Agency Orientation Packet - Carroll Hospital

NURSING STUDENT

ORIENTATION PACKET

2013 - 2014

Welcome to Carroll Hospital Center

This presentation will provide you a

foundation of knowledge as you begin your

Student Rotation here at

Carroll Hospital Center.

JOURNEY TO EXCELLENCE

L E S L I E S I M M O N S , R N

P R E S I D E N T O F C A R R O L L H O S P I T A L

C E N T E R

TODAY…

Carroll Hospital Center :

• Has more than 400 physicians on its medical

staff representing over 35 medical specialties

• Has over 1,800 employees is the second largest employer

in Carroll County

• Has an annual budget in excess of $175 million

• Annually serves more than 300,000 individuals with

direct medical care, outreach and community programs,

diagnostic and outpatient services and health screenings

Mission – Our Communities expect and deserve excellent medical treatment, compassionate care and expert guidance in maintaining their health and well-being. At Carroll Hospital Center, we offer an uncompromising commitment to the highest quality health care experience for people in all stages of life. We are the heart of health care in our communities.

Vision – Founded by and for our communities, Carroll Hospital Center will help people maintain the highest attainable level of good health throughout their lives. We strive to be the best place to work, practice medicine and receive care. Our commitment is to be the hospital of choice.

CHC BUSINESS INITIATIVES VS PILLARS

CHC Business

Initiatives

Customer Service

Innovation

High Quality

Right Cost

People Growth

Pillars of Excellence

Service

People

Quality

Financial

Growth

Community

PILLARS OF EXCELLENCE

•Found on the Ground Floor near the

cafeteria

•Contains vital information regarding

our clinical indicators

•Also known as the “Dashboard”

INTRODUCE YOURSELF:

• To the Staff

• To the Manager

• To the patient if you are involved in

patient care

DRESS CODE

• Dress according to the department where you will be. (no

jeans or shirts with offensive) Or use a school approved

uniform with name pin/badge visible.

• Piercings are limited to 2 post piercings in each ear.

• Tattoos should be covered.

• Cell phones are to be silenced while at the hospital.

PAIN MANAGEMENT

If a patient complains of pain

to you, inform the patients

nurse so that she can get

something to make the patient

more comfortable.

SAFE MEDICATION :

HIGH RISK DRUGS

WHY ARE WE EMPHASIZING

HIGH-RISK MEDICATIONS?

These medications are associated with significant risk

of causing serious injuries or death, when used in

error. Special consideration should be taken when

giving these medications.

ISMP (INSTITUTE FOR SAFE MEDICATION PRACTICES)

STATED THAT…

“Errors with these medications are

not necessarily more common but the

consequences are clearly more

devastating.”

YOU NEED TO…

Teach your patient the reason why

this medication is being administered

Explain significant side effects they

may experience

Describe special precautions that

must be followed while on this

medication

Document the teaching and the

patient’s response to teaching

FIRST, AS A REFRESHER, LET’S LOOK AT

SOME DEFINITIONS:

Therapeutic Range- is the range of drug levels within which most patients will experience significant therapeutic effect without an undesirable degree of toxicity.

PT/INR- (International Normalized Ratio) a system established by the World Health Organization for reporting the results of blood coagulation tests. All results are standardized using the international sensitivity index for the particular thromboplastin reagent and instrument combination utilized to perform the test.

THERE ARE MANY MEDICATIONS

IDENTIFIED BY THE ISMP AS HIGH

RISK…

To make it easy, we will use the acronym

CHICKEN

WATCH OUT FOR THESE HIGH

ALERT MEDICATIONS

C OUMADIN

H EPARIN

I NSULIN

C HEMOTHERAPY

K Cl

E NOXAPARIN

N ARCOTICS

LESSON #1:

DON’T GET

FRIED!

WATCH YOUR

HIGH ALERT

DRUGS!

LOOK ON THE MAR…

For instructions

addressing

administration and

monitoring information

addressing

“CHICKEN” drugs.

AT CARROLL HOSPITAL CENTER…

….our Medication CPT

has identified some specific

medication that we will

focus on here!

CLASSIFICATION: ANTICOAGULANT

Warfarin (Coumadin)

Monitor PT/INR daily or as needed

HOLD if INR is above the high end range

Inform Physician

REMEMBER….

You must record the most

recent PT/INR on the

medication record (MAR)

prior to administering the

drug.

WHAT IS THE THERAPEUTIC RANGE FOR

COUMADIN YOU ASK??

PT within desired range…1.5- 2 times the control

INR, 2.0-3.0 with standard therapy (venous

thrombosis, pulmonary embolism, prophylaxis for

DVT)

With other conditions like prosthetic valves INR

would be 2.5-3.5

CLASSIFICATION: ANTICOAGULANT

Enoxaparin (Lovenox)

The first dose cannot be given until 1-2 hours after

heparin IV is finished

This drug is given every 12 hours or 24 hours as

ordered

IMPORTANT POINT!

If the patient is already

taking Lovenox, do not

start Heparin until 12 hours

after the LAST Lovenox

dose!

CLASSIFICATION: ELECTROLYTE BALANCE

Replacement

Potassium (K+)

If the serum K+ is greater then 5.5 the medication must be held, and the nurse must inform the physician

Record the most recent serum K+ on the MAR

Check magnesium level, it must be normal to treat hypokalemia


Please Note:

A common cause of low K+ is K+

free IV fluid. You can recommend to

the physician to add 20meq KCL per

liter of IV fluid if K+ is low, the IV

fluids do not contain KCL and if renal

function is normal.


But… remember to hold

KCL if your patient is

receiving Kayexalate


Potassium-removing resin

Kayexalate (sodium polystyrene sulfonate)

Monitor daily serum potassium level

Hold and inform physician when potassium level is 4-5 mEq/L

Record serum potassium level on MAR prior to giving drug


Magnesium Sulfate (in FBP)

Magnesium sulfate is double checked in L&D.

ADD Click below to see the Patient Care Guideline for more information.

ADD Click below to ISMP Med Safety Alert June 2006

CLASSIFICATION: CARDIOTONICS

Digoxin

You will need to assess the most recent digoxin level prior to

administering this drug.

If level >2.0, hold medication and inform Physician.

Assess and record heart rate on MAR prior to administering this

drug.

If heart rate < 60 bpm or order specified by Physician, do not

give this drug.

CLASSIFICATION: ANTI-DIABETIC

Metformin

The most recent serum creatinine level must be documented

on the MAR.

Hold medication if creatinine is 1.4mg/dl or > in a female

or 1.5mg/dl or > in a male. Inform physician.


Metformin

Hold medication if:

Patient is in metabolic acidosis

Patient is to receive iodinated radiologic contrast media.

Continue to hold until 48 hours after the procedure and serum creatinine is repeated and found to be normal.


Did you know?

You should monitor for Signs and Symptoms of hypoglycemia (fatigue, excessive hunger, sweating, & numbness of extremities)

Hold insulin for fasting blood sugars

< 70mg/dl or if patient is not eating or receiving external/parenteral nutrition.

Insulin must be discarded 30 days after first use, please remember to date when opened.


Insulin

Syringe, MAR and bottle must all be checked by another nurse, for proper product and dosage prior to administration.

Doses > 50 units must be checked w/prescriber before administration.


Does the chart on the next slide look familiar?

It is our current list of insulins used.

Take a minute to review it.

1. Hydromorphone (Dilaudid)

This drug is 3-5 times more potent than morphine!

See PCG for dosing.

2. PCA/PCEA pumps

Two nurses are required to check programming, dose

changes, and waste.

CLASSIFICATION: NARCOTICS

THAT’S NOT ALL FOLKS…

More information can be obtained through the

PDR, Nursing Drug reference on your unit,

particular PCG or consulting a Pharmacist.

Environment of Care

(EOC)

EMERGENCY

RESPONSE CODES

Know your responsibilities as a

student during all of the emergency

response codes reviewed in this

program.

Identify each code and what it

represents.

Code

BRT

The State of Maryland

adopted these codes to be

used universally throughout

Maryland hospitals

Emergency codes provide a system

to manage unexpected situations

that may occur on our campus.

Everyone should know how to

report an emergency.

To activate ALL CODES call

Extension 4444.

Let’s review the Codes

utilized at

Carroll Hospital Center

Code Green

Used for a

Behavioral Emergency

What Students Need to Know:

•Make the staff nurse and your instructor aware that the patient

is starting to “escalate”.

•Position yourself in the room close to the door so that you have a

way out if need be.

•Don’t corner yourself in the room.

•Call a Code Green for any situation involving a patient with

aggressive behavior.

Code Grey

Elopement


An elopement occurs when a patient attempts to leave/flee the

unit assigned and/or the hospital

A Code Gray or elopement is not when a patient leaves against

medical advice.

All staff/ students must observe

corridors, look out windows and check

general areas for the eloped patient.

Code Orange

Hazardous Chemical

Spill

Any time an Student works with a

chemical, it’s their job to know and

understand the hazards or risks to using

that chemical.


Information about Hazardous materials

can be found on Material Safety Data

Sheets (MSDS) on the Carroll Hospital

Center Intranet page.

MSDS

http://www.intra.carrollhospitalcenter.org/BinderView/tabHome/Home.asp

Code Blue: Adult/Child/Infant

Cardiopulmonary

Resuscitation Emergency

This code is activated when

anyone is discovered in respiratory

and/or cardiac arrest.

Code Pink

Infant/Child

Abduction

A Code Pink alert is activated in

the event of an attempted or actual

infant or child abduction.

What Students Need to Know :

Cover the building exit nearest to your location in

accordance with the Code Pink Plan.

Environmental Services and Maintenance Associates

will patrol the building perimeter during a Code Pink

Alarm.

•Anyone acting suspicious

•Any person or Associate carrying an infant or small

child

• Any person or Associate carrying a large bag, box,

coat or anything which could conceal an

infant/child

Be on Alert for:

OBRRT

OB Rapid Response Team

The OB Rapid Response Team (OBRRT) will

respond to any woman presenting with an

obstetrical or newborn emergency.

• The OBRRT can be initiated by any staff

member by dialing 4444.

• Ask the operator to page an OBRRT.

• Caller will need to give the patient location.

• All OBRRT members carry pagers.

• A group page is sent out to the team.

• An overhead page will be announced.


CODE GOLD

Bomb Threat


All Students and Associates will assess their own area

for any suspicious objects.

If a suspicious object is located:

Do not move the object

Do not touch the object or anything

attached to it

CODE O2

Oxygen Emergency

Procedure


Telecommunications will page the:

• Nursing Shift Coordinator

• Cardiopulmonary Director

• Respiratory Therapist

• Maintenance personnel

Those on duty will report to Telecommunications.

Code Purple

Firearm / Weapon

Present


If you observe or receive a report of an individual(s)

displaying a fire arm or other lethal weapon in a threatening

manner, contact the following, if possible:

• ext 4444

• Maryland State Police – 911

Notify patients and visitors of the situation and direct them

to an area of refuge.

An area of refuge is any area that will

keep you out of harm’s way, such as:

•locked restroom

•locked office

•closet

•exit the building

Fire Response Plan

Code Red

This code is activated in the event of a fire, smoke, odor

of smoke, suspected fire, etc.

If you report the fire by telephone

(ex.4444), you MUST also activate the

nearest Fire Alarm Pull Station.


Ensure that all exit doors, especially those to stairways,

are not propped open.

All stairwell doors must remain closed and latched to

prevent smoke and fire from entering escape routes.

DO NOT use elevators during a fire emergency.

To help you remember the steps to take in the event of a

fire, use the acronym RACE

R –rescue

A – alarm

C – confine

E – extinguish

COT

Critical Outreach Team


Inpatients require urgent attention

Initiated by nurse or other clinical staff

Reasons for call: Acute clinical change or nurse

considers patient at risk

Code Emergency Response


Staff, Visitor, or Outpatient in need

Code Emergency Response is to ensure that all

individuals requiring emergency care, who are

located on the hospital campus, receive care in a

well-coordinated manner.

Documentation Security

If you have access into the Electronic

documentation system the next slides are

important to remember.

YOU WILL REVIEW:

How to change the password

Why changing the password is important

How often it is required to change your password

How to keep a computer screen secure in the hospital environment

The role each Carroll Hospital Center associate/student plays in keeping

health information and computers secure- HIPAA

Where to find more information on these topics

LOGGING IN

• Passwords are secret and should NEVER be shared with anyone

• Students who are caught sharing their password, can lose access to electronic systems

• You may be asked to change your password periodically

• It is important to remember that all passwords are case sensitive. This means if you choose UPPER case letters, that is how the computer will set the log in until the password is changed.

PASSWORD PROBLEMS

• Remember, different systems will

have unique logins.

• If you have forgotten your

password for any system, call the

HELP DESK x6809

BASIC DOCUMENTATION GUIDELINES

Each Associate/student at Carroll Hospital

Center that uses a computer is responsible

for making sure their documentation is

secure and complies with HIPAA

regulations.

Security is maintained in several ways.

• Personal log in

• Changing the password

• Keeping computer screens closed or

minimized

All Associates/students have the responsibility

to protect the information they see on the

screen from outside eyes.

This can be accomplished by

Exiting the program

Minimizing the screen if someone is

attempting to view the information

HOW TO HANDLE PROBLEMS

If a visitor is found reading over the shoulder of an Associate/student, ask

them to stop and inform them protected

health information cannot be viewed by

unauthorized personnel.

PROBLEM SOLVING

ALL Carroll Hospital Center Associates/Students Should:

Log off the user and exit the program on an

unattended computer that you find

confidential information displayed .

Now that you have completed

this CBT you will need to print the

Certificate on the TLC site, sign it and give

it to your instructor.

We hope that your clinical rotation

a worthwhile experience here at

Carroll Hospital Center.

Agency Orientation Packet - Carroll Hospital

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