faculty/student orientation
TRANSCRIPT
FACULTY/STUDENT
ORIENTATION
Prepared by:
Department of Organizational Learning
TABLE OF CONTENTS
INTRODUCTION ……………………………………… 4
Scope of Care/Patient and
Language of Population Served ……………………………………… 4
Clinical Services Provided ……………………………………… 4
Mission Statement ……………………………………… 5
Patient Satisfaction/
Customer Service ……………………………………… 5
Ethics ……………………………………… 5
Floor Directory ……………………………………… 6
Key personnel ……………………………………… 8
Nursing Directors ……………………………………… 9
Map of CRB Parking ……………………………………… 10
General Information ……………………………………… 11
Risk Management ……………………………………… 12
HIPAA ……………………………………… 13
Patient Safety ……………………………………… 13
Performance Improvement ……………………………………… 14
Emergency Codes ……………………………………… 14
Infection Control ……………………………………… 15
Safety Reminders ……………………………………… 16
Nursing Documentation ……………………………………… 17
Patient/Family Education ……………………………………… 18
Administration of Medication ……………………………………… 19
IV Therapy/Phlebotomy ……………………………………… 20
Specimen Collection ……………………………………… 20
Blood/Blood Product
Administration …………………………………….... 21
Bedside Glucose Monitoring ……………………………………… 21
Intake & Output ……………………………………… 21
Daily Weights ……………………………………… 22
Care of a Patient Going for a
Procedure or Surgery ……………………………………… 22
Reporting Child/Adult/Elderly
Spouse Abuse ……………………………………… 22
Population/specific Care ……………………………………… 22
Patient Rights ……………………………………… 23
Pain Management ……………………………………… 23
Patient Safety/Fall Risk ……………………………………… 24
Restraints ……………………………………… 25
“Hand-off” Communication ……………………………………… 26
Storage of Patient Belongings ……………………………………… 27
Patient Transfer ……………………………………… 27
Patient Discharges ……………………………………… 27
Post Test ……………………………….. 29-33
Answer Sheet ……………………………….. 34
INTRODUCTION
Number of Beds in Facility: __560__
Brief Description of Scope of Care/Patient Population Served
University of Miami Hospital is a fully-accredited 560-bed hospital designed and
equipped to use the latest technological advances in the delivery of high quality
healthcare. All patient rooms in the 560-bed patient tower are private, attractive and
situated to provide a pleasant view.
University of Miami Hospital is a full service facility with an emphasis on Cardiac
Medicine, including Open Heart surgery, Comprehensive Cancer Care, Neurology,
Neurosurgery, Orthopedic Surgery and Rehabilitation, Hepatology, Dermatology, Plastic
and reconstructive Surgery. Among the hospital‟s specialized departments are Psychiatry,
which includes a Baker Act receiving facility for in-patient psychiatric services in
addition to a Psychiatric Outpatient Day Treatment Program; Emergency Services and a
Diagnostic Center for complete physical examinations; an Ambulatory surgery center for
same-day surgery; a Sleep Disorders Center; a G.I. Center; a Center for Pain Management;
a Wound Care Center, Hyperbaric Medicine Center & a Sports Medicine department. We
have recently opened a new Cardiac Rehab Center.
Languages of Populations Served:
Hispanic Creole French Canadian Other
Clinical Services Provided
Ambulatory Surgery Heart Aware Pain Center
Bariatrics Immunology Progressive Care Unit
Cardiac Intervention Interventional Radiology Psychiatry
Cardiology/Cardiovascular Medical ICU Radiation Oncology
Cardio Vascular ICU Medical Surgical Telemetry Sports medicine
Dermatology Neuro ICU Surgical ICU
Emergency Department Neurosurgery Surgical Services
General surgery Oncology Wound Cure
GI Center Orthopedics Physical, Occupational, Speech
Therapy
4
Our Mission Statement
The University of Miami Health System delivers high-caliber, compassionate health
care; advances patient care through applied research; educates the next generation of medical
leaders; and contributes to a healthier world.
Patient Satisfaction/Customer Service
You will come into contact with many customers while in our facility. It is important to treat
each customer with respect and dignity. Our goal is to assure that each patient, family member
and visitor feels cared about his or her stay here. The customer service role is as important as
the care you provide. We align ourselves to greet, welcome and interact with them using the
AIDET model:
A- Acknowledge I-Introduce
D-Duration E-Explain T-Thank you
Ethics
We will strive to be honest and forthright and meet the highest ethical standards,
especially in the areas of marketing, admission, transfer, discharge billing practices. The goal is
to maintain an ethical relationship between patients, staff, health care providers and payers.
We are committed to a code of ethical business and professional behavior which protects the
integrity of clinical decision making, regardless of how the hospital is compensated or shares
financial risk with its leaders, managers, clinical staff, and licensed independent practitioners.
5
FLOOR DIRECTORY
FLOOR AREA SCOPE/SERVICE HOURS OF OPERATION
1ST
Ambulatory Surgery Patient Service 6A – 5P (M – F )
Cafeteria Food service 7A – 10P, 11A – 3P, 430P – 630P
Company Care Employee service 8A – 430P (M – F)
Day Care Center Employee Service 7A – 7P (M – F)
ER/Psychiatry Intake Patient Service 24 hours
Environmental Services Housekeeping 24 hours
GI Service Patient Service 7A – 4P (M – F)
Human Resources Employee service 8A – 430P (M – F)
Hyperbaric Patient Service 8A – 430P (M – F)
Outpatient Admission Patient Service 530A – 5P (M – F)
Outpatient Pharmacy Patient/Employee Service 8A – 430P (M – Sa)
Pain Center Patient Service 830A – 430P (M – F )
Physical Therapy Patient Service 830A – 430P (M – F )
Physician Offices Patient Service 9A – 5P (M – F)
Plant Operation Operation 7A – 3P/On-call
Radiation Oncology Patient Service 830A – 430P (M – F )
Radiology Services Patient Service 24 Hours
Seminar Center Classroom/Conference On a reserve basis
Wound C.U.R.E. Patient Service 830A – 430P (M – F )
2nd
Administrative Offices Operation 830A – 430P (M – F )
Admitting (In – patient) Patient Service 530A – 730P (M – F )
Coffee Cart Employee/Visitor Service 630A – 9P (All days)
Gift Shop Employee/Visitor 9A – 8P (M – F),
10A – 7P (Sat, Sun)
Ethics & Compliance Office 830A – 430P (M – F )
Finance Operation 830A – 430P (M – F )
Main Lobby Employee/Visitor 24 Hours
Marketing Operation 830A – 430P (M – F )
Materials Management Operation 830A – 430P (M – F )
Medical Records Operation 7A – 1130P
Medical Staff Operation 830A – 430P (M – F )
Nursing Office Nursing Administration 7A-5P/Nsg. supervisor (On-call)
Physicians Dining Physician Service 830A – 430P (M – F )/On Call
Regulatory/Risk Operation 830A – 430P (M – F )
Security Employee/Visitor 24 hours
3rd
Cardiac Cath Lab Patient Service 7A/On-call
CSR Patient Service 24 hours
Pharmacy Patient Service 24 hours
Surgical Services Patient Service 7A/On-call
6
FLOOR DIRECTORY
AREA SCOPE/SERVICE HOURS OF OPERATION
4th
Biomedical Engineering Operation 8A-5P
C/P Services (Respiratory) Patient Service 24 hours
Consumer Relations Patient Service 830A – 430P (M – F )
Dietary (MNT) Patient/Employee Service 24 hours
Information Systems Patient Service/Training 830A – 430P (M – F)/On Call
Laboratory/Blood Bank Patient Service 24 hours
Mail Room Patient/Employee Service 830A – 430P (M – F )
5th
ABG Lab Patient Service 24 hours
Case Management Patient Service 8A – 530P (M – F)/On Call
ICU Nursing Directors Offices NA
Intensive care Units:
MICU (10) Medical 24 hours
CCU (12) Cardiovascular 24 hours
SICU 1 (16) Surgical 24 hours
SICU 2 (8) Surgical (infection risks) 24 hours
Medical Intensivists Offices NA
Visitor’s Lounge (ICUs) Visitors/Family Per visiting times/As necessary
6th
6 South Dermatology 24 hours
6 North Med/Surg 24 hours
6th
Floor Telemetry Rm. Wireless Telemetry 24 hours
Photophoresis Patient Service 8A-5P
7th
7 South ½= Hospice Unit 24 hours
7 North Progressive Care Unit/Step-
down Ventilator
24 hours
Bronchoscopy Lab Patient Service 8A-5P
EKG Patient Service 24 hours
8th
8 South Cardiovascular 24 hours
8 North Interventional Cardiology 24 hours
9th
Dept. – Org. Learning Education (Offices) 8A – 530P (M – F)
9 South Psychiatry 24 hours
9 North Psychiatry 24 hours
9 East ICU Overflow 24 hours (as needed)
10th
10 South Psychiatry 24 hours
10 North Psychiatry 24 hours
11th
11 South Med/Surg/Ortho/ 24 hours
11 North Oncology 24 hours
12th
12 South Med/Surg Telemetry/Bariatric 24 hours
12 North Closed Unit Closed
Hemodialysis Dialysis 7A -6P
PH PH South Med/Surg Telemetry 24 hours
PH North Med/Surg Telemetry 24 hours
PH Skills Lab Classroom/conference NA
7
NURSING: KEY PERSONNEL
Name Title Phone Number
David Zambrana
Chief Nursing and Operating Officer
305-689-5620
Amy Martin
AVP, Acute/Critical Care Services
305-689-5620
Stephanie Moss
Exec. Director of Professional Practice
& Standards
305-689-5620
James Agnew
AVP, Surgical Services
305-689-5620
Tony Santa
AVP, Psychiatric Services
305-689-5066
Kymberlee Manni
AVP, Cardiac Catheterization lab
305-689-5620
Carlos Aja
AVP, Operations
305-689-5620
Anexis Lopez
Infection Control
305-689-5620
Forts Joaquin
Director, Organizational Learning
305-689-5594
Erika Jamieson
Clinical Educator
305-689-4586
Ajit Kaur
Clinical Educator
305-689-5373
Suzan Blacher
Clinical Educator
305-689-5832
David Livengood
Instructional Designer
305-689-5831
Johanna Cardona-Kelly
Org. Learning Office Coordinator
305-689-4406
Cristy Garcia
Administrative Asst. to the CNO
305-689-4519
NURSING: KEY PERSONNEL (Cont.)
(NURSING DIRECTOR &/or ASSISTANT DIRECTOR)
Name
Area
Phone Number
(Area)
Levi DeCotto Penthouse South (13th Floor
) 305-689-5377
Levi DeCotto Penthouse North (13th Floor
) 305-689-5366
Cassandra Sturrup 12 South 305-689-5277
Close 12 North Close
Cassandra Sturrup Dialysis (12th Floor
) 305 689-5520
Daphne Charles 11 North 305-689-5166
Daphne Charles 11 South 305-689-5177
Tony Santa/Hilda Rodriguez 10 North 305-689-5066
Tony Santa/Hilda Rodriguez 10 South 305-689-5077
Tony Santa/Hilda Rodriguez 9 North 305-689-4966
Tony Santa/Hilda Rodriguez 9 South 305-689-4977
Marie Dowd/Novie Bautista 8 North 305-689-4866
Marie Dowd 8 South 305-689-4877
Velma Davis 7 North 305-689-4766
Pamela Gordon 6 North 305-689-4666
Pamela Gordon 6 South 305-689-4677
Doreen Ashley SICU 1 (5th floor
) 305-689-5437
Doreen Ashley SICU 2 (5th floor
) 305-689-5871
Doreen Ashley MICU (5th floor
) 305-689-5571
Doreen Ashley CCU (5th floor
) 305-689-4392
Samantha Helm Surgical Services/CSR (3rd floor
) 305-689-5601
Miguel Diaz Ambulatory (1st)/PACs 305-689-5603
George Benelli Cath Lab (Operations) (3rd floor
)
302-689-5894
Rey Hondrade GI (1st floor
) 305-689-5413
Gilda Vallina ER (1st floor
) 305-689-5464
Tony Santa/Hilda Rodriguez Psych Intake (1st floor
) 305-689-5066
Anexis Lopez Infection Control/Co. Care-
Workmen’s Comp.
305-689-5620
Margarita Ramos-Morlans Wound Care (1st floor
) 305-689-5808
9
Map of Clinical Research Building
Student/Faculty Parking
Address:
1120 NW 14th
St. Miami, Fl, 33136
Directions:
From I-95, points north:
Exit I-95 at SR 836 West, exit number 3-A. Exit SR 836 at NW 14th St. NW 14th St. East to Clinical Research Building. Clinical Research Building is after the first stop light, on the South side of the street.
From I-95, points south and east:
Exit I-95 at SR 836 West. Exit SR 836 at NW 12th Ave. and turn right onto NW 12th Ave. Be sure to change into the right-hand lane. NW 14th St. East to Clinical Research Building. Clinical Research Building is after the first stop light, on the South side of the street.
From SR 836, the Airport, and points west:
Take SR 836 East and exit at NW 17th Ave., North. Take the Hospitals and Civic Center Exit, which is at the toll booth. Turn right at the stop sign. Continue 3 blocks and turn left on NW 7th St.. Follow NW 7th St.. to NW 12th Ave. (major intersection) and turn left. Go over the 12th Ave. bridge and under the 836 expressway. At the next light, you will be at the corner of 12th Ave. and NW 14th St. NW 14th St. East to Clinical Research Building. Clinical Research Building is after the first stop light, on the South side of the street.
10
GENERAL INFORMATION
CRITERIA DESCRIPTION
Location of parking facilities
a. Clinical Research Building (Monday – Friday) is free with
parking ticket validation.
Saturday & Sunday park in main building garage it‟s free –
Please present your school ID.
Procedure to follow before the nurse first
assignment
You are required to present your license, BLS card, and
ACLS/PALS if applicable.
Orientation provided by our facility
Hospital orientation is offered bi-monthly for all new
employees/staff. Clinical/meditech orientation is offered to
nursing staff.
Unit specific orientation is given by senior nursing staff.
Shift times: In-patient care areas
7 a – 7:30 pm 7 p – 7:30 am
Staff is expected to report on time for scheduled shift.
Disciplinary action will be taken for excessive tardiness.
Smoking policy Our smoke free facility prohibits all health care members,
customers and visitors from smoking in the workplace.
Refer to designated smoking areas.
Uniform policy Staff is required to present a clean, neat and professional
appearance. Hospital/school name badge is required at all
times.
Unit/Patient assignments Nursing personnel will be assigned duties within their scope of
practice and responsibility. Patient assignments will be based on
the documented qualifications and competencies of the nurse
and the needs of the patients.
Nursing care delivery system Team
The Policy & Procedures are located: Policies are located in manuals in each nursing unit.
Procedure for locating patient supplies
& charges
CSR is located on the 3rd
floor. Supplies are available on each
unit via Supply Pyxis. Obtain a temporary access code from the
Charge Nurse at the beginning of the shift.
RN’s are responsible for the following
order transcription
Signing off physician orders for shift
Order Entry
12 hour chart check
Conflict resolution occurring in patient
care setting
Mobilize chain of command: Charge Nurse / Nurse Director /
Nursing Supervisor/AVP and/or Chief Nursing Officer.
11
RISK MANAGEMENT
What is an incident? Incident is an occurrence that has caused, or has the potential to
cause, injury to a patient, employee, physician or visitor.
What is a sentinel event? It is an event that occurs as a result of an unanticipated death or
major permanent loss of function, not related to the expected course
of the patient illness or underlying condition.
Sentinel events include: Suicide of a patient in a setting where the patient receives
around-the-clock care (e.g., hospital, residential nursing or
treatment centers, crisis rehabilitation center)
Infant abduction or discharge to the wrong family
Rape
Hemolytic transfusion reaction involving administration of
blood and blood products having major blood group
incompatibilities
Surgery on the wrong patient or wrong body part
Reporting of serious events/incident :
If you are involved in a sentinel event you
must:
Notify your supervisor immediately
Notify the physician
Enter an incident report Meditech
Within 24 hours of their occurrence the sentinel event needs to be
reported to the Risk manager.
What is medical error? According to IOM Committee on Healthcare in America Medical
error is defined as “the failure of a planned action to be completed as
intended or the use of a wrong plan to achieve an aim”
Types of medical error includes: Surgical errors
Diagnostic inaccuracy
Medication errors
What is Root Cause Analysis? A structured step by step technique that focuses on finding the causes
of the problem, and analyzing them to determine how they can be
solved or to prevent them from happening again.
What is the Safe Medical Device Act? The act that requires health care facilities to report serious or
potentially serious device-related injuries or illness of patients
and/or employees to the manufacturer of the device, and if death
is involved, to the Federal Food and Drug Administration
("FDA"). Its provisions apply to all inpatient units, ambulatory
surgical care units, perioperative units, diagnostic units and
outpatient treatment centers within the Health System which are
not designated physician offices.
What should be done if an incident involves
an equipment or a device
Remove patient from the device, asses the patient and contact the
Biomedical engineering department. Complete an incident report.
12
MANAGEMENT OF INFORMATION
What is HIPAA? Stands for Health Insurance Portability and Accountability Act – An
act which provides for the patient‟s right to confidentiality of their
medical information.
How do you maintain patient confidentiality? Logging off Meditech terminals when they are left
unattended
No discussion of patients in public places, nor in private with
people who do not have the need to know
Not releasing information to anyone without the expressed
written consent of the patient , or legal guardian
Securing fax and copy machines so that confidential patient
information is not left in view
Placing patient related information in the approved shredding
bins for destruction.
How is it determined what information an
individual needs to access to?
Access to patient care system through a password system
approved by their supervisor and issued by the Information
System department
Job descriptions that explain what jobs are to be performed
by the individual
Changing of passwords on a regular basis
PATIENT SAFETY
Patient safety is a priority because:
It is a major public concern.
It is the right thing to do.
More than 50,000 people per year may die in hospitals as a result of
medical errors.
Priorities for patient safety include:
Medication safety
Medical equipment safety
Patient Falls
Restraint use
National Patient Safety Goals are: Improve the accuracy of Patient Identification
Improve effectiveness of Communication among caregivers
Improve safety of using Medications
Reduce the risk of health care associated infections
Medication Reconciliation
Universal Protocol
Examples of medical errors are:
Wrong site surgery
Medication errors
Misidentification of patients
Common causes of medical errors are: Miscommunication
Inaccurate patient identification
Knowledge deficit
13
PERFORMANCE IMPROVEMENT
The goal of the Performance Improvement
Program is:
Develop a system to continuously measure and improve the processes
and procedures involved in patient care
The methodology used for performance
improvement at UMH is:
PDMAI: Plan, Design, Monitor, Analyze and Improve
CODES AND OTHER SAFETY REMINDERS
CODES DEFINITION PROCEDURE
Code Black Bomb Threat Dial 277 to notify PBX
Code Blue Cardiopulmonary Arrest Dial 277 to notify PBX.
Code Team available in facility Yes No
Code Brown Severe Weather/Hurricane PBX
Code Gray Combative Situation Dial 277 help clear the area of equipment, patients
and visitors. Prepare restraints if necessary.
Code Green Mass Casualty/Disaster Dial 277 to notify PBX
Code Orange Hazmat/Bioterrorism Dial 277 to notify PBX
Code Pink
Lost Child/Abduction Dial 277 to notify PBX
Code Red Fire Dial 277 to notify PBX
Code White Hostage/Weapon Dial 277 to notify PBX
Code Yellow Lockdown Per hospital administration
RRT Rapid Response Team Dial “O” or 277
14
INFECTION CONTROL
A thorough infection control program can:
Help shorten the patient‟s stay/decrease hospital cost
Decrease nosocomial infections
Standard precautions means: Wearing appropriate personal protective equipment (PPE).
The most important thing you can do to
prevent most infections:
WASH YOUR HANDS!
Use of Alcohol based products in between
patients care and washing hands with
soap/water:
Helps prevent the spread of disease and infection
Remove all personal protective equipment
(PPE) before leaving a patient care area:
THIS IS A MUST!
You must consider that all patients may carry
HIV or Hepatitis B infection:
KEEP THIS IN MIND AT ALL TIMES!
Other important Key Points:
It is not acceptable to eat/drink in the work area
You must wear eye protection/mask if splashing or spraying of body
fluid is anticipated.
If you come in contact with blood or other body fluids, you should
wash your skin immediately.
You must clean equipment and work surfaces at the end of your shift
or when they are visibly contaminated?
DO NOT recap needles.
List of Disposal Containers:
CLEAR plastic bag – paper, cups, etc.
RED plastic bag – biohazard waste, any material saturated
with blood
Puncture resistant container – needle/sharps
Cardboard box, double lined with a RED plastic bag – plastic
sharps
Transmission-based precautions: Droplet - transmitted by large particle droplets
containing microorganism. Droplets can be generated
from coughing, sneezing, talking, during suctioning or
bronchoscopy. (ex: meningitis, pneumonia, mumps,
rubella) Precaution: Gloves, gown, surgical mask,
protective eyewear, private room
Airborne = transmitted by airborne droplet nuclei. (ex:
measles, chickenpox, tuberculosis)
Precaution: N95 particulate respirator mask, gloves,
private room with negative pressure.
Care giver & visitors must have immunity
Pt‟s room door must remain closed
Contact - transmitted by direct patient contact or by
contact with items in the patient‟s environment. (ex:
VRE, MRSA, scabies, conjunctivitis)
Precaution: Gloves, gown, strict hand washing
15
SAFETY REMINDERS WHEN YOU DISCOVER A FIRE
R
Rescue
Anyone in danger.
A
Alert
Activate Fire Alarm and dial extension 277
C
Contain
The Fire, close doors
E
Extinguish
The fire if possible
WHEN YOU FIGHT THE FIRE (using Fire Extinguisher)
P
Pull the Pin Out
Twist the Plastic Pin Holder
A
Aim
At the base of the Fire
S
Squeeze
The handle to discharge Agent
S
Sweep
From Side to Side
MEDICAL GAS VALVE
In the event of a fire the medical gas valves on
patient floors will be turned off.
This is an urgent and collaborative between the charge
nurse and plant operation personnel.
16
NURSING DOCUMENTATION
*Students will observe staff nurse with electronic documentation.
Areas MEDITECH
DOCUMENTATION
INITIAL ASSESSMENT REASSESSMENT
Critical
Care (ICUs)
Admission
assessments/notes
Care Plan
Within 15 minutes
Every 2 hours w/ changes
Telemetry
Admissions,
Assessments, Care Plan,
notes
Within 15 minutes
Every 4 hours w/ EKG strips
Med Surg
All documentation in
Meditech except I&O.
Within 15 minutes
Every 12 hours
PCU/7South
Admission History and
Assessment, Plan of
Care
Within 15 minutes
Every 4 hours
PACU
Admission assessment,
Care Plan
Upon arrival
Every 15 minutes
Emergency
Services
Triage Assessment
Emergent = Every 15 minutes
Urgent = Every 2 hours
Non-urgent = Every 4 hours
Every 2 hours & as necessary
Psych
Admission assessment,
Within 30 minutes
Daily patient progress
Daily response to therapy
Weekly interdisciplinary
conference
17
PATIENT FAMILY EDUCATION
1. It is the responsibility of each nurse to
Document Education provided to
PT/Family as indicated
Interdisciplinary Patient education will be completed upon
admission and every time teaching occurs. The patient/family can
expect to be provided with education/knowledge regarding New
Medications, Food & Drug Interactions, Disease Process,
Medical/Surgical Procedures, Equipment , Discharge Planning.
2. The method to document Patient
education is:
Meditech
3. Education Resource information for
PT/family is located in each patient care
area
Brochures, handouts available in all units
Food and drug allergy
Smoking cessation
18
A. ADMINISTRATION OF MEDICATIONS
1. Allergies and weights must be communicated
per policy to pharmacy prior to filling of
medication order.
Pharmacy will only dispense a medication after receiving a
copy of the physician‟s order.
2. Nurses signing off the physician‟s order will
check for unapproved abbreviations.
Transcriptions are to include ALLERGIES, name, strength,
route, frequency and time of medication by pharmacy.
3. Medication administration is done via e-MAR.
Military time is used. The approved medication frequency
schedule is as follows:
Daily Every 8 hours
Twice a day Every 12 hours
Three times a day Hour of sleep/At bedtime
Four times a day Before meals
Every 4/6 hours After meals
4. The procedure for acknowledging
medication/signing the scheduled medications
that were not administered
Electronically
5. The procedure for indicating a discontinued
medication on the e-MAR
Electronically
6. The procedure for routine checking MARS
each shift prior to administration of
medications is:
eMAR to Dr‟s orders with 12-hr chart check at change of shift
with off-going nurse.
7. The procedure for reconciliation of the MAR
is:
Electronic
AO-Acknowledge order after reconciling with physician‟s
orders.
8. The procedure for resolving / communicating
to pharmacy any e-MAR discrepancies:
Notify pharmacy and scanning of physician orders to
pharmacy.
The automated system utilized for medication is:
Pyxis
Pharmacy enters orders electronically.
9. Agency employees needing an access code to
the automated system will:
Receive „temp” user code by charge staff or assist/director.
10. The procedures for obtaining a missing
medication from pharmacy
Request replacement via Meditech to pharmacy or access Pyxis
dispensing for 1st time dose.
13. The procedure for reporting a medication error
is:
Notify pharmacy, file incident report.
14. Unless ordered otherwise, daily oral Anticoagulants are
given :
Standard time: 2pm
15. Heparin Administration Requires:
Premixed from pharmacy 25, 000 units in 250cc D5W
Heparin Protocol signed by physician.
16. TPN/Lipid standard hanging time 24 hours/12hours
19
17. A Pharmacist is assigned to different units/floor.
18. Any patient having an adverse drug reaction
must be reported as follows:
Notify physician. Complete electronic reporting of adverse
drug reaction and document.
19. Food supplements are entered on the e-MAR
by pharmacy .
Food supplements orders are scanned to pharmacy.
IV THERAPY
1. IV SITE CARE /SITE CHANGE per
policy is:
Q96 hours and PRN.
2. IV tubing change per policy is: IV tubing Q 96 hours, i.e. TPN/Lipids 24 /12 hours
3. IV fluids are documented as follows: Signed off on MAR, any IV flow sheets, where to document
infused and left to infuse
4. The procedure for adding IV admixtures
to fluids & giving piggy backs is:
As per pharmacy.
PHLEBOTOMY 1. Phlebotomy is performed by:
Nursing Lab Personnel
Nursing - Critical Care Units and Emergency Services.
Lab - all other patient care areas.
2. Procedure for difficult draw is: Attempt x3, call physician for difficult venipuncture
SPECIMEN COLLECTION/LABELING/TRANSPORTING
1. Specimens to be collected during your
shift are identified by: Listed on Kardex from OE, checking orders during shift,
2. Each Meditech Label must be checked to
the patients armband prior to obtaining any
Specimen:
All labeling is completed at the patient‟s bedside at the time of
specimen collection. Labels applied to specimens and sent with
specimens must include clearly CSS___ ___ ___ (your 3 initials
assigned by AAS) the date and time. Specimens are to then be
placed in specimen bags for delivery.
3. The documentation of “collection of
specimen “in the Meditech system is
performed by:
Lab Nursing
4. The responsibility/procedure to transport
collected specimens to the lab is
Enter obtained/collected specimen in computer, transportation
makes scheduled rounds.
20
BLOOD/BLOOD PRODUCT ADMINISTRATION
1. Patient consent is required prior to
transfusion of blood/ blood products and
remains valid throughout hospitalization.
Patients receiving blood require this check and procedure to
hang: 2 RN‟s to check band, unit of blood, initial vital signs obtain,
IV NS prior to transfusion.
2. Assessment of patient vital signs for
transfusion is:
Prior to start, 15 minutes x 1 and after completion.
3. Personnel may obtain blood products
from the blood bank with proper patient ID
CNAs (Certified Nursing Assistant) secretaries and techs will
present labeled slip with patient ID to the lab with RN signature.
4. Some important criteria to be followed for
transfusions includes:
Specified gauge of IV required. NS only as piggyback.
Blood warmer if ordered obtained from Central Service Appropriate
filters for platelets supplied by Blood Bank
5. The format for documentation of a
transfusion is:
A Blood transfusion (unit) will have a 4
hour infusion limit unless otherwise
ordered by a physician.
I.e. transfusion record Meditech or paper, fill out lab blood slip &
in notes whatever applies
6. If a blood transfusion reaction is
suspected or evident, the following
procedure is to be followed:
STOP THE TRANSFUSION IMMEDIATELY
Assess patient, notify the physician, lab, and record vital signs.
Complete blood transfusion reaction record and return it along with
remainder of blood bag, tubing and urine sample to the blood bank.
BEDSIDE GLUCOSE MONITORING 1. The tool utilized for Bedside Glucose
monitoring is:
Accu check Inform
2. For code entry into the glucose monitor
system we use:
Social Security (last 5 digits)
3. The procedure for documenting blood
glucose results is:
In Meditech /MAR
4. The procedure when bedside glucose
monitoring results are out of range is :
Repeat test within 5 minutes & make necessary comment in meter.
INTAKE & OUTPUT Intake and output are tallied on appropriate
patients every 8 hours:
Refer to Unit Charge Nurse for unit specific frequencies.
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DAILY WEIGHTS Daily Weights are performed: As ordered per MD by 7P – 7A shift.
CARE OF THE PATIENT
GOING FOR A PROCEDURE OR SURGERY Pre-op/Pre-Procedure Complete the pre-operative checklist.
Ensure that all required tests have been completed, results are
on the chart and abnormals have been reported to the physician.
Pre-op/procedure orders need to be checked and completed.
The consent is signed.
Post-op/Post Procedure It is your responsibility to review all orders to ensure appropriate
follow-up care and institution of physician orders.
Reconcile medications.
Follow assessment/reassessment and care of the patient per policy.
REPORTING CHILD/ADULT/ELDERLY/SPOUSE ABUSE Each staff member has an affirmative duty to
report any actual or suspected case of
child/adult/elderly abuse or neglect.
Notify charge RN/Supervisor who will evaluate and report to Risk
Management.
Call: 1-800-96-abuse
POPULATION SPECIFIC CARE
ADOLESCENTS (13-17) Assess/interpret age specific data for this group.
Select appropriate equipment for age group.
Recognize/address the patient needs to assert independence and their
reluctance to express dependency and anxiety about their
hospitalization. Obtain/interprets information effectively relating to
individual patient needs; recognizes/addresses potential for increase
stress related to living and/or family situation.
Communicate effectively.
Assess learning preference and barriers to education needs.
Address and coordinated post d/c needs
ADULTS (18-65)
DISABLED/CHALLENGED PATIENTS
DIVERSITY/ETHNICITY
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PATIENT RIGHTS All patients can expect to receive
consideration for respectful care, privacy,
confidentiality, dignity and continuity of care.
The nurse will provide respectful care to the patient and his/her
significant others while maintaining confidentiality.
DNR
A physician‟s order is required.
Complete all required forms per hospital
policy.
MD order confirmed purple armband placed on patient.
Necessary forms must be filled out, signed and placed in the
patient‟s medical record.
Patients and/or significant others will be given
written information on Advanced Directives
upon admission.
A copy of the Living Will, Durable Power of Attorney and/or
Health Care Surrogate Designation must become part of the
patient‟s medical record. You are responsible to follow through
and ensure the documents are obtained and placed in the
medical record if you ascertain during your Admission
History that documents have been enforced prior to admission
When the patient does not speak or
understand the predominant language, he/she
will have access to and interpreter:.
The process to obtain an interpreter is:
Using the AT&T Language line.
Informed consent: Florida Statute 381.026
establishes the right of all patients to be given
informed consent, by health care provider,
information concerning diagnosis, planned
course of treatment, alternatives, risks and
prognosis. Such information shall be the basis
upon which the patient, provided with that
understanding, makes the
Decision to undergo the anticipated treatment.
Refer to specific consent for each type of procedure.
PAIN MANAGEMENT 1. An assessment of Pain will be completed
on admission.
Document on admission database.
2. An ongoing assessment of pain and
management will continue throughout the
patient‟s hospital stay following this format:
Standardized Pain Scale from 1 to 10. Document on Pain
Assessment Tool kept at bedside.
Pain is whatever the perceiver states it is.
3. Patients response to pain following
intervention must be documented as follows:
Refer to specified guidelines on Pain Assessment Tool, based
upon route of administration.
Time frame for reassessment of pain is based on the intervention.
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PATIENT SAFETY/FALL RISK 1. Nursing staff will assess the patient for
safety/fall risk at the time of admission,
every shift and as change in condition:
Place patient at risk for falls on Fall precautions. Place a yellow
armband. Yellow Booties, Yellow label to door, assignment board
& chart. Bed alarms should be on at all times.
2. Safety rounds are completed and
documented as follows:
RNs on the even hours.
CNAs on the odd hours.
3. The following reporting system is used for
all patient falls:
Incident report. Post Fall Assessment must be completed.
PATIENT SAFETY ALERT ARMBANDS
Patient safety alert armbands: White In-patient ID band
White with
Green stripes
ER ID band
Red Allergy
Yellow Fall
Blue Anticoagulants
Pink Do not use this arm for
BP,IV,labs
Purple Do Not Resuscitate
MENTAL HEALTH AWARENESS (SUICIDE RISK) The organization identifies patients at
risk for suicide.
All patients are screened upon admission and every shift.
Risk factors increasing likelihood of suicide attempt:
History of suicide
Suicide ideation with a concrete plan
Command hallucination
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RESTRAINTS
Patient population (s) or risk factors
of those prone to the use of
restraints:
Patients who are confused, disoriented, have an unsteady gait and are
prone to wandering with a risk for injury, pose a danger to self or others,
and which have not responded to alternatives attempted.
Alternatives must be attempted prior
to restraint use
Quiet area Nutrition/hygiene Change area
Diversional activity Bed alarm Reassurance
Family interaction Pain management Commode
Orientation Reposition Medications
Close to nursing station Sitter Music/TV
Criteria for the use of restraints:
Non-behavioral reasons – patient is unable to follow directions to
refrain actions that can injure self, impulsive disconnecting/removing
therapeutic devices, medically unsafe attempts at mobility
Behavioral reasons – Combative, danger to self and others
Second tier evaluation: A second tier evaluation is required prior to restraining the patient
by the following: Director and/or designee-“charge nurse only,”
supervisor, AVP or CNO.
Physician orders: If physician is not present, nurse can obtain order via the phone for Non
behavioral Restraints. Physician must see patient face to face within one
hour for Behavioral Restraints.
Behavioral orders must be renewed every 4 hours
Non-behavioral must be renewed every 24 hours
Restraints devices:
Bedrails Mittens
Enclosed bed Sheets tied around waist
Free splint Tucked sheets
Gerichair Seclusion
Leather Restrictive positioning
Soft wrist Physical pinning down
Medication
Monitoring/Documentation The following will be assessed, monitored and documented:
Alternatives attempted
Behavior
Respiratory status
Compromised circulation
Readiness for Release/continue to be required
Restraint device
Vital signs (BP, HR, RR)
Removal and reapplication to provide care
Patient rights, dignity maintained every 15 minutes
Hydration and nutrition needs
Elimination and hygiene needs
Skin integrity
Skin care and repositioning
Signs of injury
Range of motion/Exercise of limbs
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HAND-OFF COMMUNICATION
What is “Hand-Off” communication? It is the provision of verbal and written information from one
healthcare provider to another so that pertinent care, treatment, or
service needs as well as the patient's current condition and any recent
or anticipated changes are accurately communicated.
Invasive procedures
Hand-off report will be conducted both verbally and in writing for, and
a transfer from one clinical unit to another.
Non – Invasive Procedures Hand-off report will be written.
Standardized approach will be
applicable but not limited to:
Shift change in nursing units
Leaving unit for a short period of time (e.g. lunch breaks)
Transfer of patients between units
Example:
Transferring a patient from one internal
level of care to another, including admissions from the ER
Transfer of patient between ancillary departments
Transfer of a patient from the Emergency Department
or other hospital unit to another hospital or healthcare organization
Discharges to home with Home Health and Hospice or other caregiver agency
How do we accomplish these as a team? Medical Record
Interactive communication
Hands off Process N – Name… Must give patient‟s name, other identification
U - Unique… Must relay information related to care
T – Tube… Must recount IV‟s, catheters, other tubes
S - Safety…Must share concerns such as fall risk with the suggestions…the responses
Process upon departure from primary
unit
The US/nurses will print a most current Hand-off Report/Kardex
The nurse will document hand-off report in the Patient Care Module
(PCM) note section and place in front of chart.
Process upon return to primary unit The ancillary department will document hand-off written report in
the Patient Care Module Note Section and will continue to give verbal
report for any pertinent information if applicable.
The Nurse and /or designee will review Hand-off report for any
updates and re-assess patient.
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STORAGE OF PATIENT BELONGINGS
Patient belongings should be sent home
when possible. The procedure for storage
of personal belongings is:
All belongings are sent to security in hospital bag with ID label.
Patient may keep eye glasses, hearing aids, and dentures at bedside.
Patient valuables should be sent home or
given to hospital security.
The procedure for securing valuables is:
Notify admitting, place valuables in security envelope, detach claim
stub and attach to patient chart. Document on Admission Assessment
and have patient/family sign.
Please check all patient rooms carefully
prior to discharge to prevent loss of items.
If items are found at the bedside. Tag and send to security office.
PATIENT TRANSFERS
The following procedure is followed for
transfers within the facility (unit to unit).
Obtain MD order for transfer.
Reconcile all medication.
Documentation/computer entry on transfer summary.
Call report to receiving RN/unit.
Notify transportation & send all patient belongings
Notify all physicians.
Transfers from facility to facility require the
following :
The hospital abides by the EMTALA act (Emergency Medical Treatment
and Labor Act).
Prior to the transfer of a patient please refer to hospital specific policies
and consult with the charge nurse to ensure compliance.
PATIENT DISCHARGES
The following procedure is followed for
discharges to a lower level of care:
Lower level of care is defined as SNU, ALF,
and Nursing Home.
Complete all forms prior to discharge, notification of case management,
physician, call report receiving facility, notify family), documentation,
and mode of transport and assessment upon discharge with current vital
signs. Transportation arranged by case management.
Refer and use Nursing Module Discharge Checklist available in all
patient care units to ensure completeness of the medical record prior
to sending chart to medical records.
The procedure for discharges to home is as
follows:
Complete all components of the patient discharge instruction.
Assure that patient/family understand instruction.
Reconcile medication and provide patient with prescriptions.
Document disposition on discharge in Meditech.
Refer and use Nursing Module Discharge Checklist available in all
patient care units to ensure completeness of the medical record prior
to sending chart to medical records.
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Test No. __
FACULTY/STUDENT
ORIENTATION
POST TEST
Prepared by:
Department of Education & Research
DIRECTIONS:
1. Use provided answer sheet and return to your program coordinator/faculty after
completing the test.
2. Circle the appropriate letter for “best” answer to questions.
3. Questions which require True (Circle “A”) - False (Circle “B”).
4. Passing score : 88%
DO NOT WRITE ON THIS TEST
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RISK MANAGEMENT
1. The definition of an “incident” is:
A. An event that should only be reported to the Administrator
B. An occurrence that should not be documented in the medical record
C. An occurrence that has caused, or has the potential to cause, injury to a patient, physician, employee or visitor
D. An event that the staff does not want anyone to know about
2. “Serious Incidents” include:
A. Wrong surgical procedures being done
B. Death or brain damage to a patient
C. Involvement of the patient‟s family
D. A & B
3. Which statement best describes entries made in incident reports?
A. Report only what your manager tells you to report
B. Report patients who are refusing treatment
C. Report an incident‟s facts, as you know them
D. Report what you think happened
4. Incidents that should be reported include:
A. Injuries from procedures
B. Patients who sing in the shower
C. Patient falls & medication incidents
D. Allegations of sexual misconduct by hospital staff
E. A, C & D
5. When should “serious incidents” be reported to the Risk Manager?
A. After the patient is discharged
B. Only when a patient dies unexpectedly
C. Within 24 hours
D. Only if the doctor writes an order
6. What should be done if an incident involving equipment or a device
occurs? A. Remove the patient from the device and contact Biomed
B. Tag the equipment and lock up for safety
C. Save the packaging, or the device for Risk Management
D. Complete an Incident Report
E. All of the above
7. Examples of Sentinel Events include except: A. Hemolytic blood transfusion reaction
B. Patient Suicide
C. Omission of medication
D. Wrong site surgery
E. All of the above
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MANAGEMENT OF INFORMATION
8. Everyone in the facility is responsible for assuring that patient
information is maintained as confidential. How is it determined what
information an individual needs access to: A. Changing of passwords on a regular time schedule
B. Job descriptions that explain what jobs are to be performed by the
individual
C. Access to patient care system through a password system approved by
their supervisor and issued by Information Systems department
D. B & C
9. The Health Insurance Portability and Accountability Act (HIPAA)
provides for the patient’s right to confidentiality of their medical
information. How do you maintain patient confidentiality?
A. Securing fax machines and copy machines so that confidential patient information is not left in view B. Not releasing information to anyone without the expressed written consent of the patient, or legal guardian
C. Logging off Meditech terminals when they are left unattended No discussion of patients in public places, nor in private with people who do not have a need to know
D. Placing patient related information in the approved shredding bins for destruction
E. All of the above
PERFORMANCE IMPROVEMENT
10. The goal of the Performance Improvement Program is: A. Improve the patient access to care
B. Develop a system to continuously measure and improve the processes and procedures involved in patient care
C. Monitor compliance of the patient
D. None of the above
PATIENT SAFETY
11. Patient safety is a priority because:
A. More than 50,000 people per year may die in hospitals as a result of medical errors
B. It is a major public concern
C. It is the right thing to do
D. All of the above
12. The 2010 JCAHO National Patient Safety Goals include:
A. Goal #1 Patient identification
B. Goal #2 Effectiveness of communication
C. Goal #7 Reduce the risk of healthcare-associated infections
D. Goal #8 Medication reconciliation
E. All of the above
13. What is a cause of medical errors?
A. Poor communication
B. Knowledge deficit
C. Carelessness
D. Faulty equipment
E. All of the above
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PATIENT RIGHTS
14. Patient rights include which of the following:
A. Right to confidentiality B. Right to be pain free
C. Right to privacy
D. Right to be treated in a safe environment
E. All of the above
15. Who can respond to a patient complaint? A. Administrator
B. Supervisor
C. Any employee
D. Patient Representative
E. All of the above
16. Who can give consent for treatment if the patient is unable to
consent for himself? A. The doctor
B. Whoever is with the patient
C. Healthcare surrogate
D. Caregiver
INFECTION CONTROL
17. The most important thing you can do to prevent most infections is:
A. Wear gloves
B. Avoid contact with patients and staff
C. Take antibiotics
D. Wash hands
18. Use of Alcohol based products before in between patient care and
washing hands with soap/water when visibly soiled is important to:
A. Spread disease and infection
B. Prevent the spread of disease and infection
C. Create a hospital full of infection
D. None of the above
19. All personal protection equipment (PPE) should be removed before
leaving a patient care area?
A. True
B. False
20. You must consider that any patient may carry HIV or Hepatitis B
infection.
A. True
B. False
21. If you come in contact with blood or other body fluids, you should
wash your skin immediately with soap and water?
A. True
B. False
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ENVIRONMENT OF CARE
22. In the event of a fire, who makes the decision to turn off medical gas
valves on patient floors? A. Employee who is nearest to the valve
B. Registered Nurse
C. Environmental worker
D. Respiratory therapist E. Charge nurse in collaboration with Plant Operation personnel
23. What do the letters, p-a-s-s stand for in reference to extinguishing
fires?
A. Perform Arrive Smoke Soak
B. Pull Aim Squeeze Sweep
C. Pass Aim Sweep Squeeze
D. Aim Pull Squeeze Sweep
E. Pull Squeeze Sweep Squeeze
24. What procedure should you follow, when a Code Red is announced?
A. Rescue Alert Confine Extinguish
B. Confine Alert Rescue Extinguish
C. Run As Fast As you Can
D. Extinguish Alert Confine Race
E. Extinguish As Fast As you can
25. Any injury should be immediately be reported to: A. Safety Manager
B. Security Officer C. Immediate Supervisor
D. Unit secretary
E. All of the above
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FACULTY/STUDENT ORIENTATION POST TEST
ANSWER SHEET
Print name of student: ________________________________ Date: ______
Student signature: ________________________________ Score: ______
School: ________________________________
Clinical Rotation Date/Area: __________________/______________
Program Coordinator/Faculty Signature: ____________________ Date: ______
1. A B C D E
2. A B C D E
3. A B C D E
4. A B C D E
5. A B C D E
6. A B C D E
7. A B C D E
8. A B C D E
9. A B C D E
10. A B C D E
11. A B C D E
12. A B C D E
13. A B C D E
14. A B C D E
15. A B C D E
16. A B C D E
17. A B C D E
18. A B C D E
19. A B C D E
20. A B C D E
21. A B C D E
22. A B C D E
23. A B C D E
24. A B C D E
25. A B C D E
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