OnLine Faculty Orientation

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On-Line Faculty Orientation

• Saint Joseph Health System (SJHS)
• 2008-2009

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Greetings

• On behalf of SJHS, WELCOME! We are pleased to
  provide a worthwhile clinical rotation for your
  students. In order to provide the best and safest
  care for our patients, we will adhere to certain
  mandatory requirements that JCAHO, OSHA, HIPAA,
  and legal counsel have recommended. Based on
  this, we are required to request certain
  information from you on an annual basis.
• To communicate this necessary information,
  please review this entire presentation and
  complete the acknowledgement agreement. A
  faculty handbook and student handbook should be
  printed as orientation tools to accompany this
  presentation. If this is your first clinical
  group at SJHS please contact me for information
  regarding unit orientation, 859-313-4493,
  marjoriefuller_at_catholichealth.net
• Thank you,
• Margie Fuller, RN
• Education Coordinator

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Faculty Responsibility

• Prior to the first day of the clinical rotation,
  each instructor should review the orientation
  handbook with the students. This handbook
  outlines general information on basic procedures
  utilized at SJHS. On the last page of the
  handbook is a form that must be signed by the
  student and faculty/preceptor. Please turn this
  completed information in to the education office
  at the Saint Joseph Office Park.

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SJHS Mission

• To nurture the healing ministry of the Church by
  bringing it new life, energy and viability in the
  21st century. Fidelity to the Gospel urges us to
  emphasize human dignity and social justice as we
  move toward the creation of healthier
  communities.

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Our Core Values

• Reverence Profound spirit of awe and respect for
  all of creation, shaping relationships to self,
  to one another and to God, and acknowledging that
  we hold in trust all that has been given to us.
• Integrity Moral wholeness, soundness,
  uprightness, honesty, sincerity, as the basis of
  trustworthiness.
• Compassion Feeling with others, being one with
  others in their joy and sorrows.
• Excellence Outstanding achievement, merit,
  virtue continually surpassing standards to
  achieve/maintain quality.

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Customer Servicethats what we are here for!

• Please join us in maintaining our high Service
  Standards

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Communication Attitude

• Greet the patient/customer promptly with a
  friendly smile
• Correct problems apologize for inconveniences
• Listen attentively and do not interrupt

• Address the customer by name
• Keep all patient information confidential
• Thank the patient for choosing Saint Joseph
  Health System
• Direct conversation to patient

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Introductions / Telephone Etiquette

• Use please, thank you", "sir maam
  appropriately in conversations
• Answer all calls within 3 rings
• When answering calls, identify your department
  and yourself
• Ask all callers, How may I help you?
• Ask permission before placing caller on hold

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Call Lights

• Do not leave the floor until the patients
  request has been conveyed to the appropriate
  caregiver
• Acknowledge all call lights by the 5th ring

• When answering calls, address patient by name
  ask, What can your nurse bring you?
• The appropriate caregiver must respond to a
  patient call/request within 3 minutes
• Before leaving the floor, notify patients when
  you will return

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Privacy

• Always knock before entering
• Interview customers in private
• During examinations, procedures interviews,
  close curtains or keep a distance between
  customers
• Close doors if available
• Provide robe or 2nd gown if patient is ambulating
  or in a wheelchair
• Provide sheets or blankets when transporting a
  customer

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Customer Service

• Prior to leaving a patients room, please ask,
  Is there anything else that I can do for you?
• At the beginning of your shift, introduce
  yourself by name and title to the patients and
  families.
• Communicate to them regarding how to notify you
  directly if your are carrying a phone (as
  appropriate).

• Set a goal of a 5 minute response time for all
  patient call lights.
• If you are unable to reply to a patients
  request, please redirect the request back to the
  nurses station so someone else can respond to
  the patient

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Service Recovery

• Initiate service recovery if a patient has been
  waiting longer than 15 minutes for a response
• Apologize for the wait (Im sorry that I kept
  you waiting)
• Do not blame delays on another department of SJHS
• Communicate angry patient complaints immediately
  to a supervisor for quick follow-up.

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SJHS Celebrates Diversity
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Diversity Categories

• Race
• Religion
• Gender
• Age
• Disability
• Lifestyles, Class
• Language
• Culture, Customs and Traditions
• Abilities and Conditions

• Human Relations
• Physical Appearance
• Family Values and Composition
• Life Experiences
• Personal Beliefs
• Personalities
• Communication Styles
• Behaviors and Etiquette
• Education Levels

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How SJHS Meets Patient Diversity Needs

• Patients Rights Responsibilities
• (Administrative Policy-093-P-9f)
• Kids Traxx _at_ SJE
• 24-hour Interpretative Services
• Alternative types of patient education materials
  videos, classes, written, etc.
• Case Management

• Ethics Committee Consultation
• (Administrative Policy-093-P-43g)
• 24-hour Chaplaincy Services
• Language Line
• Spanish patient education and consent forms.
• Dying Customs Reference Hospice Care

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Cultural Diversity Its not just what you know
but how you act!

• How SJHS does it
• Reverence for those we serve
• Integrity in what we do
• Compassion for those less fortunate
• Excellence in the service delivered

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Resources
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Who are the Directors?

• Medical-Surgical
• LaJava Chenault
• Critical Care Telemetry
• Debbie Hampton
• Pharmacy
• Eric Miller
• Lab/Radiology
• Dennis Netzel
• Rehab Services
• Debbie Ison
• Women's Services
• JoAnn Lytton
• Emergency Services
• Marilyn Swinford

• Educational Services
• Rose Patrick
• Continuing Care Hospital
• Gwen Howard-Gamber
• Respiratory Therapy
• Marlene Riggle
• Case Management
• Cinda Fluke
• Surgery (West)
• Dwayne Gossett
• Surgery (East)
• Linda Watt
• Nursing Service Berea
• Pat Patton

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Clinical Specialists

• Debbie Griffith Critical Care (Surgical) Ext.
  1765
• Jennifer Drum CC, ED, Cath Lab Ext. 1836
• Billie May Palliative Care Ext. 1988
• Teresa McKinney-Enterstomal Therapy Ext. 1237
• DTC-Diabetes Treatment Center Ext. 2958
• Debbie Kitchen Gerontology, 4A/5B Ext. 1168

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Clinical Educators

• CTVU(SJH),ICU (SJE), 3East (SJH)
• Cheryl Watson
• CCU/ICU-N S (SJH), 4MS (SJE), 3B
• Karen Cooper
• 2E, 4IC (SJH), 3 Tele (SJE), 5A
• Jan Hovekamp

• 3A, 4A,5A, 5B, 6 ONC (SJH)
• Tracey McFarland
• ED (SJE,SJB,SJH)
• Tammy Whitehead
• Heart Institute (SJH, SJE)
• Margaret Kramer

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Policies Procedures

• Administrative, Patient Care Services, and Human
  Resources policies and procedures are all
  available on-line via the Intranet.
• Each department may have a department specific
  manual. Please inquire with the manager to review
  if necessary.
• Unit Specific Resource Manuals are located on the
  individual Units.

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Medical Library

• Librarian-Laurie Henderson (313-1677)
• Hours 8-430, M - F
• Located on the ground floor of the West Campus
• Multiple computers with printing capability
• Small conference room
• Textbooks, journals, and other research material
  available
• Small TV/VCR for in-library viewing

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The Intranet

• SJHS internal communication and resource site.
  Accessed only from a computer within the
  hospital.
• Intranet resources
• Policies and Procedures-Click on P P Seeker
• Standing Orders/Consents
• Education-Patient Care Information (Click on
  Micromedex, Up To Date, etc.)
• Variance Reports
• Clinical Care Site/VSDS
• Unit Specific Scopes of Service

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How to Access

• Click on the Big E (Internet Explorer icon) on
  any computer desktop. This will take you to our
  hospital intranet not the internet.
• On this page you can click on
• Hospital Departments
• Administration
• Nursing
• Human Resources
• Education
• MD Orders
• P P Seeker
• From there, you can access volumes of necessary
  information

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Documentation
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Multi-Disciplinary Forms

• Admission History Record-PCS-III-40E
• Patient Flow Sheet-PCS-III-43F
• Medication Administration Record
  (MAR)-PCS-III-28C
• Interdisciplinary Consult and Education Record
• and Discharge Record-PCS-III-53A
• Care Maps/Care Guide-PCS-III-63
• Medication Reconciliation Sheet
• Please refer to the listed policy for detailed
  information.
• Policies can only be accessed on the in-hospital
  intranet.
• Intranet instructions are also listed in the
• faculty handbook.

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Departmental Forms

• Each department has specific documentation forms.
  Please contact the unit manager or the clinical
  educator for the area to review.

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Infection Control

• Hand Hygiene
• New CDC guidelines outline hand washing and also
  state that alcohol-based hand cleansers are as
  effective as soap and water.

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Alcohol-Based Hand Cleansers

• Use before and after all patient care unless
  hands are visibly soiled
• Apply cleanser to hands and rub until dry. Use
  only a small amount- too much product will not
  evaporate and will result in a slimy or sticky
  feeling
• Do not alternate with soap and water-this will
  result in an increase in chapping and drying of
  the skin

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Alcohol-Based Hand Cleansers

• Let the patients see you use the product-it is a
  great patient satisfaction practice.
• Offer alcohol hand rub to patients prior to meals
  and after bathroom visits-also to family members
  who provide care.
• Pay close attention to nail beds and finger nails

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Artificial Nails

• CDC guidelines discourage the use of artificial
  nails in patient care settings. Bacteria can
  build up under the artificial nail, thus
  increasing the risk of bacterial contamination.
• SJHS policy states NO artificial nails or
  extenders (are to be) worn by RNs, LPNs,
  Physical Therapists in direct patient care.

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Radiation Safety

• Minimize time in radiation area
• Dosimetry Monitoring
• Do not place your body in the direct path of an
  x-ray field
• Wear lead aprons when around x-ray
• Stay as far from the source of radiation as
  practical
• Patient is a greater source for personal exposure
  than the x-ray

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MRI Safety

• Magnet is always on
• Move patient from the scanner to the holding room
  in the event of a Code Blue
• NO metal objects in the MRI scan room because it
  can cause serious injury/death
• Only MRI SAFE oxygen tanks and regulators are
  allowed in the MRI area. Patient beds and IV
  pumps are not MRI SAFE. Pumps must be removed
  prior to entering the MRI scan room.

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Isolation Categories
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Standard Precautions

• Assume all patients/body fluids are potentially
  infectious.
• Perform hand hygiene before and after contact
  with patient or patients environment
• Dispose of bio-hazardous waste in the proper
  container (sharps in sharps containers, etc.)
• Use sharps safety products and work practice
  standards to prevent exposures

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Standard Precautions

• Perform hand hygiene before and after each
  patient contact.
• Use Personal Protective Equipment (PPE) whenever
  there is a possibility of exposure to blood or
  body fluids (wear mask and eye protection when
  patient shows signs/symptoms of respiratory
  infection)
• Report all exposures immediately to your
  supervisor
• Clean all patient care areas regularly with the
  hospital disinfectant. Clean all spills
  immediately
• Handle soiled linen as little as possible and
  place in covered hamper

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Transmission-Based Precautions

• Serves the following functions
• Prevents the spread of infection
• Controls the spread of communicable diseases and
  drug resistant organisms

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Contact Isolation

• For patients with known or suspected diseases or
  conditions transmitted by direct contact with the
  patient or patients environment.

• Examples include
• MRSA
• VRE
• Clostridium difficile
• Shigella species
• Head and body lice
• Viral conjunctivitis
• Deep skin infections

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Contact Isolation Precautions

• Wear gloves every time you enter the room. After
  glove removal perform hand hygiene.
• Wear a gown when performing patient care
  activities or when in contact with patient
  environment. When the patient has diarrhea, a
  colostomy, an ileostomy, or wound drainage, wear
  a gown.
• Dedicate a thermometer and blood pressure cuff to
  the patient.

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Contact Isolation Precautions

• Limit the movement of the patient perform
  procedures in their room when possible.
• Teach the patient and family about hand hygiene.
• Communicate the need for contact precautions to
  all departments/staff.
• Frequently clean the room and patient care
  equipment using the hospital approved
  disinfectant.

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Airborne Precautions

• For patients with diseases or conditions
  transmitted by airborne droplet-nuclei including
• TB
• Chicken Pox
• Measles
• SARS
• Smallpox

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Airborne Precautions

• Keep the door closed.
• Limit all persons entering the room. (provide a
  surgical mask for visitors).
• Wear a N-95 respirator prior to entering the
  room. (Ensure you have been fit-tested for the
  respirator).
• Communicate airborne precautions to all
  departments and staff.

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Droplet Precautions

• For patients with known or suspected diseases or
  conditions transmitted by droplets produced
  through coughing, sneezing, talking, or laughing

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Illness Examples

• Examples of illnesses include
• Pertussis
• Influenza
• Virulent bacterial infections
• Meningitis caused by
• N. meningitis
• H. influenza
• Streptococcus group A
• Diphtheria

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Droplet Precautions

• Place a surgical mask on the patient or give them
  tissues to cover their mouth when moving through
  the hospital.
• Place patient in a room with a door. Keep the
  door closed.
• Wear a surgical mask when entering the room to
  perform patient care.
• Maintain a distance of 3 feet (arms length) if
  not wearing a surgical mask.

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Drug Resistant Organisms

• Things to remember
• Frequent hand hygiene
• Minimize indwelling time of invasive catheters
• Monitor the antibiotic appropriateness
• Observe proper isolation techniques
• Reduce risk of transmission through proper
  communication

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JCAHO 2008 National Patient Safety Goals

• Goal 1 Improve the accuracy of patient
  identification
• Goal 2 Improve effectiveness of communication
  among caregivers
• Goal 3 Improve the safety of using medications
• Goal 7 Reduce the risk of health care associated
  infections.
• Goal 8 Accurately and completely reconcile
  medications across the continuum of care
• Goal 9 Reduce the risk of patient harm resulting
  from falls
• Goal 13 Encourage patients active involvement
  in their own care as a patient safety strategy.
• Goal 15 The organization identifies safety risks
  inherent in its patient population
• Goal 16 Improve recognition and response to
  changes in a patients condition

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Improve the Accuracy of Patient Identification

• Have patient state their name and birth date
  (check armband) prior to meds, blood transfusion,
  lab specimen collection, any procedures or
  treatments.
• Prior to OR and invasive procedures, perform a
  TIME-OUT , ask patient to state their name,
  birth date, and planned procedure (check
  armband).
• Verify necessary paperwork in chart and
  equipment/supplies are ready.
• Check armband and verify with MAR, chart, or
  order

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Improve the Accuracy of Patient Identification

• Final verification process prior to start of any
  surgical or invasive procedure
• Time-out confirms
• Correct patient
• Correct procedure and position
• Correct site
• Readiness of the team
• ( Requires documentation)

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Improve the Effectiveness of Communication Among
Caregivers

• Verification and documentation of all
• Verbal and Telephone Orders and/or Critical Test
  Results
• Example of Telephone Order Read Back Verified
• TORB Dr. Smith/P. Jones, Office Clerk/Any Nurse
  R.N.
• Example of Verbal Order Read Back Verified
• VORB Dr. Smith/Any Nurse R.N.
• CRITICAL LABS Read back verified by MD to RN
• RBV/Dr. Smith/Any Nurse RN

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Improve the Effectiveness of Communication Among
Caregivers

• Use standardized abbreviations, acronyms and
  symbols. Do NOT use prohibited abbreviations,
  acronyms or symbols within the medical record.

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Prohibited List (do not use anywhere within the
medical record)
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Improve the Safety of Using Medications

• Always identify the patient using name and date
  of birth (2-identifier system)
• Always triple check medications
• Chart medications immediately after administering
• Double-check calculated doses or flow rates
  consider having another nurse or pharmacist check
  your calculations

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High-Alert Medications

• Potassium Chloride
• Neuromuscular Blockers
• Intravenous calcium
• Benzodiazepines
• Chemotherapy
• Lidocaine
• Vasoactive substances

• Parenteral narcotics
• Theophylline
• Anticoagulants (heparin)
• Insulin
• Magnesium Sulfate
• Digoxin

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High Alert Medication Issues

• Anticoagulants should not be administered for 2
  hours after an epidural catheter is removed
• Heparin doses that are miscalculated or sliding
  scale orders that are misinterpreted
• Benzodiazepines (sedatives) should be
  administered with caution to identified sleep
  apnea patients

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High Alert Medication Issues

• Teaching the patient and family that IV PCA is
  controlled by the patient and only the patient
  should be pushing the button for pain relief
• Nurses should avoid multiple forms of
  pharmacologic pain management for a patient (e.g.
  administering oral narcotic pain meds to a
  patient with an epidural)

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How Can Nurses Minimize Medication Errors?

• Complete the Medication Reconciliation Form
• If in doubt check it out!
• If unsure about a medication or a dose, contact
  the pharmacy before administering
• Carefully read all drug labels
• Never borrow medications from another patient
  or from drugs that need to be returned to the
  pharmacy

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How Can Nurses Minimize Medication Errors?

• Verify secondary tubing is unclamped after
  hanging
• Use only standardized abbreviations
• Always read back telephone orders to ensure
  accuracy
• Always clarify unclear verbal or written orders
• Never assume the physician has more information
  than you

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Medication Safety

• Label all medications, medication containers
  (e.g., syringes, medicine cups, basins) or other
  solutions on and off the sterile field in
  operative and other procedural settings

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Reduce the Risk of Health Care Associated
Infections

• CDC Guidelines
• Use alcohol rub upon entering and exiting
  patients rooms, prior to and after procedures
• Manage as sentinel events all identified cases of
  unanticipated death or major permanent loss of
  function associated with a health care-associated
  infection
• Wash hands with soap and water if visibly
• soiled or exposure to C-diff/anthrax or caring
• for an immuno-suppressed patient

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Accurately and Completely Reconcile Medications
Across the Continuum of Care

• Accurate documentation of all meds upon
  admission, transfer, and at discharge
• Place medication reconciliation form under MD
  order section in the medical record
• Fax to pharmacy once reconciled

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Accurately and Completely Reconcile Medications
Across the Continuum of Care

• Greatest risk at transitions of care
• Admission
• Transfer to lower or higher levels care
• Medical-surgical to critical care
• Critical care to surgery
• Telemetry to critical care
• Discharge

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Reduce the Risk of Patient Harm Resulting From
Falls

• Use interventions when patient is cognitively
  impaired
• Consider bedexit
• Ambualarm
• Bed check at SJE
• Assess and re-assess frequently
• Place falling star outside patients door on
  M/S and telemetry

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Reduce the Risk of Influenza and Pneumococcal
Disease in Institutionalized Adults

• Patients screened with the admission medication
  reconciliation form (MR-17ADM)
• Complete pneumococcal influenza vaccination
  assessment if unable to obtain information from
  the patient

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Encourage Patients Active Involvement in Their
Own Care as a Patient Safety Strategy

• Define and communicate the means for patients to
  report concerns about safety and encourage them
  to do so
• Safety posters/brochures placed in patient rooms
  and waiting areas

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Prevent Healthcare-Associated Pressure Ulcers

• Turn patients frequently
• Keep skin clean and dry
• Monitor skin closely
• Identify high risk patients

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Improve Recognition and Response to Changes in a
Patients Condition

• Rapid Response Team (SJH/SJE)
• Activate by calling hospital operator at
  extension 1111
• Team consists of a critical care RN and/or ARNP
  and a respiratory therapist

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We all have a role in ensuring the safety of our
patients

• Do your part!
• Apply the National Patient Safety Goals to your
  practice!

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Thank you for your time and effort to familiarize
yourself and your students with Saint Joseph
Health System

• Please remember to
• Print both the Faculty and Student Handbooks
• Complete and return required documents from both
  Handbooks to Educational Services
• Print the on-line rotation evaluations
• Thank you,
• Margie Fuller, RN
• Student/Faculty Coordinator
• Saint Joseph Health System
• 859/313-4493
• marjoriefuller_at_catholichealth.net