patient.
  • Ask them to read it.
  • Document on medical record that you did this.
  • Answer any questions they may have.

49
Vital Patient Care Issues
  • Grievances
  • What is it?
  • A verbal or written complaint 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 by the staff
    present (with-in your scope of practice).
  • If not resolved, give patient the options of
    talking to the Patient Rep, Manager, or
    Administrative Supervisor, or to the Office of
    Health Facility Complaints (OHFC) listed in the
    Patient Bill of Rights
  • 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

50
Vital Patient Care Issues
  • Informed Consent
  • What is it?
  • Informed decision making and consent is required
    for all medical procedures and treatments with
    more than slight risk, or that may change the
    patients body structure.
  • Why is it important?
  • To assure that the patient has adequate
    information in order to engage in informed
    decision making regarding their treatment. Use
    of the Verification of Informed Consent Form is
    required to verify all surgical, invasive
    cardiac, endoscopic procedures and any procedure
    requiring biopsy of tissue or use of sedation
    that results in loss of protective reflexes.
  • What do I do?
  • Hospital staff preparing the patient for the
    procedure will verify the procedure, site or
    side, and the patients understanding of the
    proposed procedure and document on this form.
    The form is a two sided form one side is
    completed by the MD (informed consent), the other
    side is signed by the patient and witnessed by
    hospital staff (verification of informed
    consent).

51
Vital Patient Care Issues
  • And Finally
  • Sentinel Events A sentinel event is defined as
    any unanticipated death or serious injury
    resulting in a major permanent loss of function
    not attributed to natural course of affected
    persons illness or underlying condition or
    an event such as infant abduction, hemolytic
    transfusion reaction, surgery on wrong patient,
    wrong body part, medication error resulting in a
    life threatening affect on health status.
  • All employees are responsible to immediately
    report to their supervisor any patient events
    that met the definition of a sentinel event and
    complete the appropriate form. An initial
    investigation will occur within the first 36
    hours of the event.
  • A near miss is a significant event that could
    have been a sentinel event. These should also be
    reported so that processes can be re-evaluated to
    prevent future misses or sentinel events.

52
Advance Directives
  • Key Points to Consider
  • The admitting nurse must ask all inpatients if
    they have an Advance Directive (AD) and, if not,
    whether they would like additional information or
    assistance.
  • No patient is required to have an AD.
  • Completing an AD while the 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 so the patient
    has the option to discuss their wishes with
    family, clergy and Medical physician.
  • DNR and DNI status is independent of, but can be
    a component of, Advance Directives. A patient
    does not need to have an AD to request DNR or DNI
    status, nor is DNR or DNI always a component of a
    patients AD.

53
Advance Directives Continued
  • If the patient has an Advance Directive
  • Obtain a copy from the patient or their old
    medical record. If a copy is not available,
    document on the pathway your efforts to obtain
    the AD from the family.
  • Nurses should place the AD in the most current
    medical record and must verify that it
  • Reflects the patients current wishes and
  • That it is a valid (written, dated, patients
    name and signature is notarized or witnessed, it
    contains healthcare directives and /or the names
    of the agent or proxy.
  • If a patient wants DNR or DNI status, contact the
    MD. An order from the physician is required
    prior to implementing DNR or DNI status. Verbal
    or telephone orders require two RNs.
  • If the nurse is unable to reach the MD or is
    unsuccessful in obtaining a response from the
    physician, they must communicate/escalate the
    issue to a higher authority to obtain MD follow
    through.

54
Advance Directives Continued
  • If the patient does not have an Advance
    Directive
  • The admitting nurse must ask if the patient wants
    additional information
  • If the patient says no, document on flow-sheet or
    in Notes section.
  • If the patient says yes, provide with Allina
    Advance Directive booklet.
  • If the patient has questions or requests
    assistance, consult chaplain, social worker,
    administrative supervisor, or a member of the
    ethics committee. Remember patients are not
    required to complete the form.
  • If a patient says yes, but they would like to
    take it with them, document on flow-sheet or in
    Notes section.
  • If the patient chooses to complete the form, then
    place the completed form on the front of the
    shadow chart and inform the physician.

55
Information for Non-Employee Staff Assigned to
Patient Care
  • Dress Standard
  • Nametag with employee name, job title and photo
    must be work at all times.
  • All clothing must be neat, clean, well fitting,
    non-transparent, in good condition. Employees
    are to be free of offensive odors (including
    perfumes and colognes).
  • Appropriate barrier clothing, including masks and
    eyewear, is work in accordance with infection
    control precautions.
  • You may wear scrub uniforms or dresses, culottes,
    or pants and tops with sleeves, except ceil
    blue. A warm-up jacket with any matching print
    is acceptable.
  • Point of Care Testing
  • Non-employees may not perform point of care
    testing.
  • Wireless Phones
  • All caregivers will sign out a phone at the
    beginning of the shift.
  • Return phone prior to the end of the shift.
  • Answer phone, identifying self by name and title.
  • Confidentiality is to be maintained at all times.
  • Clean phone with disinfectant prior to use.

56
Information for Non-Employee Staff Assigned to
Patient Care
  • 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 Patient Care Policy on restraints
    and seclusion.
  • Equipment
  • Faulty equipment is reported to Facility
    Operations or Bio-Medical Departments 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
    Bio-Med.
  • 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. Patient Visitor
    Safety Report is the tool used to document the
    event.
  • 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
    Department.
  • Notification of incident is to include the charge
    nurse, department manager and/or the
    administrative supervisor.

57
Information for Non-Employee Staff Assigned to
Patient Care
  • STAFF SAFETY
  • Personal Injury and Potential Health Hazards
  • Questions or incidents related to personal injury
    or potential health hazards are to be referred to
    Occupational Health Services and/or
    Administrative Supervisor.
  • Responsibility of Non-Employee Nurse
  • Non-employee nurses will function within the
    guidelines identified by the unit charge nurse in
    accordance with the hospital policies and
    procedures.
  • Non-employee nurses will not be responsible
    for Discharge planning Charge nurse functions
  • PROCESS FOR WORK ASSIGNMENTS
  • Report to the Staffing Office 30 minutes prior to
    the start of the assigned shift. Be ready to show
    your nursing license and picture identification.
  • BLS certification is verified prior to
    assignment.
  • Check with the charge nurse for assignment and if
    this is new unit for you then orientation to the
    physical layout of the unit is needed, as well as
    any populations specific considerations.
  • Complete billing slip/timecard and present to the
    staffing office for a signature before leaving
    the facility.
  • The Administrative Supervisor must approve all
    overtime prior to working overtime.

58
Medication Safety
  • Allinas Nine Principles for Medication Safety
  • Do no harm
  • The Five Rights
  • Right Patient
  • Right Medication
  • Right Route
  • Right Dose
  • Right Time
  • Nothing is taken for granted
  • Communication clarify, ask questions
  • Teamwork work with MD, pharmacist and patient.
  • Report chart significant patient information,
    medication given or omitted on Medication
    Administration Record (MAR)
  • Safety is a system
  • Engage the patient
  • Inform the organization complete the
    Pt./Visitor Safety form, do not record your
    completion of this on the pts. medical record, do
    not speculate to the cause of the event on your
    charting
  • Learning is the goal of medication safety

59
Medication Safety
  • Safe Delivery Principles
  • Protocols for high risk medications
  • NO KCL on units
  • Patient information _at_ point of care
  • Pharmacist on rounds
  • Allergy wrist bands
  • Computerized MARs
  • Bar coding

60
Medication Safety
  • High Risk Medications
  • Heparin/anticoagulants (requires 2
    signatures)
  • Insulin ( requires 2 signatures)
  • PCA Pumps (requires 2 signatures)
  • Antibiotics (IV)
  • Concentrated electrolytes (KCL)
  • Benzodiazipines
  • Narcotics
  • Chemotherapy
  • Anyone Writing Orders
  • Please DO
  • - Write clear legible orders
  • - Date and time all orders
  • - Print your name under your signature
  • - Use leading zeros when writing decimals (0.1)
  • - Telephone/Verbal order read back (TORB / VORB)
  • Please DO NOT

61
Documentation Overview
  • Mercy and Unity Hospital nursing units utilize
    Excellian, a computerized medical record system.
  • There are general documentation consideration
    that pertain to both hospitals and both systems.
  • General Documentation Guidelines
  • Review Electronic Medical Record Documentation
    policy
  • RN only
  • Assess and document changes in patients
    condition, as well as responses to interventions
  • Focus notes-should be documented through the
    patients care plan
  • General Tips
  • Review and sign Referral/Transfer formsPhysician
    signs all pages
  • Review and sign all Discharge Instruction
  • Focus note all unmet outcomes at discharge
  • ETOH Assessments per protocol

62
Documentation Overview
  • Documentation Time Frames-
  • These are Medical Surgical parameters this
    differs on specialty units
  • Complete physical assessment within 2 hours
  • Admission History within 8 hours reassessment
    of patient every 8 hours
  • Pain Assessment Upon admission, at least every 8
    hours and upon discharge. Reassess after every
    pain medication or intervention administered.
  • Focus Notes Upon admission, discharge, transfer,
    new findings, significant events, physician
    notification, response to plan of care at a
    minimum of every 24 hours. Use DAR format (D-
    data, A action, R response). Some Smart Text
    notes are already in DAR format.

63
Documentation Overview
  • Other assessments areas and issues
  • Bill of Rights
  • Advanced Directives/Health Care Directives
  • Domestic Abuse Assessment - Patient must be alone
  • Medication History
  • Functional Status Assessment
  • Nutrition Assessment
  • Skin Assessment determined by Braden Risk Score
  • Fall Risk Assessment
  • Suicide and Violence Risk Assessments
  • Latex Allergy Assessment
  • Pain Assessment and Management
  • Patient and family education
  • Assessment/Reassessment
  • Discharge planning
  • Patient Transfer forms and EMTALA forms
  • Utilize your colleagues and leaders on any and
    all documentation questions or concerns.

64
In Closing...
  • Final Considerations

65
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
  • Demonstration of quick release tie and
    application of locking restraints (required for
    anyone working with patients).

66
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