Jordan Hospital

Nursing Student Orientation

OutlineSection A:

General Health Care Organization Information

Health care organization description Mission/Vision/Values Unit Names with Descriptions Nurse Theorist Benner’s Novice to Expert Model Preceptor Program Resources

Medical library Photocopier Policy & Procedure Manuals

Parking Personal belonging Identification Smoking Concerns

OutlineSection B:

Environment of Care Codes Interruption of Utilities Hazardous medical Waste Radiation Safety Exposure Control Protocol Injuries Incident Reporting Latex Allergy

Section C: Specifics with Safety and Patient Care     

Patient ID wrist Bands Medication Administration Documentation

Progress Notes Braden Scale of Skin Breakdown AIM Flow Sheet© Pain Scale Order Sheet

OutlineSection D: Specifics with Safety and Patient Care Safety Goals

Prohibited Abbreviation List Hands off Communication Time Out Stroke Recognition Reduce the Risk of Infection Fall Prevention

Rapid Response Team ETOH Withdrawal Protocol

Section E: Other Iportal Staff Development Contact Information Paperwork

Section AGeneral Health Care Organization Information

Health care organization description Mission/Vision/Values Unit Names with Descriptions Nurse Theorist Benner’s Novice to Expert Model Preceptor Program Resources

Medical library Photocopier Policy & Procedure Manuals

Parking Personal belonging Identification Paperwork Smoking Concerns

Jordan Hospital Jordan is a 155 bed community hospital.

More than 100 years after caring for its first patients, Jordan Hospital remains a private, not-for-profit hospital.

We proudly serve the communities of Bourne, Carver, Duxbury, Halifax, Kingston, Lakeville, Pembroke, Plympton, Plymouth, Marshfield, Middleboro, Sandwich and Wareham, as well as numerous visitors to our historic area.

Jordan Hospital

Jordan Hospital is an affiliate of Jordan Health Systems,

a not-for-profit corporation that also includes Hospice,

Jordan Health and Wellness Center, and Affiliated Medical Practice of

Jordan Hospital (the hospital’s physician group).

Jordan Mission/Vision

MISSIONTo provide health and wellness services to all with excellence.

The Mission, Vision and Values of the Division of Nursing are closely aligned with the hospital mission.

The Mission of Jordan’s nurses:

…to provide excellent care in a safe environment via skilled nurses resulting in high patient and nurse satisfaction.

The Vision for Jordan’s Nurses…

The Jordan Hospital professional nurse will continuously strive to

integrate the science of technology and research with a caring and

compassionate practice….always keeping the PATIENT as the center

of our focus.

Jordan’s Nursing Values……

The Jordan professional nurse is a caring individual who values the INDIVIDUALITY of each person throughout the life span, across the continuum with respect and dignity.

The Division of nursing has chosen Virginia Henderson as our nurse theorist:

JH’s Mission & Values fit well with Henderson’s challenge to help the individual do what he or she would if able.

Our Mission, Vision and Value statements advocate for the patient as the focus of care.

We use Patricia Benner’s “Novice to Expert” Model

Professional Development strives to assist staff at ALL levels to improve.

Improvement may not be linear (you may be an expert in one area while a novice in another).

Through practice, developing “know how”

“Intuitive knowing” (doing something over and over makes for easier recognition).

The Jordan Preceptor Program

Jordan hires new graduate nurses into its orientation program after they take the nursing boards.

They are assigned one preceptor and follow the JH Preceptor Program which is a based on the Vermont Model of new graduate orientation.

Nursing Student Resources Medical Library: varied texts, and journals that

may be viewed, not borrowed.

Photocopier: Available to copy articles for student use, free of charge.

Policy and Procedure Manuals: Lippincott Manual of Nursing Practice iPortal with Micromedex MSDS on line E-Medicine Policies on-line

Parking at Jordan

All nursing students, and employees are required to park in the Employee Lot (see next slide).

Students and staff are required to leave the other lots for patients and visitors.

Parking

Lot E

Park in this lot ONLY!

Obery St. Main

Entrance

Sandwich St.ED Entrance

Personal Belongings

There no place to secure personal belongings on the patient care areas.

Please do not bring valuables with you.

Identification All students are required to wear their

school uniform while at Jordan. Exceptions: OR, or other such areas

Students are required to wear their school name tag with their name and designation clearly visible to patients.

Students are also required to wear their JH photo ID badge. The photo must not be obscured.

Smoking Jordan Hospital is a non-smoking campus.

There are specific areas on hospital grounds where smoking is allowed.

Concerns

Only concerns that are reported can dealt with and/or lead to change

All safety and/or quality concerns should be addressed with a student’s instructor.

Alternative routes for addressing concerns: Risk Manager (ext.2262) Joint Commission of Accreditation of Health Care

Organizations. complaint(Q);jcaho.orq, fax: 630-792-5636, phone: 800-994-6610, or mail: Office of Quality Monitoring, JCAHO, One Renaissance Blvd., Oakbrook Terrace, Illinois 60181.

Section B: Environment of Care

Codes Interruption of Utilities Hazardous medical Waste Radiation Safety Exposure Control Protocol Injuries Incident Reporting Latex Allergy

CODES Code Pink (Infant or child abduction) Code Blue (Medical emergency) Code Red (Fire) Code Yellow (Violence) Code Grey (Elopement from SBHC) Code (Mass Casualty/Disaster)

In-House External

Calling a Code . . . .To call any code: dial 66 and state the code type and location.

Interruption of Utilities

All vital equipment must be plugged into the RED outlets to run on back-up power.

In the event of an unplanned communication failure there are alternative methods of communication on each unit (Ring Master) and Security will also deliver walkie-talkies if needed.

Hazardous Medication Waste

All hazardous waste needs to be properly disposed.

Certain hazardous medication waste is disposed of in the Black Box located by each McKesson machine. These medications will have a black dot on them. See the Black Boxes for a list of medication waste that is considered hazardous.

Radiation Safety In all circumstances, exposure to ionizing radiation

should be minimized. Toward this end, the ALARA principles (as low as reasonably achievable), as defined by the Nuclear Regulatory Commission, will be observed.

Protection from ionizing radiation may be achieved by adhering to the basic principles of radiation protection:

1. Time (minimal time spent in exposure area) 2. Distance (maximum distance from exposure areas) 3. Shielding (lead shields, walls, doors and aprons)

When in contact with patients who have been given oral or IV radioactive substances for Nuclear Medicine testing, please refer to the policy and consult the Nuclear Medicine Department to answer questions and concerns.

Exposure Protocol

If you feel you were exposed to blood and/or body fluids, putting you at risk, please follow the protocol as well as notifying the charge nurse, your instructor, and the nursing supervisor (You may have to remind them that you go to the ER and not Occupational Health).

For any injury while you are at Jordan hospital

You are here not as an employee but as a guest.

The contract between your school and the hospital stipulates that you are responsible for your own health insurance.

If you are injured in any way, you must report to the Emergency Department, not Occupational Health.

Your physician should be listed as the physician of record with whom any follow up should be done.

Incident Reporting All staff/students have a duty to report all

incidents in writing using the JH Variance Report form.

Incidents are unintended events such as: falls (whether this involves staff, visitor, patient, or student injury), loss or breakage of patient belongings, equipment or medical device failure, or a procedure error that results in injury.

The person who discovers the incident should complete the report as close to the time of discovery as possible. The report should be submitted to the Department Director, or during off-shift hours, to the Supervisor.

Latex Allergy

Patients with an allergy to latex will be given a Green colored ID bracelet to readily identify them as at risk for a life threatening allergic reaction.

A Latex Allergy Cart is available for use when caring for patients allergic to Latex.

This cart contains latex-free equipment and a list noting whether or not other potential patient-care products contain latex.

Section C: Specifics with Safety and Patient Care

         Patient ID wrist Bands Medication Administration Documentation

Progress Notes Braden Scale of Skin Breakdown AIM Flow Sheet© Pain Scale Order Sheet

Patient ID Wrist Bands

Orange - Patient at risk for fall Red - Allergies, written with sharpie, no abbreviations Blue - DNR/DNI, written w/ sharpie Green - Latex Allergy Yellow - W/ stickers (Fenwal-Blood Bank)

- General hospital name band

Medication Administration Jordan Hospital uses patient name and date

of birth as the two unique identifiers for medication administration and any other patient interventions.

Medication administration may be done by students only under direct supervision of your nursing instructor.

Please use available resources to look up medications, their actions, interactions, and side effects.

Documentation Please follow Jordan Hospital approved protocols

No block charting

DO NOT use non-approved abbreviations

Use proper format i.e. episodic charting, SOAP etc. Always note:

the problem the intervention the result.

Please check with your instructor and patient’s nurse for approval prior to any documentation.

Progress Notes: Our Nursing notes are computerized, You will

be oriented to the system by your instructor.

The remainder of the written progress notes are interdisciplinary.

Each department (social services, discharge planning, nutrition, Pharmacy etc.) have a different colored sticker to make finding a specific note easy.

Physicians do not have a sticker. (See chart during in-house orientation for

samples)

Braden Scale for Risk of Skin Breakdown

JH uses the Braden Scale to assess a patient’s risk for skin breakdown. Any score less than 16 means the patient is at risk.

A Skin Care Protocol provides standing orders so that a nursing can address any skin issue immediately.

The iPortal contains resources regarding skin care and staging of pressure ulcers.

When doing wound care or documenting on skin related issues, please confer with the primary nurse.

The AIM Flow Sheet©

This new documentation tool will be tailored to fit each new Pathway as they are developed for the 10-15 most common admission diagnoses.

This documentation replaces a written note for all issues related to that admission diagnoses.

Other documentation may be required for other problems such as skin or psych-social issues.

Patients on the AIM Flow Sheet will have a pink “AIM” tag on their chart as a reminder to document in this format.

The Computerized AIM Sheets

The AIM sheets will be part of the new computerized documentation.

They are still developed and taught via the above example and then set up in the computer format. It still captures all the same information – giving a snapshot view of the patient’s progress.

JH uses the 0-10 Pain Scale

These signs are in all patient rooms.Other pain scales are used for specific patient populations (i.e. Pediatrics).

Order Sheets - enhancing safety

Formatted for as little free text as possible

Lines have been eliminated

Check off boxes indicated gold standards in many cases (comment for variation)

Sample of a Diagnosis Specific, Form Fast,

Order Sheet

Safety Goals:Prohibited Abbreviation List

“U” for unit Mistaken as zero Write “unit”

.5mg ( naked decimal point)

Mistaken as “5” Write 0.5mg

5.0mg (trailing zero)

Miss decimal and give 50mg

Write: 5mg

Certain abbreviations were found to be more at risk for misinterpretation than others. These are no longer allowed in the medical record.

Prohibited Abbreviations (Cont’d)

MS04, MgS04

Confused Don’t use abbreviations for medications

X3D 3 days? Doses? Write out

C.C. Mistaken for U Write ml

PT Prothrombin time? Physical Therapy?

Write out

Safety Goals: “Hand-off” Communications

Better communication is needed when handing-off to another department or staff member.

At JH we use the SBAR format to standardize communicationSituationBackgroundAssessmentRecommendation

Safety Goal: Time OutAny test or procedure,

whether in the OR, or at the bedside, requires a “Time Out” to double ID the patient, and verify the side, site, and procedure.

Safety Goal: Stroke Recognition

Stroke is a leading cause of death and serious disability.

Jordan Hospital has been designated a Stroke Center by the state. It is important that all students be aware of the warning signs. Your fast action will help the victim get needed treatment.

Safety Goal: Stroke Recognition (Cont’d)

The warning signs of stroke are: Sudden onset of:

numbness or weakness of face, arm, or leg confusion, trouble speaking or understanding trouble seeing in one or both eyes trouble walking, dizziness, loss of balance or

coordination severe headache with no known cause

If your patient displays has any of these symptoms, alert the nurse ASAP.

Safety Goals: Reduce the Risk of Infections

o Reduce the risk of healthcare-associated infections by complying with CDC guidelines:

frequent hand washing no artificial nails.

o All staff, students are required to observe proper hand washing, and/or utilization of hand sanitizer when appropriate.

At Jordan Hospital: Artificial nails are not allowed. Natural nails must be of appropriate length.

Safety Goals: Fall Prevention

o Reduce the risk of patient harm from falls through:o Fall assessment, orange band on

patient, individualizing the plan of care, & inspecting the environment.

o Our Fall Prevention Unit is aimed at reducing falls among our most at-risk population.

RRT (Rapid Response Team) Part of the Institute for Healthcare Improvement

(IHI) 100,000 lives Campaign.

Is a team effort by critically trained staff.

Provides early intervention for warning signs or trends (Doesn’t replace a code but hopefully may prevent a code).

Responders assist with assessing, but do not take over care of patient

Our data across 2 years shows positive outcomes

Families may initiate the RTT if they see a change in the patient’s condition.

Prevention of ETOH Withdrawal

The new protocol is in place and contains regularly scheduled dosing as well as PRN dosing, based on the CIWA scale, to prevent the DTs (See samples during in-house orientation).

Section D: Other

iportal

Staff Development Contact Information

Paperwork

The iPortal This JH internal web site connects you

to many Reference sites:PoliciesThe Adult IV Medication PoliciesMSDS – product informationeMedicine - a clinical knowledge base Micromedex

Drug informationCareNotes – patient teaching sheets

The iPortal

The Connect tab on the iPortal links you to other sources:The CDCPatients FirstThe Patient ChannelThe Joint Commission, etc.

Professional Development (Staff Education)

We are here to assist you and help you have a good learning experience!

If issues arise, please feel free to call upon us. We are the contact between the hospital and your school and we will make every effort to assist you!

Page *5678 or *LOST - if any educators are in-house, someone will carry the LOST pager.

WELCOME!

P.S. Do not forget your paperwork! (see slide #20)

Paperwork: Please Print, complete, and bring with you on your first day of clinical::

Orientation Post-test

ID Badge Form

IT User Form Confidentiality is the patient’s right

and your responsibility.

Medical Records Form: Print your name and then sign as you will in the Medical Record (i.e. M.Smith,

CCCC, SN)