Welcome to New Employee orientation VCMC and … · Welcome to New Employee orientation VCMC and...
Transcript of Welcome to New Employee orientation VCMC and … · Welcome to New Employee orientation VCMC and...
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AboutVenturaCountyMedicalCenterandSantaPaulaHospital
VCMCisafullservice223bedAcuteCareHospitalincludinga43bedinpatientpsychiatricunit.WeareassociatedwithUCLAschoolofMedicineandhaveanationallyrecognizedFamilyMedicineResidencyprogramandhavebeen
educatingphysiciansheresince1928.VCMCresidentsaretrainedinbothinpatientandoutpatientmedicine,surgery,OB,ICU,ERandpediatrics.WehaveoneoftheoldestNICU’sinVenturaCountywhichwasopenedin1974.In2010,VCMCbecameaLevelIITraumaCenterforWestVenturaCountyprovidingcomprehensiveandcomplexcaretocriticallyinjuredpatientsinVenturaCounty.Notonlydowehavesomeofthetoptraumaphysicians,
surgeonsandnurses,wealsohaveawidevarietyofscreeningandpreventionprogramstodecreasetherisksofinjurywithinourcommunity.
SPHisafullservice49bedAcuteCareHospital.SPHisacampusofVCMCandservestheruralcommunitiesofSantaPaula,Fillmore,Piru,Saticoy,VenturaandOjai.SPHisavitalruralhealthcareaccesspointsituatedinthebeautifulhillsofSantaPaulaoverlookingthefertileSantaPaulaValley.Thesamehighqualityscreeningand
preventionprogramsarealsoavailableatourSantaPaulasite.
BothVCMCandSPHhavereceivedtheprestigiousBabyFriendlyHospitaldesignation.
OURMISSIONSTATEMENT
Providecomprehensive,responsible,compassionatehealthcareforourdiversecommunity,includingthosefacingbarriers,througheducation,anexceptionalworkforce,andforwardthinkingleadership.
Vision
ProviderofChoiceforIntegratedQualityHealthCare
PhilosophyofNursing
Webelieveinpatient/familyfocusedcare.Webelieveinpromotinghealthierlivinginourcommunity.Webelieveinacollaborative/multidisciplinaryapproachguardinganindividual’srighttoconfidentialityoftheirmedicalinformation.Webelieveinrespectingculturaldiversityandindividualityofeachpatient.Webelieveeach
professionalisaccountableandresponsiblefortheirindividualnursingjudgmentsandactions.
NewHospital
Ournewhospital,the“NorthTower,”iscurrentlyonscheduleformove-inattheendof2016.Theemergencydepartmentwillbethefirsttotransitionintothenewhospital.Priortotransitioningintothenewbuilding,there
willbescheduledtoursandcompetenciesforallstaff.
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ImportantPhonenumbers
VCMC SPHVCMCMain 652-6000 Admitting/Paging 933-8632Admitting 652-6071 NursingOffice 933-8620AncillaryServices 652-6693 AncillaryServices 652-6693Lab 652-6037 PatientAdvocate 652-6691NursingOffice 652-6001 PatientRep 933-8605PatientAdvocate 652-6691 SocialServices 933-8637Paging 652-6075PalliativeCare 652-6093Payroll 677-5133Radiology 652-6080SocialServices 652-3280
CodesorRapidResponse
VCMC 7-6666 SPH 7-8666
UnitSpecific
Unit Manager ManagerPhone# UnitPhone#DOU CristinaMartinez 652-3254 7-6054ER SarahMelgoza 652-6658 7-6165ICU CristinaMartinez 652-3254 7-6195IPU JeffHawkins 652-6032 7-6729MedSurg-2west GracieDiaz 652-5704 7-6244 MedSurg-3west GracieDiaz 652-5704 7-6271 Peds KurtPeifer 652-5763 7-6224Surgery GregAnderson 652-6067 7-6237Telemetry CristinaMartinez 652-3254 7-6572NICU JennyBaarstad 652-6084 7-6088OB LisaMcPheeters 652-6704 7-6090L&D LisaMcPheeters 652-6704 7-6090SPHDOU CarrieHolt 933-8632 7-8689SPHER CarrieHolt 933-8632 7-8663SPHICU CarrieHolt 933-8632 7-8689SPHMedSurg BeaFrias 933-8603 7-8487SPHOB LisaMcPheeters 933-8620 7-8620SPHSurgery AzelaOconer 933-8637 7-8637
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TimeCardsandCodes
Timecardsarecurrentlydonemanually.Yourunitpreceptorcanhelpyouwithyourfirsttimecard.Inthebackofthismanualyouwillfindactivitycodesspecifictoyourunitaswellastimereportingcodes(TRC)necessarytofillingoutyourtimecard(AppendixA).
Certificationpaywillautomaticallybeaddedtoyourtimecardonceyouhavefilledouttherequestform.Certificationsmustbejobrelated.Regularemployeescanbecompensated$0.813foreachcertificationuptofive,perdiememployeesuptothree.Youwillfindacopyofthisforminthebackofthismanual(AppendixB).
TimeAdjustmentForms–IfyoufindthatthereisanerroronyourtimecardpleasefillouttheTimeCardAdjustmentformandhaveitsignedbyyourmanager.Youwillfindacopyoftheforminthebackofthismanual.(AppendixC).
RegularemployeesarealsoeligibleforTextbookandTuitionReimbursement.Youwillfindinformationonthisinthebackofthismanual(AppendixD).
Competencies
Competenciesmaybedeliveredinavarietyofmethods.Competencieswillconsistofhospitalwidecompetenciesandunitspecificcompetencies.
TargetSolutionsisouronlinetrainingcenter.Youwillreceiveinstructionstosetthisuponceyouactivateyourcountyemail.
ReportinganInjury
Ifyouareinjuredonthejobpleasereporttheinjuryimmediatelytoyournursemanagerandthenursingsupervisor.Theywillassistyouinfillingouttheappropriatepaperworkandyoushouldseekmedicalcareasappropriate.
HIPAAPatientPrivacyandConfidentiality
Everypatientwithinoursystemhastherighttoexpectabsoluteconfidentialityoftheirmedicalrecordandhealthcareinformation.VCMC/SPHhasazerotoleranceforunauthorizedentryintoapatientsoryourownchart.Theonlyacceptablereasonstoaccessamedicalrecordareasfollows:youareateammemberprovidingcare,peerrevieworchartaudit,billingorinsurancepractices,partofalegal,regulatoryorlitigationmatter,reviewingaspartofastudentnursingassignment.Anyotherreasonsmustbeapprovedbyadministrationinwriting.IfyouwouldliketolookupyourownmedicalrecordpleasefillouttheappropriateforminMedicalRecordsandtheywillbehappytoassistyou.RefertoPolicy109.001
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Professionalism
Weexpectallemployeestoconductthemselvesinaprofessionalmannerwhileatworkorwhenrepresentingouragency.
SocialMedia–theuseofpersonaldevicesshouldbelimitedtowork-relateduseonly.Pleasedonotdiscusspatientrelatedsituationsonsocialmediaandpleaserefrainfrompostingonsocialmediawhileatwork.Alsorefrainfrompostingphotographsofyourselfand/orcoworkersinthesettingoftheworkplace.Ifyouneedtomakeaphonecallorcheckyouremail,pleasedosoonyourbreak.
DressCode–PictureIDmustbewornabovethewaist.Pleasereporttoworkcleanandwellgroomedandfreeofstrongfragrances.Professionalattireshouldbeworn,nojeans.Ifyouareprovidingdirectpatientcare,pleasewearauniformandappropriatefootwear.Noartificialnailsandnaturalnailsmust¼”orshorterinlength.
HealthyWorkEnvironment
Wewantallemployeestoworkinanenvironmentthatissafe,empowering,supportiveandsatisfying.TheCountyofVenturahasaZeroTolerancepolicyforbullying,violent,ordisrespectfulbehaviorandweencourageyoutoreportanysuchbehaviortoyourdirectsupervisor.
Bullying–canbeanyverbal,non-verbalorphysicalbehaviorthatdiminishesanotherperson’sneeds,concerns,orcontributions.PleasedoyourpartinhelpinguscreateaHealthyWorkEnvironment.
SickCalls
Pleasedoyourpatientsandyourco-workersafavoranddon’tcometoworksick.Ifyouneedtocallinsick,youmustnotifyyourmanagerand/orthenursingsupervisoratleast2hourspriortothestartofyourshiftsothatyourshiftcanbecovered.Annualflushotsareofferedtoallemployees,freeofchargethroughEmployeeHealthServices.Ifyouchoosenottoreceivetheflushot,youwillwearamaskforeveryshiftduringfluseason,asrecommendedbytheCDCinordertoprotectco-workersandpatientsfromillness.
SafePatientHandlingandLifting
TheSafePatientHandlingandLiftingpolicyhasbeenimplementedtoimprovethesafetyofourpatientsandhealthcareworkforce.Itprovidesformethodsoracombinationofmethodstoreplacemanualliftingandtransferring.Staffwilluseappropriatehandlingandmobilitytechniques,mechanical,non-mechanical,andtransferaidsordevicesinaccordancewitheducation,training,andmanufacturer’sinstructionsandguidelines.Staffwillrefrainfrommanualliftingmethodsforsafepatienthandlingtasksandmobilityinallbutexceptionalorlifethreateningsituations.Policy100.099
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“Liftteam”isdefinedasanyhospitalemployeesspecificallytrainedtohandlepatientlifts,repositioningandtransfersusingpatienttransfer,repositioningorliftingdevicesasappropriateforthespecificpatient.
PalliativeCare
• PalliativeCareTeamincludes:Physician,Nurses,aPsychologist,andaChaplainwhosegoalistoimprovequalityoflifeforboththepatientandthefamily.
o PhysicalWell-Beingo PsychologicalWell-Beingo SocialWell-Beingo SpiritualWell-Being
• PalliativeCareisappropriateatanyageandatanystageinaseriousillness,andcanbeprovidedtogetherwithcurativetreatment.
BloodTransfusion
• RNandanotherlicensedstaff(RN,LVNorPhysician)verifybloodagainstunittagandagainstpatientbandsatbedside
o Nameo MRNo Bloodbando ABO/Rho Unit#o Verifyexpirationdateandtime
• Bothmustsignunittagandco-signinCerner• Tagmustremainattachedtoblooduntilcompletion• Verifyingpersonmustremainatbedsideuntiltransfusionisconnectedtopatientandinfusionisstarted• Starttransfusionslow(75ml/hr)andincreasetoprescribedrateafter15minutesifpatienttoleratingwell.• Bloodtransfusionmustbecompletedwithin4hours• Tubinglifefortransfusionis4hours• Vitalsigns
o Upto30minutespriortotransfusiono 15minutesafterstartingtransfusiono Atcompletionoftransfusion
• WatchforsignsoftransfusionreactionincludingTRALI–mostcommonisfevero Stoptransfusionimmediatelyo StartNormalSalinetokeepveinopeno NotifyPhysiciano ReturnBloodtothebloodblankwithtubing,completedbloodtransfusionreactionform,andurine
specimeno MonitorVSo Enterlaborderfor“TransfusionReactionInitial”
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o DocumentinCerner(note)o CompleteNotificationForm
• RefertoPolicyE.1
OneLegacy
• OneLegacyisthenon-profitorganizationdedicatedtosavinglivesthroughorgan,eyeandtissuedonationintheseven-countygreaterLosAngelesarea.
• AsrequiredbyCMS,VCMCandSPHwillreferALLDEATHStotheappropriateOrganandtissueProcurementOrganProcurementOrganization,whichisOneLegacy.
• Donationshouldnotbediscussedwithfamily,insteadanypotentialdeath,imminentdeathoractualdeathshouldbereferredtoOneLegacyat800-338-6112.Theywillreviewthecaseanddetermineifandwhentoapproachfamily.
• RefertoPolicy100.048
QualityAssessmentandPerformanceImprovement
• HospitalAcquiredinfections(HAI)o Greatestprevention–WashyourHands
• CatheterAssociatedUrinaryTractInfections(CAUTI)o Assesseveryshiftfornecessity,removeassoonaspossibleo Bedsidebladderscanningo FollowUrinaryCatheterAssessment,MaintenanceandBestPracticesBundleo FollowNurse-DrivenFoleyRemovalProtocolo Policy1.3
• CentralLineAssociatedBloodStreamInfections(CLABSI)o Assesseveryshiftfornecessity,removeassoonaspossibleo CentralLineInsertionProcess(CLIP)formoneverycentrallineinsertionattempto PolicyE.10,E.9,E.5o FollowCVCCareandMaintenanceBestPracticeBundleo Capsandtubingchangedevery96hoursorafterblooddrawsortransfusionso Dressingchangewithin24hoursofinsertionandatleastevery7dayso AllportsofCentralLinesshouldbecoveredwithone-timeuseCurosProtectivePortandtip
protectors.Theseshouldbechangedanytimetheyareremovedforanyreasonorevery7days• SurgicalSiteInfections(SSIs)
o Pre-operativeChlorhexidineGluconatebathingo Smokingcessationo Glucosecontrolpre,postandintraoperativeo ObservanceofAsepticTechnique
• NotificationandIncidentReportingo ReportallsafetyrelatedeventsandsentineleventstoManager/NursingSupervisoro SubmitElectronicNotificationFormfoundPolicies&Proceduresandicononeverydesktop
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• PatientExperiences–NursingRelatedSurvey o Listencarefully,communicatewithcourtesyandrespecto Answercallbellspromptlyandattendtopatientsneedso Makeeveryattempttoprovideappropriatepaincontrolo Educateyourpatientsonnewmedications,diagnosis,anddischargeinstructionso Rememberpatientsneedaquietenvironment
• ComplaintsandGrievanceso VCMC/SPHgoalisearlycomplaintresolution.o Anystaffmembercanreportthepatientcomplainttomanagementorthepatientadvocateto
expediteresolutiono Anycomplaintthatcannotberesolvedimmediatelybecomesagrievanceandwillbehandedoff
tothepatientadvocatewhowillformalizetheprocess
VCMC/SPHCoreMeasures2016
• HospitalBasedInpatientPsychiatricCareReportingMeasureso HBIPS-1Admissionscreeningforviolencerisk,substanceuse,psychologicaltraumahistoryand
patientstrengthsiscompletedo HBIPS-2Hoursofphysicalrestraintuseo HBIPS-3Hoursofseclusionuseo HBIPS-5Patientsdischargedonmultipleantipsychoticmedicationswithappropriatejustification
• HospitalInpatientQualityReportingMeasureso Sepsis(SEP)
§ SEP-1EarlyManagementBundle(63dataelements)inadults18yearsandolderwithadiagnosisofsepsis,severesepsisorsepticshock
o AcuteMyocardialInfarction(AMI)§ AMI-7aFibrinolytictherapyreceivedwithin30minutesofhospitalarrival
o Stroke(STK)§ STK-1VTEprophylaxis§ STK-4Thrombolytictherapy§ STK-6Dischargedonastatinmedication§ STK-8Strokeeducation
o VenousThrombusEmbolism(VTE)§ VTE-1VTEprophylaxis§ VTE-2ICUVTE § VTE-3VTEpatientswithanticoagulationoverlaptherapy§ VTE-5VTEwarfarintherapydischargeinstructions§ VTE-6HospitalacquiredpotentiallypreventableVTE
o EmergencyDepartment(ED)§ ED-1MediantimefromEDarrivaltoEDdepartureforadmittedEDpatients§ ED-2AdmitdecisiontimetoEDdeparturetimeforadmittedpatients
o Immunization(IMM)§ IMM-2Screenallinpatientsforinfluenzaimmunizationstatus
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o PerinatalCare(PC)§ PC-01Numberofpatientswithelectivedeliverypriorto39weeks
Stroke
• Stroke
Patientswithsuddenstroke-likesymptoms,andlastknownwelltimeiswithin6hoursofpresentingintheEmergencydepartmentorinpatients,willbetriagedandconsideredforeligibilityintheadministrationofIVt-PA,standardizedtreatmentfortransientischemicattack,ischemic,orhemorrhagicstroke,neurosurgicalservices,admissionasanobservationorin-patienttoadesignatedunit,and/orinter-hospitaltransferforneuro-interventionalservices.Physiciansutilize/accessneurologicalexpertisetoexpeditecareofthestrokepatient.Neurologicalexpertise(asdefinedbyVCMC/SPHmedicalpolicies)isavailablewithin15minutes,eitherbytelephoneand/ortelemedicine.Amultidisciplinaryapproachisintegratedinthestrokesystemtopromotethoroughcommunicationanddecisionmakingforbestoutcomes.RefertohandoutsinAppendixE
• SwallowScreen
Thenurse,competentinswallowscreening,willaccuratelyidentifypotentialpatientsatriskforaspirationandperforma“Threestepswallowscreen”.First,thepatients’presentationandpastmedicalhistorywillbereviewedtoidentifythepredispositionforaspiration.Second,asimple3ouncewatertestwillbeconductedandthenursewillproceedtothethirdstepifthepatienttolerates3ouncesofwater.Third,3sipsofwaterwillbegivenandadeterminationwillbemadeforapassorfailstatus.The“Threestepscreenwillbeconductedtodetermineifpatientsareatriskforclinicallysignificantaspirationorrequireaspeechreferralforadefinitiveswallowevaluation.RefertohandoutsinAppendixE
MedicationSafety
RefertohandoutsprovidedbyTorriBoghossian,MedicationSafetyOfficer
Glucostabilizer
RefertohandoutsprovidedbyClaireRithner,DiabeticEducator
Restraints
Restraintisanymanualmethod,physicalormechanicaldevice,materialorequipmentthatimmobilizesorreducestheabilityofapatienttomovehisorherarms,legs,bodyorheadfreely.Physicalrestraintsaretheonlytypeofrestraintsusedhere,VCMCdoesnotusemedicationrestraints.
• Typeso Non-violent–formanagementofbehaviorthatdisruptsorinterfereswiththepatients’abilitytoheal
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o Violent–forthemanagementofviolentorself-destructivebehaviorthatjeopardizestheimmediatephysicalsafetyofthepatient,staff,orothers.
o Seclusion–involuntaryconfinement,usedonlyforthemanagementofviolentorself-destructivebehavior
• Alwaysattemptalternativemethodsfirsto Diversiono FamilyInvolvemento Sitteratbedside
• Whenrestraintsarenecessary,chooseleastrestrictive,optionsincludeo Handmittso Vesto Limbrestraints
• Ordersarerequiredassoonaspossibleforallrestraintso Emergencyinitiationo TemporaryPhysicalHoldo ViolentorSeclusion–
§ agebaseddurationorsoonerifable§ In-personre-orderifneeded>24hours
o Non-violent§ Re-ordereachcalendarday
• Properapplicationo Useonlyhospitalapprovedrestraintso UseQuickreleaseslipknotso Assuredeviceislooseenoughtoprovideadequatecirculationandbodyalignment
• Documentation• PlanofCare• RefertoPolicy100.075
CrashCart
• Crashcartshouldbekeptlockedatalltimeswhennotinuse.• Everynurseshouldbecomefamiliarwiththecrashcartanditscontents.• Crashcartshouldbecheckedasperunitpolicy.• RefertoPolicy100.055
CodeBlue&RapidResponse
Anycodeshouldbecalledusingthefollowingemergencynumbers
• VCMC7-6666• SPH7-8666
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CodeBlue–CardiacArrest(alongwithcallingtheabovenumber,thein-roomcodebuttonshouldbeactivated,whereavailable).Refertopolicy100.055
RapidResponse–Calledforanypatientwhoexhibitshemodynamic,respiratoryorneurologicalinstability/deteriorationorwhenthenurseisotherwiseconcernedaboutapatientandisunabletoreachphysician.Refertopolicy100.086
Sepsis
Sepsisisanewcoremeasureandeveryadultpatientmusthaveadocumentedscreen–• Intriage• Uponadmission• Atleastevery12hours• Anychangeorworseningofconditionoranytimeyouareconcerned
UnderstandingSepsis-Firstyoueitherhaveaninfectionorsomesortofphysiologicaltraumaorevent.• SIRS–systemicinflammatoryresponsesyndrome.Canbecausedbyinfectionorotherinsult.• Sepsis–systemicresponsetoinfection,youhavetohaveaninfectiontohavesepsis.Thatwould
beSIRSplusdocumentedorpresumedinfection.• SevereSepsis–sepsisplussepsis-inducedorgandysfunctionortissuehypo-perfusion.• SepticShock-severesepsisplushypotensionnotreversedwithfluidresuscitation.
WhatisaPositiveSepsisScreen?• Apatientscreenspositiveforsepsisiftheymeet2ormoreofthecriteriafromQuestion1AND1or
moreofthecriteriafromQuestion2oftheSepsisClock(AppendixF)• IfbothcriteriaaremetthenaLactatemustbedrawn,followSepsisProtocol(AppendixG)
WhodrawstheLactate?• Drawingalactateisasharedresponsibility• RT,RN,Physician,phlebotomist• MUSTberunbyRT,DONOTsendtolab• MUSTbeplacedonice,MUSTbetoanalyzerandprocessedwithin15minutes
LactateResults• Lactate<2mmol/L–Assessforseveresepsisasnotedonsepsisclock• Lactate>2but<4mmol/L(2.1to3.9)–RNtonotifythephysicianofresultsandcontinuewithsepsisclock• Lactate>4mmol/L–
o EmergencyDepartment-RN(ordelegate)callsaCODESEPSIS,notifiesphysicianstatandcontinueswithSepsisClock
o Inpatient-RN(ordelegate)overheadpagesCODESEPSISandnotifiesphysicianandcontinueswithSepsisClock
SepsisCare� Obtainurineculture(beforeantibioticsifpossible)� TwosetofBloodculturesbeforeantibiotics� Antibioticswithin3hourofseveresepsis� A30ml/kgcrystalloidinfusionforhypotensionand/orLactate>4.Documentfluidstartandcompletion
time.
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� Norepinephrineifhypotensiondoesnotrespondtoinitialfluidresuscitationwithin1hour� Repeatlactatewithin4hoursofseveresepsisifinitiallactate>2
RefertoPolicy100.201
WoundCare
• GoalistoPreventpressureulcersinsteadoftreat• RiskAssessmentusingtheBradenScoring
o Score<18callsforearlyinterventiono AtleastQ2hrturnso Offloading
• Accuratedocumentationandpicturesuponadmission• Documentation
o Shiftassessmento Turnso Ofwoundifpresento Notificationformfilledoutandmanagernotified
• PlanofCareenteredasappropriate• Appropriatebedorbedsurface• RefertoAppendixH
Age&CulturalSpecificPatientCenteredCare
• CulturalCompetencyo WevaluethediversepopulationthatweserveinVenturaCounty.Allpatientsandlovedones
mustbetreatedwithdignity,respectandwithculturalsensitivity.Refertopolicy100.053• AgeSpecificgroupsforphysiologicalandpsychologicalcare.Refertopolicy108.017
o Neonate–first4weeksoflifeo Infants–upto1yearo Toddler–1-3yearso Preschool–3-5yearso SchoolAge–6-12yearso Adolescent–13-18yearso YoungAdult–19-44yearso Adult/MiddleAge–45-65yearso OlderAdults/Geriatrics–over65years
AddressingPain&Sedation
• Painmustbedocumentedwitheverysetofvitalsigns.Painisdocumentedbeforeand30minutesafteradministrationofpainmedications.
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• Sedationlevelmustbedocumentedanytimeapatientisonmedicationsforsedationandorwhenthatmedicationistitrated.
• Treatmentofpainandsedationmayvarydependinguponage,sizeandpatients’individualperceptionofpain.
• PainScalesusedatVCMC/SPH(AppendixI)o VisualAnaloguePainScale–askpatienttoratepainonscaleof0-10o FacesRatingPainScale–askpatienttoratepainonscaleof0-10usingpicturesoffaceso VenturaObservationalPainScale(VOPS)–ascoringsystemusedtoratepaininthenon-verbal
adultpatiento Face,Legs,Arms,CryandConsolability(FLACC)–ascoringsystemusedtomeasurepainin
infantsandchildrenwhoareunabletocommunicatetheirpaino NeonatalPain,AgitationandSedationScale(N-PASS)–ascoringsystemusedtodeterminepain,
agitationandsedationleveloftheneonate• AgitationScale(AppendixJ)
o RichmondAgitationandSedationScale(RASS)–ascoringsystemusedtomeasureagitationorsedationlevelofapatient
o NeonatalPain,AgitationandSedationScale(N-PASS)–ascoringsystemusedtodeterminepain,agitationandsedationleveloftheneonate
• RefertoPolicy100.076
InterpretationServices
• VCMC/SPHhasavailableaninterpretationserviceformanydifferentlanguages.Thesedevicesarelocatedineachnursingstation,onthe2ndand5thfloorsofAFMCbuilding,andthreemoredevicesarelocatedinAncillaryservicesandareavailablebycallingDebbieHillinAncillaryServices.
FallPrevention
• FallPreventionProgramo VCMCTraumaincollaborationwithEMSidentifypre-hospitalfallso ElectronicFallFormisfilledout,ahomereferralforsafetycheck,etc.ismadeasappropriateo Fallpreventioneducationalmaterialsaredeliveredtopatientupondischargeo Ifpatientisadmittedareferraltosocialservicesismadeandappropriatereferralsaremade
• InhospitalFallPreventiono Goal–Reducefallsbyidentifypatientsatriskandinitiateinterventionsthatpreventaperson
fromfallingo Fallisdefinedasalossofuprightpositionthatresultsinlandingonthefloor,groundoranobject
offurnitureorsuddenuncontrolled,unintentional,non-purposeful,downwarddisplacementofthebodytothefloor.
o Completefallassessmentonadmissionandevery12hours,atchangeofcondition,attransfertoanewunitorafterafall.
§ MorseFallScale(Adult)(AppendixK)
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§ HumptyDumptyFallScale(Pediatric)(AppendixL)o Highrisk>45onMorseFallScale
§ Yellowwristband§ Re-assessenvironmentandre-orientpatientasneeded§ Assuresupervisionandassistance§ Notifyphysician(iffalloccurs)§ Notificationform(iffalloccurs)
o Educatepatient&familyonfallriskreduction–callbutton,footwear,etc.o Bedsinlowpositiono Answercalllightspromptly
• RefertopoliciesA.24and107
SBAR
• Therecommendedmodeofcommunicationbetweenhealthcareproviderstodiscusspatients,patientneedsandpatientrelatedeventsatVCMC/SPH
• WhatisSBARo S=Situation–Whatisgoingonwiththepatient?Aconcisestatementoftheproblem.o B=Background–Whatistheclinicalbackgroundinformationthatispertinenttothesituation?o A=Assessment–Whatdidyoufind?Analysisandconsiderationsofoptions.o R=Recommendation–Whatactionorrecommendationisneededtocorrectthe
problem?Whatdoyouwanttohappenforthispatient?• WhySBAR
o Asimplemethodtohelpstandardizecommunicationo SBARallowsallpartiestohavecommonexpectations:
§ Whatisgoingtobecommunicated§ Howthecommunicationisstructured?§ Requiredelements
o Focusesontheproblem,notthepeopleo TheformatofSBARallowsprofessionalstodelivershort,organizedandpredictableinformation
inaneasytounderstandformat.• ImplementingSBARforpatienthandoffs
o Handoffsincludeverbalcommunicationo Face-to-faceinteractiono Opportunitytoaskandanswerquestionso Documentation
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APPENDIXA-ActivityCodes–UnitSpecific
VCMC
6010 Intensive Care - ICU 6020 Definitive Observation - DOU 6050 PICU 6070 NICU 6171 Med Surg - 3 North 6173 Med Surg - 3 West 6174 Med Surg - 4 North (OB) 6177 Med Surg - 2W 6290 Pediatric Acute 6340 Psychiatric Acute - IPU 6380 Obstetrics Acute - OB 6381 Obstetrics Acute - OB 6530 Nursery Acute - TCN 7010 Emergency Services - ER 7400 Labor and Delivery - L&D 7421 Surgery (General) - OR 7425 Surgery - Pre-Op 7426 Surgery - GI Lab 7427 Surgery - PACU
SPH
6011 Intensive Care - ICU 6131 Definitive Observation - DOU 6180 Med Surg - M/S 6385 Obstetrics Acute - OB 6535 Nursery Acute - TCN 7015 Emergency Services - ER 7405 Labor and Delivery - L&D 7423 Surgery - Pre-Op 7424 Surgery - GI Lab 7428 Surgery - PACU 7429 Surgery (General) - OR 7435 Surgery - SDS
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APPENDIXD
Textbook & Tuition Reimbursement
All Regular full and part time employees are eligible for textbook & tuition reimbursement for job related courses, workshops and seminars. Courses must be taken on employees own time with proof of successful completion.
How much?
x $600 per fiscal year for lower division courses x $900 per fiscal year for upper division or graduate coursework x $900 Nurse certification testing fee reimbursement x $2000 RN to BSN coursework with pre-approval (40 employee slots available)
Did you know...
x All courses need pre-approval for guaranteed reimbursement (Pink T&T sheet) x Per our contract, "Reimbursement will be made to the employee within 2 weeks after the grade cards and
receipts have been received by the Agency head" x New employees must work 1040 hours to be eligible x Part time employees will be reimbursed on a pro rata basis
What's the Process?
Before Class
x Prior to class fill out the pink "Textbook & Tuition Reimbursement Application" and turn it in to your manager for signature. It will be sent to Nursing Administration for processing.
x A copy will be returned to you with instructions on how to fill out the "Textbook & Tuition Claim" form.
After Class
x Fill out the "Textbook & Tuition Claim" form x Attach proof of payment AND proof of satisfactory completion x Sign the claim form and return it to your manager for their signature. The form then goes to Nursing
Administration x Reimbursement check will be mailed to your home address
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SIRS SEPSIS SEVERE SEPSIS SEPTIC SHOCK
DEFINITIONS
SystemicInflammatoryRespons
eSyndrome(SIRS)Musthaveatleast2ofthefollowing:• Temp<
96.8F• Temp>
100.4• HR>90• RR>20• WBC<
4,000• WBC>
12,000• Bands>
10%
SIRS
+ Infection
/ Suspect
ed Infection
16% Mortality
Rate
SIRS +
Infection/ Suspected Infection
+ Organ Dysfunction
Musthaveatleast1ofthefollowing:• Lactate>2• SBP<90• SBPdecrease>40mmHgfrombaseline**• MAP<65• Bilirubin>2*• Creatinine>2*• Platelets<100*• INR>1.5*• PTT>60seconds*• UO<0.5ml/kg/hourfor2hours*• Respiratoryfailure(requiringCPAP/BIPAP)*
*newforpatient**ReasonforrequiredfromMD>20%MortalityRate
SIRS +
Infection/ Suspected Infection
+ Organ Dysfunction
+ LA > 4
and/or
Persistent Hypotension In The 1 Hour After 30ml/Kg IVF Bolus Completion
What is hypotension?
• SBP<90• SBPdecreaseofmorethan40mmHGfrompatientsbaseline
• MAP<65>46%MortalityRate
TO D
O L
IST
Recognize & Assess for infection
Order & draw lactate within 30 minutes of recognition
w/in 3 hours of meeting severe sepsis: 1. Initial Lactate level 2. Blood cultures before antibiotics 3. Broad Spectrum Antibiotics
o If C-diff suspected then ORAL Vancomycin to be started w/in 3hrs.
4. *IF initial hypotension START LR/NS 30ml/kg bolus (rate no less than 126ml/hr)
w/in 4 hours of initial lactate: 1. Repeat Lactate Level
o Only required if initial LA>2 (Cerner automatically orders)
2. IF patient received bolus: assess & document BP x2 w/in hour bolus completes. *done to assess if patient is in Septic Shock
w/in 3 hours of meeting septic shock: 1. Initial Lactate level & repeat w/in 4hr
when ≥ 4 2. Blood cultures before antibiotics start 3. Broad Spectrum Antibiotics o If C-diff suspected then ORAL
Vancomycin to be started w/in 3hrs. 4. START LR or NS 30ml/kg. Assess &
document BPx2. w/in 6 hours of meeting septic shock 1. Start Vasopressors within 6 hours post IVF
bolus completion for persistent hypotension 2. MD/PA/NP Need to document bolus status &
tissue perfusion assessment from either option below: a. Focus assessment doc by MD/PA/NP:
1.All 4 Vitals: HR, B/P, Temp & RR 2.Cardiopulmonary assessment 3.Capillary refill 4.Skin color exam
b. MD/PA/NP to document on 2 options below: 1.CVP 2.ScvO2 or SvO2 3.Bedside CV ultrasound 4.Passive leg raise OR Fluid Challenge
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APPENDIXL
HumptyDumptyFallScale
Parameter Criteria ScoreAge Lessthan3yearsold 4
3tolessthan7yearsold 37tolessthan13yearsold 213yearsandabove 1
Gender Male 2Female 1
Diagnosis NeurologicalDiagnosis 4Alterationsinoxygenation(respiratorydiagnosis,dehydration,anemia,Anorexia,syncope,dizziness,etc.)
3
Psych/BehavioralDisorders 2OtherDiagnosis 1
CognitiveImpairments Notawareoflimitations 3Forgetslimitations 2Orientedtoownability 1
EnvironmentalFactors Historyoffallsorinfant–toddlerplacesinAdultbed 4Patientusesassistivedevicesorinfant–toddlerincriborfurniture/lighting
3
Patientplacedinbed 2Outpatientarea 1
ResponsetoSurgery/Sedation/Anesthesia
Within24hours 3Within48hours 2Morethan48hours/None 1
MedicationUsage Multipleusageof:Sedatives,hypnotics,barbiturates,phenothiazines,Antidepressants,laxatives,diuretics,narcotics
3
Oneofthemedslistedabove 2Othermedications/None 1