Agency Orientation Packet

Nursing Student Orientation Packet

2011 - 2012

Welcome to Carroll Hospital Center

This presentation will provide you a

foundation of knowledge as you begin

your patient care here at Carroll

Hospital Center.

Journey to Excellence

Leslie Simmons, RN

Chief Operating Officer

Today…

Carroll Hospital Center has more

than 400 physicians on its medical

staff representing over 35 medical

specialties

Has over 1,800 employees

Is the second largest employer in Carroll County

Has an annual budget in excess of $175 million

Annually serves more than 300,000 individuals

with direct medical care, outreach and community

programs, diagnostic and outpatient services and

health screenings

Mission – Our Communities expect and deserve excellent medical treatment, compassionate care and expert guidance in maintaining their health and well-being. At Carroll Hospital Center, we offer an uncompromising commitment to the highest quality health care experience for people in all stages of life. We are the heart of health care in our communities.

Vision – Founded by and for our communities, Carroll Hospital Center will help people maintain the highest attainable level of good health throughout their lives. We strive to be the best place to work, practice medicine and receive care. Our commitment is to be the hospital of choice.

CHC Business Initiatives vs Pillars

CHC Business Initiatives

• Customer Service

• Innovation

• High Quality

• Right Cost

• People Growth

Pillars of Excellence

• Service

• People

• Quality

• Financial

• Growth

• Community

Pillars of Excellence

•Found on the Ground Floor

near the cafeteria

•Contains vital information

regarding our clinical

indicators

•Also known as the “Dashboard”

Temporal thermometer

Exergen Temporal Artery

Scanner Thermometer

http://www.exergen.com/medical/index.htm

Information and Cleaning

• Use an germicidal wipe after each patient

use

• Please use plastic covers while in Contact

Isolation rooms

Cleaning the Temporal

Thermometer

Introduce yourself

• To the staff nurse

• To the PCT on the unit

• To the Manager

• To the patient

Documentation Reminders

• Are restraints in use? What kind and what

is the patients’ response?

• Is the patient in pain? What is their score?

Reassess score within 1 hour after giving

pain medication.

• Fall Potential? What devices are we using

to keep the patient safe?

Reminders

• Parking is on the 4th and 5th floors of the

parking garage. If security finds a student

parking in the wrong area they will ask the

student to move their car. If this continues

the student will lose parking privileges.

• Smoking is prohibited on Carroll Hospital

Center campus. First offense results in a

warning, second offense results in loss of

clinical site experience.

Dress Code

• When coming in for your assignment;

dress in casual clothing (no jeans, no

offensive logos) or use school approved

uniform with name pin/badge visible.

• Piercings are limited to 2 post piercings in

each ear.

• Tattoos should be covered.

• Cell phones are to be silenced while at the

hospital.

Safe Medication Practice for

High Risk Drugs

Why are we emphasizing

High-Risk Medications?

Because these medication are associated with significant risk of causing serious injuries or death,

when used in error. Special consideration should be taken when

giving these medications.

ISMP stated that… (Institute for Safe Medication Practices)

“Errors with these medications are not

necessarily more common but the consequences are

clearly more devastating.”

You need to…

Teach your patient the reason why this medication is being administered

Explain significant side effects they may experience

Describe special precautions that must be followed while on this medication

Document the teaching and the patient’s response to teaching

First, as a refresher, let’s look at

some Definitions:

Therapeutic Range- is the range of drug levels within which most patients will experience significant therapeutic effect without an undesirable degree of toxicity.

PT/INR- (International Normalized Ratio) a system established by the World Health Organization for reporting the results of blood coagulation tests. All results are standardized using the international sensitivity index for the particular thromboplastin reagent and instrument combination utilized to perform the test.

There are many medications identified

by the ISMP as High Risk…

To make it easy, we will use the

acronym CHICKEN

WATCH OUT FOR THESE HIGH

ALERT MEDICATIONS

C OUMADIN

H EPARIN

I NSULIN

C HEMOTHERAPY

K Cl

E NOXAPARIN

N ARCOTICS

LESSON #1:

DON’T GET

FRIED!

WATCH YOUR

HIGH ALERT

DRUGS!

Look on the MAR…

For instructions addressing

administration and monitoring information addressing

“CHICKEN” drugs.

At Carroll Hospital Center…

….our Medication CPT has identified some specific medication that we will focus on here!

Classification: Anticoagulant

Warfarin (Coumadin)

Monitor PT/INR daily or as needed

HOLD if INR is above the high end range

Inform Physician

Remember….

You must record the most recent PT/INR on the medication record (MAR) prior to administering the drug.

What is the therapeutic range for

Coumadin you ask??

PT within desired range…1.5- 2 times the control

INR, 2.0-3.0 with standard therapy (venous thrombosis, pulmonary embolism, prophylaxis for DVT)

With other conditions like prosthetic valves INR would be 2.5-3.5

Classification: Anticoagulant

Enoxaparin (Lovenox)

The first dose cannot be given until 1-2 hours after heparin IV is finished

This drug is given every 12 hours or 24 hours as ordered

Important Point!

If the patient is already taking Lovenox, do not start Heparin until 12 hours after the LAST Lovenex dose!

Classification: Electrolyte Balance

Replacement

Potassium (K+)

If the serum K+ is greater then 5.5 the medication must be held, and the nurse must inform the physician

Record the most recent serum K+ on the MAR

Check magnesium level, it must be normal to treat hypokalemia


Please Note:

A common cause of low K+ is K+ free IV fluid. You can recommend to the physician to add 20meq KCL per liter of IV fluid if K+ is low, the IV fluids do not contain KCL and if renal function is normal.


But… remember to hold KCL if your

patient is receiving Kayexalate


Potassium-removing resin

Kayexalate (sodium polystyrene sulfonate)

Monitor daily serum potassium level

Hold and inform physician when potassium level is 4-5 mEq/L

Record serum potassium level on MAR prior to giving drug


Magnesium Sulfate (in FBP) Magnesium sulfate is double

checked in L&D. ADD Click below to see the Patient Care

Guideline for more information.

ADD Click below to ISMP Med Safety Alert June 2006

Classification: Cardiotonics

Digoxin

You will need to assess the most recent digoxin level prior to administering this drug.

If level >2.0, hold medication and inform Physician.

Assess and record heart rate on MAR prior to administering this drug.

If heart rate < 60 bpm or order specified by Physician, do not give this drug.

Classification: Anti-diabetic

Metformin

The most recent serum creatinine level must be documented on the MAR.

Hold medication if creatinine is 1.4mg/dl or > in a female or 1.5mg/dl or > in a male. Inform physician.


Metformin

Hold medication if:

Patient is in metabolic acidosis

Patient is to receive iodinated radiologic contrast media.

Continue to hold until 48 hours after the procedure and serum creatinine is repeated and found to be normal.


Did you know;

You should monitor for S&S of hypoglycemia (fatigue, excessive hunger, sweating, & numbness of extremities)

Hold insulin for fasting blood sugars

< 70mg/dl or if patient is not eating or receiving external/parenteral nutrition.

Insulin must be discarded 30 days after first use, please remember to date when opened.


Insulin

Syringe, MAR and bottle must all be checked by another nurse, for proper product and dosage prior to administration.

Doses > 50 units must be checked w/prescriber before administration.


Does the following chart look familiar?

It is our current list of insulins used.

Take a minute to review it.

1. Hydromorphone (Dilaudid)

This drug is 3-5 times more potent than morphine!

See PCG for dosing.

2. PCA/PCEA pumps

Two nurses are required to check programming, dose changes, and waste.

Classification: Narcotics

That’s not all Folks…

More information can be obtained through the PDR, Nursing Drug

reference on your unit, particular PCG or consulting a Pharmacist.

Pain Management

Click the links below to

view these Care

Guidelines:

Pain Management

Emergency Room Pain

Management

Pediatric Pain Management

../../HealthStream Power Point/Pain Mgt.pdf

../../HealthStream Power Point/Pain Mgt for ED.pdf

../../HealthStream Power Point/Pain Mgt for ED.pdf

../../HealthStream Power Point/Pediatric Pain.pdf

Environment of Care

(EOC)

EMERGENCY RESPONSE

CODES

Know your responsibilities as a student during all of the emergency response codes reviewed in this program.

Identify each code and what it represents.

Code

BRT

The State of Maryland adopted these codes to be used universally

throughout Maryland hospitals

Emergency codes provide a system to manage

unexpected situations that may occur on our campus.

Everyone should know how to report an emergency.

To activate ALL CODES call

Extension 4444

Let’s review the Codes

utilized at Carroll H0spital Center

Code Green

Used for a Behavioral Emergency

What Students Need to Know:

•Make the staff nurse and your instructor aware that the patient is starting to “escalate” . •Position yourself in the room close to the door so that you have a way out if need be. Don’t corner yourself in the room. •Call a Code Green for any situation involving a patient with aggressive behavior.

Code Grey

Elopement


An elopement occurs when a

patient attempts to leave/flee the unit assigned

and/or the hospital

A Code Gray or elopement is not when a patient leaves

against medical advice.

All staff/ students must observe corridors, look out

windows and check general areas for the

eloped patient.

Code Orange

Hazardous Chemical Spill

Any time an Student works with a chemical, it’s their job to know and understand the

hazards or risks to using that chemical.


Information about Hazardous materials can be

found on Material Safety Data Sheets (MSDS)

MSDS

Click on the button to the right to see the MSDS home page

http://www.intra.carrollhospitalcenter.org/BinderView/tabHome/Home.asp

Code Blue: Adult/Child/Infant

Cardiopulmonary Resuscitation

Emergency

This code is activated when anyone is

discovered in respiratory and/or

cardiac arrest.

Code Pink

Infant/Child Abduction

A Code Pink alert is activated in the event of an attempted or actual

infant or child abduction.

What Students

Need to Know :

Cover the building exit nearest to your location in accordance

with the Code Pink Plan

Environmental Services and Maintenance Associates will

patrol the building perimeter during a Code Pink Alarm

•Anyone acting suspicious •Any person or Associate carrying an infant or small child • Any person or Associate carrying a large bag, box, coat or anything which could conceal an infant/child

Be on Alert for:

CODE GOLD

Bomb Threat


All Students and Associates will assess their own area for any

suspicious objects

If a suspicious object is located: Do not move the object Do not touch the object or anything attached to it

CODE O2

Oxygen Emergency Procedure


Telecommunications will page the:

Nursing Shift Coordinator Cardiopulmonary Director Respiratory Therapist Maintenance personnel

Those on duty will report to

Telecommunications.

Code Purple

Firearm / Weapon Present


If you observe or receive a

report of an individual(s) displaying a fire arm or other

lethal weapon in a threatening manner, contact the following, if

possible: x4444

Maryland State Police – 911 Notify patients and visitors of the situation and direct them to

an area of refuge.

An area of refuge is any area that will keep you out

of harm’s way, such as:

• locked restroom • locked office • closet •exit the building

Fire Response

Plan

Code Red

This code is activated in the event of a fire, smoke, odor

of smoke, suspected fire, etc.

If you report the fire by telephone (ex.4444), you

MUST also activate the nearest Fire Alarm Pull

Station.


Ensure that all exit doors,

especially those to stairways, are not propped open. All stairwell doors must remain closed and

latched to prevent smoke and fire from entering

escape routes.

DO NOT use elevators during a fire emergency.

To help you remember the

steps to take in the event of a fire, use the acronym RACE

R –rescue A – alarm

C – confine E – extinguish

COT

Critical Outreach

Team

What Students

Need to Know:

Inpatient requires urgent

attention

Initiated by nurse or other clinical staff

Reasons for call: Acute clinical change or nurse considers patient

at risk

Code Emergency Response


Staff, Visitor, or Outpatient in need

Code Emergency Response is to ensure that all individuals

requiring emergency care, who are located on the hospital campus, receive care in a

well-coordinated manner.

Documentation

Security

You will review:

– How to change the password

– Why changing the password is important

– How often it is required to change your password

– How to keep a computer screen secure in the hospital

environment

– The role each Carroll Hospital Center

associate/student plays in keeping health information

and computers secure- HIPAA

– Where to find more information on these topics

Logging In

• Passwords are secret and should NEVER be shared with

anyone

• Students who are caught sharing their password, can lose

access to electronic systems

• You may be asked to change your password periodically

• It is important to remember that all passwords are case

sensitive. This means if you choose UPPER case letters,

that is how the computer will set the log in until the

password is changed.

Password Problems

• Remember, different

systems will have unique

logins.

• If you have forgotten your

password for any system,

call the HELP DESK

x6809

Basic Documentation

Guidelines

• Each Associate/student at Carroll

Hospital Center that uses a

computer is responsible for

making sure their documentation

is secure and complies with

HIPAA regulations.

• Security is maintained in

several ways.

– Personal log in

– Changing the password

– Keeping computer screens

closed or minimized

• All Associates/students have

the responsibility to protect the

information they see on the

screen from outside eyes.

• This can be accomplished by

– Exiting the program

– Minimizing the screen if

someone is attempting to

view the information

How to Handle Problems

If a visitor is found

reading over the shoulder

of an Associate/student,

ask them to stop and

inform them protected

health information cannot

be viewed by

unauthorized personnel.

Problem Solving

ALL Carroll Hospital Center

Associates/Students:

If you walk by a Computer on

Wheels and find confidential

information displayed, log off

the user and exit the program.

Now that you have completed

this CBT you will need to print the

Certificate on the next slide, sign it and give

it to your instructor.

We hope that your clinical rotation

is worthwhile experience here at

Carroll Hospital Center.

This certificate is verification that I have

reviewed the 2011 – 2012

Nursing Student Orientation Packet.

Date

Signature

_______________________

Name of Recipient

Certificate of

Completion

Documents

Agency Orientation Packet