Chapter 21

1. Chapter 21 CPCT Skills

2. Admission/Transfer or Discharges • Many HC facilities have specific forms & admission/transfers/ discharge procedures to complete- they can include: • H & P • Advanced Directives • consents • Medication form/ allergies • Emergency contact form • Pt. valuable form • Orientation to room and equipment

3. Admission Procedure • Wash hands • Set up room for new admission— • Open the bed linen by fan folding linen • Assemble admission kit • Check all room equipment to ensure all equipment is operational; • Go pick up the patient • Meet, Greet and Identify patient • Ensure privacy • Assist the patient to change into hospital gown • Complete necessary paperwork • Ensure comfort and safety

4. Transferring Patients • Many HC facilities have a transfer checklist that must be completed and travels with the patient • This will include: • Transfer list • Personal belongings/ Valuables list • Wheelchair or stretcher

5. Transfer Procedure • Gather equipment & Wash hands • Gather patient belongings • Assist patient safely into W/C or stretcher • Transfer to new unit • Introduce patient to new staff members • Orient to new surroundings • Review personal belonging checklist with new staff member • Complete transfer checklist & Obtain signatures • Ensure comfort and privacy

6. Discharging Patients • Dr. order required for discharges • If AMA_ Follow specific protocol • Assist pt with gathering belongings • Inventory and compare to admission form • Check over room • Allow RN to give all DC instructions • Escort patient • Or wait on other transportation

7. Discharge Procedure • Be sure an order is written • Assemble equipment • Wash hands • Coordinate discharge time with patient • Help patient dress if needed • Gather all of the patient belongings • Check over room • Have RN give all instructions • Complete valuable & belongs sheet- pt & staff member sign • Assist into WC and escort to lobby/car

8. Documentation • Record all information on the patients chart • Date • Time • Whether admission, transfer or discharge • How patient tolerated • Any other pertinent information • Signature • Report procedure and all findings to your superior

9. Summary • Make every attempt to alleviate anxiety and fear during admissions, transfers, and discharges • Follow agency policy and use the proper forms • Care for the patient’s belongings and valuables and always obtain proper signatures when these items are checked

10. DHO- Chapter 21:1Positioning, Turning, Moving, and Transferring Patients

11. Positioning, Turning, Moving, and Transferring Patients • Improper turning, moving can cause serious injury • Enough staff, proper mechanical devices, and good body mechanics are essential

12. Alignment • Is defined as positioning body parts in relation to each other to maintain correct body posture • Benefits include: • Pressure ulcer prevention aka Decubitus ulcers • Contractures- • Tightening or shortening of muscle- caused by lack of movement ---- Foot drop prevention

13. Decubitus or Pressure Ulcers • AKA= bedsores • Caused by prolonged pressure to an area of the body • Interferes with circulation • Common areas ( bones close to the skin) • Sacral area • Hips • knees • Heels • elbows

14. Pressure points

15. Stages of Decubitus Ulcers/Bedsores Stage 1- Skin is unbroken but irritated Stage 2- Skin is broken into the epidermis or dermis Stage 3- Ulcer extends to the subcutaneous fat tissue Stage 4- Ulcer extends to muscle or bone

16. Progression of Pressure Ulcer

17. Sacral, Buttock and Gluteal Areas

18. Elbow, Heels, Ankles, Head

19. Pressure Ulcers

20. Prevention • Turning patients every 2 hours • Elevate and cushion pressure points at all times • Massage high pressure areas to promote circulation • Use of egg crates- gel mattress, air mattress • Careful observation and documentation of skin condition • Good nutrition

21. Contractures • Contractures • Tightening or shortening of muscle- caused by lack of movement ---- Foot drop prevention

22. Contractures

23. Preventive Devices

24. Positioning, Turning, Moving,and Transferring Patients(continued) • Turning • Dangling • Transfers

25. Turning • All patients confined to bed must be turned frequently • Stimulated circulation • Exercise • Preventing ulcers & contractures • At a MINIMUN – q2h!!!! • Turning clock used in most facilities

26. Dangling • Should be done when patients has been in bed for a long period of time • Recommendation- check pulse rate before, during and after the dangling procedure • Dangling_ • Sitting on the side of the bed with legs hanging over the side • Allows for readjustment of BP and pulse rate • Assess of dizziness or weakness, pallor, respiratory changes as well

27. Dangling

28. Transfers • Patients are frequently moved in the hospital environment • Before moving • check doctor order • mode of transportation • utilize the necessary staff • During the move • Assess and constantly observe patient • Any changes in pulse, RR, color, weakness, dizziness, pain must be reported STAT • RETURN To Comfortable position

29. Transportation & Mechanical Lifts • Many modes of transportation are used • Wheelchairs • Stretchers • Mechanical lift

30. Wheelchairs

31. Stretchers

32. Mechanical Lifts

33. Summary • Always obtain proper authorization or orders before moving or transferring a patient • Never move or transfer a patient without correct authorization • Watch the patient closely during any move or transfer

34. Summary(continued) • If you note any abnormal changes, return the patient to a safe and comfortable position and check with your immediate supervisor • Supervisor will determine if the move or transfer should be attempted

35. DHO- Chapter 21:2BEDMAKING

36. 21:3 Bed making • Correctly made beds provide comfort and protection for patients confined to bed for long periods of time • Care must be taken when beds are made • Beds must be free from wrinkles (continues)

37. Bed making(continued) • Mitered corners • Types of beds • Draw sheets • Body mechanics • Infection control • Standard precautions

38. Bed making(continued) • Mitered corners • Used to hold the linen in place • If fitted sheets are used– you should only miter the top sheets & blankets

39. Types of Beds You Will Make • Types of beds • Closed bed • Done after a patient is discharged • After terminal cleaning of a unit • Open bed • This is a closed bed converted to an open bed by fan folding (pleating) the top sheets back • Done to welcome a patient or for patient who are OOB for short periods of time

40. Types of Beds ( continued) • Occupied Bed • A bed made while the patient is still in it • Done after a bath or whenever linen is soiled and requires changing • Bed Cradle • A device placed on a bed under the top sheets to prevent bed linen from touching parts of the patient’s body

41. Bed Cradle Images

42. Linens • Draw sheets • Aka half sheet, pull sheet or lift sheet • Placed between a patients shoulders and knees • Used to protect the mattress • Can be easily changed if soiled without the need of making the entire bed • Some institutions will also use either a washable or disposable impervious pad to protect bed linens

43. Bed making • Body mechanics • To prevent injury always use proper body mechanics while changing/making a bed • Use common sense--- attempt to have the linen in the correct order of use to minimize time and conserve energy • Make the bed in its entirety of one side--- then move to the opposite side

44. Infection Control with Bed Making • Infection control • If linen is contaminated with blood and /or body fluids • Observe STANDARD PRECAUTIONS • Standard precautions • Hands should be washed prior to making and after making a bed • Always wear gloves to handle soiled linens • Follow the policy of the healthcare facility for disposal of linen

45. Contaminated Linen • Contaminated linen • is always handled differently than linen that is just “ dirty” • Heavily contaminated lined • is doubled red bagged a discarded for cleaning separately • Double bagging • prevents leakage of contaminated linen

46. Summary • Follow correct procedures for bed making • Observe infection control methods and standard precautions at all times • Use correct body mechanics to prevent injury • Be alert to patient safety and comfort

47. Summary • Follow correct procedures for bed making • Observe infection control methods and standard precautions at all times • Use correct body mechanics to prevent injury • Be alert to patient safety and comfort

48. Personal Hygiene

49. 21:4 Administering Personal Hygiene • Usually includes the bath, back care, perineal care, oral hygiene, hair care, nail care, and shaving when necessary • Must be sensitive to the patient’s needs and respect the patient’s rights to privacy while personal care is administered • Reasons for providing personal hygiene (continues)

50. Administering Personal Hygiene(continued) • Types of baths • Oral hygiene • Hair care • Nail care • Shaving • Backrub • Gowning