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Patient Care Services
Self-Learning Packet

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Advanced Directive
and POLST
Patient Care Services Orientation

3. Advanced Directive & POLST
• An Advanced Directive is a Legal Document where
the POLST is an order.
• Advanced Directive
o A document allowing a patient to direct who
will make their health care decisions and state
wishes for treatment if he/she is unable to
decide for oneself in the future.
o Patients have a right to formulate an Advanced
Directive and to have hospital staff and
practitioners who provide care in the hospital
to comply with the directives.
• Advanced Directives are followed in hospitals where the
POLST can be followed by all aspects of care including:
Home Care, EMS & Nursing Homes
• Practitioner Orders in Life Sustaining Treatment
o For patients who have an advanced chronic
progressive illnesses or life expectancy less than
five years
o Complements a patient’s advanced directive by
converting the person’s wishes regarding life-
sustaining treatment into a medical order which
can accompany the patient in any health care
setting, including pre and post-hospital care
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4. Infection Prevention
Patient Care Services Orientation
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5. Infection Prevention
• National Patient Safety Goal 7
There are a number of National Patient Safety Goals directed toward
infection prevention
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6. Infection Prevention
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– Perception of risk to the patient is sadly the least motivating
in terms of Compliance with Hand Hygiene
• Completing hand hygiene frequently and at key points of patient care
significantly decreases the spread of infection
– Surfaces are Contaminated with the Patient’s Organisms
therefore Hand Hygiene must be performed after contact
with Patient’s Environment.
• The longer a patient is in a hospital the greater their risk is of
contracting an infection due to the increase in the number of contacts
Hand Hygiene is the most important means of
preventing and/or controlling infections

7. Infection Prevention
Moments of Hand Hygiene
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Entering a
patient's room
Exiting a
patient's room
Between caring for patients in
the same room

8. Moments of hand hygiene need to occur:
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•Before and after each patient
contact
•Before and after each glove use
•Before and after contact with
patient belongings
•Before entering a patient room
•After exiting a patient room

9. Infection Prevention
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• Important Hand Hygiene Facts
o Pathogens can travel from patient to patient on
the gloves/hands of healthcare workers.
 Wash or gel before and after
patient/belonging/equipment contact.
o Materials can transfer to hands when removing
gloves.
 Wash or gel before and after glove use.
 Germs are able to transfer to our hands from gloves,
for this reason it is important to perform hand
hygiene before and after glove use.

10. Infection Prevention
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Equipment Cleaning
Here at Cooper, we
use different chemical
wipes for specific
cleaning.
• Each wipe
container states the
kill/dwell time of
the product.
• When using the
wipes, do not reach
into the container
(causing
contamination of
the entire
container) instead
pull them out of
the feeder hole in
o Purple Top (2 minute kill/dwell time)
 equipment cleaning
o Gray Top (3 minute kill/dwell time)
 equipment sensitive to alcohol
o Orange Top (4 minute kill/dwell time)
 contains BLEACH

11. Infection Prevention
• Hospital Associated Infections (HAIs)
o What are HAIs?
 Infections the patient would not have acquired if they were not in the hospital
setting.
o Hospital Associated Infections
• CAUTI – Catheter Associated Urinary Tract Infections
• CLABSI – Central Line Associated Blood Stream Infections
• VAP – Ventilator Associated Pneumonia
• SSI – Surgical Site Infections
o How do HAIs affect the hospital if they are not contagious?
 Patient Length of Stay is longer
 Cooper does not get reimbursed for any care necessary to treat HAIs
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12. Infection Prevention
• How can you prevent HAIs?
o CAUTI
 Absence of catheter
 Assess the need for Foley Catheters every shift
 Initiate the Nurse-Driven Foley Removal Protocol when
appropriate
 Keep Foley bags off the floor, below the bladder and
EMPTY
 Secure tubing to the leg to prevent tension
 Good Perineal care every shift and as needed
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13. Infection Prevention
• How can you prevent HAIs?
o CLABSI
 Assess the need for Central Lines every shift
 Assess the site every shift and change the dressing
if loose or soiled
 Scrub the hub before every access
– 15-30 seconds and allow AIR DRY
 Change any line placed under adverse conditions
(EMS or emergently) within 24 hours
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14. Infection Prevention
• How can you prevent HAIs?
o VAP
 Head of bead positioned at 30O
 Oral care every 4 hours and as needed
 Sedation Vacation
o SSI
 Pre-op antibiotics
 Appropriate hair removal (no shaving)
 Glucose and temperature control
 Pre-op CHG bathing
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15. Infection Prevention
• Isolation Precautions (in addition to standard precautions)
o Contact
 Gloves and gown
o Airborne
 Negative pressure room
 N95 mask for healthcare workers
 Standard mask for patients during transport
o Droplet
 Mask and eye protection within 3 feet of patient
o Enteric
 Must use soap and water for hand hygiene
*Any Nurse or Physician may initiate isolation precautions
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Notes:
• Cooper uses standardized signs and
carts to designate patients that are on
isolation precautions.
• Any nurse or physician may initiate
isolation precautions
• Patient’s must stay on isolation if they
are being ruled out for an infection
(such as flu or c-diff)
• Additional isolation precautions
include
• Airborne and contact for Flu
• Reverse isolation – for patients
who are immunocompromised

16. Infection Prevention
• Safe Injection Practices include using one syringe and one
needle only one time on a patient.
o One Syringe
o One Time
o One Needle
• Become familiar with all Cooper Devices before use on patients.
o IV catheters
o Butterfly needles
Example: Cooper’s butterfly needles retract with a push of a button and
that button can be very sensitive.
o Insulin Syringes
o Safety needles
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17. Infection Prevention
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• Patient Education
o Information and materials are available on the Portal (English
& Spanish)
o Topics include
 Preventing line infections
 Preventing surgical site infections
 Isolation Precautions…..and more
• Vaccine Information Sheets (VIS) are in the Infection
Prevention Information Box and medication rooms.
o Patients should receives the appropriate VIS when receiving
any vaccine.

18. Patient Care Services Orientation
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19. Pain
• Joint Commission New and Revised Requirements
o Involve patients in developing their treatment plans and
setting realistic expectations and measurable goals
o Promoting safe opioid use by identifying and monitoring
high-risk patients
o Facilitating clinician access to prescription drug monitoring
program databases
o Performance improvement activities focusing on pain
assessment and management to increase the safety and
quality for patients
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20. Pain
 Taking a Pain
History
 Physical Exam on
the patient
 Identifying pain on
the intensity scale
appropriate for the
patient
 Setting a pain goal.
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• Pain Assessment includes:
• There are a few pain scales used at Cooper, this is the Wong-Baker Face
scale and numeric pain scale

21. Pain
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Notes:
This is the FLACC scale for
infants.
There is also a scale used
for intubated/sedated
patients in critical care
settings.
Pain scales and
assessments will be
reviewed during unit
orientation.

22. Pain
Key aspects of Pain Management
• Pain assessment must be completed upon initial evaluation and in regular assessments
• Reassessment must occur after each intervention (Medications 30 min post IV/60 min post
PO/IM)
• The absence of pain should be documented at regular intervals
• Pain relief requires individualized treatment of pain
• Healthcare providers, family and the patient must all work together to develop and
implement a plan of pain relief
• Effective pain relief is an important part of treatment
• Communication of unrelieved pain is essential
• Healthcare professionals shall respond quickly to reports of pain
Please Review Policy – Pain Management
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23. Pain
Pain education is not only for the patient. Staff and Family members also have a
role in pain education.
• Staff need to understand the expectations for pain management at Cooper and
regularly document assessments, interventions and reassessments.
• Staff should advocate for patients to receive the most appropriate pain
management, which is not always more of the same medicine.
• Patient and Family learning needs need to be evaluated and addressed.
• Everyone should be aware of their role and responsibility regarding pain.
• patients should not wait until pain is at an unacceptable level before
notifying their nurse
• The Care team, along with the patient and family, should set a pain goal that is
acceptable and attainable for the patient in his/her situation
• a post-op patient should not expect to be pain free post-op day 1
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24. Pain
Resources
• Anesthesia Pain Management
• Acute post-op complex pain management cases
• Invasive techniques (epidurals/nerve blocks)
• Physical Medicine and Rehabilitation (PM&R)
• Physical Therapy Consults
• Medication Management Consults
• Palliative Care
• Pain management in patients facing life threatening illnesses
• Provides support for the patient and family
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Patient Care Services Orientation
Performance
Improvement

26. Performance Improvement
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• PI-Performance Improvement
o A planned systematic approach to monitoring, analyzing, and improving performance to achieve
optimal outcome and experience.
• Quality
• Providing the best Patient experience, to every Patient, every day
o Six elements of quality:
 Effectiveness
 Efficiency
 Equity
 Safety
 Timeliness
 Pt centered
• Clinical Outcomes
 measures by which we compare ourselves to other providers

27. Performance Improvement
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• Core Measures are developed by the Joint Commission.
• The first Core Measures were publicly reported in 2005 for AMI, HF and PNA
• As hospitals become proficient at core measures, they retire old ones and add
new ones, or modify existing ones
• The Core Measures are the Foundation of how we deliver care using Evidenced-
based practice
• Cooper utilizes order sets, best practice alerts, and clinical documentation to
improve quality in the organization.
• Example of Current Core Measures
o Stroke Core Measure (STK-1)
 Venous Thromboembolism (VTE Prophylaxis)
– Ischemic or hemorrhagic stroke patients to receive VTE prophylaxis
the day of or the day after hospital admission

28. Performance Improvement
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• Value Based Purchasing
o Participating hospitals are paid for inpatient
acute care services based on the quality of
care, not just quantity of services. Value based
purchasing ensures that hospitals provide
quality of care over quantity.

29. Performance Improvement
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• Outcomes Based Reimbursement
o Patient Safety Indicators
 CMS determines what Patient Safety Indicators to focus on based on
National Standards and the cost to hospitals if these standards are not
met.
o Hospital Acquired Infections
 Hospitals are financially penalized for patients who develop Hospital
Acquired infections (such as CAUTI/CLABSI/VAP/SSI).
 Hospitals do not receive reimbursement for care needed for a hospital
acquired infection/problem.
This is why it is so important to document wounds on admission, perform
peri-care, follow removal bundles, follow antibiotic guidelines, etc.

30. Performance Improvement
Patient Safety Indicators
• Pressure Ulcer Rate
• Postoperative Hip Fracture Rate
• Accidental Puncture or
Laceration Rate
• Transfusion Reaction Count
• Death Rate in Low-Mortality
Diagnosis Related Groups
Hospital Acquired Infections
• Central Line Associated
Bloodstream Infections (CLABSI)
• Catheter Associated Urinary
Tract Infections (CAUTI)
• Surgical Site Infections (SSI)
• Methicillin resistant
Staphylococcus aureus (MRSA)
• Clostridium Difficile (C-Diff)
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31. Performance Improvement
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Strategies to Keep Quality Affordable
• DMAIC process
• Define, Measure, Analyze, Improve and Control.
• Six Sigma
• Improvement teams use the DMAIC methodology to root out and
eliminate the causes of defects
• Population Health:
• Goal to keep pts out of ED by utilizing Health Coaches, APN’s, RN’s
MA’s, primary care providers and community outreach to manage
chronic conditions
• Clinical Documentation
• RN’s trained in latest coding working with providers to clarify
diagnoses and charting
• Prevents the hospital from incurring penalties

32. Performance Improvement
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The entire organization has a role in quality.
• What can you do?
– Document accurately & timely
– Educate the pt and the family
– Minimize waste (time & resources)
– Keep the pt safe (from injury & infections)
– Participate in UBC, unit projects, LSS, staff mtgs, huddles & Nsg
councils
– Vaccinate and Immunize your pts and yourself
– Use appropriate d/c instructions to prevent readmission.
– Remember, if you didn’t document it, you didn’t do it!!

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Transitional Care
Patient Care Services Orientation

34. Transitional Care
Social Work * Home Care * Health Coaches
Main Department Number - (856)342-3270
• AMION
• Staff coverage is listed daily
• Social Workers are on every unit
• Home Care Coordinators cover multiple units
• Individual contact information is provided
• STAFFING
• There is one social worker assigned to every in-patient unit
• Home Care Coordinators cover multiple in-patient units
• Referrals
• Be Proactive - Early referrals allow for efficient & timely throughput

35. Transitional Care
Social Work –
Consult Required. Staffed 7 days a week
• Crisis intervention
• Homelessness
• Abuse/Neglect (Child/Adult)
• ESRD (End Stage Renal Patients)
• ETOH/Substance Abuse
• In patient psychiatric Social Work coverage
• Facility Placement (long-term care, rehab, LTACH)
• Hospice (In-Patient/Scatter Bed)
• Some transportation Needs (for patients Social Work is following)

36. Home Care Coordinators –
Consult Required. Staffed 7 days a week.
• Visiting Nurse Follow Up
• Home PT, OT, ST
• Home Infusions (TPN, IV Antibiotics)
• Wound Vacs
• Durable Medical Equipment (DME)
• Home Hospice
• Transportation Needs (for patients Home Care is following)
Transitional Care

37. Transitional Care
Transitional Health Care Coach
• Health Care Coaches use a risk stratification tool to determine need and are staffed
Monday thru Friday.
• Health Care Coaches
• provide community-based resources
• Evaluate self-management goals
• Coordinate follow-up appointments and transportation
• Utilize Risk Stratification. Staffed Monday thru Friday
• Follow patients while admitted
• If appropriate, follow for 30 days post discharge
• Linkage to community based resources
• Determine post discharge self-management goals with the patients
• Coordinate follow-up appointments & transportation

38. Wound Care
Patient Care Services Orientation
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39. What is a Wound/Ostomy/Continence (WOC)
Nurse
• Specialty of Nursing
• Advanced education/certification
• Acute/rehabilitative care for GI, GU, Skin system problems
• Direct/Assistive care:
o Evaluation/Implementation/Planning
• WOC nurses are able to provide direct or assistive care for the following:
• Skin care prevention
• Abdominal stomas
• Complex wounds
• Fistulas/Drains
• Pressure injuries
• Continence disorders
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Wound Care

40. Consulting WOCN Educators
• Educate staff and physicians
• Provide consults and recommendations
• Review quality
• Always evaluate situation before consult
• Place consult in EPIC
o Enterostomal Therapy. (Follow prompts)
o Complete all requested information
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Wound Care

41. Questions to WOCNs?
• Daytime – Immediate
o Linda Gazzerro- 1008445
o Elizabeth Sgrillo-1008716
• After 4:30pm- 856-963-3957. Leave message
• Email- Days/Nights/Weekends-
Gazzerro-Linda@Cooperhealth.edu
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Wound Care

42. This completes the self-learning packet form Patient Care Services. You will be required to sign an
attestation at Patient Care Service Orientation acknowledging receipt of the packet.
Patient Care Service Orientation occurs on the Tuesday after Hospital Orientation .
Questions or concerns feel free to contact
Jennifer Harbourt (856) 968-8522 or Christal Young (856) 968-7829
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