Core values : All employees and students. Quality respectful care. Personal pride Respect for all. Listen to and assist our patients’ and families Meet or exceed our standards of service, promote highest level of safety. Care for human, environmental and financial resources held in our trust.
We look at all issues or complaints as a “gift” so we can take action to avoid the issue in the future. We have an opportunity to improve our service. Staff can issue Café 95 coupon for cafeteria or use in Gift Shop Gift stickers.
We get positive responses on our discharge surveys when students have cared for patients.
Any time anything is being done to a patient: medications, treatments, procedures, transport; Always get this information. ID band if patient unable to communicate.
Policies regarding medication administration and the student nurse, high risk meds, etc are in handout.
Information to patient and family. Signage for room and chart Wrist band
Behavioral : threaten to harm self or staff. Students usually do not care for these patients. Medical: patient is interfering with medical care, pulling out IV’s, foley, etc. Bed rails up is considered a restraint by Joint Commission. Posey belt: know who has the key. Wrist restraints. Address ALL patient needs before leaving room!
Newborns have specific tools . Patients are instructed on the use of the Pain Scale used at LCMH. Copy of pain scale in handout.
Wash your hands, wash your hands, wash your hands. Signage will tell you what you need to wear when you enter the patient’s room. Isolation gowns are NOT disposable. Put the used gowns in linen bag marked “Isolation Gowns” which is in the room. Biohazard waste: Examples – soaked dressings, Levine tube drainage containers, soiled bed pads. Make sure only biohazard goes in these cans. Exposures are treated in the same manner as previously stated. Wash areas with soap and water, rinse eyes/mouth with water or saline. Notify faculty nurse manager ED for fast track. Clothing: notify faculty nurse manager MDC notified clean scrubs Linen dept will clean your clothes
Clothing contamination process
E nter the patient ’ s room E valuate the linen needs
All patients admitted will receive full Basic and Advanced Cardiac Life Support measures referred to as a “ Full Code” unless a DNR order is on the chart.
This patient may be threatening to harm staff or self. Patient may need restraints. Behavioral nursing staff trained to deescalate a situation. Patient safety and staff safety is key in these situations.
When moving patients in bed get assistance. Do not “drag” the patient up. Lift and move up to avoid shearing of the skin, especially in the elderly.
HIECS allows for communication between the emergency organizations in a disaster. Improves communication and patient care.
Care without pain of travel : affiliation with Medical Oncology Group from Univ of Chicago. affiliation with Johns Hopkins Hospital for cardiac care. Easy access without feeling neglected Personal attention Hospital visits without the hassle of getting lost. Not being treated like a number.
Little company of mary
Little Company of Mary Hospital Direct Patient Care ForStudent Nurses and Faculty 1 1
You are a Valuable Member of Our TeamThank you for entering health care! 2
MissionIn solidarity with the Sisters of the Little Company of Mary we are entrusted to serve the community through our ministry of Catholic Health CareWe are the empowered laity – the Greater Company of MaryRooted in a deep heritage of prayerful support of the sick and dying, we strive to enhance the sacredness of life and human dignity. 3
Core ValuesProfessionalism: take pride in your quality based, respectful careCompassion: respect patients and families by listening to and assisting with their needsQuality: promote highest level of safety in your care for quality patient outcomes. Anticipate patient needsResponsibility: patient care, environmental and financial resources are in your hands 4
Standards of Performance Attitude Maintain a professional attitude Sense of Ownership Take pride in your work Commitment to Co-Workers Treat co-workers with respect Appearance Dress appropriately for the clinical setting Communication Keep communication open among nursing staff, students and instructors Customer’s Rights Give respectful care Safety & Awareness Be aware of your environment Elevator Etiquette Allow everyone to get off the elevator before you get on Do not block people exiting the elevator Do not discuss patients, patient’s families or co-workers on the elevator Keep voice down when with a group 5
Gift ProgramIs a Service Recovery Process For ACTing on patient complaints It allows us to take corrective action to prevent the problem from occurring again We: A: Apologize for mistake C: Correct the problem promptly T: Take action so problem will not occur again 6
What you do, does make a difference!Introduce yourselfBe polite, listen attentively to your patientMake eye contactExplain why you are thereFirst impressions count! “In the first 8-30 seconds after a customer talks with or sees you an opinion of you and your facility has been formed” (Personal Growth January 2009) 7
Hourly Rounding at LCM Occurs on all patients Every hour from 6am-10pm Every two hours from 10pm-6am Focus on the 4P’s Pain – using the 1-10 scale Positioning – is the patient in a comfortable position Toileting (potty) – does the patient need to go to the bathroom Placement – move items within reach (table, call light, tissue, phone, water, urinal) A scan of the environment To be sure that all items are within reach To insure safety measures are in place To deliver the care patients need and expect All above documented on Inpatient Hourly Rounding Log The white board in the patients room will be updated at the beginning of tour of duty: With patients goal Ask the patient, “The one most important thing I can do for your care?” Names of caregivers 8
Student Parking Parking at LCMH Evergreen Bath and Tennis 91st California 91st Street The Employee Parking lot is located on C the east side of California at 95th Street. A Park on east portion of lot closer to Office Max L Enter the hospital through the revolving I door at the front entrance F Other designated parking areas Blue - Employee/Volunteer O Green - Physician N Yellow - Patient/Visitor Red- Unavailable I LCMH is undergoing a campus A transformation Parking will be restricted A **Students are to park at a remote location V East Evergreen Bath & E Parking Tennis Lot 91st and California West end of parking lot 95th Street Check with your instructor for up to date information 9
Student IdentificationIn order to maintain safety it is required that students and instructors : Wear their school picture ID in clear badge holder ID must be worn at chest level Must wear your school uniform and ID during clinical Must wear professional dress with lab coat and ID if in hospital other than clinical No Cut offs Flip flops Tank tops Jeans If the hospital provided you with the clear badge holder please return it to your faculty at end of clinical. 10
Tobacco-FreeSmoking is not allowed in thehospital, or in areas surroundingthe hospital including sidewalksand parking lots 11
Health Insurance Privacy And Portability Act (HIPAA) HIPAA protects the privacy of individually identifiable health information When working in the clinical setting ask your self Do I need to know this to complete my patient care???? If you answer “no”, then stop If you answer “yes”, follow the HIPAA TIPS …………… 12
HIPAA TIPS Don’t talk about a patient’s condition in front of others Keep patient information safe Close off the computer Put charts away Copying of any portion of the medical record is a HIPAA violation and can be prosecuted by law If patient information is necessary for your learning process and to deliver patient care Keep the information within the learning environment Share pertinent information with the staff to provide quality care for the patient 13
HIPAA Guidelines: Releasing Information Over the TelephoneAt LCMH on admission the patient and his/her personal representative will be given a paper with a four digit identification number The last four digits of the current visit numberAny calls received requesting patient information will only be honored if the caller knows the identification numberFor unresponsive patients having no family request assistance from Case Management 14
Patient IdentificationIn an effort to maintain patient safety ALWAYS verify: Patient’s name Patient’s date of birth1. By having the patient verbalize this information2. Verifying the information with the patient’s ID band. 15
Cell PhonesCell phones are not to be used in the clinical area! For any reason!Cell phones can only be used in public areas The lobby The cafeteriaStaff nurses will use hospital issued cell phones for communication with physicians and families 16
Hospital PoliciesAll hospital policies can be found on Meditech-LCHM’s computer system Under “Patient Care Services Policies and Procedures” Your instructor will have access to LCMH’s library 17
CommunicationGet report.Let RN and Care Partner know what you will be doing for your patientLet RN and Care Partner know when you are leaving the unitsReport off to RN when clinical completed 18 18
Fall Prevention Protocol When a patient is identified to be at risk for fall. Fall Protocol is initiated Follow the information provided in the Fall Prevention Protocol Packet Found on MDC cart Fall protocol (yellow) ID band is placed on patient. Fall protocol signage is placed outside the patient’s door and on the front of the patient’s chart Before leaving the patient’s room Meet patient’s toileting needs Place the bed in the low position De-clutter the walk way Place the phone within reach Place the call light within reach Ask “Is there anything else I can do for you before I leave your room?” 19
Restraint Policy at LCMH At LCM we reduce the use of restraints as much as possible We use the least amount of restriction for the least amount of time The dignity and rights of our patients MUST be maintained at all times At lease every two hours we meet the patient’s needs of: Nutrition Toileting Repositioning We follow the the “Three Ps” Potty Pain Positioning When a patient is in Medical Restraints staff will document every two hours 20
Restraints at LCMHBehavioral Restraints Are applied when a patient is at risk to harm self or others Students usually do not take care of these patients Must have a 1:1 sitter at all timesMedical Restraints Are applied when a patient is interfering with their healthcare The need for medical restraints is reevaluated frequently and a doctors order is required 21
Latex AllergyAlways be aware of allergies identified by the patientLatex-free gloves are on the units for use with patients having a latex allergy or if you have a latex allergyLatex-free equipment is available for those patients with a latex allergy MDC has a list of all available latex free equipment 22
Call Light Used At LCMH Volume Control on the side Volume Control on the side Nurse Call Button TV Control | Nurse Call Button | TV Control |This call light is used in some of the patient rooms 23
Pain Across the Continuum Pain is observed in patients of all ages When accessing pain use the age appropriate pain tools Available for newborns to the elderly Our Pain Scale at LCMH 0 – 10 with verbiage and Smiley Faces 0 being no pain 10 being the worst possible pain A Patient’s self-report is the only reliable report of pain Report patient’s self-report of pain to the nurse At LCMH a pain score of equal to or greater than a 4 requires intervention It can interfere with activities of daily living and hinder recovery LCMH Care Partners can document the patient’s self report 24
Patient Handout on Pain Assessment at LCMH LCMH’s platform of care: “In Pursuit of Pain-Free Health Care” A copy of Our “Commitment to Pain” sheet Is given to all patients on admit Is available, on every unit, in many different languages Explains LCMH’s philosophy on pain relief Explains how they will rate their pain Explains what the patient can expect fro us Explains how the patient can help manage their pain 25
Age Appropriate Care At LCMH care is provide taking into consideration The growth and development the physiological changes that occur with the aging process 26
Infection Control Issues Wash your hands!! Wash your hands!!! Signage will be placed outside the patient’s room indicating the type of isolation precaution the patient is on Wear the appropriate personal protective equipment (PPE) NEVER ENTER AN ISOLATION ROOM WITHOUT THE APPROPRIATE PPE Antibacterial soap & alcohol based cleanser are available in every patient room Red garbage cans are placed in each patient room for biohazard wasteIsolation gowns are NOT DISPOSABLE 27
Infection Control TipsArtificial nails spread infection and are not allowedNatural nails should be < ¼ inch longAlways check signage outside the patients room for PPE to be usedIf the patient has C-Diff They will be on Contact “Plus” Isolation Wash hands with soap and water This is the ONLY way to kill C-Diff Alcohol gels DO NOT kill C-Diff” 28
Infection Control Guidelines• Health care institutions are mandated by regulatory agencies • These mandates require students have specific immunizations for their protection• If you are sick DO NOT come to the clinical setting • A make up day can be arranged with your faculty if school policy allows• Though not required consider getting the flu vaccine 29
N95 Respirator• The N95 Respirator is a special fit-tested mask • Worn when caring for patients on Airborne isolation-in negative air flow rooms• Staff are trained on the proper use of the N95 Respirator • Students will not care for patients in negative air flow rooms• Commonly seen conditions requiring Airborne Precautions include suspected or confirmed: • MTB (mycobacterium tuberculosis) • Positive AFB (acid fast bacilli) until MTB is ruled out • Varicella/Chickenpox • Varicella/Shingles • If disseminated • More than 25 vesicles 30
Exposure Incidents Exposure to blood and body fluids is taken very seriously at LCMH Take all precautions to reduce exposure to blood or body fluids If exposed to blood or body fluids Report it to your faculty and charge nurse immediately Wash exposed area with soap and water for 3-5 minutes Rinse splashes to eyes or mouth with water or sterile saline for 10 minutes Wash puncture wounds with soap and water for 3-5 minutes Report to the Emergency Room Treatment needs to be completed within 2 hours You are financially responsible for treatment you receive. Uniforms soiled with blood or body fluids will be cleaned by the hospital Notify the charge nurse You will be given scrubs in exchange for your soiled uniform Your cleaned uniform will be returned when you return the scrubs 31 31
Occurrence ReportsIf involved in an occurrence with potential to cause harm to anyone an occurrence report needs to be filled out Occurrence Reports are on the Meditech computer system Report the occurrence to your instructor and the nurse manager Documentation of the occurrence is only in the Occurrence Report computer module 32
Linen Utilization LCMH has initiated a linen campaign To ensure proper and efficient use of linen items for patient comfort and safety To limit the misuse and the unnecessary contamination of linen LCMH spends more than $500,000 annually on linen processing $400,000 annually in linen replacement 33
Linen “As Needed” Bed ChangeChanging the linen “as needed” Is a new conservative program at LCM H It is easy on the environment by Protecting our natural resources Conserving water Exposing fewer chemicals into the environment 34
“As Needed” Bed Change GuidelinesStraighten bed linens every dayChange the patient’s bed linens with what is needed whenneeded When the bed is visibly soiled When the bed is damp When the Physician’s request or care giver requests the bed linens be changed When the patient requests or a family member requests 35
Steps to follow to go “Easy on the Environment” Maintain LCMHs commitment to outstanding patient care while being “easy on the environment” Enter the patient’s room Exchange only what is needed Explain the process Educate the patient on how they are helping to protect the environment 36
What to do With Soiled Linen All soiled linen is to be put in BLUE plastic bags while still in the patient’s room Any linen that is brought into a patient’s room is considered contaminated and must be placed in BLUE plastic bags Only linen that will be used should be brought into the patient room 37
DNR Status Do Not Resuscitate A DNR means the patient has chosen to have no intervention or partial interventions if they become unresponsive without a pulse A doctor’s order MUST be on chart if patient has a “Do Not Resuscitate” status Always know your patient’s code status A sticker is placed on on front of chart to indicate the patients code status No Code Status Partial Code Status 38
Emergency Codes Rapid Response Is activated when a patients condition is deteriorating Anyone can activate a Rapid Response Families, patients and visitors are educated on Rapid Response Activate by dialing 5960 Announce Rapid Response and your location Code 70 Is activated when a patient is unresponsive without a pulse Code Brain Is activated when a patient has an acute ischemic stroke and requires TPA Code Purple The Perinatal Hemorrhage Rapid Response Team 39
Emergency Codes Code 99 Is activated in fire situations Activate by pulling the nearest fire alarm Know the locations of the fire alarms Code 33 Yellow Is activated in a disaster Standby Wait for direction from your instructor Code 33 Red Is activated in a disaster Wait for direction from your instructor Code 33 Orange Is activated in a hazardous material or Bioterrorism situation If you discover a Hazmat incident Activate by calling Security 5313 Announce Code 33 orange and your location Wait for direction from your instructor 40
Emergency Codes Code 66 Water sprinkler activation Activate by calling Security 5313 Announce Code 66 and your location Code Gray Is activated in a sever weather watch Wait for direction from your instructor Code Black Is activated in a sever weather warning A tornado or severe thunderstorm has been sighted in Southern Cook County Wait for direction from your instructor 41
Emergency Codes Code Kid Is activated in an infant abduction Activate by dialing 5960 Announce Code Kid and your location Be alert to any unusual activity Report unusual activity to security 5313 Code Dr. Blue Is activated for security assistance if you feel threatened and the offender is present or if you see a suspicious person Activate by calling 5313 Announce Dr. Blue and your location Code Silver Is activated when there is an armed intruder Activate by calling Security 5313 Announce Code Silver and your location If you hear a Code Silver called DO NOT go to that area Crisis Intervention Team Is activated for violent patient situations 42
Code 70 Know your patient’s code status! If you find someone unresponsive and without a pulse Activate a Code 70 Activate by dialing 70 and announce Code 70 and your location Begin CPR Compressions only until Code 70 team arrives 43
Code 99 Fire situations• Fire Plan: R – Rescue patient from room A – Alarm, know where they are C – Contain, close door E – Extinguisher to room• Fire Extinguisher Plan: P – Pull the pin A – Aim at base of fire S – Squeeze the trigger S – Sweep base of fire 44 44
Code Brain A Code Brain Is activated when a patient with acute ISCHEMIC stroke meets the criteria for thrombolytic therapy (TPA) (Tissue Plasminogen Activator) treatment A MD order has been received for TPA administration Process Activate by calling 5960 Announce Code Brain and your location Included in the “Code Brain” batched page will be The house MD http://www.health.com/health/static/hw/media/medical/hw/h5551195.jpg The Nursing Supervisor The stroke coordinator 45
Symptoms of a Possible Stroke Acute stroke signs and symptoms SUDDEN ONSET F = FACE Uneven smile Facial droop/numbness Vision disturbance in one or both eyes Double, blurred or blackened vision A = ARM Weakness, numbness difficulty walking Balance or coordination difficulties S = SPEECH Slurred speech Inappropriate words Mute Difficulty understanding words Confusion T = TIME This is a MEDICAL EMERGENCY – Call 911 Other Headache May be sudden and severe in nature http://braininjurypeervisitor.org/web_images/act_fast.jpg 46
What To Do If You Recognize Signs and Symptoms of a Possible Stroke For Patients on Medical/Surgical Units Activate the “Rapid Response Team” Dial 5960 and announce Rapid Response and your location ICU RN will Access the patient Order ACUTE STROKE PROTOCOL diagnostics Accompany the patient for STAT Acute Stroke Protocol Plain Brain CT Transfer the patient to ICU if needed For Visitors and Patients Outside Inpatient Units Activate by dialing 70 and announce Code 70 and your location Code team will transport the victim to the Emergency Room upon stabilization For Patients and Visitors Outside the Hospital (Mary Potter Physicians’ Pavilion, Halsted Center, Burbank Facility, Palos Diagnostic Center Call 911 to activate the Emergency Medical System 47
Code Purple Code Purple is the Perinatal Hemorrhage Rapid Response Team This Is a perinatal situation requiring additional staff, lab, blood products, personnel and equipment To activate dial 70 Announce Code Purple and your location The Code Purple team consists of Lab Respiratory Nursing Supervisor ICU RN Various physicians 48
Crisis Intervention Team• Is activated for violent patient situations • Activate by calling 5960 • Announce you need the Crisis Intervention Team and your location• The Crisis Intervention Team consists of • Security personnel • The Nursing supervisor • Pastoral Care personnel • A Behavioral Health RN 49
Documentation• If documenting in the Meditech Computer system • Document under your instructors Meditech number • Make a note: “Documentation done by and your name” • Performing a blood glucose with the LifeScan meter • Is done under your instructors INS # number• Rather than documenting in the computer system • A hand written note may be done on the Progress Notes • Co-signed by faculty 50
Medication Administration• Medications are obtained from the automated dispensing machine - Pyxis • Using your your instructors bio-ID.• Remember the RIGHTS of medication administration • Right patient • Right time and frequency • Right dose • Right route of administration • Right drug• You are responsible for all medications you administer! 51
Medication PoliciesWhat medications students DO NOT give Blood or any blood products The initial dose of any IV medications Chemotherapy 52
Medication DocumentationDocumentation of medications and IV’s is Done on the Medication Administration Record - MAR, PRN Medication Administration Record - PRN MAR and the IV Administration Record - IVAR The MAR, PRN MAR and IVAR are kept on the patient’s clipboardAll medications must be Signed by you Co-signed by your faculty According to LCMH policy 53
MARInformation contained onMAR Patient visit # Patient Name DOB Patient Medical Record # Age Date Admitted Primary Diagnosis MAR Date Allergies 54
High Alert Medications• Be aware of those medications that when taken as recommended can cause injury to the patient• Always do a 2 RN check on High Alert Medications • Such as insulin. • This is a 2 RN check • Between instructor and RN • Not just student with faculty• Your faculty has the LCMH policy regarding what medications are High Alert Medications 57
Measuring I&0 at LCMH Fluid Equivalents 1 oz.= 30cc Plastic glass 210cc 1 cup (8oz) 240cc Plastic Pitcher 900cc Soup Bowl 180cc Milk Carton 240cc Jello/Ice Cream/ Fruit Ice ½ cup 120cc Juice (foil cover) 120cc Juice (plastic cover) 80cc Pop 1 can (12oz) 360cc Coffee/Tea (8oz) 240cc Ensure 1 can 240cc Small Milkshake (8oz) 240cc Large Milkshake(16oz) 480cc 58
ErgonomicsAlways ask for assistance with lifting or moving patientsBend your knees and lift with your legsTighten your stomach muscles and pull the object close to your body Be sure the weight of the object isn’t more than you can lift 59
Safety & Emergency PreparednessSafety and Emergency preparedness are necessary To promote and maintain a safe and secure environment for patients, staff and visitorsLCMH has information on Chemical spills and directions on cleaning the spill This can be found in the Material Safety Data Sheet (MSDS) Found in the Environment of Care (EOC) manual on each unitIn the event of a power failure All rooms are equipped with red outlets for critical care equipmentLCMH is part of a Hospital and Community Emergency Response System This is a community based response by healthcare organizations to emergencies 60
Our Platform at LCMH “Pursuit of Pain-Free Health Care” In our efforts to maintain this platform LCMH Provides Minimally invasive procedures such as Da Vinci robotic surgery Diagnostic tools Laparoscopic cameras 40-slice CT scanners Continues to promote a health care experience that provides Easy access Personal attention 61
The Future of LCMHTo be completed in the fall of 2012 62