Student

1
Student Instructor Orientation

• Part 2

2
National Patient Safety Goals

• 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
• VORB/TORB
• Medication Safety labeling, look-alike,
  sound-alike meds, limit number of drug
  concentrations
• Communication Handoffs
• Medication Reconciliation
• Fall risk assessment
• Increased patient involvement in own care
• Suicide and violence risk assessment
• We will discuss several of these goals in greater
  depth in subsequent slides.

3

• 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.

4
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

5
Time Out

• Goal Eliminate wrong site, wrong patient, wrong
  procedure/surgery.
• Done prior to local injection/incision/start of
  procedure in surgery or any other patient care
  area.
• 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).

6
Hand-Off Communication

• A Hand-off is any transfer in the care of a
  patient this is a vulnerable point the most
  likely place errors harm can occur
• Examples -
• ? Nurse to Dept Dept back to Nurse - for
  tests/procedures off the
• unit
• ? Nurse to Nurse for unit-to-unit patient
  transfers or shift-to-shift
• report
• ? Nurse to Nurse for short-term break
  coverage
• Hand-offs require standardized communication that
  provides accurate, clear complete patient
  information to receiving staff
• Hand-offs must include an opportunity to ask
  respond to questions

7
Hand-offs Continued

• At Mercy Unity, all Hand-offs must include the
  6Ps
• Patient Problem Pertinent History
  Precautions Plan Person/Phone
• The Patient Passport must be completed and
  clipped to front of chart when patient is
  transported to another department for
  test/procedures without a nurse.

8
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 for an unacceptable
  abbreviation/practice will not be accepted or
  executed.
• Unacceptable orders will be clarified by the
  nurse and documented as a verbal order before
  executing.

9
Unacceptable Abbreviations

• Abbreviation/Practice
• U
• ug (microgram)
• Eliminate trailing Zeros after a decimal
  (2.0 mg)
• Require leading zero before a decimal (0.5
  mg)
• AZT (Zidovudine)
• AZA (Azathioprine)
• HCT (Hydrocortisone)
• MS (Morphine Sulfate)
• MSO4 (Morphine)
• MgSO4 (Magnesium Sulfate)
• Nitro NTP (Nitroglycerine or
  Nitroprusside)
• 6MP (6-Mercaptopurine)
• Chemotherapy Abbreviations
• QD, QOD, AS/AD/AU/OS/OD/OU

• Correct Practice
• Write the word units
• Use mcg
• Never use a zero after a decimal point (2 mg)
• Always use a zero before a decimal (0.5 mg)
• Write the full drug name for each example
• Write the full words

10
Clinical Alarms

• Goal Improve the effectiveness of clinical
  alarms.
• Examples of clinical alarms are cardiac monitor
  alarms, fetal monitor alarms, apnea alarms, door
  alarms in behavioral health, elopement/abduction
  alarms, infusion pump alarms, bed alarms,
  bathroom alarms or respirator alarms.

11
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.
  Students/instructors should collaborate with
  assigned staff RN when setting/adjusting alarm
  parameters.
• Staff/Students must be trained in the use of
  alarms
• How parameters are set
• Who sets parameters
• Who responds to the alarm
• In the case of critical alarms, are they
  deactivated at the central desk or does a
  qualified staff member enter the room and assess
  the patient.
• 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.

12
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 staff co-assigned with you and/or your
  instructor.
• 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 your instructor or
  co-assigned staff will 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.

13
Medication Safety

• CMS and JCAHO require that all drugs, biologicals
  and radiologicals must be kept in a locked room
  or container
• If the container is portable, it must be stored
  in a locked room, constantly monitored location,
  or secured location
• All drugs and biologicals must be stored in a
  manner to prevent access by non-authorized
  individuals
• Individuals without legal access to drugs and
  biologicals cannot have unmonitored access

14
Medication Security Examples

• All medication refrigerators must be locked
• Respiratory Therapists (RCPs) may only have
  access to respiratory medications (e.g. inhalers,
  nebulized medications)
• - Medications administered by RCPs are NOT
  
• kept with all other patient medications
• Medications can not be unsupervised (e.g. on
  counters, in rooms)
• Medication carts and kits must be locked in a
  room or cabinet that is not accessible to
  unauthorized personnel

15
Medication Security Examples, continued

• Keys used to access medication locations must be
  secure
• Medication carts and kits are considered secure
  if constantly monitored by authorized personnel
• Medication cabinets at Unity bedside storage at
  Mercy must be locked at all times. Only
  authorized personnel know code/have key access
• Units which have medications delivered via the
  pneumatic tube system must have this constantly
  monitored by authorized personnel or must secure
  the tube station/incoming tubes

16
Medication Labeling
? Quick Expiration Date Labeling Add 1 month to
open date subtract 3 days
17
Pharmaceutical Waste Collection
18
Pharmaceutical Collection Process

• The EPA and MPCA have mandated that all unused
  pharmaceuticals will be collected as hazardous
  waste (no longer drained in sewer or trash)
• Exception DEA Controlled Drugs (Narcotics) must
  be witness wasted in sewer-empty containers are
  collected
• The following slides describe different
  collection bins and the types of pharmaceutical
  waste that should be placed in them.

19
Pharmaceutical Waste (No sharps, controlled
drugs or infectious waste)

• Dispose of unused or outdated pharmaceutical
  products
• Partially used vials, tubes, inhalers, IV bags
  and tubing containing medications
• Discontinued medications
• Tablets or capsules dropped or refused by patient
• P-listed drugs including empty vials, bottles,
  IVs etc.

20
Dual Waste Hazardous and a Sharp

• Hazardous Drug waste with sharp
• Syringe not fully dispensed (partial) with sharp
  containing hazardous drug
• Empty P-listed (Warfarin, Epinephrine,
  Phentermine, Nicotine, Physostigmine) drug
  ampules and syringes.

21
Dual Waste Hazardous and Infectious

• Hazardous Drug waste mixed with Infectious waste
• Place in BLACK hazardous pharmaceutical waste
  container with red bag and a biohazard sticker
• An example of this waste stream would be an IV
  bag or tubing containing a drug and patient
  blood in the tubing
• By regulation this has to be handled separately
  and not thrown into Infectious Waste

22
Bulk Chemotherapy

• Dispose of bulk chemotherapy drugs, products,
  and contaminated waste items containing more than
  residual trace contamination.
• Label container Bulk Chemo
• The container will also be identified with a
  Hazardous Waste Label.

23
Infection Control
24
Safety Phone Contacts

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

25
Where do germs come from?

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

• Equipment
• Water
• Flowers/plants

26
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.
27
Risk of Transmission

• Intact skin is a good barrier to organisms
• organisms can enter through non-intact skin
  (cuts, scrapes, eczema)
• Mucous membranes allow transmission, such as
  through
• eyes
• nose
• mouth

28
Risk of Transmission

• 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

29
Hand Washing

• Hand washing is the single most effective way you
  can break the chain of infection.

30
Hand Antisepsis

• Hand antisepsis should be done
• Between patients and patient body sites
• After removing gloves
• After using restroom, nose-blowing or covering a
  sneeze
• Before eating and preparing food
• Before entering and leaving the work area
• Gently remind others if they forget to do
• proper hand hygiene

31
Hand Washing Basics

• Soap
• Use only hospital approved soaps, lotions foam
  products.
• Warm running water
• 10-15 seconds
• Use friction
• Turn off faucet with paper towel.

32
Waterless Hand Washing (Quik-Care Alcohol foam)

• Can be used instead of soap and water 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.

33
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.

34
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

35
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

36
Patient Care Equipment

• Clean and disinfect patient care equipment after
  contact with blood, body fluids, secretions, or
  excretions
• Equipment contaminated by contact with
  contaminated surfaces such as the floor, must be
  cleaned and disinfected before reusing on
  patient.
• Equipment which contacts a patients intact skin
  must be disinfected between patients.
• If the equipment cannot be adequately cleaned and
  disinfected, the item must be replaced.
• Immediately clean isolation room equipment upon
  discharge/D/Cd isolation. Equipment should be
  dedicated to the room
• Remove contaminated gloves and perform hand
  hygiene before touching key boards in patient
  care areas.

37
Hospital Approved Disinfectants for General Use

• Bleach (110)
• Sani Cloth Wipes
• 3M Quat 25 dated with 60 day expiration

38
Compression Boots

• When boots are not on patients, tuck sequential
  boots at the end of the bed. Do not store or
  place on the floor.
• If the boots fall on the floor, clean and
  disinfect with Super Sani-Cloth wipes
• If unable to clean, replace boots with new ones.

39
Safe Patient Moving Equipment

• Clean and disinfect between
• patients.
• Use hospital disinfectant or Super
• Sani-cloth wipes.
• Protect slings with towel or sheet if
• cannot be changed or disinfected
• between patients.
• Wear non-sterile Nitrile gloves
• when cleaning and disinfecting items
• contaminated by blood or body fluids
• with wet appearance.

40
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.
• Clean up spill and then disinfect area.
• Wash hands.

41
Location of Exposure Control Plan and Infection
Control Policies
The Allina Knowledge Network (AKN)
42
In Closing...
43
Documentation of Orientation

• You have now completed general orientation to
  Mercy Unity Hospitals.
• The 2nd part of your orientation will be obtained
  in your specific dept/unit, based on your
  specific role. Either your instructor or the
  unit leadership will provide this information.
• It is our expectation that orientation is
  completed prior to an experience at our
  hospitals. However, verification and tracking of
  its completion is the responsibility of the
  school.

44
Department Specific Orientation Checklist

• Minimally, your department specific orientation
  should include the following items
• Location of
• Crash Cart
• Emergency Equipment
• 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).

45
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.

46
You Are Finished!!!