Agency and Travel Non-Employee Orientation Program

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Mercy Unity Hospitals

• Agency and Travel Non-Employee Orientation Program

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Welcome to Mercy Unity Hospitals Non-Employee
Orientation Program

• The following slides will aid you in preparing
  yourself to provide an excellent healthcare
  experience for our patients.
• To progress through the orientation information
  use the action buttons at the bottom right of the
  screen to proceed forward (right button) or
  backward (left button) by clicking on it with the
  mouse.
• While you are reading through these slides
  check-off your progress on the Non-Employee
  Patient Care Staff Orientation Checklist This
  form can be obtained from the site you found this
  program on or your agency. It is then to be
  returned to your agency upon completion of this
  program.
• We hope you find this information helpful and
  look forward to having you join our exceptional
  health care team.

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Contents

• Who Are We
• Mission, Vision Values
• Allina Hospitals Customers
• Accessing the Allina Knowledge Network
• Confidentiality / HIPAA
• Extraordinary Workplace with Extraordinary
  Employees
• Safety Awareness
• Infection Control
• Your Role in Restraint Use
• Vital Patient Care Issues
• Advanced Directives
• Medication Safety
• Documentation Overview
• Information Services and Clinical Systems

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Who We Are

• Mercy Unity Hospitals are part of Allina
  Hospitals Clinics
• Allina is a not-for-profit healthcare
  organization serving Minnesota and western
  Wisconsin
• Although we are not-for-profit, it is still
  necessary to watch the financial bottom line. We
  need to be able to meet the current and future
  needs of the communities we serve. We reinvest
  profits in new equipment and advanced
  technologies to better care for our patients.
• Allina Hospitals Clinics
• 13 hospitals
• 42 clinics
• Medical transportation services serving 70
  Minnesota communities
• Home care, Hospice, and Palliative Care

• Metro Hospitals
• Mercy
• Unity
• Abbott Northwestern
• United
• Phillips Eye Institute

• Regional Hospitals
• Buffalo
• Cambridge
• Owatonna
• St. Francis
• River Falls
• New Ulm

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What we strive for...

• Allina Mission
• We serve our communities by providing exceptional
  care, as we prevent illness, restore health and
  provide comfort to all who entrust us with their
  care.
• Allina Vision
• Put the patient first,
• Make a difference in peoples lives by providing
  exceptional care service,
• Create a healing environment where passionate
  people thrive excel, and
• Lead collaborative efforts that solve our
  communitys health care challenges.
• Allina Values
• Integrity - Match our actions with our words. We
  live our values and mission in all decisions and
  actions.
• Respect - Treat everyone with honor, dignity and
  courtesy. Respect values, cultures, beliefs and
  traditions of others. Value each others talents
  and contributions.
• Trust - We act in the best interests of out
  patients, physicians, communities and one
  another.
• Compassion - Dedicated to creating a healing and
  caring environment to support the emotional,
  physical spiritual well-being of all.
• Stewardship - Use our resources wisely. Commit
  to being thoughtful stewards of time, energy and
  talent.

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Living the Values

• Why is it that some patients can have poor
  outcomes and still say that they wouldnt go
  anywhere else for their healthcare?
• The difference is the relationships that we
  create with our patients.
• Its the customer service we provide.
• People come back to our hospitals because we live
  out our values and walk the talk-not just give
  them lip service.
• Customer Service Basics
• Creating an excellent experience where patients
  feel assured, included and appreciated.
• While much of our work is of a high tech nature,
  we know the importance of connecting with our
  customers on a human/emotional level when
  beginning and ending any interaction.
• Who are our customers?

• External Customers
• Patients
• Families
• Physicians

• Internal Customers
• Coworkers
• Other departments

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The impact of body language, voice, tone and words

• Are the words you are saying congruent with your
  body language and our tone of voice?
• Do we say one thing but project the opposite?
• Do we ask What else can I do for you? each time
  before we leave their room?
• When we breakdown communication, we realize that
• 55 of the message is our body language
• 38 of the message is our tone of voice
• 7 of the message is the actual words we use.
• To make the biggest impact, youre actions must
  match your words

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How to access policies on the Allina Knowledge
Network (AKN)

• All policies are located on the AKN, an
  intranet site which can be accessed using our
  network computers. Ask the charge nurse to show
  you this site during your first shift.

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Confidentiality

• HIPAAs Privacy Law

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Confidentiality

• Maintaining a patients privacy and
  confidentiality is not only the ethical thing to
  do, its the law.
• We are committed to preserving the
  confidentiality of patient information.
• The inappropriate use and or release of
  information will result in disciplinary action
  and possible legal action.
• HIPAA - The Health Insurance Portability and
  Accountability Act
• This revised Privacy Law places strict
  regulations around the privacy and security of
  patients health information.
• The law also mandates that we train everyone in
  the rules and provisions of this law.

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Protected Health Information

• PHI is basically any information that identifies
  an individual or could reasonably be used to
  identify an individual.
• This includes, but is not limited to
• Name, address, age or SSN
• Health history and conditions, treatment or meds
• Hospital or clinic bill or payment record
• Any identification that an individual is a
  patient.
• It can be in any form
• Verbal, written or electronic
• Past, present or future medical information
• Minimum Necessary Rule
• Minimum Necessary Rule We must only use and
  disclose the minimum amount of patient
  information needed to do our jobs.
• Simply put You may only ask for, use and
  disclose patient information as needed for
  legitimate patient care or business purposes.

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Curiosity Killed the Cat Dont let it get you!

• Sharing with others that you saw someone at the
  hospital or sharing of their health information
  may seem harmless to you- but it can be very
  harmful to the patient-and its illegal!
• You might be curious to look up information on a
  family member that is a patient here. Unless you
  need that information to do your job, you are
  prohibited from accessing that info.
• If in doubt, caution on the side of maintaining
  patient privacy.
• Release of Health Information
• We must have consent from the patient before
  giving any information to others, including
  spouse, family members, or friends.
• The inappropriate release of protected health
  information is illegal and we must address any
  harm that occurs because of its inappropriate
  release.
• You are held legally accountable to maintain a
  patients privacy and confidentiality.

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An Extraordinary Workplace with Extraordinary
Employees

• A Culture of Caring

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An Environment for Healing

• When patients see how well we treat one another,
  they will know this is a good place for healing.
• We cannot provide to patients what we are unable
  or unwilling to provide each other.
• If they see or hear uncaring behaviors, they will
  not find the healthy, healing environment they
  need.
• Create a Respectful and Professional Workplace
• Where You Would Want to Give and Receive Care

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Diversity

• Defined as all the differences and similarities
  that exist among people - including race, gender,
  age, sexual orientation, job status, physical
  differences, political affiliations and religious
  beliefs.
• We value the differing points of view, varied
  experiences and the talents of each and every
  person!

• Harassment Free Workplace
• We have a zero tolerance policy for harassment in
  all of its forms. Including, but not limited to,
  harassment based on
• Sex
• Race
• Age
• National Origin
• Religion
• Sexual Orientation
• Political Preference

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Key Points on Harassment

• Its the impact, not the intent.
• Whether or not you intended harm doesnt change
  the fact that someone was impacted by your
  actions or behavior.
• Direct or indirect, subtle or obvious
• Employees expect to work in an environment that
  is not hostile or intimidating. This includes
  jokes, slurs, pictures, comments anything that
  could be felt as harassment.
• It can take place at the workplace or at off duty
  related activities such as social gatherings or
  calls to your home.
• Act early and talk to the accused. Ask them to
  stop the behavior. If not resolved, escalate
  this situation by discussing with your leader or
  manager who will then investigate the activities
  with the assistance of human resources. If you
  are uncomfortable talking with the person contact
  your manager. If it is your manager that is the
  cause of the problem then speak with an human
  resource generalist.

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Safety Vision

• To make Mercy Unity Hospitals a safer place to
  give and receive care

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Minnesota Employee Right to Know Act (ERTK) 1983

• The law was passed to make sure employees are
  told about the dangers associated in working with
  hazardous substances and harmful physical or
  infectious agents.
• The law outlines both employer and employee
  responsibilities for safety from work related
  injury or illness.
• What does exposed to mean?
• You are considered routinely exposed to a
  substance or agent if there is a reasonable
  possibility youll be in contact with one of the
  items during the normal course of your assigned
  work.

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Employer Requirements

• Education of staff and new employees on
• The types of hazardous materials, agents and
  equipment in your work area.
• How to properly handle and work safely with the
  products.
• Where information about hazardous materials is
  located.
• Education specific to the materials/agents in
  your work areas will need to be covered during
  unit specific orientation. Material Safety Data
  Sheets can be located on the AKN, but clicking on
  the Safety button.
• Employee Requirements
• The law gives you the right to refuse to work
  under imminent danger conditions or if
  information or training about how to safely
  proceed with your job is not provided.
• Use personal protective equipment (PPE) available
  on each unit you will be assigned to. It is your
  responsibility to use this equipment when
  situations require protection. Ask the charge
  nurse if you have questions about the PPEs for
  that unit.

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What if Im asked to work in an unsafe situation?

• Tell the unit charge nurse if you feel a work
  situation may be dangerous
• Tell the unit charge nurse if you dont know how
  to use or handle hazardous materials and/or
  equipment.
• Report faulty equipment so it can be repaired or
  replaced.
• Dont put yourself in any situation where you
  could be injured or harmed. You have the right to
  refuse to work under dangerous conditions.
• What Happens Next?
• The unit charge nurse will
• Evaluate the situation for safety and the
  presence of hazards.
• Teach you how to safely use the product, direct
  you to the appropriate resource, provide you with
  learning materials, give you the appropriate
  Personal Protective Equipment.
• Reassign you to an alternate job until a
  hazardous condition can be corrected or
  eliminated.

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Chemical Spills/Release

• Each department maintains procedures for the safe
  handling and spill clean-up of the hazardous
  products used in their areas.
• You need to receive unit specific orientation on
  the hazards found in your area.
• With any chemical spill, you should notify the
  supervisor and maintenance.

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Locating information on Hazardous Substances
Chemicals
Material Safety Data Sheets (MSDS) provide
information on the effects and properties of
hazardous substances. These can be accessed on
the Allina Knowledge Network (AKN).
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Emergency Codes

• You might hear these emergency codes paged
  overhead, so it is important to know their
  meanings. Ask the charge nurse for your role
  when one of these codes is paged.
• Red Alert Fire Alarm
• Pink Alert Infant Abduction
• Code Blue Cardiac and/or
  Respiratory Arrest (All
• 
  ages)
• Green Alert Restraint Personnel Respond
• Orange Alert Disaster Plan in effect
• Yellow Alert Bomb Threat

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Severe Weather Codes

• Severe Thunderstorm Warning-conditions are
  favorable for severe weather
• Tornado Warning (phase 1) - a tornado has been
  sighted. Close windows, blinds and curtains.
  Keep corridors clear.
• Tornado Warning (phase 2) - hospital is in the
  path of the tornado. Move patients and visitors
  away from windows to interior corridors closing
  all doors. Visitors should stay with the
  patients and staff should move the the best
  shelter in the department.

• Fire Safety Essentials in
• Your Department
• You will need to locate this information in the
  areas you work.
• Location of the fire alarm pull boxes
• Location and type(s) of extinguishers
• Emergency phone number x63333
• The stations main oxygen shutoff valve(s)
• Evacuation plans and routes

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R.A.C.E.
Rescue

• Rescue Move anyone in danger to a safe area.
• Alert Pull fire alarm box and call x63333 to
  report the fires location.
• Confine Close doors windows in area, clear
  corridors and fire exit areas.
• Extinguish Fight the fire only if it will not
  place you in danger. Blankets can be used to
  smother the flames of small fires or waste basket
  fires as well as using extinguishers.

Alert
Confine
Extinguish
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How to Use Extinguishers

• Know the types of extinguisher in your work
  area. Choose the appropriate extinguisher for
  the type of fire.
• Then
• P Pull-the pin
• A Aim-the extinguisher
• S Squeeze-the handle
• S Sweep-the extinguisher hose at the base of the
  fire.

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Patient Safety Initiatives

• To provide our patients with a safe healing
  environment we have initiated safety goals around
  the care of the patient. Some of the goals you
  should become familiar with include
• 2 Patient Identifiers
• Unacceptable abbreviations
• Clinical Alarms
• Time Out Surgical Site Marking
• Reduce hospital acquired infections hand hygiene
• Fall Risk Reduction
• Increased Patient Involvement in their own Care
• Suicide/Violence Risk Assessment
• Verbal Order Read Back and Telephone Order Read
  Back
• Sound-alike and Look-alike Medications
• Hand Hygiene
• Medication Reconciliation
• We will discuss several of these initiatives on
  subsequent slides. Please talk to your preceptor
  or charge nurse about the remaining initiatives.

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• Matching the right patient to the right treatment
  or service
• When obtaining blood samples or administering
  medication or applying the patients armband, two
  patient identifiers will be used to compare to
  the same two printed identifiers on the lab
  request, medication record, or patients medical
  record.
• Patient Identifiers Include
• Patients stated name and date of birth are
  compared against the printed name and DOB on the
  medication record, specimen label, or medical
  record.
• Patients unable to state their name and DOB
• Verification by a family member
• Verification by carefully matching the name and
  DOB on the wristband with the same info on the
  medical record, specimen label.
• A patient room number will never be used as a
  method of patient identification or verification.
• Exception to above is the administration of blood
  products. In this instance, use patient name,
  birth date and social security number.

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Unacceptable Abbreviations

• We have developed a list of abbreviations that
  are not approved for use within the medical
  record (documentation, notes or orders).
• Orders written with an unacceptable abbreviation
  will not be accepted or executed.
• Unacceptable orders will be clarified by the
  nurse and documented as a verbal order before
  executing.
• Ask the unit charge nurse for more information
  regarding unacceptable abbreviations
• Clinical Alarms
• Goal Improve the effectiveness of clinical
  alarms.
• Examples of clinical alarms are cardiac monitor
  alarms, fetal monitor alarms, apnea alarms, door
  alarms, elopement / abduction alarms, infusion
  pump alarms, bed alarms, bathroom alarms or
  respirator alarms
• Clinical Alarm Considerations
• Clinical alarms are basically all patient care
  equipment containing alarm functions
• Alarm functions should be managed/adjusted by the
  assigned staff RN or other hospital designee.
  Collaborate with the charge nurse if you are
  having difficulty setting/adjusting alarm
  parameters with your patients.
• Alarm policies are practiced
• If an alarms fails, a Patient/Visitor Safety
  Report is completed, Risk Management is notified,
  and the equipment is immediately sent to Clinical
  Equipment Services (CES) for evaluation

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Time Out

• Goal Eliminate wrong site, wrong patient, wrong
  procedure/surgery. Done prior to local
  injection/incision/start of procedure
• Surgical Site Marking The surgical site is
  marked for correct site and laterality, per
  policy.
• Time Out The circulating RN reads the
  patients full name and procedure including site
  / side, from the consent form. All members of
  the surgical team listen and confirm the correct
  procedure, patient, surgical site and side
  (laterality).

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Safety Ethical Situations

• If you encounter a potential hazard or unsafe
  situation in our hospital or if you have an
  ethical concern regarding our practices or a
  patient care situation, you should discuss this
  with the charge nurse.
• We encourage reporting of safety concerns,
  incidents, hazards and ethical concerns.
• We have committees and processes in place to
  address these issues and make changes when
  appropriate.
• Concerns reported to the charge nurse may be
  escalated to the unit leadership.
• You may be asked to complete a Patient/Safety
  Visitor Report or Area of Concern Form to
  document the events.
• When in doubt fill it out!

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Safety Contacts

• Security Manager
• Employee Safety Specialist
• Patient Safety Director
• 763/236-SAFE
• Phone Numbers can be found on each unit.

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Infection Control
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Where do germs come from?

• Environment
• surfaces
• floors
• gardens
• People
• skin
• intestines

• Equipment
• Water
• Flowers/plants

Chain of Infection
All links must be complete for an organism to
spread from one place to another. Our goal is to
break the chain in one or more links.
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Risk of Transmission

• Intact skin is a good barrier to organisms but
  remember that organisms can enter through
  non-intact skin (cuts, scrapes, eczema)
• Mucous membranes allow transmission, such as
  through
• eyes
• nose
• mouth
• Most transmission occurs through contact
• Direct contact- touching patient
• Indirect contact - touching a contaminated
  surface
• Spray/splashes Fluids, sputum, etc
• Most contact is with our hands

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Hand Washing

• Hand washing is the single most effective way you
  can break the chain of infection.
• Hand Washing Basics
• Soap - Use only hospital approved soaps, lotions
  foam products.
• Warm running water
• 15 seconds sing the ABCs song or Happy
  Birthday twice
• Use friction
• Turn off faucet with paper towel.
• Waterless Hand Washing (Quik-Care Alcohol foam)
• Preferred method of hand cleaning if hands are
  not visibly soiled or contaminated with blood or
  body fluids.
• Dispense a walnut size amount and rub hands and
  under nails until dry.
• Use before and after every patient contact or
  contact with contaminated equipment.
• Contains emollients, therefore is better for your
  hands and is less drying to hands than soap and
  water.
• The emollients can build up on the hands after
  repeated use, so, wash with soap and water
  occasionally.
• Lotion
• Accent Plus is the hospital approved lotion which
  is compatible with hospital microbial soap and
  gloves.
• Use at least 3-4 times each shift.

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Artificial Nail Restriction

• This restriction must be followed by everyone who
  has direct patient contact, cleans rooms, handles
  patient supplies, prepares or serves food/drinks,
  handles medications or blood products.
• Artificial nails including tips, wraps, overlays,
  acrylics, gels, any appliques, nail piercing,
  nail jewelry or any other artificial nail
  enhancements of any kind are not allowed in our
  facility.
• Natural nails must be kept 1/4 inch or less.
• Blood Spills
• Potential exposure to blood or body fluids could
  occur at any work site
• There is a plan in place for each work site
• Guiding principles of each plan
• Avoid direct contact with body fluid.
• Wear gloves.
• Cleanup Twice once for the spill and once to
  disinfect the area.
• Remove gloves
• Wash hands.
• Allow area to air dry e.g. 10 minutes

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Standard Precautions

• Standard Precautions considers all patients as
  potentially infectious.
• Prevent exposure to infectious organisms by
  wearing Personal Protective Equipment (PPE) when
  contact with the following is anticipated
• blood
• body fluids, secretions and excretions
• non-intact or broken skin
• mucous membranes
• Personal Protective Equipment (PPE)
• PPE is located in all patient care areas. Exact
  location should be sought out during unit
  specific orientation.
• Gloves - to keep hands clean
• Gowns - to protect uniform from getting splashed
  or wet
• Facial protection - to protect mucous membranes
  from getting splashed or sprayed

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Other Infection Control Issues

Issue Implementation Resources
Transmission-Based Precautions Second tier of Infection Control Precautions assess each patient for need and print custom document Droplet Contact Resistant Organism Contact Other Airborne TB Airborne - Other Infection Control Precautions policy and procedure on AKN
Post Blood/Body Fluid Exposure Initial assessment and treatment will be done Complete Employee Exposure Report form Report to EOHS Other times report to ED Allina EOHS policies on AKN
Cleaning of environmental surfaces and spill clean-up Quaternary ammonium compound Infection Control Precaution policy and procedure on AKN
Sharps Containers Most are wall mounted in holder some free standing in stabilizer at patients bedside everyone is responsible for change out when fullness criteria are met Infection Control Precautions and Waste Management policy and procedure on AKN
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Other Infection Control Issues
Issue Implementation Resources
Safe Needle Devices Safety IV start catheters, lancets, butterfly needles, vacutainer needles, injection needles, blood transfer device, blood collection device, scalpel, fetal electrodes needleless IV tubing system. activate device immediately after use place in sharps container Infection Control Precautions policy and procedure on AKN
Infectious Waste Management Items containing and saturated with blood and regulated body fluids place in red bag place sharps in sharps containers place bags and sharps containers in infectious waste barrel As above and Waste Management policy and procedure on AKN
Tuberculosis Special Airborne Precautions Negative pressure room Respiratory protection using N95 respirator mask or PAPRs (fit testing required) DO NOT care for patient provide support outside of patient TB Exposure Control Plan on AKN
Neutropenic Patients Neutropenia Precautions Do not care for patient when ill Infection Control Precautions policy and procedure on AKN
Patient Linen Bag used linen in universal linen bag, close bag and place in linen chute As above
Patient Care Equipment Reprocess (disinfection/sterilization) between patient uses or discard disposables into appropriate waste stream As above
MN Employee-Right-to-Know Law OSHA Bloodborne Pathogens Rule Incorporated into Infection Control Precautions OSHA Exposure Control Plan and MN ERTK policy and procedure on AKN
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Location of Exposure Control Plan and Infection
Control Policies
The Allina Knowledge Network (AKN) Ask your
charge nurse about access to the AKN.
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Patient Care Orientation
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Your Role In Restraint Use

• The restraint event begins with the RN
  assessment. Other disciplines contribute data to
  this assessment.
• Alternatives to Restraints
• Each department has its own set of restraint
  alternatives that they have chosen for use with
  their patient populations. Alternatives must be
  trailed and documented before restraints can be
  considered. Each policy has a list of restraint
  alternatives.
• Mercy and Unity have 3 types of restraints
• Waist Restraint disposable
• Velcro Tying Restraints disposable
• Velcro Locking Restraints cleaned and reused
• There are 7 points of restraint taught to the
  staff as well as positioning the patient on the
  bed.
• 1 point waist restraint
• 2 points most frequently are the two wrists
• 3 points waist and wrists
• 4 points ankles and wrists
• 5 points ankles, wrists and waist
• 7 points ankles, wrists, waist and biceps
• The patient can be positioned face up or face
  down based on status. When ankles are in
  restraints they should be anchored straight to
  the bottom of the bed and not spread eagle to
  the sides of the bed.

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Restraints Continued

• Safe discontinuation Restraints will be removed
  one at a time as the RN assesses the patients
  readiness for restraints to be removed. The
  patient must never be in one point of restraint
  unless that is a waist restraint. When a patient
  is in four point restraints the RN should remove
  an ankle or wrist first. The next restraint
  removed must be the opposite limb for example
  if the right wrist is removed the next restraint
  removed is the left ankle. The time of
  discontinuation must be charted.
• There are two restraint policies (AKN)
• Restraints for Non-Behavioral or Acute Medical
  Surgical Care
• Restraint/Seclusion for Behavioral Management of
  Patients
• There are basically 3 exclusions to the policies
• Devices used to aid with positioning and/or keep
  immobilized during medical, dental, diagnostic or
  surgical procedures.
• Adaptive/supportive devices, such as braces,
  orthopedic appliances which are used for
  voluntary support to achieve proper body position
  or alignment.
• Use of forensic restraints (such as handcuffs or
  shackles) applied by law enforcement officials.

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Restraints Continued

• Restraints for Non-Behavioral or Acute Medical
  Surgical Care (AKN)
• This policy is used for anticipated situations
  when there is a need to restrict the patients
  free movement and access to the tubes, drains,
  etc. (Restraint during detoxification is to
  follow the medical/surgical restraint policy.)
• The order is for 24 hours and the preprinted
  order set must be used. The MD will authenticate
  the order within 24 hours along with their face
  to face assessment of the patient and the need
  for continued restraint on this preprinted order
  set.
• The patient will receive the following cares at a
  minimum
• Q hour CMS
• Q 2 hours Fluid, elimination and repositioning
• TID and PRN Food
• Q12 hours ADLs and hygiene
• Cares are documented on the flow sheet.
• The MD will complete a face to face assessment
  for continued need every 24 hours.
• RN re-assessments are done q 8 hours.
• If after a period of time without restraints the
  patient needs to have them re-applied, a new
  order must be obtained.

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Restraints Continued

• Restraint/Seclusion for Behavioral Management of
  Patients (AKN)
• This policy is for unanticipated situations of
  sudden aggressive behavior that could result in
  harm to self or others.
• The order is age dependent there are order sets
  for each age group. The MD will authenticate the
  order within 24 hours.
• A MD Face to Face Assessment is completed within
  1 hour after the restraints have been applied.
• Care for the patient includes 11 staffing the
  entire time they are in restraints and cares
  given the same as the acute med/surgical policy.
  The patient will be checked every 15 minutes and
  those checks documented.
• The order renewal and face to face MD
  reassessment are guided by the age of the patient
  as follows
• Order Renewal
• Adult (18 yr.-older)
• Adolescent (9-17 yrs)
• Child (under 9 yrs.)
• Face to Face Assessment
• Adult Q 8 hours
• Adolescent and child Q 4 hours
• Once restraints are released the patient will
  have a debriefing with the staff and it will be
  documented in the chart. The family, patient and
  staff will also have a debriefing and it will be
  documented as well. The only exception is if the
  patient does not want the family involved.

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Final Restraints Comments

• Notify hospital leadership if the patient remains
  in restraints for more than 12 hours. They will
  be involved in reassessment of the need for
  restraints. During the day it is the Nurse
  Manager, on other shifts it is the Administrative
  Supervisor.
• If the order for restraint was obtained from an
  MD that is not the attending physician, then the
  attending must be notified. The attending will
  have more information about the patient that may
  impact the continued use of restraints.
• Remember to document and get credit for all the
  alternatives that you attempt before during and
  after restraint are utilized.

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Vital Patient Care Issues

• Patient Bill of Rights
• Patients have the fundamental right to receive
  considerate healthcare that safeguards their
  dignity and respects their cultural,
  psychological and spiritual values
• The Patient Self-Determination Act of 1990
• What is it?
• A Document based on a law that states the rights
  that patients have while in a facility
• Available in 6 languages and Braille.
• Why is it Important?
• The law requires that all patients or their proxy
  receive this information upon admission.
• Patient Registration Department gives the patient
  the document.
• What do I do?
• Verify and Document that the patient or proxy
  received the document.
• Explain that these are their rights as a patient.
  
• Ask them to read it.
• Document on medical record that you did this.
• Answer any questions they may have.

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Vital Patient Care Issues

• Grievances
• What is it?
• A verbal or written complaint that cannot be
  promptly resolved to the patients satisfaction
  by staff present
• Why is it important?
• It is a patient right
• It is a customer service issue.
• What do I do?
• Try to promptly resolve the issue by the staff
  present (with-in your scope of practice).
• If not resolved, give patient the options of
  talking to the Patient Rep, Manager, or
  Administrative Supervisor, or to the Office of
  Health Facility Complaints (OHFC) listed in the
  Patient Bill of Rights
• Vulnerable Adult
• What is it?
• All patients in a health care facility are
  considered to be vulnerable.
• Why is it important?
• It is a MN Statute/ law.
• What do I do?
• If patient alleges Abuse, Neglect, Harassment or
  Maltreatment while hospitalized-
• Assure patient safety immediately

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Vital Patient Care Issues

• Informed Consent
• What is it?
• Informed decision making and consent is required
  for all medical procedures and treatments with
  more than slight risk, or that may change the
  patients body structure.
• Why is it important?
• To assure that the patient has adequate
  information in order to engage in informed
  decision making regarding their treatment. Use
  of the Verification of Informed Consent Form is
  required to verify all surgical, invasive
  cardiac, endoscopic procedures and any procedure
  requiring biopsy of tissue or use of sedation
  that results in loss of protective reflexes.
• What do I do?
• Hospital staff preparing the patient for the
  procedure will verify the procedure, site or
  side, and the patients understanding of the
  proposed procedure and document on this form.
  The form is a two sided form one side is
  completed by the MD (informed consent), the other
  side is signed by the patient and witnessed by
  hospital staff (verification of informed
  consent).

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Vital Patient Care Issues

• And Finally
• Sentinel Events A sentinel event is defined as
  any unanticipated death or serious injury
  resulting in a major permanent loss of function
  not attributed to natural course of affected
  persons illness or underlying condition or
  an event such as infant abduction, hemolytic
  transfusion reaction, surgery on wrong patient,
  wrong body part, medication error resulting in a
  life threatening affect on health status.
• All employees are responsible to immediately
  report to their supervisor any patient events
  that met the definition of a sentinel event and
  complete the appropriate form. An initial
  investigation will occur within the first 36
  hours of the event.
• A near miss is a significant event that could
  have been a sentinel event. These should also be
  reported so that processes can be re-evaluated to
  prevent future misses or sentinel events.

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Advance Directives

• Key Points to Consider
• The admitting nurse must ask all inpatients if
  they have an Advance Directive (AD) and, if not,
  whether they would like additional information or
  assistance.
• No patient is required to have an AD.
• Completing an AD while the hospitalized may not
  always be the most appropriate time or place. It
  may be more appropriate for the patient to take
  the forms home following discharge so the patient
  has the option to discuss their wishes with
  family, clergy and Medical physician.
• DNR and DNI status is independent of, but can be
  a component of, Advance Directives. A patient
  does not need to have an AD to request DNR or DNI
  status, nor is DNR or DNI always a component of a
  patients AD.

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Advance Directives Continued

• If the patient has an Advance Directive
• Obtain a copy from the patient or their old
  medical record. If a copy is not available,
  document on the pathway your efforts to obtain
  the AD from the family.
• Nurses should place the AD in the most current
  medical record and must verify that it
• Reflects the patients current wishes and
• That it is a valid (written, dated, patients
  name and signature is notarized or witnessed, it
  contains healthcare directives and /or the names
  of the agent or proxy.
• If a patient wants DNR or DNI status, contact the
  MD. An order from the physician is required
  prior to implementing DNR or DNI status. Verbal
  or telephone orders require two RNs.
• If the nurse is unable to reach the MD or is
  unsuccessful in obtaining a response from the
  physician, they must communicate/escalate the
  issue to a higher authority to obtain MD follow
  through.

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Advance Directives Continued

• If the patient does not have an Advance
  Directive
• The admitting nurse must ask if the patient wants
  additional information
• If the patient says no, document on flow-sheet or
  in Notes section.
• If the patient says yes, provide with Allina
  Advance Directive booklet.
• If the patient has questions or requests
  assistance, consult chaplain, social worker,
  administrative supervisor, or a member of the
  ethics committee. Remember patients are not
  required to complete the form.
• If a patient says yes, but they would like to
  take it with them, document on flow-sheet or in
  Notes section.
• If the patient chooses to complete the form, then
  place the completed form on the front of the
  shadow chart and inform the physician.

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Information for Non-Employee Staff Assigned to
Patient Care

• Dress Standard
• Nametag with employee name, job title and photo
  must be work at all times.
• All clothing must be neat, clean, well fitting,
  non-transparent, in good condition. Employees
  are to be free of offensive odors (including
  perfumes and colognes).
• Appropriate barrier clothing, including masks and
  eyewear, is work in accordance with infection
  control precautions.
• You may wear scrub uniforms or dresses, culottes,
  or pants and tops with sleeves, except ceil
  blue. A warm-up jacket with any matching print
  is acceptable.
• Point of Care Testing
• Non-employees may not perform point of care
  testing.
• Wireless Phones
• All caregivers will sign out a phone at the
  beginning of the shift.
• Return phone prior to the end of the shift.
• Answer phone, identifying self by name and title.
• Confidentiality is to be maintained at all times.
• Clean phone with disinfectant prior to use.

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Information for Non-Employee Staff Assigned to
Patient Care

• PATIENT SAFETY
• Physical Safety
• Call lights will be placed within easy reach of
  the patient.
• Beds will be kept in low position.
• Bed wheels will be kept in locked position except
  during transport.
• Floors will be kept free of spills.
• All ambulatory patients will use foot coverings.
• Restraints/seclusion will be implemented
  following the Patient Care Policy on restraints
  and seclusion.
• Equipment
• Faulty equipment is reported to Facility
  Operations or Bio-Medical Departments immediately
  and tagged out of service.
• Equipment brought from home by patients is
  limited to personal care items, such as electric
  razors and hair dryers, and must be checked by
  Bio-Med.
• Risk Management Safety Reports
• Any incidents with a potential or actual adverse
  occurrence involving patients, families,
  visitors, volunteers, physicians, employees, or
  students must be reported. Patient Visitor
  Safety Report is the tool used to document the
  event.
• A visitor with an obvious injury due to an
  incident on hospital property is to be encouraged
  to be evaluated by a physician in the Emergency
  Department.
• Notification of incident is to include the charge
  nurse, department manager and/or the
  administrative supervisor.

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Information for Non-Employee Staff Assigned to
Patient Care

• STAFF SAFETY
• Personal Injury and Potential Health Hazards
• Questions or incidents related to personal injury
  or potential health hazards are to be referred to
  Occupational Health Services and/or
  Administrative Supervisor.
• Responsibility of Non-Employee Nurse
• Non-employee nurses will function within the
  guidelines identified by the unit charge nurse in
  accordance with the hospital policies and
  procedures.
• Non-employee nurses will not be responsible
  forDischarge planningCharge nurse functions
• PROCESS FOR WORK ASSIGNMENTS
• Report to the Staffing Office 30 minutes prior to
  the start of the assigned shift. Be ready to show
  your nursing license and picture identification.
• BLS certification is verified prior to
  assignment.
• Check with the charge nurse for assignment and if
  this is new unit for you then orientation to the
  physical layout of the unit is needed, as well as
  any populations specific considerations.
• Complete billing slip/timecard and present to the
  staffing office for a signature before leaving
  the facility.
• The Administrative Supervisor must approve all
  overtime prior to working overtime.

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Medication Safety

• Allinas Nine Principles for Medication Safety
• Do no harm
• The Five Rights
• Right Patient
• Right Medication
• Right Route
• Right Dose
• Right Time
• Nothing is taken for granted
• Communication clarify, ask questions
• Teamwork work with MD, pharmacist and patient.
• Report chart significant patient information,
  medication given or omitted on Medication
  Administration Record (MAR)
• Safety is a system
• Engage the patient
• Inform the organization complete the
  Pt./Visitor Safety form, do not record your
  completion of this on the pts. medical record, do
  not speculate to the cause of the event on your
  charting
• Learning is the goal of medication safety

59
Medication Safety

• Safe Delivery Principles
• Protocols for high risk medications
• NO KCL on units
• Patient information _at_ point of care
• Pharmacist on rounds
• Allergy wrist bands
• Computerized MARs
• Bar coding

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Medication Safety

• High Risk Medications
• Heparin/anticoagulants (requires 2
  signatures)
• Insulin ( requires 2 signatures)
• PCA Pumps (requires 2 signatures)
• Antibiotics (IV)
• Concentrated electrolytes (KCL)
• Benzodiazipines
• Narcotics
• Chemotherapy
• Anyone Writing Orders
• Please DO
• - Write clear legible orders
• - Date and time all orders
• - Print your name under your signature
• - Use leading zeros when writing decimals (0.1)
• - Telephone/Verbal order read back (TORB / VORB)
• Please DO NOT

61
Documentation Overview

• Mercy and Unity Hospital nursing units utilize
  Excellian, a computerized medical record system.
• There are general documentation consideration
  that pertain to both hospitals and both systems.
• General Documentation Guidelines
• Review Electronic Medical Record Documentation
  policy
• RN only
• Assess and document changes in patients
  condition, as well as responses to interventions
• Focus notes-should be documented through the
  patients care plan
• General Tips
• Review and sign Referral/Transfer formsPhysician
  signs all pages
• Review and sign all Discharge Instruction
• Focus note all unmet outcomes at discharge
• ETOH Assessments per protocol

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Documentation Overview

• Documentation Time Frames-
• These are Medical Surgical parameters this
  differs on specialty units
• Complete physical assessment within 2 hours
• Admission History within 8 hours reassessment
  of patient every 8 hours
• Pain Assessment Upon admission, at least every 8
  hours and upon discharge. Reassess after every
  pain medication or intervention administered.
• Focus Notes Upon admission, discharge, transfer,
  new findings, significant events, physician
  notification, response to plan of care at a
  minimum of every 24 hours. Use DAR format (D-
  data, A action, R response). Some Smart Text
  notes are already in DAR format.

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Documentation Overview

• Other assessments areas and issues
• Bill of Rights
• Advanced Directives/Health Care Directives
• Domestic Abuse Assessment - Patient must be alone
• Medication History
• Functional Status Assessment
• Nutrition Assessment
• Skin Assessment determined by Braden Risk Score
• Fall Risk Assessment
• Suicide and Violence Risk Assessments
• Latex Allergy Assessment
• Pain Assessment and Management
• Patient and family education
• Assessment/Reassessment
• Discharge planning
• Patient Transfer forms and EMTALA forms
• Utilize your colleagues and leaders on any and
  all documentation questions or concerns.

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In Closing...

• Final Considerations

65
Department Specific Orientation Checklist

• Minimally, your department specific orientation
  should include the following items
• Location of
• Crash Cart
• Emergency Equipment
• Fire Safety
• Personal Protective Equipment
• Evacuation Map
• Orientation to
• Documentation process and related technology
• Medication administration and related technology
• Accessing policies, procedures and other
  resources
• Hospital and unit care quality improvement
  initiatives
• Demonstration of quick release tie and
  application of locking restraints (required for
  anyone working with patients).

66
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