NURSING STUDENT ORIENTATION 2009-2010

1. NURSING STUDENT ORIENTATION2009-2010 Welcome……

2. MISSION STATEMENT To deliver accessible, high quality health services in a focused caring environment while providing health advocacy for the community and people we serve.

3. Our hospital……. • 321 beds • Not for profit • Built in 1956 • Huge ED with over 70,000 patients/year • 2 Health Centers EAST AND WEST • Hospice, home care, outpatient dialysis • Is smoke free

4. Long Island Health Network (LIHN) Guidelines Pathways/clinical maps developed through evidence based practice for disease processes that designs the patient’s plan of care Identify your patients that are on guidelines and learn how they are used. This process improves patient outcomes, and uses standard best practice

5. A CULTURE OF PATIENT SAFETY Patient Identification 2 identifiers: Name and DOB when giving meds, drawing blood, transporting patients, treatments….etc Improve Communication Abbreviations: DO NOT USE LIST Read back telephone orders, do not accept verbal orders Read back of critical lab results Appropriate ‘hand offs’

6. A CULTURE OF PATIENT SAFETY Improve the Safety of Using Meds Standardize drug concentrations Watch for look alike/sound alike meds Label all meds in your work area Reduce the risk of health care associated infections Wash your hands!!! Hand gel available, not effective against C Diff.

7. A CULTURE OF PATIENT SAFETY Reconcile meds across the continuum of care Communicate a list of meds upon admission, at time of transfer, and upon discharge Reduce the risk of patient harm from falls Green armbands Be vigilant Use lifting equipment Report all falls Be alert to meds that may cause patient falls

8. A CULTURE OF PATIENT SAFETY Encourage patients’ involvement in their own care SPEAK UP Campaign, see posters in the hospital Identify safety risks, patients at risk for suicide Special assessment is done on these patients UNIVERSAL PROTOCOL: Conduct a pre-operative verification process Mark operative sites Conduct ‘TIME OUT’ immediately before starting any invasive procedure, even at the bedside.

9. SERVICE EXCELLENCE • Be friendly  • Wear your ID badge so we can say hello to you • Introduce yourselves to your patients • Keep the environment clean • Look and act like the professional you are PATIENTS ALWAYS COME FIRST!!

10. WHO’s WHO?? Mr. Ockers President and CEO Mr. Margulis Senior VP ofOperations Dr. Kim Mendez Chief Nursing Officer Mr. Phil Messina AVP Patient Care Services Mrs. Gail Steiger Director of Nursing Mrs. Mary Ellen LindrosDirector of Nsg Prof. Development

11. NURSING DEPARTMENT Kim Mendez/Gail Steiger Nurse Managers Nursing Supervisors Clinical Nursing Supervisors Clinical Educators (med surg, diabetes, wounds, ICU) RN’s and LPN’s Cardiac Monitor Techs Nursing Assistants

12. MISSION of the NURSING DEPARTMENT To communicate…advocate……and promote safety and quality care for our patients, families, and each other.

13. UNIT SECRETARIES On every nursing station VERY HELPFUL!! Maintain charts Enter orders Facilitate patient care

14. CASE MANAGERS Discharge Planners Coordinators of care Social Work Home Care/Hospice Referrals Transportation Complicated Cases

15. Home Care and Hospice Some of you may rotate to the home care/hospice area……. INFECTION CONTROL in the HOME • Nursing Bag Technique • Handwashing is essential, hand cleanser is available • Universal Precautions, discuss with CHN and review policies • Double bag dirty dressings • Dispose of sharps per home policy • Oxygen safety in the home is paramount

16. Home Care and Hospice Some of you may rotate to the home care/hospice area…… EMERGENCY PLANS • Follow HICS as set forth by the hospital • Triage patients according to need and location (most common events are snow and flooding) • Follow policies for home care and hospice • Home and Hospice participate in pandemic flu planning • Work with Fire Department and/or Police Department as needed • Radio announcements in events of emergency • WBLI FM 106.1 and WALK 97.5

17. CULTURAL DIVERSITY • Be respectful of others - Understand that there is a great diversity in BMHMC and all patients and staff should be treated with respect as you would expect to be treated. • International Nurses – BMHMC staff includes nurses from other countries including the Philippines and India • Language – please be sure to speak only English when working at BMHMC • Cyra Phone for Interpreters – this phone is used for our non English speaking patients and a phone is available on each unit. • Deaf Talk - is used for hearing impaired ( ask your nurse if the patient needs this equipment)

18. FIRE SAFETY R Remove patient from danger A Activate the alarm C Contain the fire and close doors E Extinguish the fire if you can THE CODE IS CALLED DR. PEPPER Dial 3040 and state your location

19. CODE 64 This is the code for cardiac arrest If it happens to your patient: • Call for help • Call or have someone call 7333 and state your location • Start CPR

20. DR. HEAVY This is the code for violence!! Call 7911 and state your location Your responsibility is to get out of harm’s way and allow security to do their job

21. OTHER CODES… CODE PINK: Infant Abduction, LOCKDOWN!! Babies have HUGS tags CODE GREEN: Oxygen Alarm CODE DECON: Biohazard coming to ED HICS: Hospital Incident Command Center. Mobilized in crisis events. Report to your instructor and wait for direction. CODE RAPID RESPONSE: Team called to assess sudden acute changes in patient condition

22. HIPAA and PATIENT CONFIDENTIALITY • Any information learned in the hospital should be contained here and not discussed with anyone not associated with the patient ( this includes family and friends) • The computer should only be used for patients that have been assigned to you. Unauthorized use of the computer will result in your removal from the organization • Patient status should not be discussed in public • Comply with all security and privacy regulations • Report any concerns to your instructor • Any documents with patient identification used during your shift should be placed in the shredder box before leaving • The confidentiality statement must be signed prior to starting your hospital rotation

23. INFECTION CONTROL WASH YOUR HANDS before and after caring for each patient and after removing gloves!!! • Infection Control Manuals on each unit • Watch for ISOLATION SIGNS and follow instructions • Use gloves when you need to • Put sharps in appropriate containers • Red Bag Waste is in Dirty Utility Rooms

24. Patient Bill of Rights • See Handout and competency. • Competency should be completed prior to starting your rotation.

25. INCIDENT REPORTS/ERRORS Do not be afraid to report an error!!! Errors are usually due to process issues and must be reported. This information is used for performance improvement and can result in changing process to prevent future errors. Reports are computerized and should be filled out prior to the end of the shift. All incidents must be reported to the Nurse Manager or Nursing Administrative Supervisor through your instructor.

26. MEDICATIONS Be sure to check the patient’s identification with order, patient and screen of computer prior to any procedure MAK System: Medication Administration Check System Bar Coding scanner Pharmacists on the Floors during the day Patient Education for medications ongoing. Hand outs available for printing on the Intranet

27. PROHIBITED ABBREVIATIONS Do not useMust use U units QD Daily QOD Every other day SC, SQ Subq or subcutaneous TIW Three times a week CC ML OD once daily or right eye MS Morphine Sulfate Do not use Zeros after a decimal point Write 1 mg, not 1.0 mg Always use a Zero before a decimal point Write 0.5 mg, not .5 mg

28. MILITARY TIME • Based on a 24 hour clock, no am or pm • Used for all documentation • 2400 is Midnight

29. CHARTING Interdisciplinary Database and Plan of Care Action Flow Records Vital signs and Intake and Output Restraint documentation for compliance Initial FOCUS Notes Patient Education Sheets All on computer in Soarian Documentation LIHN Guidelines continue to be paper

30. ID BAND COLORS White: Standard band, name & DOB Pink: Arm or side affected, no blood draws or BP’s Green: Patient at risk for falls Red: Allergy, read it for specifics Orange: Latex Allergy Blue: On anticoagulation therapy Yellow: used for non admitted patient(should be changed immediately on arrival to floor)

31. Your practice….. • BE SAFE!!! • Do not give medications without your instructor • You are beginning a very honorable career, act professionally at all times. • Any issues or concerns should be reported immediately to your instructor

32. FINAL WORDS Provide quality nursing care and be proud of your profession Offer compassion to all patients Maintain your integrity Respect the dignity and privacy of your patients Be responsible for your actions Take accountability for yourself WELCOME TO BROOKHAVEN MEMORIAL HOSPITAL MEDICAL CENTER

33. BE PROUD TO BE A NURSE