ORIENTATION

1. PREFERRED NURSE STAFFING ORIENTATION WELCOME

2. NATIONAL PATIENT SAFETY GOAL • Improve the accuracy of patient identification • Improve the effectiveness of communication among caregivers • Improve the safety of using medications • Reduce the Risk of Health care-associated infections • Accurately and completely reconcile medications across the continuum of care Patient Safety Goals • Improve the accuracy of Patient Identification • Use at least two patient identifiers (neither to be the patient’s room number) whenever administering medications or blood products; taking blood samples and other specimens for clinical testing, or providing any other treatments or procedures. • Examples include patient name and account number or record number

3. Patient Safety Goals • Improve the effectiveness of communication among caregivers • For verbal or telephone orders or for telephonic reporting of critical tests results, verify the complete order or test results by having the person receiving the order or test result “read-back” the complete order or test result. • Standardize a list of abbreviations, acronyms, and symbols that are not to be used throughout organization.

4. Patient Safety Goals • Effective Communication • Measure, assess and, if appropriate, take action to improve the timeliness of reporting, and the timeliness of receipt by the responsible licensed caregiver, of critical test results and values. • Implement a standardized approach to “hand off” communication, including an opportunity to ask and respond to questions

5. Patient Safety Goals • Effective Communication • List of abbreviations that are not to be used • Abbreviation Correction • MgSO4 Write out name of drug • MSO4 Write out name of drug • MS Morphine Sulfate • U or u Write out “unit” • IU Write out “International Unit” • Q.D., Q.O.D. Write “daily” and “every other day” Leading zeros ARE to be used. Trailing zeros are NOT to be used

6. Patient Safety Goals • Effective Communication How Do We comply? • No more Taped Reports • Hand-off communication should take place whenever there is a change in the patient’s caregiver • Includes all clinical staff • Report patient’s condition, tx, services, relevant historical data and anticipated changes

7. Patient Safety Goals • Improve the safety of using medications • Limited Drug concentrations • Many commonly used infusions are provided in pre-mixed, standardized concentrations (dopamine, dobutamine, milrinone, heparin, levofloxacin) • Many compounded infusions are mixed in standard concentrations (felnoldopam, diltiazem, nitroprusside) • Concentrated Electrolytes • Concentrated electrolyte injections (potassium chloride, potassium phosphate, and sodium chloride) are not stored in o made available to patient care areas. Concentrated electrolytes are only available in the pharmacy for use in IV fluid preparation.

8. Patient Safety Goals • Improve the safety of using medications • Look-alike/Sound-alike drugs have been physically separated in the • Acudose Rx cabinets and on shelves in the pharmacy. • Drug master files are being modified to note on the MAR which items are “look-alike/sound-alike (Tall Lettering).

9. Patient Safety Goals • Medications must be delivered to the procedure field in an aseptic manner • All medications, med containers and other solutions on or off the field should be labeled. • Medications which are drawn up and given immediately does not leave your hand or sight) do not have to be labeled. • Label includes: name, strength, dosage and initials of person drawing up meds.

10. Patient Safety Goals • Reduce the Risk of Health care-associated Infections • Comply with current CDC hand hygiene guidelines. • Wash hands with soap and water when hands are visibly soiled • Decontaminate hands with alcohol-based foam when hands are not visibly soiled • Banning of artificial nails in the hospital-setting • Manage as sentinel events all identified cases of unanticipated death or major permanent loss of function associated with a health care-associated infection.

11. Patient Safety Goals Accurately and completely reconcile medications across the continuum of care • Implement a process for obtaining and documenting a complete list of the patient’s current medications upon the patient’s admission to the organization and with the involvement of the patient. This process includes a comparison of the medications the organization provides to those on the list. • A complete list of the patient’s medication is communicated to the next provider of service when it refers or transfers a patient to another setting, service practitioner, or level of care within or outside the organization.

12. Patient Safety Goals Reduce the risk of patient harm resulting from falls • Implement a fall reduction program and evaluate the effectiveness of the program. • Assess daily and periodically reassess each patient’s risk for falling, including the potential risk associated with the patient’s medication regimen, and take action to address any identified risks • Stickers are placed on chart, patient’s armband, call light and the Kardex is flagged.

13. Lift Devices NO SMOKING Write legibly! PATIENT SAFETY Suicide precautions Never use equipment you are not familiar with… ask for assistance! Safety Rails

14. FALL PREVENTION • EVALUATE RISK Q 8 HRS • INITIATE ORDERS • PROVIDE INFORMATION • PLACE LABELS ACCORDING POLICY

15. SAFETY WITH APPLICATIONOF RESTRAINTS • Limb restraints • Vest restraints Do not attach to side rails

16. WHY USE FOOT PUMPS OR A SEQUENTIAL COMPRESSION DEVICE? • PREVENTION OF DVT • CONTRAINDICATED WITH EXISTING DVT

17. FOOT PUMP SAFETY… • SIZE • SOCK/STOCKING • INSPECT q SHIFT • REPORT ANY S/S SKIN IRRITATION • KEEP HEELS OFF BED • REMOVE AND INSPECT WITH ANY C/O PAIN

18. MALFUNCTIONING EQUIPMENT WHAT TO DO WHO TO NOTIFY

19. EQUIPMENT MALFUNCTION • REMOVE FROM SERVICE • TAG EQUIPMENT • FOR CLINICAL: CALL BIOMED • ALL OTHER: CALL MAINTAINENCE

20. FACE PATIENTS TOWARD THE ELEVATOR DOOR MAKE SURE THE WAY IS CLEAR BEFORE PUSHING THE PATIENT INTO THE HALLWAY TO EXIT THE ELEVATOR WHEN TRANSPORTING A PATIENT BY WHEELCHAIR…

21. CORE MEASURES • ANTERIOR MYOCARDIAL INFARACTION • PNEUMONIA • HEART FAILURE • SURGICAL CARE INFECTION PROJECT

22. KEEP HANDS INSIDE RAILS USE SAFETY STRAPS ON STRETCHERS KEEP OUT OF LOW POSITION WHEN TRANSPORTING A PATIENT BY STRETCHER OR BED…

23. LEAVING AGAINST MEDICAL ADVICE • WHAT TO DO? • WHO TO NOTIFY? • AMA FORM • EVENT REPORT • DOCUMENTATION

24. ETHICS COMMITTE • MEMBERS • MEETINGS • RECOMMENDATIONS • EDUCATION

25. MEDICATION ADMINISTRATION

26. Home meds • Send any meds brought to the hospital by the patient to the pharmacy for identification and/or safekeeping • “Continue home med orders” • Medication Reconciliation Form

27. ALLERGIES • FACILITIES HAVE DIFFERENT • POLICIES RELATED TO • ALLERGY ARMBANDS • KNOW WHERE ALLERGIES • MUST BE DOCUMENTED! • PHYSICIAN ORDER SHEET FRONT OF CHART • MAR • KARDEX

28. FOOD DRUG INTERACTIONS

29. PHARMACY WILL IDENTIFY MEDICATIONS THAT REQUIRE FOOD DRUG EDUCATION ON THE MAR THE NURSE WILL EDUCATE THE PATIENT USE THE HAND-OUTS PROVIDED DOCUMENT ON PATIENT RECORD

30. AUTOMATIC STOP ORDERS • PHARMACY WILL SEND A NOTIFICATION • PHYSICIAN MUST SIGN FOR MEDICATION TO BE CONTINUED

31. MEDICATION ADMINISTRATION • STAT MEDS • NOW MEDS • GIVE ROUTINE MEDS FROM 30 MINUTES BEFORE TO 30 MINUTES AFTER THE SCHEDULED TIME KNOW POLICY !

32. ADMINISTERING MEDICATIONS • OPEN THE INDIVIDUAL MED PACKAGES AT THE BEDSIDE • TELL THE PATIENT WHAT EACH MEDICATION IS • EXPLAIN THE ACTION OF EACH MEDICATION • IF THE PATIENT QUESTIONS THE MEDICATION… LISTEN TO THEM!

33. ADVERSE DRUG REACTIONS • REPORT ADVERSE DRUG REACTIONS TO THE PHYSICIAN • REPORT ADVERSE DRUG REACTIONS TO PHARMACY

34. NARCOTIC WASTING • REQUIRES A WITNESS • MISSISSIPPI LAW ALLOWS FOR WASTING OF A “PARTIAL, UNUSED DOSE.” • WHOLE DOSES THAT HAVE BEEN OPENED BUT ARE NOT TO BE GIVEN MUST BE RETURNED TO THE PHARMACY

35. WHAT IS A MEDICATION ERROR • “Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is under the control of the health care professional, patient or consumer.”

36. MEDICATION ERRORS CAN BE CLASSIFIED AS A • POTENTIAL EVENT (ERROR IS DETECTED AND CORRECTED BEFORE IT REACHES THE PATIENT • ACTUAL OCCURRENCE (ACTUALLY REACHES THE PATIENT) BOTH SHOULD BE REPORTED USING AN EVENT REPORT FORM

37. THE FIVE RIGHTS • RIGHT DRUG • RIGHT DOSE • RIGHT ROUTE • RIGHT PATIENT • RIGHT TIME

38. MEDICATION ERRORS • DISPENSING ERRORS—EXAMPLES: WRONG DRUG, WRONG DOSE, IMPROPER PREPARATION • ADMINISTRATION ERRORS—EXAMPLES: WRONG PATIENT, WRONG MEDICATION, WRONG TIME, OMISSION OF ORDERED MED, ADMINISTRATION OF AN UNORDERED MEDICATION • OTHER ERRORS—TRANSCRIBING ERROR, DOCUMENTATION ERROR, ILLEGIBLE ORDERS

39. PREVENTING MEDICATION ERRORS • FIVE RIGHTS • SPELL THE DRUG • USE OF “0” IN ORDERS • LOOK ALIKE/SOUND ALIKE DRUGS/TALL • LETTERING • ASSESS PATIENT CONDITION AND DRUG • INDICATIONS

40. MEDICATIONS AT THE BEDSIDE • If the physician writes an order to leave medication at the bedside, only a 24 hour supply may be left with the patient. • No schedule drugs may be kept at bedside. • The nurse should check to ensure that the 24 hour supply is not depleted prematurely. • Document instructions to patient • Document medication administration on MAR

41. PATIENT EDUCATION • ADMISSION ASSESSMENT • BARRIERS TO LEARNING • SPECIFIC NEEDS • TEACH TO IDENTIFIED NEEDS • INCLUDE PATIENT, FAMILY, SIGNIFICANT OTHER

42. PATIENT EDUCATION EDUCATE PATIENTS ABOUT: • PAIN • MEDICATIONS • EQUIPMENT SAFETY • DISCHARGE PLANNING • SAFETY MEASURES • FALL PREVENTION • DOCUMENT EDUCATION ON THE PATIENT EDUCATION RECORD

43. HEARING AND SPEAKINGIMPAIRED PATIENTS • TELEPHONES FOR THE HEARING IMPAIRED • CLOSED CAPTION DEVICE FOR TV • SIGN LANGUAGE INTERPRETER • COMMUNICATION BOARDS

44. LANGUAGE PROBLEMS • ARRANGEMENTS CAN BE MADE FOR AN INTERPETER: • SOCIAL SERVICE • LANGUAGE LINE

45. SURGICAL ASSESSMENT

46. PRE-OPERATIVE ASSESSMENT History • Personal and family history of surgery/anesthesia experiences • Pre-existing medical conditions & Risk factors • Allergies • Medications (include OTC) • Alterations in physical & communication status • Religious considerations • Cultural considerations

47. Required Documentation • Physician History AND Physical • Lab & Diagnostic Data • Consents • Surgical and Blood • Allergies: Drugs; Foods; Latex • Medications • Special Forms: Sterilization paper; DNR; Advanced Directives • Miscellaneous: Old Chart; X-rays; Special Equipment

48. X SIGNATURE CCONSENT FORM TIME CONSENT Know Policy for each facility WHEN TO SIGN INFORMED CONSENT

49. Comfort Measures • Undergarments • Prosthetics • Jewelry • Cosmetics • Family

50. PRE-OP CARE… PRE-OP PRE-OP MEDICATIONS PRE-OP CHECKLIST ARM BAND STANDING ANESTHESIA ORDERS