Agency Orientation Packet - Carroll Hospital
Transcript of Agency Orientation Packet - Carroll Hospital
NURSING STUDENT
ORIENTATION PACKET
2013 - 2014
Welcome to Carroll Hospital Center
This presentation will provide you a
foundation of knowledge as you begin your
Student Rotation here at
Carroll Hospital Center.
JOURNEY TO EXCELLENCE
L E S L I E S I M M O N S , R N
P R E S I D E N T O F C A R R O L L H O S P I T A L
C E N T E R
TODAY…
Carroll Hospital Center :
• Has more than 400 physicians on its medical
staff representing over 35 medical specialties
• Has over 1,800 employees is the second largest employer
in Carroll County
• Has an annual budget in excess of $175 million
• Annually serves more than 300,000 individuals with
direct medical care, outreach and community programs,
diagnostic and outpatient services and health screenings
Mission – Our Communities expect and deserve excellent medical treatment, compassionate care and expert guidance in maintaining their health and well-being. At Carroll Hospital Center, we offer an uncompromising commitment to the highest quality health care experience for people in all stages of life. We are the heart of health care in our communities.
Vision – Founded by and for our communities, Carroll Hospital Center will help people maintain the highest attainable level of good health throughout their lives. We strive to be the best place to work, practice medicine and receive care. Our commitment is to be the hospital of choice.
CHC BUSINESS INITIATIVES VS PILLARS
CHC Business
Initiatives
Customer Service
Innovation
High Quality
Right Cost
People Growth
Pillars of Excellence
Service
People
Quality
Financial
Growth
Community
PILLARS OF EXCELLENCE
•Found on the Ground Floor near the
cafeteria
•Contains vital information regarding
our clinical indicators
•Also known as the “Dashboard”
INTRODUCE YOURSELF:
• To the Staff
• To the Manager
• To the patient if you are involved in
patient care
DRESS CODE
• Dress according to the department where you will be. (no
jeans or shirts with offensive) Or use a school approved
uniform with name pin/badge visible.
• Piercings are limited to 2 post piercings in each ear.
• Tattoos should be covered.
• Cell phones are to be silenced while at the hospital.
PAIN MANAGEMENT
If a patient complains of pain
to you, inform the patients
nurse so that she can get
something to make the patient
more comfortable.
SAFE MEDICATION :
HIGH RISK DRUGS
WHY ARE WE EMPHASIZING
HIGH-RISK MEDICATIONS?
These medications are associated with significant risk
of causing serious injuries or death, when used in
error. Special consideration should be taken when
giving these medications.
ISMP (INSTITUTE FOR SAFE MEDICATION PRACTICES)
STATED THAT…
“Errors with these medications are
not necessarily more common but the
consequences are clearly more
devastating.”
YOU NEED TO…
Teach your patient the reason why
this medication is being administered
Explain significant side effects they
may experience
Describe special precautions that
must be followed while on this
medication
Document the teaching and the
patient’s response to teaching
FIRST, AS A REFRESHER, LET’S LOOK AT
SOME DEFINITIONS:
Therapeutic Range- is the range of drug levels within which most patients will experience significant therapeutic effect without an undesirable degree of toxicity.
PT/INR- (International Normalized Ratio) a system established by the World Health Organization for reporting the results of blood coagulation tests. All results are standardized using the international sensitivity index for the particular thromboplastin reagent and instrument combination utilized to perform the test.
THERE ARE MANY MEDICATIONS
IDENTIFIED BY THE ISMP AS HIGH
RISK…
To make it easy, we will use the acronym
CHICKEN
WATCH OUT FOR THESE HIGH
ALERT MEDICATIONS
C OUMADIN
H EPARIN
I NSULIN
C HEMOTHERAPY
K Cl
E NOXAPARIN
N ARCOTICS
LESSON #1:
DON’T GET
FRIED!
WATCH YOUR
HIGH ALERT
DRUGS!
LOOK ON THE MAR…
For instructions
addressing
administration and
monitoring information
addressing
“CHICKEN” drugs.
AT CARROLL HOSPITAL CENTER…
….our Medication CPT
has identified some specific
medication that we will
focus on here!
CLASSIFICATION: ANTICOAGULANT
Warfarin (Coumadin)
Monitor PT/INR daily or as needed
HOLD if INR is above the high end range
Inform Physician
REMEMBER….
You must record the most
recent PT/INR on the
medication record (MAR)
prior to administering the
drug.
WHAT IS THE THERAPEUTIC RANGE FOR
COUMADIN YOU ASK??
PT within desired range…1.5- 2 times the control
INR, 2.0-3.0 with standard therapy (venous
thrombosis, pulmonary embolism, prophylaxis for
DVT)
With other conditions like prosthetic valves INR
would be 2.5-3.5
CLASSIFICATION: ANTICOAGULANT
Enoxaparin (Lovenox)
The first dose cannot be given until 1-2 hours after
heparin IV is finished
This drug is given every 12 hours or 24 hours as
ordered
IMPORTANT POINT!
If the patient is already
taking Lovenox, do not
start Heparin until 12 hours
after the LAST Lovenox
dose!
CLASSIFICATION: ELECTROLYTE BALANCE
Replacement
Potassium (K+)
If the serum K+ is greater then 5.5 the medication must be held, and the nurse must inform the physician
Record the most recent serum K+ on the MAR
Check magnesium level, it must be normal to treat hypokalemia
CLASSIFICATION: ELECTROLYTE BALANCE
Please Note:
A common cause of low K+ is K+
free IV fluid. You can recommend to
the physician to add 20meq KCL per
liter of IV fluid if K+ is low, the IV
fluids do not contain KCL and if renal
function is normal.
CLASSIFICATION: ELECTROLYTE BALANCE
But… remember to hold
KCL if your patient is
receiving Kayexalate
CLASSIFICATION: ELECTROLYTE BALANCE
Potassium-removing resin
Kayexalate (sodium polystyrene sulfonate)
Monitor daily serum potassium level
Hold and inform physician when potassium level is 4-5 mEq/L
Record serum potassium level on MAR prior to giving drug
CLASSIFICATION: ELECTROLYTE BALANCE
Magnesium Sulfate (in FBP)
Magnesium sulfate is double checked in L&D.
ADD Click below to see the Patient Care Guideline for more information.
ADD Click below to ISMP Med Safety Alert June 2006
CLASSIFICATION: CARDIOTONICS
Digoxin
You will need to assess the most recent digoxin level prior to
administering this drug.
If level >2.0, hold medication and inform Physician.
Assess and record heart rate on MAR prior to administering this
drug.
If heart rate < 60 bpm or order specified by Physician, do not
give this drug.
CLASSIFICATION: ANTI-DIABETIC
Metformin
The most recent serum creatinine level must be documented
on the MAR.
Hold medication if creatinine is 1.4mg/dl or > in a female
or 1.5mg/dl or > in a male. Inform physician.
CLASSIFICATION: ANTI-DIABETIC
Metformin
Hold medication if:
Patient is in metabolic acidosis
Patient is to receive iodinated radiologic contrast media.
Continue to hold until 48 hours after the procedure and serum creatinine is repeated and found to be normal.
CLASSIFICATION: ANTI-DIABETIC
Did you know?
You should monitor for Signs and Symptoms of hypoglycemia (fatigue, excessive hunger, sweating, & numbness of extremities)
Hold insulin for fasting blood sugars
< 70mg/dl or if patient is not eating or receiving external/parenteral nutrition.
Insulin must be discarded 30 days after first use, please remember to date when opened.
CLASSIFICATION: ANTI-DIABETIC
Insulin
Syringe, MAR and bottle must all be checked by another nurse, for proper product and dosage prior to administration.
Doses > 50 units must be checked w/prescriber before administration.
CLASSIFICATION: ANTI-DIABETIC
Does the chart on the next slide look familiar?
It is our current list of insulins used.
Take a minute to review it.
1. Hydromorphone (Dilaudid)
This drug is 3-5 times more potent than morphine!
See PCG for dosing.
2. PCA/PCEA pumps
Two nurses are required to check programming, dose
changes, and waste.
CLASSIFICATION: NARCOTICS
THAT’S NOT ALL FOLKS…
More information can be obtained through the
PDR, Nursing Drug reference on your unit,
particular PCG or consulting a Pharmacist.
Environment of Care
(EOC)
EMERGENCY
RESPONSE CODES
Know your responsibilities as a
student during all of the emergency
response codes reviewed in this
program.
Identify each code and what it
represents.
Code
BRT
The State of Maryland
adopted these codes to be
used universally throughout
Maryland hospitals
Emergency codes provide a system
to manage unexpected situations
that may occur on our campus.
Everyone should know how to
report an emergency.
To activate ALL CODES call
Extension 4444.
Let’s review the Codes
utilized at
Carroll Hospital Center
Code Green
Used for a
Behavioral Emergency
What Students Need to Know:
•Make the staff nurse and your instructor aware that the patient
is starting to “escalate”.
•Position yourself in the room close to the door so that you have a
way out if need be.
•Don’t corner yourself in the room.
•Call a Code Green for any situation involving a patient with
aggressive behavior.
Code Grey
Elopement
What Students Need to Know:
An elopement occurs when a patient attempts to leave/flee the
unit assigned and/or the hospital
A Code Gray or elopement is not when a patient leaves against
medical advice.
All staff/ students must observe
corridors, look out windows and check
general areas for the eloped patient.
Code Orange
Hazardous Chemical
Spill
Any time an Student works with a
chemical, it’s their job to know and
understand the hazards or risks to using
that chemical.
What Students Need to Know:
Information about Hazardous materials
can be found on Material Safety Data
Sheets (MSDS) on the Carroll Hospital
Center Intranet page.
MSDS
Code Blue: Adult/Child/Infant
Cardiopulmonary
Resuscitation Emergency
This code is activated when
anyone is discovered in respiratory
and/or cardiac arrest.
Code Pink
Infant/Child
Abduction
A Code Pink alert is activated in
the event of an attempted or actual
infant or child abduction.
What Students Need to Know :
Cover the building exit nearest to your location in
accordance with the Code Pink Plan.
Environmental Services and Maintenance Associates
will patrol the building perimeter during a Code Pink
Alarm.
•Anyone acting suspicious
•Any person or Associate carrying an infant or small
child
• Any person or Associate carrying a large bag, box,
coat or anything which could conceal an
infant/child
Be on Alert for:
OBRRT
OB Rapid Response Team
The OB Rapid Response Team (OBRRT) will
respond to any woman presenting with an
obstetrical or newborn emergency.
• The OBRRT can be initiated by any staff
member by dialing 4444.
• Ask the operator to page an OBRRT.
• Caller will need to give the patient location.
• All OBRRT members carry pagers.
• A group page is sent out to the team.
• An overhead page will be announced.
What Students Need to Know:
CODE GOLD
Bomb Threat
What Students Need to Know:
All Students and Associates will assess their own area
for any suspicious objects.
If a suspicious object is located:
Do not move the object
Do not touch the object or anything
attached to it
CODE O2
Oxygen Emergency
Procedure
What Students Need to Know:
Telecommunications will page the:
• Nursing Shift Coordinator
• Cardiopulmonary Director
• Respiratory Therapist
• Maintenance personnel
Those on duty will report to Telecommunications.
Code Purple
Firearm / Weapon
Present
What Students Need to Know:
If you observe or receive a report of an individual(s)
displaying a fire arm or other lethal weapon in a threatening
manner, contact the following, if possible:
• ext 4444
• Maryland State Police – 911
Notify patients and visitors of the situation and direct them
to an area of refuge.
An area of refuge is any area that will
keep you out of harm’s way, such as:
•locked restroom
•locked office
•closet
•exit the building
Fire Response Plan
Code Red
This code is activated in the event of a fire, smoke, odor
of smoke, suspected fire, etc.
If you report the fire by telephone
(ex.4444), you MUST also activate the
nearest Fire Alarm Pull Station.
What Students Need to Know:
Ensure that all exit doors, especially those to stairways,
are not propped open.
All stairwell doors must remain closed and latched to
prevent smoke and fire from entering escape routes.
DO NOT use elevators during a fire emergency.
To help you remember the steps to take in the event of a
fire, use the acronym RACE
R –rescue
A – alarm
C – confine
E – extinguish
COT
Critical Outreach Team
What Students Need to Know:
Inpatients require urgent attention
Initiated by nurse or other clinical staff
Reasons for call: Acute clinical change or nurse
considers patient at risk
Code Emergency Response
What Students Need to Know:
Staff, Visitor, or Outpatient in need
Code Emergency Response is to ensure that all
individuals requiring emergency care, who are
located on the hospital campus, receive care in a
well-coordinated manner.
Documentation Security
If you have access into the Electronic
documentation system the next slides are
important to remember.
YOU WILL REVIEW:
How to change the password
Why changing the password is important
How often it is required to change your password
How to keep a computer screen secure in the hospital environment
The role each Carroll Hospital Center associate/student plays in keeping
health information and computers secure- HIPAA
Where to find more information on these topics
LOGGING IN
• Passwords are secret and should NEVER be shared with anyone
• Students who are caught sharing their password, can lose access to electronic systems
• You may be asked to change your password periodically
• It is important to remember that all passwords are case sensitive. This means if you choose UPPER case letters, that is how the computer will set the log in until the password is changed.
PASSWORD PROBLEMS
• Remember, different systems will
have unique logins.
• If you have forgotten your
password for any system, call the
HELP DESK x6809
BASIC DOCUMENTATION GUIDELINES
Each Associate/student at Carroll Hospital
Center that uses a computer is responsible
for making sure their documentation is
secure and complies with HIPAA
regulations.
Security is maintained in several ways.
• Personal log in
• Changing the password
• Keeping computer screens closed or
minimized
All Associates/students have the responsibility
to protect the information they see on the
screen from outside eyes.
This can be accomplished by
Exiting the program
Minimizing the screen if someone is
attempting to view the information
HOW TO HANDLE PROBLEMS
If a visitor is found reading over the shoulder of an Associate/student, ask
them to stop and inform them protected
health information cannot be viewed by
unauthorized personnel.
PROBLEM SOLVING
ALL Carroll Hospital Center Associates/Students Should:
Log off the user and exit the program on an
unattended computer that you find
confidential information displayed .
Now that you have completed
this CBT you will need to print the
Certificate on the TLC site, sign it and give
it to your instructor.
We hope that your clinical rotation
a worthwhile experience here at
Carroll Hospital Center.