Jordan Hospital

1. Jordan Hospital Nursing Student Orientation

2. Outline Section 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

3. Outline Section 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

4. Outline Section 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

5. Section 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 • Paperwork • Smoking • Concerns

6. JordanHospital • 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.

7. 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).

8. 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.

9. The Mission of Jordan’s nurses: • …to provide excellent care in a safe environment via skilled nurses resulting in high patient and nurse satisfaction.

10. 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.

11. 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.

12. 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.

13. 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).

14. 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.

15. 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 • Medicine • Documentum: Policies on-line e

16. 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.

17. Parking Sandwich St. ED Entrance Park in this lot ONLY! Obery St. Main Entrance Lot E

18. Personal Belongings • There no place to secure personal belongings on the patient care areas. • Please do not bring valuables with you.

19. Identification • All students are required to wear their school uniform while at Jordan, even when planning on changes to scrubs. • 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.

20. Smoking • Jordan Hospital is a non-smoking campus. • There are specific areas on hospital grounds where smoking is allowed.

21. Fragrance Free Facility • JH is a fragrance free facility. • Perfumes and other fragrances often aggravate nausea and/or allergies in both patients and employees. • Remember to refrain from using scented products.

22. 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.

23. Section B: Environment of Care • Codes • Interruption of Utilities • Hazardous medical Waste • Radiation Safety • Exposure Control Protocol • Injuries • Incident Reporting • Latex Allergy

24. 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 White

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

26. Interruption of Utilities • All vital equipment must be plugged into the RED outlets to run on back-up power. • In the event ofan unplanned communicationfailure there are alternative methods of communication on each unit (Ring Master) and Security will also deliver walkie-talkies if needed.

27. 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.

28. 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 ofradiation 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.

29. 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.

30. Exposure Protocol • If you feel you were exposed to blood and/or body fluids (i.e. a needle stick, splash), putting you at risk, you MUST follow the protocol and • Fill out a Variance Report • Notify 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).

31. Follow-up • Though no one expects to experience an injury or exposure during clinical, please plan ahead and be sure you have Primary Care Physician selected who can receive test results and manage your follow-up care if needed.

32. 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.

33. Latex Allergy • Patients with an allergy to latex will be given aGreencolored 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.

34. 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

35. 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 white

36. 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.

37. 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.

38. 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)

39. 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 and the Wound Care Handbook (located on each unit), contain 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. Braden Scale for Risk of Skin Breakdown

40. 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. • To date this includes: Pneumonia, Chest Pain, TIA, CHF, Fractured Hip, Diverticulitis, Stroke, Syncope, and ETOH Withdrawal.

43. 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).

44. 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)

45. Sample of a Diagnosis Specific, Form Fast, Order Sheet

46. Safety Goals:Prohibited Abbreviation List Certain abbreviations were found to be more at risk for misinterpretation than others. These are no longer allowed in the medical record.

47. Prohibited Abbreviations (Cont’d)

48. 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 communication • Situation • Background • Assessment • Recommendation

49. Comfort Care We have implemented a way to communicate to all staff, that a patient is Comfort Care Only. This Post Card sized sign will be placed on the door so all will know the patient and family are dealing with end-of-life care and issues.

50. Traveling w/ Patients • Students are allowed to go with patients that leave the unit for diagnostics and procedures. • They must be aware, however, that they cannot be the one individual responsible for the patient and that the patient must have a “Passport” to travel, which provides information such as precaution status and fall risk (the UC will take care of printing this).